heads or tails?

win or lose? sickness or health? darkness or light? imagine if our whole lives were determined by a single coin toss. in many ways, i guess they are. there are thousands of moments every day in which life could go in different directions – applying for a job, taking a test, investing in stocks. and every day, all around the world, people’s lives are hanging in the balance; hoping to come up lucky.

i used to wear a bracelet that said, make your own luck. i liked the thinking that i had control over something, particularly my happiness. i’ve always known that prayer, or thought, or wishing was not enough for life to work out. i believe that people need to be active participants in their lives. but i’ve also learned that sometimes, bad fortune, or even good fortune, does just sometimes fall into your lap.

some people say they don’t believe in luck, or chance… but there is literally no world where i can make sense of what has happened to me, without admitting that i am statistically speaking, unlucky. luck – or lack thereof – is a concept we use to make sense of random events. it is not like if you are unlucky four times in a row, that all of a sudden the next time will come up lucky. if only luck were fair, equally divided. is it going to come up lucky for you? type heads or tails into google, and see what happens.

in 2009, i met a friend in las vegas. we got a good deal on a hotel, and then we proceeded to get ripped off on everything else. except for roulette. we played for no more than 10 minutes, and we won a few hundred dollars. we kept guessing… red? black? it was SUCH a thrill. it was exciting to be a bit reckless, and to come out on top. to walk away before our luck turned. and then, as if by design, we used our winnings to fund a fancy dinner that was alarmingly costly, and we were back in the hole. but i’ll never forget what it felt like to flip a coin, to take a risk, and to get the reward.

now, my whole life has become a high stakes gamble, and i’ve become risk averse. the stakes are too high. i am keenly aware of what i have to lose – and it is not a few hundred dollars.

for a logistics update, i’m doing my march scans here in thailand. many of you know that in november, there was a worrisome nodule in my lungs. the decision at the time was to “wait and see” (this approach definitely NOT being the most reassuring in my books… i much prefer the approach of “let’s do absolutely everything we can to save your life”… i digress). in the end, this was not a terribly difficult decision. the results will be the same whether i do the tests here or or in canada, and doing them here allows me to continue some semblance of normalcy for a bit longer. as well, it is unbelievably easy to schedule a test here, and the results come quickly. point for thailand, not that i’m keeping score.

once we have the information, whether good or bad, i will have to move forward. in so many ways, i do not want to know. i prefer to live in this blissful state of the unknown. right now, i feel fine. i wish i could trust that. unfortunately, i know melanoma doesn’t work that way. these last months have been good for my soul, but also very difficult. the uncertainty and the lack of a clear plan have been very trying. i’ve been using distraction as a coping mechanism, which has some flaws. many people in my life assume that since i’m back in thailand and at work, that all is well. if i open up and say i’m struggling, people react and ask what has “triggered” these emotions. the cold hard truth is that i’m not really fine any day, that i hide it pretty well because i’m very strong, and that i feel like this week i am mentally preparing to walk in front of an executioner.

**********

in order to find some levity in the situation, i have started comparing my hospital experiences. i have taken inspiration from the great falafel-off challenge that i had for my birthday a few years ago. (we tested falafel from the two most popular restaurants in bangkok and ranked them based on a variety of highly technical categories: texture, shape, crispiness-on-the-outside etc.) i’m sure many of you must think i’m insane to be getting cancer treatment in a third world country (and comparing it to a falafel at that); but honestly — the hospitals are nicer here than in canada!

i’ve now had cancer care in two countries. sometimes i am shocked by the sentences i write. cancer care in two countries? WHO ARE YOU AND WHAT HAVE YOU DONE WITH SARAH? even nine months in, this is all so surreal. i’ve always described myself as a wanderer, but a canadian at heart. i’m proud to be from canada, and generally, very proud of our health care system. but now that my life is in the hands of this medical system, i see some of the failings.

so if this is the great hospital olympics – or the great hospital-off – here is my assessment:

holistic approach to cancer care – clear winner: canada.

i asked my oncologist here in thailand what options i had for complimentary therapies, and she just laughed. she said, “we don’t do that here. you need to stress less.” thai people often laugh when they don’t know what to say, so this was not particularly surprising. i have found a counselor online through the melanoma institute australia, and have been relying on email consultation and online resources for other questions. i miss the physical and emotional support at the ottawa integrated cancer centre and the ottawa regional cancer foundation. i doubt i am truly able to eat my way out of this disease, but it helps me to feel a sense of efficacy and agency. in thailand, the disease is treated in isolation.

patient experience – clear winner: thailand.

hospitals in canada are sterile, everything is white, and the fluorescent lights are glaring. some employees don’t even smile. WHAT KIND OF CRUEL AND SCREWED UP PEOPLE WORK WITH CANCER PATIENTS AND DON’T HAVE EXPECTATIONS AROUND COMPASSIONATE COMMUNICATION, BEDSIDE MANNER AND WELCOMING SMILES?! i am not saying that everyone who works in hospitals in canada are unkind, but some of the least friendly people are the people who are sitting at the front desk. what has gone so desperately wrong in their lives, shouldn’t we be the miserable ones? there are also appointments still being made by snail mail, wait times for scan results that are inhumane, expensive parking and a stupid survey that i have to fill out on the computer every single time time i walk into the building. how anxious am i feeling on a scale of one to ten? TEN BECAUSE YOU ARE MAKING ME DO THIS STUPID SURVEY AGAIN.

in thailand, hospitals are like hotels. there is water and snacks in the waiting room. there is valet parking for a small tip. a plethora of nurses scurry around making things happen. there are private rooms for immunotherapy! each room has a window, lots of light, a private bathroom and a comfy lazy-boy chair. i can email my oncologist, and she answers…. within minutes. MINUTES! in canada, i managed to track down the email of my oncologist (through the help of a friend), and he discouraged me from writing him. he said he simply did not have time. no time? i’m sorry you are so busy having a wildly successful life – i’m busy trying to understand my results and not die from cancer. i struggle to have sympathy.

speed and efficiency – clear winner: thailand.

i can get an appointment or a scan booked any day of the week. the results will come 24 hours later, almost every single time. the news might not be what you want it to be, but you certainly don’t have to wait for it. in canada, you can wait on hold on the phone for that long.

expertise and specialists – clear winner: canada.

at my last appointment with my oncologist here in bangkok, she told me that if i had stage 4 cancer, i would have other side effects. that i shouldn’t be concerned, and that i should just relax. alarm bells went off. oncologists should never be minimizing, and certainly not with melanoma. as well, when i asked her about the other treatment that i might need if immunotherapy is proving not to be working, she told me that the bangkok hospital has experience administering lots of cutting edge drugs. when pressed, she admitted she has not a single other person taking that drug on her case load.

in canada, the oncologists actually know something about the cancer that i have.

if only i could combine the best of both worlds. wouldn’t that be nice?

**********

i am holding on by a thread these days trying to get through to my scans, and the results. i am neither fully bracing myself nor fully hopeful for a positive outcome. i am completely in limbo. i feel like i’m at a precipice and i understand viscerally that these scans will be life changing. back in may 2019, i did not see it coming. this time, i’m sitting in a boat, and the water is oddly calm – a brutal storm is coming in from one direction, and there is a tropical island off in the other direction.

which will it be? heads? or tails?

*this photo was taken in chengdu, china, in april 2014. it’s okay, little one, i feel EXACTLY the same way.