Decision Fatigue

Three and a half weeks have passed since my surgery. Most readers know, through the wonders of social media, that I am doing surprisingly well and have received good news so far. Bob is long gone and thanks to my fantastic and proactive surgeon, none of him was left behind. The silicon is taking and looking slightly more normal each day. I’m off all pain meds and, I’m just going to have to say it, I’m pooping again. I am mostly compliant with upper body movement restrictions, and I can function pretty well with T. rex arms. I have even been to the gym a few times and skirmished with the octogenarians over the recumbent bike and seated, upright leg machines. I have returned to almost normal personal hygiene and can wash my own hair, albeit testing the limits of neck flexibility. I have put on makeup and gone to restaurants.

Instead of my totally hardcore wall-sit, my mom captured me unawares, sliding down said wall to the floor. I was also unaware of the Instagram-tastic quote decal stuck to the wall over my head. #mygympicisbetterthanyours #doievenhavetoask #idefinitelydo #whatsyourexcuse #muahahaha
The amount of support and love from family and friends has been so comforting and appreciated. My mom and sister have taken turns doing the laundry and dishes and feeding, dressing and loving on my child while my dad has been on carpool, playtime and dog-walking duty. My husband was my dutiful and attentive nurse and then went back to the grind. Because, bills. Dear friends and new friends alike have brought home-cooked meals to our door and out-of-town friends have sent meal-delivery gift cards. I received an extremely generous grocery delivery gift card from a Facebook mom group, very few members of which I have ever met in person.

All of the above has been cause for a series of celebrations and generally good spirits. Cancer is now in the past tense and visible evidence of any significant change is astonishingly minimal. I do not need radiation (because my lymph nodes were cancer free), and I do not need more surgery. Can I even play the cancer card anymore?!

Well it’s cancer, and it’s not over yet.

Backing up…I didn’t understand, until personally going through it, the amount of extremely important and life-altering decisions thrust in the face of cancer patients. Yes there are algorithms and protocols, yet there is a surprising amount of nuance. In my particular case, here are some of the questions that I had to answer in a matter of 7-14 days, with professional guidance of course, but ultimately it was up to me:

  • Mastectomy or lumpectomy plus radiation?
  • Unilateral or bilateral mastectomy?
  • Before surgery, should I get a breast MRI to look for any areas of concern on the non-cancer side?
  • During surgery, should I have some lymph nodes removed and checked on the non-cancer side?
  • Reconstruction or no reconstruction?
  • What kind of reconstruction?
  • Which type of implants?

Some were easier than others to answer. And it is a luxury that I do not take for granted that my type of cancer did not dictate any of those to me. Many women aren’t so lucky. But every single question started a cascade of reading, research, grilling my support groups, listing the pros and cons, weighing the risks and benefits, deciphering emotion from evidence-based recommendations… It. Was. Exhausting. Easily my least favorite aspect of this whole cancer debacle. Yes, even worse than smelly pits.

And now here I am, seemingly at the end of my cancer journey as suddenly as it started, and my oncologist, chipper with all the good results, dealt a blow she didn’t realize by presenting me with more decisions.

Looming large is the question of whether I will need chemotherapy or not. Ten years ago there would have been no discussion of chemo for my type and grade of cancer. But now there exists a nifty test called the Oncotype DX® which determines the likelihood of chemotherapy to prevent recurrence. Low score = no chemo, high score = chemo. My oncologist informed me, however, that there is an intermediate score range wherein I might have to DECIDE whether or not to put myself on chemo to maybe decrease the odds of recurrence but to certainly feel like shit and lose my hair and maybe even fry some of my vital organs (you know— heart, lungs, what have you).

And finally, due to my cancer’s appetite for estrogen, I will be starting a medication called Tamoxifen that blocks the estrogen receptors on any silently lingering cancer cells. This is not a choice, rather a standard of care to which I will begrudgingly adhere. The side effect profile is downright rude– ranging from killer blood clots (literally) to weight gain and moodiness. HOORAY! Additionally Tamoxifen is known to have a drug interaction with a medication that I am currently taking– Zoloft. Without opening Pandora’s box of my history of waxing and waning depression dating back to my teens, know that the optimization of my current antidepressant and dose were hard-fought over the last three years and now I have to start over again.

Cue Kate spiraling into a pit of despair. More unknown, more decisions! I genuinely would rather have the four rounds of chemo than receive “intermediate” results and have to decide. But those results are completely out of my control, “outside of my hoola hoop,” to quote the wisdom of my dear friend Harmony. So, I will try my hardest to table that. As for the antidepressant, my only choice is to soldier on with a new medication and hope for the best. That’s not one of my strong suits– hoping for the best– but I commit to making the effort.

And, to be clear, I will absolutely continue to play the cancer card as I see fit.


One thought on “Decision Fatigue

  1. Wow, no wonder your hair is standing at attention. It is so good to hear from you and know I have been thinking of you always ❤️. Makes me relive the cancer world. Much love to you and your family as you continue this journey. One day at a time my precious one. Prayers!!


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