To Keep My Ass, or Not to Keep My Ass

Today we met with a colorectal surgeon at OSU. I love my surgeon up in Cleveland, and he’s one of the top rectal cancer surgeons in the country, so I’m planning to have the surgery with him — but we figured a second opinion can’t hurt as we continue our information-gathering tour. I’m already in the OSU system after having my colonoscopy there, so they keep offering us these appointments and we see no reason not to take them.

It was interesting how this OSU surgeon outlined my options. While it wasn’t necessarily new information, it was presented in a way that got me thinking. He started by explaining how the safest route is to remove the entire rectum, anus, part of the colon, and surrounding lymph nodes. Take the whole damn thing right out. Lowest possible chance of the cancer recurring and thus, statistically the longest life expectancy. The downside, of course, is that I’d have a permanent colostomy bag. Not great, and a big lifestyle change; but lots of people have them and still lead active, happy lives. (Brenda Elsagher’s books have been huge for me here.)

The other option is to attempt to cut out the tumor, but in such a way that I either (1) don’t need a colostomy bag at all or (2) need only a temporary colostomy bag so that things can heal before being reconnected. He mentioned that while option (2) sounds straightforward and maybe like a best-of-both-worlds situation, about half the time the patient struggles to regain normal bowel function and requires additional surgery. The problem with option (1), as I understood it, is that it generally requires more chemo and radiation to accompany it. Plus, most importantly, the risk of recurrence is highest, maybe on the order of 20% within five years.

Disclaimer: I’ve tried to take good notes throughout this process, but it’s very possible — likely, even — that I’m relaying some of this incorrectly from a medical or oncological perspective. Please don’t consider any of this fact; only my understanding of what’s been explained to me. Makes you wonder how much doctor-to-patient communication is really retained accurately.

Backing up a bit, here’s a good example of how the brain can be irrational under duress: When I first found out I had cancer, the thought that terrified me most wasn’t dying; it was the possibility of living the rest of my life with a colostomy bag. The mind assigns strange weights to unknowns, doesn’t it? In the weeks since then, I’ve come to my senses and realized that not dying is most definitely the priority — and if a colostomy bag makes that possible, then so be it.

In fact, last week I told my wife that my top priority right now is making sure I can dance with Addie at her wedding. And that’s really what got me thinking, Why not just cut the whole damn thing out? There’s nothing more important to me than being as sure as possible of being around for my family for as long as I can.

My tumor board meeting at University Hospitals in Cleveland was today, so tomorrow I’ll get their recommendation. My surgeon there has already told me he’ll do whatever he can to make sure I don’t need a permanent bag, and of course I trust him to accomplish that in a way that effectively mitigates the risks of recurrence. If anyone on earth can do it, it’s him. But there’s no doubt that compared to whatever he’s able to pull off in the way of safely saving my ass, taking the whole thing out would ultimately be safer statistically. I’ve always known that, but it hit me in a different way today.

Good news is, I don’t have to decide tonight, and tomorrow I’ll have much more information to consider. I guess what was strange about today was that I hadn’t really been thinking about this as a risk-reward decision that I got to make. Seems obvious in retrospect. But I suppose I was just looking for a doctor to tell me what to do — or even with multiple opinions, I was expecting each doctor to tell me what to do, and then I’d decide which doctor to listen to. I wasn’t really expecting any doctor to offer me a choice. Hey there, friend — you the gambling type?

Am I qualified to decide something like this? I have a tough time choosing pizza toppings.