Doctors -- can't count, can't write

How hard is it to count to four?

It turns out that I actually have four cancerous lymph nodes, not three as I was told last week.

The pathology report from my lymph-node surgery was so poorly written that it took a personal presentation by the pathologist to clarify this. The report said that one of the four sentinel nodes removed during the initial part of surgery was cancerous. Later it said that three out of 13 nodes were cancerous. Dr. C read that "three out of 13" as a summary of the overall findings. But yesterday she found out from the pathologist that those three cancerous axillary (underarm) nodes are in addition to the one cancerous sentinel node.

You see, 1 + 3 = 4.

I could do that math without even resorting to my fingers. Why couldn't they?

The difference is significant. Four-to-nine cancerous nodes represents a higher level of danger. My cancer is now officially Stage IIB (on a scale of 0 to IV), with a five-year survival rate of 81%. That golden 100% survival rate promised at the beginning continues to erode.

(It also turns out they removed 17 nodes in total -- the four sentinels plus 13 axillary nodes -- not 13 total as I was first told. To flaunt my advanced arithmetic skills again, 4 + 13 = 17.)

Dr. C tried to cheer me up. "I had a follow-up visit today with a patient who had 34 cancerous nodes and a 15-cm tumor. That was five years ago and she's cancer-free today."

That actually did provide some good perspective to get me off the freak-out wagon for a moment. (At least until she mentioned that that same patient developed lymphodema.)

In other news, the Summit Tumor Board discussed my case yesterday. Patients are not invited to these meetings at which a dozen or so cancer doctors -- medical oncologists, radiation oncologists, surgeons, pathologists -- review all the medical data on specific patients.

I had pictured this august assembly of eminences grises each drawing upon years of education and experience to recommend the absolutely best course of treatment for moi. I was looking forward to getting a robust second opinion -- and third and fourth and fifth -- from the preeminent specialists in this field.

It turns out they talked about what I can do for them, not what they can do for me, focusing on which of their ongoing clinical trials they could enroll me in.

As Dr. C explained this to me, I could feel little whiskers sprouting from my face and the stirrings of a compulsive desire to gnaw on furniture and electrical cords.

Thanks to a good friend and stellar biotech reporter, I knew the exact question to ask and I didn't bother to finesse the wording: "How would it benefit me to be a guinea pig in a clinical trial?"

"Well, if you got the trial drug and not the placebo, and if that drug turned out to be effective, you'd get the advantage of it," she said. "And then you'd be helping breast cancer patients in the future."

That's a number of if's, without even touching on what if the trial drug has nasty side effects on top of the nasty side effects that are already expected (trial drugs would be given in addition to the normal "standard of care" treatment drugs).

I'm perfectly happy to donate my body to science when I'm all done with it.

But right now I'm still using it, thank you very much.