Thursday, September 27, 2007

Facts are like glasses of water

Last month after my visit to the doctor we got into a discussion here one weekend night about MRI scans, blood counts, prescription dosage and the general unreliability of medical prognoses. I've developed less patience for all this stuff over the months and at some point I blurted out, "Facts are like glasses of water."

Gina and Franny cracked up. What crazy nonsense is this goofy old person blathering about now?

I may have been a little drunk at the time; it doesn't sound like a very cogent statement, of anything. But I know what I meant. Get a bunch of these doctors in a room -- or better yet, talk to them separately, over many months -- and they're all capable of using the same information to reach different conclusions. Or different information to reach the same conclusion.

Facts, I was thinking, become interchangeable, like glasses of water. Blindfolded you wouldn't know one from another. Your tumor is shrinking or it's unchanged; either way that's good. Your blood counts are low, but we expect that. You seem to be tolerating the chemo pretty well, but we're going to lower your dosage.

Michelle, unreformed medical reporter, can't help cross-examining whoever's available to answer questions. She always seems (to me) to know at least as much as the people she's interviewing, and I sometimes think she actually helps them reach conclusions.

Me, I'm more of the here's-my-arm-poke-it, here's-my-head-scan-it school, and then I just do what they say. I can't tell much difference in their glasses of water, and it could all change by the next visit anyway.

So today, as she has reported, Michelle didn't make it to the appointment, which somehow began early. Mich, an occasional guest at these meetings, is out of town for work so she wasn't there either. I was flying solo at the doctor's office, for the first time since this ride began.

I tried to whip up the enthusiasm to ask some questions but my heart wasn't in it.

Jennifer Wulff, the nurse practitioner who sees me in lieu of my oncologist, Dr. Spence, said she looked at my scans "and they're fine." She looked at my blood work, "it looks good." We did the rest of our little ritual -- touch your nose, squeeze my finger, which finger am I wiggling -- and that was pretty much that.

I took some karma-depleting pleasure last month, I'll admit it, in mocking Jennifer (behind her back) when she had some math trouble. She had decided to lower my Temodar dose, the chemotherapy drug, by 20 percent. I was taking 400 mg a day at the time, so I said OK, down to 320 then? She got a kind of spooked look on her face and said she'd have to compute it. Then she left the exam room, came back five minutes later and announced, as if she'd discovered a new prime number, than the new dose would be 320 mg.

Now, if you know me you know I don't mind feeling superior to people, even on such a meager little level ... but that doesn't include the people treating me for a freaking fatal disease! Christ, I'm ingesting poison every month over here on your say-so, and you can't figure 20 percent in your head?

Today I had to resist the urge to help with the math. OK, we're not making a change. ... Let's see, we're at 320 now. Times nothing percent. That's ... duh da-duh da-duh, carry the zero, bring down the three ... 320!

The other weird thing was: Dr. Spence himself poked his head into the room at the end of the meeting. He agreed the scans look good, everything looks fine. "So if you're up to another month," he said, "I think we should continue with the treatment."

"Hey man," I said, "I'm a professional pill-popper. Bring it on."

But what the heck? There's an option? Maybe one of these months we won't continue with the treatment? Or if I'm not up to it I can take a couple of months off?

Who knows. We're going to L.A. for a week and then I'll start the next round when I get back. With big glasses of water.


Michelle said...

Nice report baby. You're a pretty good typist.

kateco said...

great typer, superior calculator -- poor nurse practitioner, perhaps a little obsessive poker playing would sharpen those percentage skills ...

Rita said...

John 11:35.

Rita said...

John 11:35.

Rita said...

Don't know how this happens, but it this case it may be worth repeating.

Mark said...

I wept today at the poker table, so I guess it all evens out.