The importance of asking the right questions
Readers of my blog know that a common theme has been the importance of asking the right questions. Today I will illustrate this with a true and painful (literally) personal story that really drives the point home.
The story will be about measuring risk vs reward and the importance of asking the right questions to properly assess both parts of that equation, especially the risk part.
After a routine colonoscopy (illustrating the importance of proactive monitoring, but that is a different blog) I was recently diagnosed with stage 3 colon cancer. This means that the cancer made it beyond the colon and into the lymph nodes, but just a little. Fortunately this means that treatment options are available that are expected to be very effective. After having surgery to remove the tumor, I was advised to undergo a three month course of chemotherapy. The surgery went very well, and after some recovery time, I was ready to begin chemo. Here is where this particular story really begins.
Risk Vs Reward
As we do in business, we are always assessing risk vs reward whenever we make any decision, including in decisions around our health. When we do this, we must determine what the potential risks are for all available options, what the rewards are for each one, and then we try to choose the option that maximizes reward while minimizing risk.
When it comes to my particular chemo treatment plan, I need to have four two-hour infusions over the course of 3 months. As a patient, I was given the choice of two methods of infusion. One option was to have a port surgically implanted in my chest that would remain there for the duration of the three months. The other option was to have the infusions done via a standard intravenous method using a vein in my hand or arm.
I was advised by the nurse and doctor that a port is recommended and that most patients do this, but that IV is an option too if I prefer not to have the port. It was here that I made a big mistake by not asking the right questions. When I asked why the port was recommended, the answer I was given was the following: It is sometimes difficult to find a vein and the nurse will have to try multiple times, and that if the IV is not placed properly, it can lead to irritation of the arm. I failed to ask followup questions, more on that later…
Weighing the Options
Option 1, Infusion Port. Risks: Small risk of infection or other complications as with any medical procedure, unsightly and potentially uncomfortable port sticking out of my chest for three months when it is only used four times. Rewards: Reduced (maybe eliminated) chance of irritation caused by the infusion, simpler actual infusion process.
Option 2, IV. Risks: possible irritation of the arm. This was mitigated in my mind by the fact nurses have always had a very easy time when I give blood. Reward: No unsightly port to potentially get in the way of the gardening and golfing I hoped to continue doing during chemo.
As I have said in the past, almost all problems are caused by poor communication and this was no different. I neglected to ask a very important question. I never asked what the nurse or doctor meant by the word irritation. When I heard the word irritation, I heard exactly what I wanted to hear (because I didn’t like the idea of a port). I heard short term redness, itchiness, and maybe a little sensitivity. But I never actually asked them what it meant. I never ascertained the actual risk, one of the most important parts of the equation.
I chose the IV option based on this flawed risk/reward analysis.
I went at the appointed time to find a very nice infusion nurse ready to connect up to my port. The fact that she was surprised and visibly concerned that I did not have a port should have sent me running, but I stayed.
She easily found a vein in my hand as I expected she would, and the infusion began. Everything was fine for about an hour and then I started to experience some strange feelings in my arm. I assumed that it was normal and had no pain so I didn’t think much of it. At about 90 minutes my arm started to hurt. By the time there was about 10 minutes of infusion left, I was in excruciating pain. When it was finally over, the pain of the removal of the bandages was similar, I imagine, to having my skin ripped off. I shook violently for thirty minutes afterward and in retrospect I think I was likely in some kind of shock.
The excruciating pain lasted for about 2 days, the inability to use my arm because of inflammation and skin or nerve damage lasted about 1 week, and very significant sensitivity and less intense pain lasted 9 days. As I write this, at 10 days, I finally feel the level of irritation that I originally imagined was the worst case scenario.
No Stupid Questions
All of this could have been avoided had I asked better questions, like “what exactly do you mean by irritation?”. As a wonderful teacher of mine once said: “the only stupid question is the one that’s never asked”
Needless to say, I am getting a port put in for the remainder of the infusions. Lesson learned the hard way.