Tag Archives: Atul Gawande

Uncertainties

Mrs. Charm’s cancer treatments were going well until the other day when her latest scan found good news and bad. The good news: her lymphoma tumor load seems to have significantly decreased across the board just four doses into her eight-dose chemo regimen.

The bad: the scan showed there was a dark mass on her small intestine where it connects with the large one. It could be a hard tumor, possibly a sign of small intestine lymphoma which is not an unusual development in lymphoma cancers. Or, as her gastroenterologist said, because she has none of the expected symptoms of small intestine lymphoma, it could be a false reading and he could be chasing a ghost.

So this morning he made what Atul Gawande says in Complications, A Surgeon’s Notes on an Imperfect Science, is the hardest medical decision of all: to do nothing, not even a biopsy. Only to continue the chemo doses. And wait until the next scan six weeks from now, unless symptoms set in before then, to see if the mass is still there. And so there we are, still uncertain about what’s going on but still seeing progress and hoping for the best.