Strategic Denial
My mom has an incredible outlook on life and seems able to find the good in everyone, the possibility in everything. This optimism allowed her to enjoy a life that others would have found difficult without sadness, bitterness or regret.
A couple years ago, during our morning call, I teased my mother about her avoidance of some (meaningless) conflict happening in our lives. When I told her to "take your head out of the sand" she was confused - maybe even insulted. She asked me to explain what I meant and I tried to reframe my comment in a positive light and praised her ability to remain focused on the positive with "a healthy dose of strategic denial".
Her niece (and dear friend) Fonda liked the phrase so much, she asked a friend to draw a picture of an ostrich with the caption and sent it to Mom.
This exchange helped me understand that her positive attitude was actively cultivated by choosing to focus on the best in people and the possibilities in the face of difficult situations. She forged forward each day with appreciation for what the day might offer with clear recognition that anything was possible - and that her actions and attitude played a central role in creating the world she wanted to live in.
We have approached Mom's cancer with a similar attitude ... at least we're trying. It isn't easy - but we have tried not to look ahead too much - but rather take each day one at a time.
When Dr. Swanson confirmed Mom's diagnosis, he gave us lots of difficult ideas to absorb: Inoperable; stage 4, metastatic. Her only treatment option would be chemotherapy. He was careful with the next words: "after we see how she responds to treatment", we would have a better idea about Mom's future. I think I expected the next words to provide statistics about life expectancy or the probability that the drugs might work. Instead, he told us to wait for the results and transferred us to the care of Dr. Wilson, an oncologist at Dana Farber.
Dr. Wilson laid out the treatment plan. There were two paths we could take - traditional chemo therapy and targeted treatments. The targeted treatments were a long shot and required that Mom's cancer contained certain genetic markers. He had already commenced these tests but warned that the chances weren't very high - about 3-5% in the general population, lower for former smokers like Mom. The tests would take a few weeks so he recommended we move forward with chemotherapy. In the unlikely case that Mom had one of these markers, we could evaluate options at that time.
My friend Scott is an oncologist who in 30 years of practice has had the opportunity to live the experience of probabilities in medicine. If a particular diagnosis has a 99% success rate, he has seen too many unlucky patients who fit the 1% failure rate; and for ever 1/1,000 long shot, there are lucky people who beat the odds. He'd seen it all and encouraged us to avoid statistics and focus, instead, on Mom.
At our recent meeting, Dr. Wilson told Mom that after three rounds of genetic scans (that would have found 90% of these markers), they had detected the EGFR marker that can be treated by a targeted therapy called Tarceva.
I was stunned. Based on the (less than) 3-5% chances, I'd completely given up hope that Mom would be eligible for the treatment and resigned myself that we would proceed down the chemotherapy path and hope for the best. Instead, we learned that she'd beaten (almost) all odds and won the statistics lottery with a chance of 3/1000.
A few days later, we spoke to Dean Hautamaki, Mom's Florida physician (and dear friend), to understand what might lay ahead. "If Mom responds to Tarceva" she faces a very bright future. Dean provided case examples of his own patients on the therapy who are living active lives for many years with undetectable levels of cancer in their body.
I asked him to elaborate on the chances that Mom would have a positive response to the therapy. He didn't remember the numbers and offered to look them up. I stopped him. I remembered the advice that we'd been given by him - and Scott's advice - that chances in the general population would not be helpful in understanding Mom's chances for a positive response. It wouldn't matter if the chances for positive response were 10% or 95% - we wouldn't know which group she'd be in until she'd been taking the drug for six weeks. Only then would we know if she was in the 10% of lucky people - or the 5% of unlucky ones.
We have chosen to proceed with her treatment with a "healthy dose of strategic denial". We will keep our head in the sand about 10% chances and 95% chances - and stay focused on Mom's health and our time together.
Perhaps I've finally learned the true meaning of hope