50/50

I still use Netflix DVDs.  Sure I use streaming too, but I get one DVD at a time as there are many quality pictures that just don't stream.  I have a long DVD queue constructed over years.  I try to keep it up to date, but sometimes when I send in one DVD I neglect to check the queue and I end up with a surprise.  

In this case, just as I am in the midst of coming to a decision about whether or not to do radiation, the surprise I get was the movie 50/50.  I didn't watch it.  I will eventually.  Please...no spoilers.  It's a movie I'm sure I'd like and Netflix thinks so too, but right now is not the time.  It's about a 27 year old guy getting diagnosed with cancer...he has a 50/50 shot at living...or at least that's the premise as I understand it.  It bills itself as a comedy, but I've heard different stories on that front.  

 

I found the timing of its unexpected arrival ironic...and yeah I really do think.

-->Clearly I'm not in that character's situation, and I'm grateful for that.  I do still have my decision to make.  I've gotten a second opinion which included a second (somewhat different) read of my pathology and another view at my films.  The end result was similar:  Either way is a good prognosis and either choice can be supported by the current research.  Risks and benefits to both decisions too.  The most realistic risk of doing it is the possibility of permanent dry mouth.  There are very very small risks of secondary cancers down the road, but at the dose I'm looking at that's nearly unheard of.  The major risk of not doing it is recurrence and the need for another surgery with its own risks.  Recurrence itself isn't that problematic with papillary thyroid cancer...again almost unheard of that it would come back more aggressive or not where we'd expect it.  Still, I think there is much to be said for avoiding it and getting rid of what might be there.  Is that logical?  I'm not sure.  I think there is more to be said for being done with the decision.  At the moment I think I've made my decision, but I want to sleep on it a few more days before sharing it.     
Apparently I'm not the only one that has a hard time making decisions, a hard time quantifying what to do.  I can look at the statistics (and oh have I!)   I can debate myself back and forth stating solid reasoning.  In the end this decision, and I think a lot of decisions, even medical, come down to what one feels is right.  Maybe not even that.  Maybe what one feels psychologically comfortable doing...a philosophical decision as one doctor put it.  My gut actually says one thing...and I think my mind agrees with it...but I just can't seem to settle on it.  How do we make these decisions?  People like me, and doctor's, look at statistics and data.  But data like that matters for large groups of people.  Each individual is a 1 or a 0.  You will or you won't.  It's not a 75 percent recurrence or a 30 percent dry mouth, it is...or it isn't.  You get a secondary cancer or you don't.  So data can say what might happen...but over 95 percent of thyroid nodules are benign...mine wasn't.  

NPR is actually doing a series on our understanding and application of statistics in decision make.  Today they started the series with a story about a graduate student who faced a much more challenging choice than I regarding his medical care.  He is now a professor in the University of Michigan School of Public Health studying medical decision making (which he also studied in graduate school).  He looked at data, understood the numbers, and with that knowledge, he made the decision based on what he thought would be best for his new family.  If he and I struggle with applying the numbers to what is best in our own contexts, I cannot imagine the typical patient.  Here's a link to the story:  http://www.npr.org/blogs/health/2014/07/21/332074963/what-the-odds-fail-to-capture-when-a-health-crisis-hits

It's nice to have choice, it's nice to have control.  It's more than nice, perceived control can impact mental and physical health positively.  But what we do with that control and choice, how we understand that in our lives...I'm still working on that.