"I'm sorry to have to tell you, but you have cancer. It seems to be in its early stages right now, so conventional therapy might work. Of course, you have plenty of options, and we want to make sure you understand what all your options are." Dr. Reynolds told Betty Stewart. This news was an earthquake shaking the entire foundation of her life. For almost thirty years, Betty had been careful with her health. She excercised regularly, she ate healthily, she made sure to sleep well every night, she had done everything she could. Her mother had impressed upon her when she was young how important her health was, and now this traumatic announcement had turned her world upside down.
"Ok, well what are the options, then?" Betty asked, as she thought about how her life and her family. She wanted to live long enough to be there for her children's graduations, marriages, grandkids if possible... that's why she had taken such good care of herself. If this thing won, not only would she miss out on that, she might not even be there for them now.
"Well, as I said, we've caught it early enough that we might be able to get rid of it with conventional methods. We could try removing it with surgery, and follow it up with chemotherapy to get what we might have missed. We could also try the direct-area radiation, with which we would aim specifically at the cancer. Of course, we also have several limited-success options too. There is biofeedback therapy, where we basically give you a specially formulated "slurry" which will help your body fight it off itself. As I said that one isn't as reliable, but when it works it's significantly less invasive." Dr. Reynolds informed her.
"I see, are those the only options?" Betty inquired, hoping for something miraculous. All of the methods she'd just heard him mention she knew weren't guaranteed successes. At any point, she could leave remission and be right back where she started, and with several of the options she had just been given, she could be incapacitated for a while just from the therapy. She knew she couldn't just let down her kids, she just didn't have it in her.
"Well, there is another option. It's a bit less conventional, and there is both an upside and a downside. Pros and cons, if you will, to using the other option we have. If you'd like I can explain it to you." Reynolds waited for her response. The hospital's policy was that he could offer her the information, but only if she asked about it.
"Ok, well, what is this other option, and is it reliable?" Thoughts raced through her head, one-million and one possible scenarios passing her by as she anxiously waited to hear good news.
"There is a new medication on the market. It can only legally be obtained and administered at hospitals, mind you, but like I said it's... an option. This medication, recently developed, has received conflicting opinions. On a less scientific note, some have called it the miracle medication of our age (like penecillin was not too long ago), others have called it a curse. Because of the implications, we're required to tell you about both the pros and the cons of taking this medication before allowing you to make a decision. The pros to this medication are that it will get rid of the cancer with a 100% success rate, and there will not be remission at all because the cancer will never come back. Numerous studies have proven that taking this medication will actually cause your body to create antibodies to the specific cancer you have, meaning it won't return." Reynolds took out a folded cloth from a pocket in his overcoat, and wiped his brow, preparing to deliver the cons.
"Well, that's excellent, it certainly is the miracle drug! 100% success, no chance of recurrence, and thus no need for remission checkups?" Betty was pleased, but then she thought about how good the offer seemed to be. Her mother had always told her that anything that is too good to be true, probably isn't. Why would the hospital require that the full disclosure be given before a decision if it were as great as it sounded? That was the thought that kept her grounded, instead of jumping out of her seat with joy.
"Yes, yes at first it does sound like a miracle. However, there are the cons to consider... well, actually just the one big con. Because of the continued development of medication with the potential for overdosing, a scientist in Germany came up with a device that would take a sample of the medication and tell how much of the medication would cause an overdose, and the average lifespan lost by taking the medication. When this miraculous sounding drug was announced, it went through the same analysis as all the other drugs. Their findings were somewhat inconclusive, until it went through the MOALD (Medication Overdoes and Lifespan Diagnosis) machine. When they put it into the device, it came back with an unexpected result. According to the machine, if you take this medicine, your effective remaining lifespan is cut in half. Naturally, this only applies to if you die due to natural causes and not through accidents or the like. This is why we have to, by law, tell you about the full implications of choosing this treatment before you decide." Reynolds looked visibly disturbed, and also anxious.
"Wait, so you're telling me that my options are to choose between 'it might not work' and 'it will work, but you will die twice as soon'? Those are my options? What type of joke is this?" Betty exclaimed, which was typical for patients receiving this news. Dr. Reynolds had had this talk many times before.
"Yes, the options are conventional treatments, which might or might not work, and will take time, or a near-instantaneous completely non-invasive medicine which will reduce your effective remaining natural lifespan by half. Ultimately, you get to choose what we do here. It's your body, and it's your life. I'll give you some time to think about all of this." Dr. Reynolds said quietly before he left the room. Now, Betty was alone in the room, and the question was her only company.
So there it was, the big decision, all right in front of her. An entire life spent trying to stay healthy, so she could grow old with her husband, watch her kids grow up and do marvelous things, see her grandchildren, and now her life stood on a precipice of uncertainty. If she took the medication, she would certainly be healthy by almost every definition of the word. If she didn't, she could still be healthy, but it wasn't certain. She wasn't prepared to make this decision. It was all too much for her.
"AHH! This is exactly why I wanted Martin to come with me today" Betty said with strain in her voice, "If he didn't insist on going to that stupid business meeting, I wouldn't be going through this alone."
Betty started to tear up a little. The pressure was palpable, the tension overbearing, stress to extremes. She knew she couldn't blame her husband. It wasn't that he wanted to go, it was that he had to if he wanted to keep his job. She still couldn't help but feel a bit bitter because she was by herself when she needed someone to talk to. For a while, she just sat in place, feeling sorry for herself. Sure, she knew this wouldn't help the situation but it made her feel a bit better. Then she started thinking about the options again. Why did they even tell her about this? What point is there in making a huge decision like this? But she knew that the doctor had only told her because she asked. She had seen it on his face, this wasn't much easier for him.
Do I really want to throw away years of my life just because of this? Or worse, do I want to spend years of my life dealing with this because I wasn't willing to sacrifice for it? How can I make a decision with such limited information?
Dr. Reynolds came back into the room, with a box of tissues. "I brought these in case you might need them. And I needed to ask if you had any questions I could answer."
"Yeah, these years that I would lose from this medication... they're from the end of my natural life, right?" Betty asked. Dr. Reynolds stoically responded that any time that would disappear would have to be considered 'from the end' considering it ended early. "So, how would I die when I reached that age? Would it be different somehow?"
"Well, that's an interesting question. The MOALD machine doesn't tell people how they'll die. It's only meant to tell people what the deadliness of a drug is, it doesn't test people. That said, you would probably die in the same manner in old age as you would otherwise die. Maybe your heart just stops while you're asleep... maybe you'll have a series of severe strokes, seizures, or heart attacks. We don't know, but I can be fairly confident saying that it would probably happen the same way it would happen if you had lived to your full age without ever having this cancer." He responded, though Betty could tell by the look on his face that he didn't really know, and was guessing but interested.
"Would I age twice as fast or something?" Betty inquired, expecting the answer to be along the lines of a 'yes'. Interestingly, Dr. Reynolds told her that externally, she would appear to age at exactly the same rate. "And I would never get cancer again?"
Dr. Reynolds shifted his position, and Betty could tell that he was feeling tense again. That meant bad news. The question was, what was the bad news he was going to say next.
"Well, actually, not quite. You would never get THIS cancer again. You wouldn't have to worry about getting breast cancer ever again, but if you were to get some other kind... say melanoma, or something, you would have that cancer. This medication would not prevent you from contracting a new type of cancer."
"Well, would the medication work more than once?"
"Yes, it would, but your lifespan would also be reduced more than once. Instead of having 50% of your remaining natural lifespan from now, you would have 50% of the lifespan you had remaining when you took it again. That's how it works. Is there anything else you need to ask?" Dr. Reynolds inquired.
"No, I think I'm good. I've made my decision." Betty said, with an unwavering certainty in her voice. All this time, she had thought about what she would be missing out on if she were to take the drug, but she had realized what counted the most. Life, as she suddenly saw it through an unclouded paradigm, was more than just how long you lived. It was about what you did with the time you had. If she were to waste her life in the hospital, she could still miss out on her kids' lives. It could be worth it to be sure she would get to see her kids grow up without having to let them see her at her weakest. It ultimately didn't matter what she chose, but she knew what she would rather have. But before she could decide, she had one more question, "Do I have your assurances that the medical procedures, whatever I choose, are going to be discreet?"
"Of course, nothing about your condition or treatment will ever be sold or told to anyone without your express consent unless we are required to give that information by law." Dr. Reynolds replied.
"Ok, then here's my decision..." And with that Betty lived her life to the fullest, she kept the fact that she had cancer a secret, and what time she had with her family. As she closed her eyes for the final time at the end of her life, she would look back on the life she had lived and would not regret her decision.
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