The Trick I Used to Make a Seemingly Impossible Medical Decision

Chaotic paralysis. It’s the best way I can describe it. I had to make a choice between two courses of treatment for my chronic illness.

Neither sounded particularly appealing.

Both had risks I really did not want to think about. Both had an unclear success rate, where “success” didn’t guarantee I would feel healthy or good.

The doctors told me it was a personal choice and only gave me a generic list of pros and cons to go on. I had questions — many, many questions. Most of those could not be answered.

My mind was overwhelmed with thoughts. But I felt completely incapable of taking steps toward a decision.

Of course, I had to make this life-altering decision while sick; a state unconducive to logical thinking, concentration and clarity.

My pre-illness decision-making strategies weren’t helpful. The chaos of unknowns, fears, doubts and feelings didn’t fit into a traditional list of pros and cons, and though it was nice to be comforted by friends, there were no golden nuggets to magically point me in the right direction.

So there I was, having to make a decision with permanent consequences for the rest of my life, while not having a clear picture of what those consequences may look like.

The anxiety was overwhelming.

I had to find a different way to make this decision, one that fit better with my current circumstances. And I needed tools to manage the anxiety constantly fluttering around in my head.

The first thing I did, in-between the bouts of tears, was to write everything out — all of the knowns, unknowns, risks, fears, questions, doubts and feelings about both options.

My head felt a little lighter, but I didn’t feel any better about either option. After a while, it dawned on me why I felt like this. I was subconsciously comparing my options to a third option: one of a healthy life, free of this disease, where I did not have to make such impossible decisions.

Compared to that, no wonder I felt like I was choosing between two doom-and-gloom scenarios.

I had to make a conscious effort to focus solely on the options I had. Once I was only comparing the two options against each other — not a magical land in which I wasn’t sick — the decision already felt more manageable.

Then began the work of making sense of the long lists of thoughts I had written down. I thought about what was important to me and what I valued most. For me, this list consisted of:

1. How long the treatment would likely take.

2. The level of certainty it would give me in knowing what I’m in for.

3. The difference in medications I would be on and their potential impact.

4. How confident I felt and the (relative) success rate of the treatment.

5. How permanent the treatment option was.

6. What risks I was taking with each option.

I compared my thoughts and the unknowns within each of these categories. That further helped me see that one option was a better fit for me.

What remained were the doubts and fears that couldn’t be categorized. I gave those their own space and wrote down my worst fears for each option, and reflected on their implications for how I would likely handle and experience each option relative to the other. What might my regrets be, and could I live with those? 

Once I had taken these steps, I knew which choice was best for me. But the anxiety didn’t end there.

Even after I had made my decision, I often woke up in doubt or found myself in tears because someone had said something that threw everything into question.

My decision wasn’t rock-solid; it was hanging on by a thin thread.

Most of the time this was because I was so exhausted that I couldn’t remember how I came to it in the first place. Other times, the “healthy life” option would sneak up in my head again, making my choice seem unreasonably drastic and unfair.

Having my reasoning written down gave me something to come back to — to remember I made a decision to the best of my ability, using the information that was available and judging my ability to walk that path with (some level of) confidence.

Even so, the day of the treatment, I woke up trembling. Even though the decision had been made, even though I knew I trusted my decision-making process, and even though I believed this was the best choice for me, I could not stop shaking.

It was the reality of making a decision that will affect my health for the rest of my life, while not knowing how it will turn out.

As my boyfriend summed it up at breakfast: “You’re destroying a part of your body and you don’t know exactly what the repercussions will be. Of course you’re nervous. I’m nervous for you.”

What I learned.

So far, I’m lucky to not have had any serious side effects and I am hoping it stays that way.

If I have to make another seemingly impossible health-related decision in the future, I am going to try my best to remember the two most important things I learned from this experience:

1. Write everything down (if possible, somehow categorized), so you can look back on it when you’re about to go into a panic spiral and remember your reasoning.

2. Clearly delineate the actual options you have, and be mindful to not (subconsciously) compare them to a magical life free of illness.

Making life-altering medical decisions when you feel sick and exhausted is extremely difficult and overwhelming. Using the above process, I was able to make a decision I am (still) happy with.

And that gives me peace.

A version of this article was previously published on Medium.