Second opinion, part 2

So I got a second opinion at the Dana-Farber Cancer Center last fall. If I had been expecting something big and different from my consultation there, I would have been disappointed. If, like my husband, I was looking for confirmation that things were already going as well as possible, then I went to the right place.

Once it became clear that we were definitely going to Boston, a number of things happened. For one thing, my plans became divided into “before” and “after.” It became something big that was going to determine what happened next. Thanks to the connections of a family friend, I was able to get an appointment with one of the world’s top oncologists in the team there. My own terrific oncologist here in London had done a fellowship there, and facilitated matters helpfully, since the transfer of medical records is still supposed to happen by fax (???), thus upsetting my geeky husband for, like, the rest of time. Quite a few people, from the neurosurgeon to the oncologist, mentioned that they were curious to hear more about what I learned in Boston.

It’s always a pleasure to go back to Boston! So we drove there, stopping at Rob’s parents’ place one night so as to stay in Canada, where I have actual health coverage, for as long as possible. Then our friends Kathryn and Ned generously had us stay with them in Cambridge, from which we were able to walk, on a gorgeous fall day, to the Dana-Farber Cancer Centre, which I had by then come to think of as the Centre of the Universe. As we turned onto Longwood Avenue, it was funny to think about how a street that for me had always signified a busy place to be avoided, was a busy mecca for patients from around the world. Here, it seemed, every building was named after an important donor, and deliverers of care rushed off to their important jobs.

From there we went to the International Patients Office, which is I guess where international patients go. As we listened to the families around us speaking Mandarin and Arabic, it was a nice reminder that people come from all over the world to consult at the CotU. Then we had to go up to the billing office and pay for our consultation because money and health care must never be separated in the U.S. Finally, we went to the actual breast cancer floor and met with a fellow to go over my medical history, before meeting with the medical oncologist and his coterie of fellows.

As I wrote earlier, there was not a whole lot new in these meetings. I had to explain to the fellow who took my health history that Ontario will not pay for more than 2 lines of treatment, so the decision to switch to a new one was a big decision. He was surprised at this, having seen an American woman just that morning who was on her SEVENTH line of treatment. Everyone was impressed with the quality of the records that had been sent from Canada, and everyone wanted to oooh and ahhh over my excellent brain surgery. “What brain surgery?” the fellow joked after running me through the requisite assessments. Also, the fact that I walked there from Cambridge was a matter of some comment.

In fact, no one knows what to do about these troublesome brain tumors, I was told. Previously these have been attributed to the “blood-brain barrier,” which was viewed as not letting drugs in to the brain. But the oncologist told me, “We’re rethinking the blood-brain barrier and why the brain seems to be extra hospitable to tumors for patients like you.” There are quite a few clinical trials happening at CotU right now, and none of them are quite right for me. I’m doing too well on the standard of care to warrant doing anything different. But! I can come back when I’m not doing as well.

I find this a fairly reassuring place to leave things, since I learned that I’m getting very good care and doing well, and that I’m living at the edge of knowledge right now, with my body getting the best that medicine has to offer, and clinicians, I hope, working on developing more treatments for people like me.