Archive for the ‘decision making’ category

Future Looking Decision Making

March 29, 2012

We have been on the market for a new van for a number of months.  The repairs on our old van were getting more frequent.  However, for us, the decision of which van to buy was not intuitive.  It would be a major expense, and we knew that we would have to live with the consequences of that decision for years.   Last Saturday we bought a new (to us) van in Pennsylvania.  We chose to buy it in Pennsylvania because it would not have been exposed to as much metal-eating salt as New York vehicles face each winter.   We looked seriously at about two dozen vans in the Lancaster area.  We considered their age, condition, features, mileage, economy, anticipated future repair costs, and price.  Ultimately, we decided on a 2006 Town and Country with 41,000 miles, but it wasn’t an easy decision.   It was complex; many interrelated factors had to be addressed.

Over the last month, we have also been addressing another complex, future looking decision about chemotherapy.  I had an uneasy feeling about the decision because chemotherapy is a process.  It is a long, demanding and debilitating “process”  (and I have a harder time with processes than events).  You don’t just receive anesthesia and wake up six hours later with it behind you.  Although I understand that chemo affects patients differently, NONE of its side effects were appealing to me.   In addition to chemo, we considered alternative approaches.  As we wrestled with this complex decision, we asked ourselves, “In which decision is it worse to be wrong?”[i]

Careful decision making is a task that I wanted to teach each of my sons as they were growing up.  In the year that each turned twelve years of age, I took them hiking.  Although we go on hikes from time to time as a family, this hike was intentionally chosen to include a mountain climb with a panoramic view from the top. At the top, I encouraged my sons to think of the view as the future. From the mountaintop you could take in not only the nearby hills, but also the distant valleys, and mountains.  As we looked out over the other mountains, hills, valleys and countryside, I challenged each of my sons to be a “mountain” man.  Not a “mountain man” in the sense of the hunters and trappers of the nineteenth century, but a “mountain” man, as opposed to a “valley” man.  I want my sons to be men who will consider the distant consequences of decisions they make in the present.  On the other hand, a man in the valley can only see what is immediately before him. If he makes decisions on the basis of his view, he will be shortsighted, only considering the immediate, the moment.

Future looking decision making is often involved when one is deciding whether or not to date someone seriously, or consider marriage, or adoption, or a home purchase, or a business venture.  Such decisions often weigh the long term, future benefit, versus the probable negative consequences or problems.  When we decided on the van, we tried to make our decision in terms of what would be best for our family over the long haul [no pun intended], and when we were weighing the decision on chemotherapy, we tried to evaluate the options in terms of their potential long term consequences.

It seems so natural to consider whether a car will meet our needs and will last into the future without needing expensive repairs,  or to consider whether option A versus option B is more probable to give us a longer life after cancer.  But future looking decision making really needs to be applied to the choices we make in the present for the distant, distant future.   Some people give more thought to their ride — which will likely be scrap metal in twenty five years — than they do to their eternal destiny.  It would be wise for them to consider the helping question, “In which decision is it worse to be wrong?”

“As it is appointed unto men once to die, but after this the judgment.”  Hebrews 9:27

Jesus said to him, “I am the way, and the truth, and the life. No one comes to the Father except through me.” John 14:6

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[i] Decision-wise, we decided to go ahead with chemotherapy, because based on my situation, chemo seemed to be the wisest choice, especially as we asked the question, “In which decision is it worse to be wrong?”  However, my future, medically speaking, or my life in general, is ultimately in God’s hands.  The outcome of the chemo, and my future life will all be up to Him.  Yesterday I had my first chemotherapy infusion at the Cancer Institute in Buffalo.  I am now back home and wearing a chemo infusion pump which will continue to dispense additional chemo agent into me today through tomorrow morning.  Then it will be disconnected and I will have about a week and a half off before I begin cycle number two of twelve two week cycles.

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Solving a Maze

January 16, 2012

The last couple of weeks have been interesting.  It has been very much like trying to figure out a maze on paper.  With a pencil one tries different paths and then finds that one after another, each path seems to be taking you to a desired end, but instead leads you to the same place, a dead-end.  In diagnosing medical conditions, doctors need to rule out improbable causes from probable ones.  It is interesting when you are the patient.  Each test could lead to an answer to the puzzle of what’s wrong with you.  As you go through each test you weigh all the “what ifs,” both good and bad, for what that test could reveal.  You don’t want to become too “invested” in the results of any particular test because you know that another test could invalidate any earlier conclusions.  This is the maze that I have been living for the last couple of weeks.

Many paths have been tested; but the results have been inconclusive.  After my colon cancer was diagnosed on December 15 I had a CT scan to see if the cancer had spread to other organs.  Good news, it hadn’t.  Then a second pathologist interpreted the biopsy.  Bad news, confirmed, it was cancerous.  Then I was given a blood test to see if there were any indications of cancer.  Good news, there weren’t.  Then I had another (abbreviated) colonoscopy. Good news(?), the ulcer was not found.  Then a PET scan.  Good news, no cancer found.  Then I was given a DNA test to see if the biopsy was someone else’s.  It was mine.  The sequencing of all these tests was giving the impression that there definitely was cancer in my colon on the day of colonoscopy #1 (December 13), but the cancer seemed to be off the radar from then on.

With each test, I couldn’t help but “imagine” what results (a) versus (b) could mean.  Naturally I was thankful for every result that indicated “no cancer.” But the seeming contradiction between the initial diagnosis and the follow-up tests was hard to reconcile.  On December 15 I became aware that God telling me it was time for a detour from the predictable (see “Detour Ahead, Exit Now,” below).  My mind was racing, thinking of all the ways my life could go with a cancer diagnosis – Metastasis? Chemo? Radiation? Surgery? Numbered Days?

First I wondered about metastasis and very numbered days, then I wondered about errors, “Whose biopsy was it?”  “Did the doctor make an error? Or the lab?” Then I wondered if God might have healed the cancer.  The result of every test could have been (a) versus (b) and it was hard to not reach premature conclusions whenever a test result came back.  I was wrestling with the questions, “God, what are you doing?”  “What’s going on?”  “God, have You, in fact, healed me? Or have You not, and would I be foolish not to pursue the recommended medical advice?”  “Or if God really had healed me, would I be foolish to let them remove one side of my colon, as a precaution, ‘just to be sure?’”  [I certainly didn’t like the last idea at all!]

I knew that when King Nebuchadnezzar threatened Shadrach, Meshach, and Abed-nego with death they acknowledged that God could deliver them miraculously, if He would so choose, but they didn’t know if God would (Daniel 3:17).  Similarly, I knew that God could have healed my cancer after it was first diagnosed, if He wanted to, but I didn’t know if He had.  Many people were praying for me, and I would imagine that some were praying for God to heal me.  However, from the beginning of this journey it has been my prayer that God would do according to his will with the result, not necessarily of my healing, but rather with the result that He would be the most glorified by what He would choose to do in my life.

I knew that the Bible recorded that God used hardship in the lives of many of his servants for his purposes, even though his purpose was often hidden from the view of the particular servant.  I wondered what God was going to do in my life.  Would I know his purposes?  I had many questions, and no idea of what the doctors were going to conclude, or if God was doing something miraculous, or where God was leading.

However, last Friday (January 13) I had colonoscopy #3.  It was a full colonoscopy, and myRoswellParkdoctor was able to find the ulcer this time.  After the procedure she said, “I found it, it is small, and that is good – but it needs to come out.”  Then, all of a sudden, it became clear to me that the other “paths” in the maze, some of which had appeared to be very appealing, were dead-ends.  God now seems to be showing me, “This is the way, walk in it.”  So, in this I will rejoice and continue to pray that God will do what He will so that He might be the most glorified.

“Yet I will rejoice in the LORD, I will joy in the God of my salvation.”

Habakkuk 3:18

Decision Helping Questions

January 8, 2012

It is now expected that the results from a DNA test on my biopsy will be back the first of next week.  Until then I am in a waiting pattern.  When the results come back it is possible that I will be faced with a difficult medical decision with no clear-cut obvious direction to go.  A couple of times I have asked a wise friend for suggestions of questions to ask doctors at difficult decision points, such as this.  The questions that have been suggested to me have been very helpful and I have decided to share them.  I have reworded them so that they all refer to a “treatment” or “procedure.”  This could be major or minor, in-patient or out-patient surgery, or some other treatment plan.  Feel free to use one or more of these as a starting point if you have to talk to a doctor about a difficult medical decision for yourself or a loved one.

As a pastor I have met with many families who have had loved ones facing decisions about medical procedures and treatment plans.  Sometimes the families have been well informed of their options, sometimes they have not.  Some have done exactly what the doctor has recommended; some have explored other possibilities, and taken slightly different routes.  Neither is necessarily right or wrong.  I know that I want to be as well informed as I can be before I make major medical decisions.  I certainly want to encourage others to be as well informed as they can be too before making (sometimes) irreversible decisions.

Regarding the current situation:

  • You may want to begin your discussion with your doctor by saying something like:  “I hope to learn from you my medical condition and its prognosis, along with all the possible treatment choices and your recommendations for which of them to do and in what order.”
  • “Do you already have all the information you need to make those determinations, or will you want any other tests?”
  • When the doctor discusses your prognosis, both in terms of the underlying disease and in terms of specific courses of action, ask him/her to please put numbers on the probabilities.*
  • “What are the risks, statistically, if I do have the treatment you are recommending?”
  • “What is the range of effects I might experience if I don’t have the recommended treatment?”
  • “What are the treatment alternatives, and their respective risks?”
  • “What might happen if I don’t do anything?”
  • “What are the risks, statistically, if I don’t do anything?”
  • “When and how might I become aware of physical effects?”
  • “If you do the recommended surgery (or procedure), what are the possible ‘surprises’ you might find, and their probability?”
  • Before any surgery or extensive treatment program it is often considered to be wise to get a second opinion from a specialist not affiliated with your doctor (in other words, not his/her partner, or in the same medical group).
  • Your meeting may end with your being faced with a decision on what to do and where to do it.  It may be helpful to make it a rule to try to never make medical decisions without having a chance to talk privately, without medical personnel present, with your spouse or other family member(s), or close friend(s).  Where possible, it would be good to have at least an overnight period to discuss and ponder, but that can’t always happen.  You almost always can go into another room with your spouse or family members or friend and talk (and pray) privately and then come back and give your answer.
  • A question to ask yourself:  “In which decision is it worse to be wrong?”

Regarding post-treatment:

  • “What effect will this procedure have on my future overall medical condition?”
  • “What effect will this procedure have on my lifestyle (for example: diet, exercise, mobility, health, etc.)?”
  • To the doctor:  “Based on your experience, do you already know what the probability is that I will be needing any particular treatment following the surgery (e.g. chemo, radiation, physical therapy, etc.)?”
  • To the doctor:  “What, if anything, can you tell me now about those post-surgical treatments and their impact, frequency, duration?”

Neither I, nor the person who gave me these suggestions, is licensed to practice medicine.  Hopefully these questions will help you get helpful information for your decision making process from those who are.

“The fear of the LORD is the beginning of knowledge: but fools despise wisdom and instruction.”
Proverbs 1:7


*  Please note that statistical probabilities are never “guarantees.”  In asking doctors about statistical probabilities you must understand that no doctor can guarantee any particular outcome and any statistical probability could be way off in any individual situation.  You must carefully weigh the answers you receive against ALL of the other options.