The Decision

When I feel up to talking, I call Dr. Ottavi and ask her if she can perform an abortion if that's the decision Boris and I make. She can't because I'll be past 12 weeks pregnant when the procedure is performed. She gives me the number of a surgical center that can. I'm crying too hard to call. Boris calls instead. They are booked until the following Wednesday. They explain to Boris that since I am in my second trimester, the abortion is a two day procedure. On day 1 they ripen my cervix and kill the fetus. On day 2, they suck it out. I am a die-hard democrat and am fervently pro-choice. But after seeing Junior Jr. several times, hearing his heartbeat and madly loving Miles, that's how I see it. Boris cries as he schedules the appointment. We wonder if we're Republicans and if I have anything in common with Sarah Palin. We're scared.

Now that we have the full picture, it's time for Boris and I to make a final decision. I set up an appointment with Dr. McAndrew to discuss treatment and my options.

Knowing that I want to keep the baby, Dr. McAndrew recommends 6 rounds of a chemo regimen called FEC. It's almost the same treatment my Mom had. I will receive it every 3 weeks. I've read numerous European studies about babies who received FEC in utero. By and large, they are healthy, normal children. I will take a short break to deliver, then will undergo 12 weekly rounds of a second chemo regimen: carboplatin and taxol. She can't tell me what the break in my treatment means to my outcome. No one can. There haven't been any studies. If I wasn't pregnant, she would recommend a different regimen. Instead of 6 cycles of FEC, she would probably recommend 4 "dose dense" (meaning every 2 weeks instead of every 3 weeks) cycles of a regimen called AC followed immediately by the 12 rounds of carboplatin and taxol. I ask her over and over again whether the dose dense AC regimen is superior and whether I am putting my life at more risk. She keeps saying that there haven't been any comparative studies on FEC versus dose dense AC and she cannot say that I'm putting myself at an increased risk. But we don't know for sure. She does take my face in her hands and tell me that she thinks I'm going to be fine. "I really do," she says. I love her. I am to start chemo next week.

I call almost every oncologist I've spoken to and discuss this regimen with them. They all think that given the circumstances, it's a good plan. Meanwhile, a recent article in the New York Times on pregnancy and cancer featured a doctor at MD Anderson who has treated a significant number of women who are pregnant with breast cancer. I speak with his office and send them my entire medical file. I ask if I can have a phone consultation with him but am told he "doesn't do phone consultations." He wants me to come to MD Anderson for a week for further tests and a consult. His assistant keeps telling me he wants to do a mammogram and biopsy and scans even though I repeatedly explain to her that I've already had a lumpectomy so there is nothing for him to biopsy. I explain ad nauseum to her that I'm not going to stay in Texas for a week when I can have any necessary additional tests done here so there would be nothing else for him to do except review my file for a consultation. Regardless, she says he won't speak to me over the phone. I book a flight for the following evening to go to Texas. Boris and I have decided that this doctor's opinion will be our final decision. If he agrees with my course of treatment, I'll move forward. If he thinks I'm placing my life in peril, I'll have an abortion.

So of course I get a message from his assistant the following morning that MD Anderson is shutting down due to hurricane Ike. God. Fucking. Dammit. Even though I had bought a ticket to fly to Texas to hear this man's opinion in person, he still refuses to speak to me over the phone. Fucker.

Instead of flying to Texas, my best friend (I have two) Amara, who has flown in from Portland to see me, and I drive to UCI to meet with an oncologist who comes highly recommended by a dear friend of mine who is an obgyn oncology fellow at UCI. This oncologist, Dr. Mehta, has published several articles on triple negative tumors. Dr. Mehta is a kind and honest woman and a good person. She tells me that she has contacted oncologists at several of the best cancer facilities in the country to find out how they would treat me and what kind of results they have had with various treatments during pregnancy. She is very aggressive in her approach to my type of tumor in response to the tumor's aggressiveness. She tells me that she does believe there is a risk in not having dose dense treatments and in the 6-8 week delay between chemo regimens. She points me to some recent research that I can obtain online. If I was her patient, she would give me the dose dense treatment followed immediately by the second regimen of chemo even though there are only 15 case studies on these drugs and fetuses. Initially I think 15 case studies doesn't sound bad until I realize that means 15 women. Period. I'm simply not comfortable with that.

I have now obtained almost every opinion humanly possible. The problem is that no one has a good answer; there is still so much unknown about pregnancy and cancer because no one would dare conduct controlled studies on pregnant women, and no one can make this decision but me and Boris. I don't understand how I'm supposed to make this decision. Without clear data, how do I decide whether to abort a wanted child who more likely than not will be perfect knowing I may never have more? How do I decide whether I'm more likely to live with one course of treatment or the other? And if I do live, how do I live with my decision? If this baby so much as sneezes, Boris and I will be struck with terror. If anything at all is wrong with him, it will be my fault. How do I live with that? What if he doesn't roll over, crawl, walk, babble as early as Miles? We'll be wracked with fear. One doctor asks me, "Mom to Mom," how compulsive I am. "On a scale of 1 to 10, I'm an 11," I tell her. Miles only eats organic food. His diapers and wipes have no synthetic chemicals or chlorine in them. Products with parabens, synthetic fragrances or chemicals have never touched his little body. If he sleeps poorly, I'm suicidal. She asks if I can make it through this pregnancy without being totally consumed with fear of the future. Can I? Can Boris? Pregnancy is hard on the body the doctors remind us. Chemo is brutal. The combination is mind blowing. Ironically, the doctors keep telling me they're not so concerned with the baby. The chance of anything being wrong with him is minute, they say. I'm the concern and the unknown.

I've never been so sad or scared in my whole life. I'm used to getting everything I want. Seriously. I think I have a pretty fearless, fierce attitude. But I can't pull it together for this. It's all consuming. I just think I'm going to die. I spend 24 hours a day afraid I'm not going to watch Miles grow up and that he's not going to remember what I look like. I tell Boris he needs to start video taping me and taking more pictures of me with Miles because I don't want Miles to forget me. I'm afraid he's going to grow up calling someone else Mommy. It's one of the most horrifying thoughts imaginable. After each doctor's appointment, Miles is the only thing that makes me happy. I can't wait to see his face, see him smile at me and give him a giant smooch on his gorgeous lips.

Boris and I keep changing positions on whether to keep the baby or not. At first, he leans towards aborting. He has realized that the real worst case scenario is a sick child and me dead. He's not sure he can handle that. He's so afraid of a sick baby. I want to keep the baby and truly believe that he's going to be fine. After more tests at the hospital where I see so many sick children, I change my mind. The only thing worse than being pregnant with cancer is to have a sick child. I'm too afraid to keep the baby. Boris however now believes that we're both going to be fine. He says that we need take his willingness to potentially raise two boys by himself off the table. He's willing he says. Although he's sure he's not going to have to.

I call Dr. McAndrew to discuss my latest oncologist meeting with her. She calls me back at 700pm on a Friday night and spends an hour with me on the phone. She's not egotistical in the least, is not offended in any way that I keep questioning her and speaking with other doctors and discusses in detail all of the information I've amassed. She even goes online with me to discuss the recent study I was pointed to at UCI. She tells me that there simply isn't enough data to know whether dose dense treatment is vastly superior and she cannot tell me that aborting this baby will increase my chances of survival. She says that if I wasn't pregnant, it would be much easier for her, but there is no good reason for me not to be. I start crying and tell her that I am faced with every mother's worst nightmare. Choosing between herself and her child. If we were dealing with Miles, the choice would be clear. I would give up my life in a heartbeat for him. And even though Junior Jr. isn't with us yet and can't survive without me, I already see him as my next Miles and simply don't think I'll be able to live after an abortion.

And that's how Boris and I make our decision. We had every piece of information possible, but it came down to what was in our hearts. I decide that I'm going to have faith in my doctors and my body and together we're going to cure me and protect my next son (no longer "Junior Jr." He's now "Miracle"). I get my first night's sleep in over 3 weeks.