Making a hard decision

For most of my life, making decisions has come quite easily for me. And that was partly because of the way I handled them.

Often I already have the necessary information I need to decide swiftly and effortlessly. Daily choices made in life and business immediately come to mind. For instance, I don’t agonize over what to wear on any given day. Nor do I characteristically hesitate whether or not to take on a new project.

“Troubleshooter” is my middle name, meaning I am adept at seeing both problems and solutions. Arriving at resolutions typically call for choices to be made along the way.

Even for bigger decisions, those with weighty consequences if wrong, I excel at doing the necessary research, including listening to other perspectives, not being impulsive or emotional, and then weighing the pros and cons. An illustrative example in this category would be my hard decision to end a business partnership that wasn’t working for me, even when it meant giving up “my baby”—and that’s happened three times in my life (!)… so heartbreaking at the time, yet so right (each time!) when I look back.

On an important decision one rarely has 100% of the information needed for a good decision no matter how much one spends or how long one waits. And, if one waits too long, he has a different problem and has to start all over. This is the terrible dilemma of the hesitant decision maker.

Robert K. Greenleaf (The Servant as Leader)

I am satisfied that most, if not nearly all, of the more difficult decisions I’ve made along the way, have turned out better than well. In the long run, almost no regrets.

So does that mean I think I’ve made no mistakes? Heavens, no!

I’ve made countless decisions that turned out to be downright wrong or led to an undesirable outcome. For instance, I’ve hired people whom I’ve later had to fire. I’ve bought clothes I ended up never wearing. I’ve befriended people who turned out to be disloyal. I’ve driven down dead-end roads.

Yet each of my wrong decisions just led to another decision to be made. And I continue to make them boldly, without fear, without dwelling on worst case scenarios. Without drama.

You can’t make decisions based on fear and the possibility of what might happen.

Michelle Obama

Are you curious what my secret is? Since I’ll tell you, it’s really no secret. I’ve said it so many times.

My main principle is this: I make my decisions intentionally, as informed as I can be, then I let go of the outcome.

I don’t second guess my choices. Once I make the decision, I’m committed until life shows me a new decision is needed.

Do the best you can until you know better. Then when you know better, do better.

Maya Angelou

Wrong decisions at best are excellent lessons. Very, very few decisions are permanent (such as deciding to give birth to a child or taking a life).

What will happen, will happen. I don’t look back and beat myself up when the outcome isn’t what I had hoped or expected. In most cases, too many factors are at play that determine the outcome, factors that are beyond my control.

I see life as a continuous stream of decision-making. We decide every minute how we want to live that minute and the next.

Living in the now means being aware of, and present to, what is happening now and what is important to us now, yet in the context of a future we want to have.

The end of this post gets rather granular, so that is for those who are following my treatment journey. Below I share how I moved toward a solution to the problem that was raised in my previous post on the hormonal therapy my oncologist prescribed.

This post was inspired by the fact that it took me a bit longer than usual to decide this possibly life-affecting issue. I wanted to consider not only the rational reasons, which I list below, but I also wanted to give myself more time to ponder my intuition, my gut feels, my emotions.

As my friend Rose asked me, “what is the wise woman in you whispering?

Visionary decision-making happens at the intersection of intuition and logic.”

Paul O’Brien (Great Decisions, Perfect Timing)

As I see it, most of my choices over the years have included this intuitive component. It was, I feel, my intuition that knew to let go of an outcome once I decide.

I am about to do so again.

How I decided about my hormonal therapy

I was having a hard time getting my oncologist to have a discussion with me about the prescription he had given me without consulting me for my post-chemo hormonal therapy. So, I decided to do the research and tell him my conclusion as I thought it best for me.

This is what I wrote to my oncologist yesterday:

Here is my current thinking on my hormonal therapy for ER+ breast cancer. It is clear that today the more effective therapy for post-menopausal women is the aromatase inhibitor (AI), as you had prescribed.

Nonetheless, there are other valid considerations, and frankly it’s down to a numbers game (ie, a crapshoot).

I consider that:

1. my diagnosed cancer is stage 1, triple positive, node-negative

2. I’m already subjecting my body to chemo, radiation, and herceptin… all, as I understand it, aimed at neutralizing my body from developing more cancer

3. the side effects of AI include arthralgias, myalgias, low-grade cholesterol elevations, bone loss and fractures, of which bone loss concerns me most

4. the cost of AI is prohibitive and it’s not covered by my private medical insurance

5. the side effects of tamoxifen also include possible concerns, like uterine cancers or thromboembolic events

6. the research indicates positive outcomes when switching to AI following 2-3 years of tamoxifen (and tamoxifen taken before an AI provides some measure of bone mineral density protection in postmenopausal women)

7. the risk reduced of AI as the starting treatment over tamoxifen may be statistically significant, but not compellingly huge, and besides, my body is not a statistic

8. we are planning a move to Canada after my treatment program and the end to the pandemic make that possible–and there AI is covered by provincial medical insurance

These considerations lead me to the conclusion that starting with tamoxifen for 2-3 years would be worth trying, both for physical and financial reasons. Of course my body’s reactions to the tamoxifen would need to be monitored.

I’d like to hear your response to this. IF you agree with this course of action, I would need from you

(1) a prescription for the tamoxifen (although I’d still rather wait to start until the radiation therapy is completed mid-Feb), and

(2) a note stating that a different course has been decided on that does not include the Arimidex that I can take to the pharmacy to get reimbursed for the Php10K I was charged (they won’t accept the return without your note)

Thought writing this down would help expedite a decision. Thanks.

My oncologist’s immediate (and only) answer:

Agree given the limitation.

If you obsess over whether you are making the right decision, you are basically assuming that the universe will reward you for one thing and punish you for another. The universe has no fixed agenda. Once you make any decision, it works around that decision. There is no right or wrong, only a series of possibilities that shift with each thought, feeling, and action that you experience.

Deepak Chopra

How at ease are you about making decisions? Is there anything that prevents you from confidently making choices? Do you have regrets?

13 comments

  • […] From the moment I was diagnosed with breast cancer, I was committed to work together with the medical professionals I chose to try to “fix” whatever could be fixed with today’s knowledge and protocols. I knew nothing was certain yet I decided to follow the current science and let go of the outcome. […]

  • no regrets. except not having the opportunity presented or making the opportunity to see you. luv you.

  • All the above seems to me (a non expert) to be very wise decisions. Also a move back to a country with a better social security system.

    If I was not so involved here I would probably also move back to a better organised country.

    What leads back to decisions. Twenty years ago my move to the Philippines made a lot of sense. Now, twenty years down the road a little bit less.

    “There are moments when you stand on the brink of a new experience and understand that you have no choice about it. Either you walk into the experience or you turn away from it, but you know that no matter what you choose, you will have altered your life in a permanent way. Either way, there will be consequences.”
    – Dennis Covington –

    “If you never leave, you’ll always wonder. You’ll wonder what your life could’ve been, if you did the right thing. Well… scratch that. You’ll always wonder if you did the right thing, no matter what your decision is, big or small. There’s always another path you’ll wonder about.”
    – Becky Chambers –

    • Sidney, our decision to move to the RP almost half my lifetime ago made prefect sense to us (it was jointly made), and not regretted by a long shot–it’s been a wonderFULL three decades. If now the time has come to revisit the question of where we can best thrive, taking into consideration all factors (friends, family, age, health, our finances, support systems, weather, etc), so be it, we’ll make it, and it won’t be easy. But that in no way affects the wisdom of our decision back in 1990. My main point in my post is the exact opposite of your Chambers quote… Once a decision is made, I do *not* wonder how my life would have turned out if I’d made a different choice. I let go of the outcome. I motor on… happily.

      The same with my decisions related to this anti-cancer journey. I make the best decision with what I’m given (and your agreeing helps validate them). It still may or may not turn out as I want it to, but even if disaster strikes, I won’t look back and blame or regret. What’s the use in that? Onward, ho! 🌸💜🌸

  • Really liked reading this post–except that you my friend will be moving away, which is essential for you but means we are time zone and distance-wise further removed than Covid has managed, and will have to work a bit harder at staying connected.

    • Yes, Jill, as you can imagine, moving away from the RP and all our friends is a huge decision we’ve not made lightly. And yes, communication technology available to us is the silver lining, even if a distant second best to doing fun stuff together in person. 💜🙏💜

  • I love your post especially as I could be better at making decisions. The universe has no fixed agenda but maybe ones soul does? On the other hand, perhaps there is no fixed path for as we become the journey… the possibilities flow as we do.

    • Thank you, Alison. So glad my musings resonate with you. 🌸🙏🌸 Yes, I’d agree our soul may have an agenda, and that is why it’s important to listen to our inner “wise woman” along with the rational reasons. And my inner wise woman is all about going with my flow. 💜

By Francisca

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