A different opinion on second opinions

Barry Bokhaut's Experience

The advice is universal – when you have a disease as vicious as esophageal cancer, get a second opinion on what to do. It seems prudent and reasonable. There is, however, a case to be made for not following that advice.

Let me first say that I am not the type to make impulsive decisions. In life I weigh alternatives, assess the options, evaluate the possibilities. Even simple decisions take an inordinate amount of time and effort. I'm the type who paces up and down the ice cream counter, trying to decide which of the 31 flavours to choose, quizzing the unfortunate person serving me with questions like "what's the most popular, what would you recommend, is it really good?"

My cancer background is a common story. In January 2000 I was on the top of the world. I was on a diplomatic assignment at the Canadian Consulate in Hong Kong; living in one of the world's most exciting cities. Work was challenging and rewarding. "Life was good".

I developed congestion in my throat that didn't go away, and I a number of bouts of indigestion. I saw a doctor in Hong Kong, who thought it was due to the authentic Chinese food I was eating and due to pollution. A minor inconvenience I thought.

Back home, back in the good Canadian air, back on my regular diet, I still felt the discomfort. Time to see my own doctor. I felt foolish describing what was basically heartburn, and answering that no, I hadn't thought of taking an antacid. My doctor prescribed one. A week later I had no relief, and he prescribed a stronger medication, and sent me for a barium swallow. When the results were in the doctor described a growth in my esophagus. He seemed afraid to use the word cancer. It was my wife, Barb, who asked to see the actual report. We read the conclusion together. "To be considered carcinoma unless proven otherwise". I pretended that I wasn't worried, as the report didn't say I had cancer.

I decided to read about esophageal cancer on the Internet that weekend, and slowly started to come to the realization that maybe I could have cancer. I called a family friend, a radiologist specializing in cancer who lived at the other end of the country. The tone of Karen's voice was chilling. " Barry, this isn't a good cancer to have". It was the worried voice that unnerved me. Karen gave me the facts of esophageal cancer, and what it would do to me. The advice, given as a parent, became my mantra through the most difficult of times. "You have one chance at fighting this; give it everything you've got. And do not delay".

It was my surgeon, who used the words "you have cancer". I was ready. It didn't come as a surprise, and I wasn't shocked. So what to do?

My doctor gave me no options. He described the surgical procedure he would do. I could think about radiation and chemotherapy once the operation was completed. At this most critical time of my life, when life and death depended on making the best decision, I didn't ask about options to surgery, or what type of surgery he would do. I didn't request a second opinion. Its incomprehensible, but despite what was going on, I had an inner peace and calm. My doctor impressed me with his confidence, and I trusted him implicitly. While my family encouraged me to seek a second opinion and explore options, even if it took a little more time, Karen's words echoed in my mind. "Don't delay". I didn't take the time to do my research, investigations, analysis, comparison and thinking. I had surgery two weeks later.

Months later I joined the esophageal cancer Internet support group. And found that there are options for surgical procedures and choices for having radiation and chemotherapy before surgery. I found the names of the most experienced esophageal cancer surgeons and best rated cancer hospitals. There were those who thrived without any surgical intervention.

I do not regret for one moment the fact that I didn't investigate all the options that might have been available to me.

My heart goes out to those faced with making a choice, watching a ticking clock, knowing each minute of delay in trying to make the best decision is bringing them closer to death. I feel fortunate that my doctor made the decision for me. After exhaustive reading, I'm convinced that my doctor made the right choice for me. His course of action is the one that I would have chosen after considering all the options. There may, however, have been complications if surgery was delayed. I believe that his surgical results were enhanced by his knowing that I had complete confidence and trust in him.

The surgery went well, and I quickly started to recover. Then came chemotherapy and radiation; the worst of my ordeal. What was hardest to take was the fact that even with everything that I was putting myself through, and my wife through, my doctors could not assure me that the radiation and chemotherapy treatments would in fact prevent the recurrence of my cancer. They were honest with me. I was going through this misery because it might help.

In May of 2002 I was feeling stronger and confident. We were visiting with out of town friends when my constant companions, heartburn and indigestion, showed up Friday night. It hadn't gone away by Saturday morning, even with a good dose of antacid. Something didn't feel right. . I was driving at the time, and used my cell phone to call 911, the emergency line. I was advised to get to a hospital without delay. It took a few minutes before I realized that if I was having a heart attack, it might be a good idea for Barb to be driving instead of me.

I was sure that I was wasting the hospital's time, but they took in into emergency, hooked me up to some machinery, and started taking blood. A few minutes later the doctor confirmed that I had experienced a major heart attack, and that they were administering a clot busting drug to dissolve any blockages in my heart or arteries.

I was in intensive care by early afternoon, and still had chest discomfort; possibly because of the indigestion that I constantly experience. When I described my pain, the doctor stated that they just had a cancellation for an angiogram, and that I could have that, and an angioplasty, if necessary. He stated that they usually don't do it so soon after administering the clot busting drug because my blood had been thinned out and there was a chance that I could bleed to death.

I told the hospital doctor that I would like to consult with my cardiologist at home and have him discuss the options. The doctor said he would not speak to my cardiologist, accused me of not trusting him, and stated that I had five minutes to decide – or else he wouldn't be able to fit me in for the procedure. In a nutshell: If I delayed, it might cause damage; however, there might not be a blockage, and the procedure, even though risky, might not be necessary. And there was the chance that I might bleed to death because of procedure that wasn't necessary.

So, no opportunity for a second opinion. I couldn't help think that this doctor is suggesting that the tests be done so that there won't be down time and a missed billing for the procedure. Trusting my doctor, and proceeding without a second opinion had worked for me before, and, with hands shaking, I signed the consent form. There were no complications from the angiogram, which threads a wire through the groin into the heart. I also had an angioplasty to remove a major blockage. I could have had more damage to my heart if I hadn't had the procedure when I did. The doctor and I had made the right choice.

Was I just lucky? Was God with me guiding my decisions? Was it smart that I went ahead without consulting? I wonder now what I would have done if a second opinion had stressed the danger of doing the procedure so soon after having the clot busting drug? Would the decision I made as a result have been better, or better informed? In the final analysis, I'm glad that I did it the way I did.

Have I applied this decisive approach to anything else in my life? Not a chance! I still stand in front of that counter, agonizing over what flavour of ice cream to choose.

Read "My Blue Hat" | Send Barry an e-mail