Safety nets

While I have written about my gratitude for my own safety net, I am blown away by some people's seeming lack of a safety net of any kind.  A guy got on the van the other day for his six week follow up appointment.  He was on the van for the first couple of days I was, finishing up his radiation cycle.  This week I chatted with him a bit.  He has some sort of cancer in his throat, jaw area.  When he was diagnosed in Long Beach,WA he was given the choice of surgery or chemo/radiation.  First of all, the whole choice thing on these big questions really, really bugs me.  As a lay person, I assume and hope that the professional person I am consulting, i.e. the medical or surgical oncologist, has a pretty good idea what he/she thinks is the best course of action.  I learned this after switching surgical oncologists and being given a very strong recommendation for neoadjuvant chemo by the new doctor, where the first doctor told me to go home for Labor Day weekend and decide which way I wanted to do it.  This made me extremely uncomfortable.  I understand that within the realm of cancer treatment there have been many choices that have been mine and could not be made by the professionals, like whether to have reconstructive surgery or whether I wanted to do radiation in Longview or Portland.  But for big medical questions I am pretty sure if the doctor was treating a relative they would likely have a recommendation for how to proceed.

Back to the van guy, Chris.  Given my caveat of knowing nothing about his cancer or his case (this has never stopped me from having an opinion), I thought it was pretty huge that his doctor did not recommend to him what to do, or what he would do, or whatever.  But here is the kicker.  Chris told me he decided to just have the chemo and radiation because he would have no way to get to Portland, where the surgery would have to take place.  And he added, he knows nothing of Portland and so given that it wasn't really an option for him to go there for surgery.  I was stunned.  And maybe this exposes my privilege or whatever, but Portland is two hours away, maybe two hours fifteen for Chris, and I wondered about his life, having not been there, ever?  So... He has had two rounds of chemo/radiation and was told at his follow up that his cancer is not fully gone.  There is no surgical option now because he wouldn't be able to heal due to all the radiation he has had.  He can try another round of chemo and that might be it.  Now, I have no idea really whether his cancer would have played out this way anyway or not.  I am just in disbelief that this human being simply had no safety net, public or private, to help him out.  Shouldn't a rural oncology clinic have a system in place to help a person in these situations?  Shouldn't people have people in their lives to lend a hand in a crisis?

I have ridden the van to save the gas money and put fewer miles on my car.  Others have no alternatives.  It is just hard to swallow, that some people are that alone.  As I said earlier, I have little information about this man, his medical situation or the presence or lack of loved ones in his life.  I only have what he stated, matter-of-factly in a brief conversation with me.  He shrugged a couple of times and said, guess we'll just see what happens, like he was talking about nothing more than a basketball or football game in which he did not have much of a stake.