Anatomy of a Choice

If you’ve read all of “The Medical Story” posts, you know that early on, we had a Big Choice to make. Should we do surgery or chemo first?

I’ve written without much description that we knew how God was leading us. I want to explain more about that for 2 reasons: 1) I want my children to know and not wonder, years from now, what I was talking about and 2) A few people have mentioned that they wonder what I was talking about.

So: surgery or chemo first?

We chose surgery. We chose a very radical surgery that, we were told, would leave me permanently deformed with a caved-in chest, without strength on the right side, with nerve damage that would limit my range of motion and let my scapula wing out sometimes, and with a cancerous lymph node stuck under my collar bone.

Why surgery?

1. From the beginning, it appealed to my common sense. I knew that the advantage of chemo first is prognostic—e.g. we can see if the tumor responds to treatment and so know for certain that all the cells we can’t see are responding, too. But leaving a tumor and cancerous lymph nodes in for longer than necessary seemed. . .dangerous. Even though statistics show that it is not.

So, from the first, this was my bias.

2. One of the first things I learned about breast cancer is that everyone knows someone who’s had it. For as much as statistics show that the outcomes are as good for surgery first as they are for chemo first, every single story I heard of a breast cancer patient featured

A) a woman who had surgery first and survived, or
B) a woman who had a lumpectomy and then had to go back for mastectomy and chemo, or
C) a woman who had chemo first and then surgery and then, sadly, the cancer came back.

Every single story. And I’d put the number of stories at 30. At least.

I didn’t hear one single story that featured a chemo-first patient who was now cancer free. (Or, in the case of one good friend, a child who endured several additional years of cancer recurrence and chemo before finally becoming cancer-free.) Statistics show that there are as many out there as surgery-first patients who are now cancer free. But I didn’t hear about any of them.

This is what we took to be the first super-natural leading. God speaking through circumstances of whom I happened to be meeting and which cancer patients they knew. Not a big thing. Not enough to base a whole decision on. But it was part of the caseload.

3. When we met with Mayfield for the first time, we concluded the appointment by scheduling the surgery for the following Friday. We were in no way locked into it. I felt completely free to cancel it, or make it a mere port installation. But I also felt a great peace about it. No misgivings at all. Plenty of grief, sure. But not even a slight inclination that maybe we shouldn’t.

We took this non-anxiety to be supernatural as well. We believe God is real and that He loves me and wants to see His will done in my life (even if that includes deformation and other side effects). If this wasn’t cool with Him, I expected the living God to tell me or us with some kind of emotional content: anxiety, disease, non-peace, unsettledness. But we experienced none of this.

4. As I thought and prayed about the choice, Biblical examples kept coming to mind of “cutting out the cancer.” Most days, I read a children’s Bible with the kids and during this time we “happened” to be on the part where many Israelites were put to death because they’d led everyone to idolatry.

And in my own reading of Acts, I “happened” to get to the story of the two fakers in the early church who tried to pull off fraud. God struck them dead. Aside from the places where I was reading, other Bible stories came to mind, and all of them had a certain theme: Don’t mess around with the trouble-causers. Cut the trouble out.

Now, there are also plenty of stories in the Bible that describe redeeming the trouble. It’s definitely God’s character to re-claim what has been spoiled and make it good again. Maybe if these portions of scripture had come to mind and our attention, we would have had to think about whether God was leading us to allow the chemo to re-claim my body from the cancer.

But these portions didn’t come to our attention. Again, we took this as more leading towards the surgery option. It’s important to note that this wasn’t Russian Roulette with a Bible—e.g. Flip open to random page, see what’s there and interpret an answer from it. These examples were what came to mind as we prayed, and what were already on the page we were already reading at that time. Was this God’s timing? That we should happen to be at those portions of scripture on those days?

Why would we think it wasn’t God’s timing?

5. A week after our first appointment with Mayfield, we had our second. The pre- surgical consult. We went in ready for mastectomy, knowing that the MRI showed the muscle had cancer, too, knowing he’d cut out a hefty portion of it.

Mayfield launched into a very serious talk about how serious this surgery was.

OK. . . We knew this already. . .

Then he told us that for the last week, since first meeting us, he hadn’t slept well. He’d had disturbing dreams. That there’d been no good rest because he couldn’t stop thinking about me and my children. He would read Scripture to help ease his mind enough to sleep. His wife, obviously, noticed the distraction and had started praying for him and for me. Finally, he told us that in the case of most other patients, he’d actually recommend chemo first. But that he really thought we needed to do the surgery, as hard as that would be.

I asked, ‘Do you get like this with everyone?’

And he looked at me with disbelief. Did that question even make sense? He’s a surgeon. He’d be dead by age 40 if he bore this much angst over everyone. “No,” he said, “That’s my point.”

“Well. . .” I began, “Are you leading up to some extra terrible news? Because we’re already going to do the surgery.”

No additional news. Why had he given such an intense plea about his disturbed sleep? He just really thought we needed to know all of this.

Okedoke.

We left the office in great spirits. I remarked to Bryan that of all the side effects Mayfield had described, the one I really wanted to avoid was the arm swelling—a potential effect of removing the lymph nodes. I said to him, “Let’s pray against that one.”

10 minutes later, Dr. Markus, the oncologist called with news: He was looking at the detailed pathology report and mine was the kind of cancer that is very responsive to the H protein. So we could do chemo starting next week, shrink this sucker down, maybe even do breast conservation surgery in the end, but almost definitely avoid the “terribly morbid” surgery that would take my muscle as well as breast.

The lymph nodes would still come out after chemo. This means I’d still be at risk for arm swelling. That’s key. If we had left Mayfield’s office, and I had remarked to Bryan, “I just wish there were some other way. Let’s ask God for some other way” and then gotten the call from Markus, maybe the decision would have been different.

Instead, I had very specifically said that the only part I really wanted to avoid was a swollen arm for the rest of my life. And the option that came in 10 minutes later, while offering to change a lot, would definitely not change my risk for a swollen arm.

I told Markus we would call back after talking about it.

This chemo option was tempting. Are you kidding me? Not losing my right pectoralis? Possibly conserving my breast? Of course it looked good.

But, but, but. We had been praying—and others had prayed with and for us—for discernment and wisdom. That we would choose what God would have us choose. What did we expect His help to look like? Writing in the sky? A letter from God in our mailbox? He’d given us scripture, circumstances and a believing-surgeon who had just given a passionate recommendation for surgery even though at the moment he was giving it, we weren’t even thinking there was another option worth considering.

What were we to do with all of the above input? And the absence of any input recommending the chemo first option? Could we write it off? Could I say that, given my bias from point #1, all the rest feel into place because that’s what I wanted/expected?

Yeah. I could have said that. But then what does that say about my alleged relationship with the living God? That He let me fake myself out? That He let me receive as His leadership something that was really just a psychological mistake?

I thought of Lot as we ate lunch and talked about this decision. I specifically mentioned him to Bryan. The famous Lot who enjoyed success and the same kind of wealth as Abraham did. And eventually, their flocks were too big to share space, so Abraham told him: You pick a region and I’ll go the opposite way. Go ahead. Pick.

And Lot “raised his eyes and saw with them” that this one direction was good and fertile. He chose it. This was his pattern for the rest of his life, to walk by sight. He might have had one foot in God’s kingdom some of the time, but all of the time, he had his other foot in the world and he chose according to what looked good and right to him. Of course, this is a life that ended in tragedy.

I told Bryan I felt a similar temptation as Lot did. Look with our eyes and we see the possibility of a healthy breast in the future, and at the very least, an avoidance of a severe procedure. With our eyes, one direction looked good.

But faith is being sure of what we hope for and certain of what we do not see. We’re certain that God is powerful enough to lead people as stupid as we are in the way we should go if, in our hearts, we truly welcome that leadership. We’re sure that God’s version of what my life should look like is the best possible version, even if it includes deformity following a bummer surgery.

In those two days before surgery, I was a wreck. A good portion of this was due to my sugar reaction to the radioactive glucose and the rough recovery from it. But a bigger portion was the sheer sadness over the coming surgery. This all was probably even harder on Bryan, who, of course, couldn’t do much to help. He kept saying, “Babe, you don’t have to do this. If you’re not feeling a peace about this, we can reconsider.”

And I kept telling him, “No, that’s just it. I have complete peace about this, which is why I know it must happen, and it just sucks that this has to happen.” I can only describe the actual feeling of those few days as being pressed. Being absolutely wrung tight.

But scripture promises that His joy comes in the morning. The morning came pretty quickly for me, didn’t it?

Praise be to God, for the miraculous surgery that left my muscle behind and pulled that last lymph node out. Praise Him for being the Good Shepherd in our lives. Praise Him that His staff is with us every day, and not just on the days when the Big Choice is before us.