What I'm thinking about – and being thankful for, today, is the disappearance of all the side effects I've been experiencing during the last four weeks or so since I began my pill regimen for my papillary thyroid cancer treatment. Too many to list, but upwards of a dozen side effects which encompass all activities from those of daily living to others pertaining to just plain living. Let me reprint the warning that came with the pills: "People using this medication may have serious side effects. However, your doctor has prescribed this drug because he or she has judged that the benefit to you is greater than the risk of side effects." Put that in your pipe and smoke it. That's what I have to smoke every day, you know figuratively what I mean?

The bigger question, the overriding concern/anxiety, is what exactly is the thyroid cancer doing now, having been left unmedicated for the last nine days? How irreparable is the damage being done when the cancer has been left unchecked? Moreover, to the extent there has been some damage, is restarting treatment even an option or have I already failed the tolerance test? Being a cancer patient is a never-ending series of questions and/or concerns for which there is hardly clarity. As I have been led to believe/educated since my initial lung cancer diagnosis, there will be no more guarantees coming.

But of course improvements in cancer treatment and ongoing research have improved survivability, and with many patients, myself included, turned the cancer treatment into a chronic disease-type protocol, like diabetes. Nevertheless, cancer is in control, the doctors are not. There are no slam-dunks in cancer treatment. How would I ever be able to unwind myself from years of stress and fear just because? I couldn't. A cancer patient today sort of means, I'll likely be a cancer patient tomorrow. I don't see how I could shake that self-image.

Somehow, I must, as I'm trying to do now, exult in the joy of a semi uncomplicated, side effect-free existence because…, it's not guaranteed. I must try even harder to compartmentalize the unknown while savoring this known, relatively easy time. It's not promised and it's not necessarily likely to occur again, certainly not after I return to treatment. But maybe, my new normal will be switching on and off treatment, sort of like I did while being infused with Alimta. Though I still had my CT scans quarterly, so long as the scans showed stable, we kept extending the interval between infusions. The goal being to balance effect on the tumors with the quality of life (freedom from side effects and infusion appointments). Eventually, we stretched the interval to as much as seven weeks from the original three, enabling me to live – occasionally – a semi cancer-free life. Perhaps this on-again, off-again schedule might apply to this recent thyroid treatment. I have to hope, because the side effects, as I alluded to initially, have been affecting my quality of life. And if there's one factor driving my better-than-expected survival, it has been my attitude, which has derived directly from my management of side effects. Anecdotally speaking (or presuming), being in a good mood, being able to function with normal parameters (to quote Data from "Star Trek: Next Generation") has been a tremendous contributor to my life expectancy (my oncologist refers to me as his "third miracle").

But I can't know for sure. And of course, that's the crux of the problem for many of us cancer patients. One can never know for sure if you're hindering or helping; and since guarantees stopped being made on the ground-zero day you were diagnosed with a "terminal disease" it's often difficult to know which path to follow. Right now, it's easy to follow the path which is creating a more normal/pleasant quality of life. But at what cost? I can't know what the tumors are doing. Perhaps, in taking a break from treatment, I have unleashed the cancer once again. That's my dilemma: reconciling the present with the future, the fear with the familiar, the hope with the inevitable. And it's likely I'll never know if what I've done has been a help or a hindrance. Yet somehow, I have to make plans and decisions. "Tomorrow is another day." Lest, I be gone with the wind.