Decision making. Oh my. (*Joanna voice* iykyk)

At the very beginning of all this cancer business I was told that I would probably have some choices to make about my treatment, particularly regarding the kind of surgery I would have. That, yes, I would need to have surgery. But that given the size (small), shape (well circumscribed I believe is the term), and some other details (insert medical medical medical) I had options.

Without going into all the gory details, either the fleshy gory kind or the emotionally vomitus gory kind, I thought I would say a few things about the decisions I came to and how I got there and where it might be going. I've had bits and pieces of this conversation with lots of people over the last 5+ weeks, from my medical team, to my family, to my therapist, to friends, lots with Michael, but also with strangers I met on the internet who are cancer survivors and strangers who are friends of friends who took time to talk with me on the phone, over email, over chats. The conversations have been helpful and healing and confusing and clarifying, and they keep going and will keep going. Because, as I have been reminded, there will be more decisions to make going forward.

Two things have impressed upon me most of all about these conversations, which I can't overemphasize or even begin to put into words (I keep saying that, don't I?) The first is the incredible generosity of people, and perhaps especially of cancer survivors. Apparently I have become part of a gracious, funny, open, and incredibly compassionate little club. This sounds awfully sentimental and nice, like a frickin' greeting card. But this club is way more gnarly than the Hallmark channel. This club is a raondom person from a Facebook group who calls and talks and answers my invasive personal questions for 45 minutes about surgery and her journey with her partner of adjusting to a new body. This club is a friend's friend who tells me lots of personal life details and sends me links for prosthetics and bras that work well after a single mastectomy. This club is other friends who literally show me their scars so that I can see and imagine and know something of what I am getting into, and where I am going, and that and how I am going to come out on the other side. This club is incredibly kind but also incredibly punk rock.

The second thing is the lack of judgment and openness and emphasis on how every person is different, every life is different, every cancer is different, which means that each person who has cancer (and maybe especially breast cancer idk I so far am (thankfully) only part of this particular club) is the only person who can make these decisions for themselves. That all sounds very nice and like what you are supposed to say. It is ethical and preserving of autonomy and nonjudgmental. It is clarifying of power dynamics and focuses on empowering the patient. It is respectful and sparing of other people throwing their weight and emotional baggage around in a time of crisis and stress. It is also not how people normally interact in times of crisis and stress. It is not how people normally interact with each other in the flesh as opposed to in theory. It is really not how people interact in public and semi-public online spaces. And yet...I kept hearing, with startlingly few exceptions, the same refrains, the same words, the same admonitions, the same genuine tones of respect and honor over and over and over from every corner I could find. The sheer lack of judgment, the multitude of reminder and reorientation to "only you can decide these things for yourself and that is really OK and no one else can make these decisions for you" was oddly, and eventually blessedly, consistent.

After lots of conversations and soul searching and indecision and "dear lord I have trouble deciding what I want to order for lunch at a familiar restaurant that hasn't changed it's menu in a decade how am I supposed to do this?!?", as well as reminders to myself of the privilege it is to get to make choices (good medical access for a cancer that is small enough for there to be multiple good treatment options), I settled. Or, at least, I mostly settled. Enough to make a call and feel a little flare of confidence, however faint that flare feels in some moments. Enough to feel relieved and move forward.

So tomorrow I'm going to have a single mastectomy. I could have done a lumpectomy with radiation. The recurrence rates for the 2 options are similar, and my MDs said I was a good candidate for the smaller surgery. But in the end I didn't want to do radiation if it could be avoided. (Even after another gracious set of conversations with a friend's spouse, who happens to be a radiation oncologist and a good one, and who helped me be less scared and who shared how he feels like nuclear medicine (also punk rock) is "like magic" that he gets to witness every day of his career and gosh he's lovely.) I am also still pretty young (lol shut up I work with really old people it's all relative), which means a slightly lower recurrence rate feels a little better. And though I considered doing a double mastectomy so that we could just be done with this whole breast cancer and scans and stress business because really life is too good for this shit, I decided I didn't want to overtreat right now.

I also decided not to do reconstruction, which felt, in some ways, like an even scarier and more complicated decision. I met with a plastic surgeon and did research and talked with a bunch of different people who have done different kinds of reconstructive surgery. I talked with people who have opted for aesthetic flat closure, both for a single and for a double mastectomy. I learned a lot of things, faced a lot of fears, and, again, talked with people who have knowledge and are brave and vulnerable and strong AF. I decided that I wanted to be done with surgery sooner and get back to my life without the more drawn out process of reconstruction. I'm still not sure I will have the confidence and badassery to pull off a unilateral flat life and surely there will be humorous foob convos in my near future and we will see how it goes. If all goes well I am about to become your friend who is here to talk about breasts and a whole new wild weird world so come at me (gently) and I'll try not to be (too) awkward. And we will see how it goes.

I don't know if any of you need to know all these things, but it helps me to say them and put them out there. It helps me to write it out. It helps me to think that if there are folks among my beloved community who have been there-done-that or who have to go there or know someone who does, that these are things we can (and maybe sometimes should) talk about when we need to, when we are ready.

A bunch of people have thanked me from writing this little blog. Which I appreciate and helps and helps to hear. But it is also puzzling, because I'm thankful that you are reading. I hope it helps us all in some way.