Treatment plan: Grim and grimmer

Me and my girls will be going to reform school, it turns out.

My new medical oncologist, Dr. D - young and whip-smart with a laser-like focus on killing cancer cells -- wants us enrolled in an aggressive chemotherapy regime asap.

Dr. D isn't big on sugar-coating. She used the phrase "that's a poor prognostic factor" at least four times in discussing various aspects of my cancer -- the fact that the lymph-node tumors had grown outside the nodes (called extra-capsular extension), the rate of cell reproduction (K-67 of 15%), the size of the lymph-node tumors (biggest was 1.2 cm), and the fact that the cancer was in the lymph nodes at all.

She recommends "dose-dense therapy" in which I'd get chemo every other week as "better for disease-free survival." The other option is chemo every three weeks, which might allow more recovery time from the nasty side effects.

I have to return for an hour-long briefing on side effects, but Dr. D touched on several that have long-term medical implications: damage to the heart muscle; bone thinning; and neuropathy, which is tingling and numbness in the extremities "that's not completely reversible."

Losing my hair is guaranteed. Fatigue and nausea are also par for the course.

Basically I'm signing up to have them inject Drano into my veins on a regular basis -- the literature they gave me said the drugs are so toxic they can burn your flesh if they leak out of the injection site.

She strongly recommended that I stop working for the rest of the year. "You'll be getting super-strong chemo and antinausea drugs every two weeks. I don't want you struggling through and feeling horrible and in the bathroom sick at work."

Mark and I both sat there in a state of shock. My take-away was that the cancer news is grim and the treatment outlook is brutal.

There's a lengthy list of procedures to tackle before treatment starts: surgical implantation of a port to deliver all these toxic drugs, echocardiogram to get a baseline of how my heart currently functions, bone density scan, full-body PET/CT scan, brain MRI.

I also need to meet the radiation oncologist who will be treating me after chemo, and take a tour of the chemo facility at Herrick.

It should be just like touring a birthing center -- but with bleak foreboding instead of happy anticipation.