A Moral Dilemma Margaret Darby   © Copyright 2022 by Margaret Darby

Photo courtesy of Pixabay.

  Before my diagnosis, I had spent months trying to convince my general practitioner that my digestive problems were not simply a lack of fiber. By the time he finally consented to send me to a specialist, my illness had reached an advanced stage. The specialist rushed me to surgery. He removed the tumor and resected the bowel.  I remember lying in bed, swathed in bandages and bedecked in plastic tubing, when the surgeon came in to tell me that the cancer had invaded the nearby fat and that metastatic cancer cells were in 10 of 23 lymph nodes.  When I looked at him blankly, he sat on the edge of the bed, looked me in the eye and told me that meant I had about a 30% chance of surviving another five years. 
 
When he left, I tried to consider my options with an open and objective mind, but the dire prognosis made me think I should wrap up all my earthly concerns and get ready for death. That meant dropping out of the library degree program I had just started, getting my recently acquired house ready for sale to make it easier on my survivors, and stopping my search for a better job. 
 
After leaving the hospital, I briefly considered some off-beat alternative cancer treatment methods – juicing, meditating, macrobiotic diet and the like, but most of those treatments would only be successful if you block yourself off in a cabin in the woods and I could ill afford that. What I needed most was to find an objective and disinterested professional who could walk me through the last months of my life – preparing me for the physical effects of my disease and helping to manage pain and provide palliative care.  So I made an appointment with a traditional oncologist. 
 
Dr. Berkowitz was one of the warmest and most positive doctors I had ever met.  He recommended chemotherapy and radiation and said I should start both simultaneously as soon as possible. I accepted at once, grasping on to the ray of hope he was extending by prescribing treatment. He also ordered a battery of tests to make sure the cancer had not taken hold somewhere else in my body.   
 
The reality of concomitant chemotherapy and radiation is like being trapped behind a belching diesel engine in a never-ending traffic jam. The treatments made me very weak  - so weak that sometimes getting out of bed and washing my hair was an entire day’s project. The chemotherapy for the colon cancer and the surgery had turned my tummy into a churning mess and I was afraid to be more than ten feet away from the nearest bathroom.  Everything I ate went right through me and I had extremely painful rectal spasms. I began to lose a lot of weight and my skin took on a grey pallor.  I became listless and depressed. 
 
Then came the clincher:  the tests revealed that I had a cyst-like shadow on my left kidney.  Dr. Berkowitz felt that it could be a cancerous lesion. A lesion on my kidney?  Another cancer?  What is the significance of a bad prognosis on top of a bad prognosis?  With this dire a situation, was there any way I would survive?   The prospect of going through another round of surgery was horrible.  I was too weak to endure the physical strain of being cut open and sewn back up again, but not courageous enough to refuse treatment. 
 
Dr. Berkowitz told me there was a possibility that the cyst was harmless, but it was difficult for me to weigh the risk. The threat of death on all sides made me feel damned no matter what choice I made.  I bought time by asking to wait a while and have another MRI of the kidney to make sure it was not a temporary cyst that might have disappeared. I struggled to read technical articles, but found them difficult to comprehend.  I read enough lay articles on kidney cancer to understand that any cancer which enters the urinary tract is going to spread through the body like wildfire.  But wasn’t I going to die anyway?  It was truly hard to give up all hope.  The treatment and the diagnosis had put my life on hold.  I continued working in a part time job at a real estate agency where I did little more than answer the phone and stuff envelopes, but at least it forced me to get dressed and get out of the house. 
 
My digestive system became so turbulent that I sometimes ate while sitting on the toilet, hoping to restore the calories on one end while they streamed out the other.  I hardly had the strength to do anything but eat and get to work.  How could I possibly consider serious surgery in this condition?  Dr. Berkowitz promised me my strength would return after I finished the radiation therapy and that it would not harm my treatment to interrupt the chemotherapy for a few weeks around the surgery. 
 
The second MRI confirmed that something was on the upper corner of the left kidney.  The urologist, with whom I had almost no rapport, assured me that when he performed the surgery, he would not remove the entire kidney unless it seemed warranted. There was a professional consensus in favor of proceeding with the surgery, but I kept wavering – hoping for some sort of miracle but fearing that if there were a cancer in my kidney, it would spread so quickly that all would be lost anyway.  I finally decided that, weighing all the doctors’ advice, I would have more chance of surviving if I fixed the kidney.   
 
I completed radiation – feeling so tired and so worn out from my digestive system’s reaction to the treatment that I just wanted to spend the rest of my life in bed.  The pain was considerable and I was taking some pretty strong drugs to alleviate the cramping and to quiet my intestines.  I had given up hope of finishing the graduate library program which had been the driving force in my search for a better future, so what did I have to live for?  Why was I even bothering with this tortuous operation? 
 
Going with the professional advice against my own instincts was the most foolish decision I could have made.   
 
During the surgery, the urologist concluded that my kidney did not look healthy and removed the entire organ – which lengthened the surgery and left me in the worst pain I had ever experienced. I had a broken rib because they had removed the kidney from my left side in order not to disturb the delicate intestines again and they put metal staples in my side. I had no appetite and had dwindled down to about 100 pounds from the 140 I had weighed before the entire cancer nightmare had begun.  I felt defeated and was really a shadow of myself when I went back to Dr. Berkowitz to get the pathology report on the kidney.  I looked as if I had just come out of a long incarceration—slumping, sallow, and sunken-cheeked. 
 
“Wow, I can’t believe it,” he said. “It was a benign cyst.” 
 
“Do you mean there was nothing wrong with the kidney?” I asked, making a slow transition from passive despair to growing anger. 
 
“Well, I couldn’t say that. There were clear cells in all of the adjacent lymph nodes and a cystic mass which was pretty big and had fluid in it.” 
 
I did not really understand all the ramifications of clear cells and cystic masses, but I did understand that I had blown it. I had endangered my weakened system by having this additional and perhaps totally unnecessary surgery to remove a vital part of my body.  How could I have been so stupid? And why did I let someone convince me to do something without following my own instinct? 
 
But my anger served me well.  I no longer felt sorry for myself. Why not look for a better job?  Why not re-enroll in the library degree program and aim for a position as a librarian as I had wanted to do before I became ill?  If I went back to school and died of cancer, what harm would be done?  It might distract me from dwelling on my physical ills and keep me focused on a project.  If I dropped out of school and survived, my chances of having a better job would be much reduced and I would spend the rest of my life kicking myself for not having continued my training. 
 
So I did return to school and finished the library degree program and found work I really enjoyed.  I began to regain my health and stopped thinking in terms of survival but in terms of what I wanted to accomplish. My anger was slowly converted into energy and enthusiasm. I began to stop blaming others and started to take responsibility for my life – however short that life might be. 
 
It has now been almost 29 years since the surgery to remove my kidney.  I have retired after a wonderful career as a librarian and am now starting to devote more time to the pleasures of writing, foreign languages, and music.  I have found a wonderful partner and am savoring every day, knowing that anticipating death is useless – it will come whether we anticipate it or not.  We simply need to live each day as best we can.   
 
We recently moved and I had my first appointment with a new physician. I handed him my medical records and he read the pathology report on the kidney and said,  “You mean they removed a perfectly good kidney?”   
 
And I smiled.  I am sure he wondered why.