Adventures in Chemotherapy

Entry 3    3:30 PM

It Never Entered My Mind

The VM social worker arrived today before Dr. P.  We had a long discussion, the therapist,  Jenny and I. Initially, it was just the MSW and Jenny talking.  This was intense, the MSW firmly but gently pushing Jenny toward reality. When asked by the social worker how she is doing, Jenny told her she is scared, but trying her hardest to keep a positive outlook about her.  "Whenever I say to my cancer coach, 'if I beat it,' my coach says, 'Not if, when you beat it.'"  The MSW was clearly uncomfortable with this power of positive thinking bullshit.  She told Jenny it's possible to hold two beliefs at the same time, that she has to beat this cancer, but that she may not.  She explained that whatever Jenny's belief is, it isn't going to manifest as illness or wellness. In other words, if she thinks the cancer is going to kill her, or if she doesn't stay positive, it won't result in tumor growth.

The MSW immediately understood that implicit in the cancer coach's philosophy is the belief that if you die, its your fault.  I imagine she would deny that, the cancer coach would, that is. Nevertheless, you can hear her coaching come through loud and clear at home when Jenny is telling me she isn't trying hard enough, despite the litany of things she is doing.  The underlying sense I got from the social worker is that Jenny needs to embrace the reality we are heading toward.  Jenny heard it, but I don't know if she actually listened.

We talked about the cancer and the mets, CA 19-9, and Dr. Picozzi always looking at the positive, never acknowledging any barrier, never seeing anything as reflecting a problem or decline.

Dr. P shows up, an hour later than scheduled, late per usual.  The MSW moved her chair, and Picozzi took a seat.  Acknowledging Jenny was in hospital yesterday, he asked her how she'd been. He tells her he can't figure out where the pain is coming from as there is no new growth in her scan.  I interject and ask if he looked at last week's scan, which he said he had.  I noted that it said the mets had grown, there was a new met and tumor had grown.  He comes back with. "Well, that's interoperator interpretation."  In other words, he disagrees with the radiologist.  But, when Jenny got her first report last August, he told us what he thought the results said, but that he had to rely on a radiologist to tell him what they really mean. 

Dr. P next told Jenny he can't figure out why her CA19-9 jumped so much. He is puzzled, given that nothing has really changed in his eyes.  I think he is bullshitting, even if he doesn't mean to do so.  Occam's razor really applies here. The CA 19-9 is up because she has new mets, growing mets, and a growing tumor.  

The doctor then said something telling. He told Jenny she was going to be in a study he is publishing about patients receiving this treatment regime.  This alternating treatment has been received by 108 patients.  He noted Jenny is an outlier, has beaten the odds by surviving so long.  He has no reason to believe she won't make it through the next 12 weeks to reach the one year mark.  He said its possible the gemcitabine has stopped working, but we will see.  Not sure what that means.    

He left, and the conversation resumed with the social worker. I told her that a friend from high school was Dr. P's lead nurse for 18 years when he was at Swedish Medical Center. My friend told me that Dr. P will give chemo until the bitter end. He won't stop. I told the MSW that my friend said to stick close to the palliative care team. It was clear from the discussion that the MSW believes as my friend did about Dr. P and his, "everything is a nail when your only tool is a hammer" flaw.

Entry 4

Frank Gorsham once played a character on Star Trek, where half his body was black, and half was white.  Ignoring the crude racial metaphor of the 1960s, my recollection is the division reflected a character's opposing nature(s). That's how I feel, a lot of the time. 

Sympathy, love and sorrow for Jenny and this ordeal.  And anger over her love for someone else.  I stupidly looked at her phone tonight when she handed it to me so I could order Grubhub delivery, and confirmed my earlier kvetching about her communicating with Eric el pinché while we were at chemo, or wherever.