Thursday, December 15, 2005

An Unwanted Journey: Day 0021 - Questions


Is it possible to get through a day without more questions?

What is the preoperative staging assigned to my case? What TNM (tumour/node/metastasis) classification has the tumour board given me (see below)? What’s my activation key for My CARE Source, the Grand River Regional Cancer Centre’s online resource for managing my treatment plan? What is the significance of clinical complete and clinical partial responders to neoadjuvant chemoradiation for rectal cancer? And what exactly is the difference between clinical responders and pathologic responders? Perhaps even more importantly, is there any point to the patient looking for and expecting answers to these kinds of questions?

***
TNM Staging System
Tumor

  1. T1: Tumor invades submucosa.

  2. T2: Tumor invades muscularis propria.

  3. T3: Tumor invades through the muscularis propria into the subserosa, or into the perirectal tissues.

  4. T4: Tumor directly invades other organs or structures, and/or perforates.
Nodes

  1. N0: No regional lymph node metastasis.

  2. N1: Metastasis in 1 to 3 regional lymph nodes.

  3. N2: Metastasis in 4 or more regional lymph nodes.
Metastasis

  1. M0: No distant metastasis.

  2. M1: Distant metastasis present.
Stage Groupings

  1. Stage 1 - T1 N0 M0; T2 N0 M0

  2. Stage 2 - T3 N0 M0; T4 N0 M0

  3. Stage 3 - any T, N1-2, M0

  4. Stage 4 - any T, any N, M1
***
I feel like I’m being tossed around, not by anybody in particular, but mainly by what I should or should not do in participating in my own treatment.

In my profession, one thing that is very clear is that there is no lack of questions to ask. There are literally dozens of tasks that can be done each and every day related to managing information technology, usually organized according to the questions being asked. The trick is not in having a lot of questions; the trick is in asking the right questions at the right time with the right goal in mind. Success is more about assessing priorities and clarifying objectives than in having immediate answers to those pressing questions.

But now I feel like I’m a novice all over again. I have no idea what the right questions are or even what my focus should be.

Question: Is this normal?

Question: Would it make more sense for me to leave the technical questions to the experts and concentrate on my emotional health and general wellbeing? Or is it silly to try to distinguish between the two?

Final question for today: Is it time to put my brain into neutral yet again?

1 comment:

Eric said...

My only recommendation is to have a Manager's state of mind. Be educated enough in the terminology and methods but not the details so that you can communicate and understand effectively. You can’t do their job for them and you do have more important things to manage. Just like a manager you will task the professionals to complete their jobs but they still need to report to you. Like a manager you’re the one who has the motivation to get the job done but the others are only motivated by their chosen careers.

Your emotional health and perspective if far more important. Serenity to accept the cancer and its consequences. Courage to keep looking for the best path a Manager needs to take for a cure. Wisdom to accept just how helpless people are and to recognize the things that give you some peace.