3 Words to Banish: Coulda, Woulda, Shoulda

2011 was full of news on the breast cancer front. One item that resonated with me was discussion of a new gene test that could pinpoint which women would be most likely to benefit from radiation for their ductal carcinoma in situ (DCIS), meaning they could also pinpoint who would benefit from a wait and see approach. By definition, DCIS is confined to the milk ducts. The question is will it mind its own business and stay there, or will it escape and start to spread?

DCIS is so new on the scene that it’s not well understood yet, and doctors would rather see their patients be safe than sorry when it comes to treatment. I went the safe route when I opted for a mastectomy over radiation (trust me, it wasn’t an easy choice, at least for me). So the obvious question is, what if I could have been spared either one? What if mine had been slower moving?

I’ll spare you the details of my decision-making process (they’re in my book, ahem) but I didn’t believe my DCIS was going to stay put, then or now. I realize there’s such a thing as cognitive dissonance (what most of us call sour grapes) but I don’t think that’s the case.

And besides, that’s not the point. Whether my belief system can handle this new information or not, we’re going to see a lot of this with breast cancer or any cancer. We also learned recently that perhaps they don’t need to remove so many lymph nodes to get a good feel for whether cancer has spread. I’m sure women with lymphedema are less than delighted by that news. Such is life. Such is medical progress. Imagine how we’d all feel if we had been operated on before they discovered anesthesia.

The point I’m trying to make is that cancer is no place for “Coulda, woulda, shoulda.” We do the best we can with the information we have at the time. Crystal balls are not retroactive.

Thinking about this also got me thinking about the “three words” concept for the start of the new year. A lot of people, including me, blogged about three words to focus on instead of making resolutions. I’d like to suggest that we also consider three words to banish from our thinking in 2012 and these three are at the top of my list. Not just for how I handled my cancer, but how I live my life.

Cancer can make you wonder what you want to do with this life you’re so lucky to have. Getting older does the same thing. 40 is called the old age of youth and 50 the youth of old age. I crossed over into the youth of old age just over six years ago. I do not intend to get to the end of my life thinking “Coulda, woulda, shoulda.” And I hope you don’t either.

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23 thoughts on “3 Words to Banish: Coulda, Woulda, Shoulda

  1. Happy New Year Jackie! It never ceases to amaze me the wonderous discoveries that are being made. I have been reading The Emporer’s Maladies this winter – trying to wrap my brain around this terrible and vast disease called cancer. Thanks for your perspective and wisdom and I hope you have a healty and prosperous 2012.

  2. Well put. And I’d never heard that about ages 40 and 50. and I’m happy to hear that means that I’m about to head into my last year of “old age” (sure, of my youth, but whatever 😉 ) and then, a year from now I’ll be back in my youth (of my old age, but again, whatever). (In other words, I turn 50 in February ’13). It’s confusing, but I kind of like it. Happy new year to you.

  3. How absolutely perfect, Jackie! The “Anti-Three Words” and these fit the bill on every level in every single aspect of life. I can’t even recall the number of times I said your words in varying forms in a whole host of situations….

    “We do the best we can with the information we have at the time.” I just love when someone takes 2012 information and questions why something was handled a certain way in oh, let’s say 1976….. HHEEELLLLLOOOOOOO….Anyone home???? I’m may be chemobraindamagedtothemax but that is logic even a child should be capable of grasping.

    One of my earliest blog entries was about how quickly medical information doubles.

    I’m with you…. “Should” SHOULD be banished from our language completely. I’m going to start my own rebellion and remove it from my vocabulary.

    Very well said…

    AnneMarie

  4. Excellent post. There are so many patients I see now that I would have treated differently 10 years ago, if we knew then what we know now…the best we can do in medicine and in life is make the most informed educated decisions with what information we have, and then be comfortable with our decisions.

  5. I agree with Dr Attai, We can second guess ourselves, put the question on ourselves “Did I make the right decicion?” But best we can do is make an informed choice with what we have. Speaking of mastectomy vs lumpectomy and rads: my onc told me last week that a study on Triple Negative Breast Cancer (and I’d imagine it may be the same with other BC) showed lumpectomy with radiation got better outcomes than mastectomy. I know, so many factors to consider first, and results change from one study to the next sometimes but just wanted to put that out there. Oh, and the most recent study that I loved hearing was on breast cancer and red wine. DId you folks hear last week that 8 ounces of red wine a day lowers estrogen levels, so this week’s research says drink wine daily! Yay!

  6. Jackie,
    Outstanding post! You are so right about not being able to go back. Medicine progresses, and your point about getting surgery without anaesthesia is well-taken. No woulda, coulda, shoulda for me! There is no going back.

  7. Yeah, Jackie!! Rock on, my friend. We’re still here to blog about it, after all, and I’m just glad to know that some kind of progress actually occurs now and then.

  8. A decision is truly up to each person based on the best information available. No one really helps when they recount horror stories, or question decisions.
    There absolutely should be mandatory recurrent training for all physicians. Too many are encouraging mastectomies without adequate current data. IMHO that is a disservice. I’ve just prevented two simply by offering data and second opinions.

  9. Jackie, your 3 “anti” words are awesome! I couldn’t agree more.

    I have a friend who catches her shoulds by saying, “There I go shoulding on myself again.” It always cracks me up.

    I plan on NOT shoulding into 2012 — and far, far beyond! 😉

    -Renn

  10. Ooh this one really resonated with me Jackie. As I was finishing my treatment for breast cancer I asked myself the question if I have survived, what is the deeper meaning of my life after this experience? I am still struggling with this question on my journey beyond breast cancer but having read your post, I know that part of the answer is to banish those shoulda, woulda, couldas!

    • Thank you, Marie. I think a lot of us struggle with that deeper meaning. I think that’s a good thing because I do think we should appreciate life. But as part of that we really need to not be so hard on ourselves. XOX

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