Saturday, November 21, 2009

What would Spock do?

The Oncotype Dx test.

That's medical lingo for a test that determines the recurrence risk of breast cancer in women like my younger sister who have been diagnosed with early breast cancer. The Oncotype Dx test is an attempt to forecast the risk of cancer recurring.

We expected the chance of recurrence to be low. Dana's only 35, the tumor was caught early, and the odds of it spreading to the rest of the body are unlikely.

The test is a formality, a final check before giving my sister a clean bill of health. All signs are good: the cancer was caught early, the tumor was small, and my sister is a paragon of fitness. Just a few months earlier she was training for a marathon.

No matter what, she'll still need six weeks of radiation and daily medication for five years to help keep the cancer away.

I pick up my father at St. John's hospital as Dana goes in with Christos to get the final results.

Thirty minutes later they haven't called. Forty five minutes later I'm getting worried; I call Christos but he doesn't answer. After an hour there is still no word.

Oh shit.

I finally get ahold of Christos. "What's going on?" I ask. "Is Dana alright?"

"Let's talk about it during dinner." Christos answers in a terse voice. "Meet us at La Vecchia Cucina. It's an Italian place off Main."

Why is bad news always best delivered in an Italian restaurant?

When we meet up for dinner Dana's face is absent of emotion. She is not so much a person as a moving statue.

The four of us sit down as Christos delivers the bad news. Dana's Oncotype Dx test (the test to predict a recurrence) didn't score as expected in the low range; it scored in the medium high range.

Translation: she has a 19% chance of the cancer coming back. That's with the radiation and medication.

If it comes back, the cancer might not come back in the breast. Much like a roaming teenager, the cancer could grow anywhere: the lungs, the skin, the bones, the liver, the pancreas, the brain. If the cancer returns, there is no way to "cure" it, only treat it.

So, the oncologist is recommending chemotherapy to reduce Dana's chances of recurrence by another 33%.

That's a difference of nineteen percent versus thirteen percent.

I can hear the dice rattling in my head.

We eat dinner in silence. Only the waiter is smiling.

Christos, normally verbose and gregarious - silent. My father, capable of delivering entire monologues throughout dinner - not a single word. My sister, my charming, vibrant, energetic sister - nothing.

This wasn't supposed to happen. The script was supposed to turn out differently. The tumor was caught early, it hadn't spread into the lymph nodes, the cancer was supposed to be cut out and then go away and disappear, like Tim Allen after Home Improvement went off the air.

I wanted a Kodak moment, not a Hallmark moment!

I am at a loss for words, and I'm the guy who thinks a soliloquy is a conversation. I've got nothing to say. What do you do? What is the right decision?

What would Spock do? "Captain, having analyzed the available data, reducing the odds from nineteen to thirteen percent makes chemotherapy the only rational decision. It is the only logical choice."

Too bad Spock ain't human.

The lasagna arrives.
I may be unhappy, but that's not going to stop me from eating.
Lasagna don't care if you got cancer.

Throughout history there is one thing that never changes. People will do anything in their power to survive. Whether it's soldiers hiding under dead bodies on Omaha beach, plane crash survivors in the Andes eating the dead, or Anne Frank hiding in an attic, everyone does whatever they can to try and make it. To live another day, another hour, even another minute.

People don't do this because they want to do it. They do it because they have to.

I relate some of this to my sister, then have to fight the urge to break down in tears. I hate myself for having to relay this.

Chemo - fucking - therapy.

In the end, survival is all that matters. Living one more day. It's what Spock would do.

Nineteen versus thirteen.

After dinner I drive my father to the airport. "If I could, I'd take the cancer for her!" he declares helplessly. "I've lived my life. She doesn't deserve this."

But you can't, Dad, you can't absorb the cancer, you can't wish it away.
All you can do is play the odds.

Chemotherapy. It's what Spock would do.

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