The Numbers Game

We met the new oncologist this week.  This is the guy who will be in charge of all secondary therapies (chemo, radiation, hormonal).

We liked him immediately.  He feels like someone we would naturally already know.  He's a year older than I am, so a year younger than Roger.  It was a good and instant sympatico.  Which is what you want in someone who is about to systematically poison you.

He laid it out clearly.  The question is how much I want to improve my odds.  The surgery itself increased my odds of being fully and completely cured by about 67%.  The fact that it was found in the lymph nodes brought this number way down, unfortunately, from the original 98% that we had heard when we first talked to my surgeon.  Still, as he pointed out, all things being equal, if there were three of us standing in a row, two of us would now be cured if nothing else happened.

That's promising.

The chemo, radiation, and hormonal therapies will give me 40% more of an edge over the remaining 33%.  Meaning, I can add another 17% to my cure odds by throwing the other therapies into the mix... which brings me up to 80%.  Ten of me in a line, 8 of us are now cured.

Better.

There's another rule to this game, however: we have to decide now.  If the cancer recurs, it will probably come back someplace a lot less convenient (relatively).  Like the bones, or the brain.  So, we can't throw this stuff at it later.  We have to assess the odds now, and then proceed to eradicate and destroy.

Can we know which therapy will add the most bang for the buck?  It looks like my tumors are strongly hormone positive, which means they REALLY like eating estrogen.  The hormonal therapy, which cuts out all estrogen from my body will be hugely effective.  Yes, I'll be sapped of all the positive aspects of estrogen for five to ten years (and may end up looking like one of those pruny old people in Desert Hot Springs that I used to see when visiting my grandmother, so dessicated and ancient that you couldn't even tell whether they were men or women) (or not) (this would be an example of a bad story to tell myself) but... the cancer will be starved into oblivion.

The chemo will be something like 4 - 6 treatments, which is on the low end as far as these things go.  He kept saying it would be manageable and not a big ordeal.  But... there could be some side effects above and beyond the usual (nausea, vomiting, we didn't even get into hair loss).  The side effect that stopped me cold was the neuropathy... numbness in the extremities, like my fingers.

Oh my fucking god.  My FINGERS?

The fingers I WRITE with?

That prompted, and still prompts, a rush of tears to my eyes.  To not be able to touch a keyboard?  That cuts me to the quick.  That actually makes me wonder how far I'd go to improve my numbers.  If I knew this would happen, for sure... which I absolutely do not... but if I did... wow.  What would life be like if I couldn't communicate to the world, and more importantly with myself, using the act of writing?  I ... I would die inside.

Now.  I do realize.  Stephen Hawking.  Voice to text software.  It would not be the end of the world.  I have frequently said that if I were stranded on a desert island, I would write with my finger in the sand.  I would figure out a way.

But I learned a world about myself at that moment.  That... given a choice between a longer life without the ability to write, and a shorter life with the ability to write... I would have to think about it.  I would actually have to think.

Luckily, I don't have to make that decision.  I will talk to him more about the odds about the neuropathy.  How many get it?  Of that number, how often is it permanent?  He will give me some numbers and they will help me figure this out.  Maybe we can go with a different regimen.  It's also possible that, if that starts happening, I can bail midstream.  He assured me that none of this is mandatory; all of it together increases my odds, but my odds are already pretty good.  If I just can't handle any part of it, I can punt.

That helps a lot.

He's a sensitive guy.  We did not go all the way down the rabbit hole for all three treatments.  First up is chemo.  He said we can totally wait a month to start.  I desperately want to go on our annual Memorial Day Pursuit of Truth in the Company of Friends weekend up north.  I should be up for that, and it will give me a much needed soul infusion that will carry me through at least a few treatments.  We'll see how that goes.  Next, I guess, is radiation.  And then the hormonal treatment.  And at the end of the day I'll have about an 80% chance, or better, of being done with this for the rest of my (hopefully long and creative) life.

The numbers are so comforting and solid, but if you look at them closely, they actually mean nothing.  They put an overlay of reason over the fact that -- if there are three of you standing in a line -- you have NO idea if you're the third person, or one of the lucky two.  You have NO idea if you're going to be the two in 10 after all the chemo and shit.  You have NO idea if you're going to be the one in 1000 that gets the one really bad side effect of the hormonal therapy (a rare cancer that tragically killed one of my good friends a few years ago, after she used this drug for breast cancer about a decade prior).

The numbers are comforting if they are high.  I am deeply grateful my numbers are as high as they are, as I know many people cling to their 5% numbers, hoping they can figure out a way to be the 1 person in a lineup of 20 who duck their particular bullet.  But the numbers are just statistics.  We don't know if we'll get hit by lightning, once or even twice.  We just don't know.

The numbers serve to help us make decisions.  We study racing forms and put money down to see if the ponies will perform according to their statistics or not.  We use statistics to give ourselves courage to get in the car and drive to work in the morning.  If we didn't have this construct of probability, we wouldn't have the guts to get out of bed in the morning.  It would all be too random. 

At the end of the day, the numbers are a way we try to know the unknowable.  They are a way to weave a story, and stories... as we all know...are intensely useful.  I do believe that the stories we tell ourselves about these things helps.  I don't want to ever mention the Desert Hot Springs dessication image again... because that's an image I want to keep as far away from my psyche as possible.  I would much rather tell myself stories about training for and riding a century on my bike with Spencer next year.  I would much rather tell myself stories about sailing across the bay with my brother and his wife, seeing the city glittering before us like an array of jewels on the hills.  I would much rather tell myself a story about being one of those 8 people in the lineup, living long past the current pain, doing yoga and writing and feeling that wild ecstatic health coursing through my body once again.