Hobson’s Choice

Chemotherapy is a highly toxic drug or combination of highly toxic drugs, given to a person who has been diagnosed with cancer, prescribed by an oncologist. Sounds straight forward enough?

I knew precisely nothing about chemotherapy before I was diagnosed with cancer other than some types of chemotherapy made people’s hair fall out and some types didn’t (I knew this odd fact because I’d met somebody once who was on ‘chemo’. They had a full head of hair and told me it wasn’t a wig. I always wondered about that…).

I’ve been told, “You’ve got cancer” three times in my life; three words that take a second to say but the impact lasts a lifetime. I was 34, 37, and 40 respectively.

Time Number One involved removing a bit of my right breast and 25 sessions of radiotherapy to the said right breast; Time Number Two saw me wave bye-bye to that right breast completely and say, “hi”, to a new, ‘reconstructed’ breast using skin and muscle from my back; Time Number Three meant I was never going to be told “You’ve got cancer”, again because it was Stage IV incurable cancer. This type means it’s found its way into one or more of your major organs and/or bones.

The thing I quickly learned about chemotherapy is that you actually get to choose if you would like to have chemotherapy or not. I never knew??? Because it turns out that if your oncologist believes that chemotherapy is going to benefit your chances of survival and you are offered it, then you, as the patient, have the final choice as to whether this chemical cocktail is allowed into your bloodstream.  There are lots of factors considered in order to arrive at this conclusion, like the size and position of tumour/s, lymph nodes affected etc, etc.

My introduction to chemotherapy came quite far along my cancer path (I don’t like the expression, ‘journey’. I’m not really sure why. I’ll have to think about that one). It was December 2007 and went something like this:

“What do you mean?”, I asked, when my oncologist ended her explanation with…..”Or you can choose not to have chemotherapy”.

“Do you mean I actually have a choice?”.

“Yes, you do!” she replied. “But if you choose not to have chemotherapy you’re looking at 3-6 months”.  Silence.

“Well, I don’t really have a choice, do I? My children are 6 and almost 10 and I’d like to try and see their next birthdays at least”.

Sometimes, a choice might be dressed up as a choice but it isn’t a proper choice really. It’s a Hobson’s choice; also known as no choice.  Decisions, decisions.

Anyway, I chose to have chemotherapy and it’s a choice I’m glad I made but not for the reason that you might think because whilst on chemotherapy my tumour sites grew and my cancer cells developed resistance to the chemotherapy drugs.  The reason I’m glad I chose to have chemotherapy was because it made me feel empowered but not in a fighting kind of way.

It makes me feel uncomfortable when I hear somebody’s experience of cancer described using the words, ‘battle’ and ‘fight’, because to me, as a cancer patient, if somebody dies from cancer, the use of these descriptors implies they have lost to the disease and that cancer has won. I personally don’t see it like that. A cancer diagnosis isn’t a battle to be won or lost; it’s a highly complex disease which if aggressive enough in nature will attack your body’s organs until they cannot function any longer. Quite simply, cancer makes its own rules and often changes them along the way; its mutations and strength have caused the deaths of lots of my friends and believe me they couldn’t have ‘fought‘ harder.

By choosing chemotherapy, psychologically I felt like I was making the best of a Hobson’s choice situation – that I was giving it my best shot. For me, empowerment meant accepting a course of treatment with the hope that it might halt the growth of my cancer. I was given facts that allowed me to make an informed choice to try to improve a bleak situation.

Sadly, my body’s response to the course of chemotherapy was not positive.  The cancer world describes it as “disease progression’ meaning there was more disease present at the end of the course of chemotherapy than there was at the beginning; utterly soul-destroying and bloody awful in equal measures. Delivering good news to a cancer patient is easy. Delivering bad news in a sensitive way isn’t; I felt just as sorry for my oncologist having to tell me as I did for myself having to hear it.

Enduring 18 weeks of chemotherapy and all it entailed was hard; being told the news, inside the claustrophobic environment of a tiny, windowless consulting room, that the disease had progressed, was harder. It took every ounce of effort not to scream loudly and claw the walls with what little I had left of my chemo-ridden fingernails.

The decision to start another 18 weeks of chemotherapy was out of my hands,  i.e. I wasn’t given a choice, because it turns out that an oncologist also decides if their patient is strong enough to have more chemotherapy and at that time, it was out of the question. White cell count, weight loss, and emotional stability of the patient, were all factors she considered for me as an individual.

Instead, she told me to go away and enjoy the summer and spend time with my husband and family in a ‘this might be your last summer’, kind of way.  I was also told I was going to be put on an aromatase inhibitor drug for three months. What the hell that meant I cared not, as long as I was able to have a break from chemotherapy which along with other side effects had caused chemotherapy-induced anorexia. My appearance fitted with the stereotypical image of a cancer patient and I was vulnerable, physically, and emotionally.

Then, several months later, something very unexpected happened. My body started to respond to the aromatase thingamajig drug and suddenly I cared very much what it was called, how it worked and why it was working. And, of course, my oncologist cared very much about what was happening too. Worldwide, it seems, there aren’t many people for whom the drug works in this way but for me, at this time, it is and it does. I’m closely monitored (every 16 weeks) and each time tumour marker testing comes, I take a look around me, count my blessings and hope for the best. None of us ever know what our tomorrows will bring.  That thought always makes me feel normal.

And that, my friends, is where I’m at. My wish beyond all wishes is that this drug could have worked for my many friends that I’ve lost to this very complicated disease; that it could have given them extra time with their family and friends. But wishing is one thing, knowledge is another; breast cancer is an umbrella term for a whole family of diseases and scientists now know there are at least ten different types. They also know that each individual cancer patient is just that, with a unique internal environment. What is less well-known is why each person’s response to cancer treatment is different.

All I know, is I’m very grateful. Very grateful indeed.