You want ME to decide?

What happens when the chemo regime you're on isn't working?  Several things can happen.  You may decide you've had enough, and it's time for hospice.  Or, your doctor may say we've done all we can do. Or, your doctor can suggest several other chemo options for you.  I am always in a state of jaw-dropping confusion when my doctor, after explaining my other treatment options (and there are always several) says, "what would you like to do?"  One of my responses when I recently recurred was, "I'd like to get off this table, go out the door, and pretend this isn't happening!"  After a chuckle from both of us my doctor patiently explained the potential side effects of each option, and the percentages of it's efficacy.

This conversation always causes a pause and a minute of quiet reflection on my part.  I have absolutely no idea what I would like to do.  I have no memory of actually earning a Doctor of Oncology degree in this lifetime.  I feel, and actually I am, completely unqualified to make this decision.  So my answer to her is "if it were you, what would you do?"  I'm terrified of making that decision purely on my own.  What if what I chose on my own and that treatment doesn't work?  This is one time when I surely don't want to be sitting in the driver's seat.

I came across an article written by Dr. Craig Hildreth, who explains what this situation is like for the M.D.  He hit the nail right on the head in this paragraph:

But, soft! What about the gentle art of medicine? Any joker with a reasonable command of the language can recite the side effects or statistics. There is more to it than this. Oncologists, like ancient trees, are layered with rings of experience. It is our duty to use this wisdom to help our patients make a pragmatic decision about taking treatment, one that they feel comfortable with, if not optimistic about. Our duty to our patients requires that we go beyond regurgitating the pros and cons of a treatment and interpret the nuances of a patient’s psyche and the dynamics of their family. Despite the growth of shared decision-making, I believe that patients simply do not know enough about the blessings and perils of modern cancer care to make the right choice based on data alone. They need sage advice from one who has seen this situation countless times before. Our patients deserve to have their oncologists collect all the pieces of the case: the goals, risks, logistics, psychological factors, caregivers, costs, and then, combined with and blessed by the ineffable magic of human interplay, guide them toward a decision that no matter what happens is never remembered with regret.

http://www.cancernetwork.com/blog/cheerful-oncologist/content/article/10165/2154307

Thank you, Dr. Hildreth.