Tuesday, December 15, 2015

Week Three Goes Nowhere Near According To Plan

One thing I have learned in my lifetime of exposure to medicine is that the old cliche about it being more art than science isn't quite right. There is loads of science, constantly shifting and evolving science, and there is also lots of art rooted in experience, judgement and a mix of expectation on the part of the doctors and the patients. And these two elements are all wrapped up in the unknowable, how the individual in question, both the conscious being with a name and an identity and that being's body, are going to react to any given experience, any given treatment. 

There are always hitches in a plan...Robbie Burns knew that ('the best laid schemes of mice and men'), philosophers and theologians know that ('from your mouth to God's ear'.., 'Man plans, God laughs,') But I am a relatively optimistic individual and I fully expected that the plan for tackling my cancer would stay on course at least for the first half, but not so.

When the options were laid out during the oncology consult, the doctors were concerned that the option that involved months of chemo might not be compatible with my immune system. Well given that my immune system, or the white blood cell component of my immune system, doesn't seemed to have coped well with two weeks of chemo-radiation, I can at least conclude that they were right about that. 

Measuring things is complicated. On Monday, after having blood work down, one of the pharmacists, explained that one of my counts was at .9 and that they were really uncomfortable proceeding with chemo when a white blood count was lower than 1.5. So no chemo for me this week. I have to admit I immediately conjured up the image of the Soup Nazi in Seinfeld telling Elaine, 'No soup for you'. It was a blow, I am in the chemo waiting room surrounded by all kinds of people waiting to get on with being treated and listening to a very kind pharmacist explain that we just can't go ahead this week gets me down. 

See, I have been doing relatively well with the chemo. Other than fatigue, none of the expected side effects have been occurring. I just imagined everything was going according to schedule. What I now know is that wiping out the immune system is one of those intended-unintended consequences of chemotherapy and when you combine chemo and radiation the possibilities are increased.

What most bummed me out about my conversation with the pharmacist was her response to my question: "so what do I do to boost my white blood count?" She looked at me and replied, there is nothing I could do. ( There are things that can be done apparently but those things are out of my control.) I hate these types of things being out of my control. ( I know, I know...worry about the things that are in your control....yada yada yada)

So this week, no chemo but the radiation marches on. Also this week, consultations with my oncologists about how we get past this roadblock. As I said, I am an optimist. I do believe that, and I have good reason to believe that this is simply a curve in the road, a google maps snafu if you will.

The science is still there, the art and the best judgments that make up the focus of medicine are clearly a bit more of a fudge this week.  


  1. The things you learn - I had no idea that you could be denied chemo because of that. I guess it's a week to trust the doctors Peter. We're thinking about you - all your fans and friends are.

  2. i surely hope it's just a cruve in the road.