At my request, Dr, Saltz outlined what I gathered to be the two remaining potential alternatives. One is a chemotherapy that I could take only if the results-- which he is awaiting-- of a genetic test indicate that it is suitable for me. This chemotherapy usually has side effects that sound hideous to me; when it works, it always has these side effects. I will not make a decision about this chemotherapy unless it becomes an actual alternative. But, at this moment, it seems to me that subjecting myself to this chemotherapy would be inconsistent with my desire for quality of life, as opposed to quantity of life.
The second potential alternative is FOLFIRI, the chemotherapy that I underwent last year. FOLFIRI could not be expected to have much effect on my cancer now; my current cancer cells have undergone a Darwinian selection process for resistance to this chemotherapy.
This morning, I learned also from Dr. Saltz that I have developed a surgical hernia-- a condition unrelated to an inguinal hernia. Like any other hernia, this surgical hernia could only be corrected through more surgery. Even if I were willing to undergo such elective surgery, I could not do so without halting chemotherapy. So, contrary to all instinct, I must passively accept permanent, uncomfortable disfigurement from surgery as part of the collateral damage of cancer treatment.
Dr. Saltz cautioned Susan and me that my disease could take take a sudden turn for the worse. In response to a question from Susan, he indicated that I should have my affairs in order. In response to a question from me, he said that although I could see the hospice consultation service at MSKCC at any time, he did not think that it was necessary at this time. I was startled and gained new perspective when he added that I could consider my chemotherapy as palliative care.
This afternoon, I received the reduced dosage of FOLFOX. Over the next couple of weeks, an absence of severe side effects-- particularly, but not exclusively, with respect to my platelet count-- would constitute good news. Of course, until I have another CT scan, Dr. Saltz will not know if the FOLFOX is actually shrinking my tumors; and if so, to what extent. Presumably, a reduced dose is less effective than a full dose.
Sic terminal cancer.
