Don't Bury the Lede: We're Staying on Chemo

Maybe subtle growth but not enough to deviate from the treatment plan; a bad scan part two

We Went to a Concert with Whitney’s OBGYN

We went to a concert with Whitney’s OBGYN.

Accidentally.

Turns out he’s friends with my buddy, Parker.

This speaks volumes—had I not already connected with Whitney’s OBGYN, his friendship with Parker would’ve vouched for him, but we became friends at Whitney’s exams for our first, Isaac.

This is all a true story.

Whitney complained that her doctor and I would talk more to each other about music than he’d pay attention to her and the pregnancy.

As I type this, I realize I should probably check with her before posting. If you’re reading this, she consented to it.

Whitney and I show up at Parker’s house. The plan is to meet up with some other people going, Parker’s friends; we’d have a couple of drinks, snack on some food, and head to the show.

You can finish the story from there. Turns out that Whitney’s doc is friends with my bud, Parker, and it all makes sense.

“Oh, you two already know each other?” I think Parker asked us.

Medical Nihilism

We’re all people who would get along together. I guess I should only speak for myself. I don’t know if that applies were someone to have completed a clinical exam of my reproductive organs, but I’ve been sponge-bathed with purple wipes in the neuro ICU, so my sense of medical modesty is as loose as the hospital gowns.

Sometime later, we heard some friends who were expecting also saw Whit’s doc.

Oh he’s the best!

I don’t think we’ll be going back.

What?! What happened?

Nothing, he’s nice. It’s just, he didn’t tell us if we were like measuring to the milestones, and didn’t really have much to say about my diet. I just don’t feel like he gave us any information. I mean, he answered our questions, but I need someone to tell me what to do. I’m pregnant!

Fair enough. He’s definitely laid back.

“I don’t suggest that to patients, but if they bring it up, I’m good with discussing it.”

That was my oncologist this morning.

He’s laid back like Whit’s doc, and I’m sure there are some brain cancer patients who are not looking for laid back, but, man, it’s hard for me to imagine any other approach.

Medical nihilism is a position in the philosophy of medicine. Medical nihilism is academic and peer-reviewed; it’s not your Trumpy uncle touting RFK Jr. MAHA claims at the dinner table. But Medical Nihilism does adopt a skeptical posture with respect to the efficacy of many of our medical interventions. Medical nihilism worries, for example, that overscreening leads to overdiagnosing, which leads to overtreatment. This is an incomplete review of the position. To humble brag, I did review an intro text from the guy who wrote a book-length treatise on Medical Nihilism. If you’re into academic reading, here’s a good discussion of the topic.

At any rate, my oncologist is a medical nihilist. He lets me drive the conversation, and like the quote above, he’s never too keen to push something outside of standard of care protocols, but if you bring it up, you’ll find that he’s on board and eager to help integrate the suggestion into your plan, so long as it’s safe. That was the sort of conversation we had been having today.

Whitney and I like laid back. Like I told you not too long ago, I’m not in a hurry. We put together a tentative plan for when the chemo fails, but it’s not time yet.

I’m Not Convinced

Doc sees what the radiologist determined “worrisome for tumor progression,” but doc says he’s not convinced. He called the changes on the scan “subtle.” His ultimate conclusion: “I don’t see enough evidence here to justify changing the treatment plan.” His idea is to continue chemo, and we’ll scan again in a month.

Does that sound okay to you, Mr. Hayden?

That is satisfactory to me.

Okay, then we’ll get you set up in four weeks and see what the scan shows.

So that’s the news. Doc thinks the radiologist was reading for accuracy and completeness, but the guy who’s been looking at pictures of my brain for eight and half years says we should stay the course. Our nihilism has gotten us this far, and the plan sounds good.

So that’s the news, as far as it goes. Now I have to go take an anti-nausea pill because tonight we’re back on chemo. xx. <3 -a.