Decision 2006

This past Tuesday, I voted in New York. As I walked through the hallways of PS 9, the hand-lettered signs on the wall pointing the way to the polls and the smell of brownies from the bake sale to benefit the PTA made me a little homesick for Des Moines.

My dad always treated Election Day as a great opportunity to give a civics lesson. Usually we would walk to Merrill Middle School when he returned home from work, him still in his three piece suit and wing-tips. We would walk the two blocks to the school, passing the rambling brick homes of Grand Avenue, each with at least one sign in the yard promoting a candidate for whatever office might be up for grabs, and usually more. Iowa takes elections very seriously – I wonder if it is from a fear that if we did not, we might lose our position as the first caucus in the presidential primaries, and our once-every-four-years guaranteed place in the national headlines would disappear.

The curtained booths in the school’s lobby held a sense of mystery and possibility. “No, you can’t come in with me,” Dad would say solemnly. “It is the right of every citizen in a democratic country to vote without having to tell anyone for whom they voted.” As I grew older, I would cajole and argue that it was a pointless charade, that of course I knew which way he voted, that it was senseless for him to be so cagey about it. When I was young, I just wanted to push the buttons and pull the lever.

I like that New York still has these old-fashioned machines – it adds a certain element of excitement to the voting process. What if I do it wrong? What if the lever gets stuck? Who is this mysterious "The Rent Is Too Damn High" party (watch out for the funky music!) and how on earth did they get onto the ballot, their name in big letters in the first row across the columns just like all the other legitimate parties? I cast my vote and pulled the lever as instructed, my action rewarded with a satisfying “clunk” as my vote was registered.

If only the rest of my decisions that day could have been so clear-cut and final. From the polling place, I went to Cornell for my blood test and ultrasound. After the obligatory waiting room shuffle, the doctor (the fifth one I had seen there in five visits) informed me that I had one “dominant follicle.” The IVF had not worked as hoped.

The idea is that the follicle stimulating hormones I was injecting into my body would allow multiple eggs to be retrieved, usually four or five, but as many as 10 in women my age. Although my initial exams did show eight or ten potential follicles, it appeared that one “greedy egg” ate all the medicine and dominated all the others, which never grew. “Tonight you take the Human Growth Hormone, and 36 hours later you come in for the retrieval surgery,” the doctor informed me as he took off his gloves and left the room.

I knew it was not that easy. I got dressed and went out to find the nurse who had guided me through the process. She gave me a hug and a Kleenex and confirmed that each egg they retrieve has only a 50% chance of being viable. Chances that the embryo will successfully be implanted and matured eventually are 55-65%. Given these odds, we decided that going in for surgery for just one egg was a waste of time and the energy it takes to get through any surgery. It would also have delayed my sentinel node biopsy by at least a few days, as the retrieval would have had to happen on Thursday.

One option was to move things around and to have the surgery first, buying myself time before I start chemotherapy. But immediate reconstruction surgery, which most doctors prefer, provides an extraordinarily complex set of options to choose from – think Italian parliament rather than the US Senate-like choices of “lumpectomy vs. mastectomy” that characterize the primary breast surgery. I also want to have the results of my genetic test before I make a surgical decision, as I will definitely opt for a bilateral mastectomy if I test positive for the gene, and I don’t want to have to go through surgery twice.

After multiple phone calls to Michael, my oncologist and my surgeon, we agreed to wait until I had the sentinel node biopsy to make a final decision about whether or not to go through with a second round of IVF. The negative node result is a good sign that the cancer is not rapidly spreading, and both doctors assured me today that delaying treatment by what will end up being about three weeks (one and a half if I were to choose the “surgery first” option) is not a concern.

I spent most of the week feeling like I was back in the voting booth without the information I needed to make a decision about which buttons to push. It will be a few years before I know for sure whether this was the right decision, but after yesterday’s surgical results, I think I am ready to pull the lever.