Ladies and gentlemen, we have a split decision...
At debate tournaments, there are preliminary debates and elimination debates. By long-standing tradition at most tournaments, elimination debates are judged by at least 3 judges. Greater redundancy, in theory, ensures higher-quality decisions in debates that are, in theory, closer and harder-fought than preliminary rounds. Panels of judges always have odd numbers of judges - 3,5,7, even the occasional and disastrous 9 or 11. When I was in high school, some “round robin” tournaments had two-person panels in every debate. That worked out, because in a round robin there are no elimination rounds, instead everyone debates everyone else one time and the team with the most wins, wins. Sometimes, it would happen that two judges disagreed, and this is referred to as “splitting a decision.”
At the moment, doctors evaluating me have split.
My oncologists at Georgetown want to do either three weeks of radiation therapy or two more cycles (two months) of chemotherapy. They are convinced that if I do not do radiation therapy, I “will have a recurrence within 6 years.” My mother, in a typical feat that only my mother could accomplish, got an appointment for a second opinion with the lymphoma clinical team at the National Institutes of Health. While not deviating from standards of professional courtesy, the NIH team basically called my Georgetown doctors crazy.
As I mentioned in a previous post, new research (a lot of it by the NIH) suggests that the long-term side-effects of radiation therapy are very bad. This research is just now getting done in quantity, so it’s hard to know what the implications are. These NIH doctors think that: a) radiation is too risky given that I’ve had such a good response to chemotherapy b) my tumor was 8.5 centimeters in diameter. When radiotherapy was the industry standard, it was used when tumors exceeded 10 centimeters, so my disease is undersized for radiation - or rather, it was, even when it was at its worst. c) if I don’t do radiation, there’s no point in giving me two more cycles of chemotherapy. That’s because after two cycles of chemo, my PET was negative, and then I had four more cycles on top of that, followed by a second negative PET scan. A third set of chemo treatments would be redundant and would do more damage to my body.
Frankly, it would have been a lot more comforting if my doctors agreed that I am a borderline case subject to a judgement call. In most split decisions, the debate is very close and the judges simply evaluate the subjective variables differently. In other cases, a judge splits from his colleague because he/she is inept, asleep, drunk or otherwise impaired. I have no way to know what the cause for the split here is.
This situation is frustrating because I am not competent to read the studies or evaluate the evidence that drive the disagreement between the doctors. It is a bit like judging a debate I can’t follow, involving incomprehensible evidence. I’ve judged hundreds of fairly meaningless debates, and this has never happened to me before. In those debates, trophies and bragging rights were on the line - now my life is at stake. It’s very… disconcerting.
Now I’m looking for a third opinion. Anyone know a hematologist-oncologist with a bunch of spare time in the next week or so?
1 year ago • 0 notes