As I wrote in my last column ^[1], I was at the Mayo Clinic in February for both an oncology check and a cardiology consult.

The cardiology consult I passed with flying colors. I do not have pulmonary hypertension; I do not have amyloid damage to my heart. To borrow from poet Archibald MacLeish, I indeed have a heart and it is in solid shape.

The oncology picture is muddier. I have not relapsed, which is great news. But the Kyprolis ^[2] (carfilzomib) regimen I am on is not knocking the myeloma down to a complete remission as the Mayo oncologist had hoped and predicted. He said I had reached a plateau.

Plateaus are problematic. (What isn’t problematic in Cancerland?) On the one hand, I’m stable. On the other hand, the myeloma is very likely trying to mutate to a Kyprolis-resistant clone that will send me into relapse.

My Mayo oncologist, who is Asian, was searching for the right phrase to describe my condition. He suddenly brightened. “Think of the 38th Parallel ^[3],” he said.

Great. I have Kim Jong-un in me.

There are different options for what to do next – each with potential risks and benefits.

One is to stay on the plateau and continue my current regimen of Kyprolis and dexamethasone ^[4] (Decadron) without change. A second option is to add Pomalyst ^[5] (pomalidomide), an oral therapy, on top of the current infusion of Kyprolis. A third one is to discontinue the Kyprolis and take Pomalyst instead. A fourth option is to switch to Darzalex ^[6] (daratumumab).

The one most heartily endorsed by my Mayo oncologist is adding Pomalyst to my current treatment. He reminded me, however, that at 11+ years post-diagnosis, how my body would react was speculative. “There are very few of you with this longevity,” he said, not for the first time.

As my husband Warren and I drove away from Mayo, we debriefed the consult.

“What are you thinking?”

“No, what are you thinking?”

Warren was thinking of things he still wants to do together.

Yeah, me too.

We talked about adding Pomalyst, the option I had reluctantly leaned towards. I wasn’t happy about it at all, but none of the options sounded good.

There was a whole lot of quiet in the car.

My local oncologist Tim, who I saw four days later, was voluble and adamant in his opinion of the "add Pomalyst" option. If I wanted to tank my quality of life, let’s add a powerful drug on top of an already powerful drug. For perhaps the first time ever in our long relationship, he passionately advocated quality of life over quantity of life.

Which did I want to count? Days or experiences?

I came out of that appointment with my head reeling. “Dueling oncologists,” Warren said. “Wasn’t that a scene in ‘Deliverance?” a friend texted when I told him the response.

Cute. But I was in knots. Do I follow the Mayo opinion? Do I follow Tim, who has been on the myeloma path with me since I started?

It wasn’t until later that same day, after infusion and while walking to the monthly legal clinic at which I volunteer, that my thoughts started to smooth out (walking does that for me). I could finally start thinking through the issues facing me. Quality versus quantity. Plateau versus complete remission. Risks of current treatment versus risks of new treatment.

Late Beacon columnist Pat Killingsworth, in his final comment – which I read after my local oncologist made his comments – underscored what I was thinking when he wrote, “Honestly, we may have pushed things too far … Apparently my body can’t take it.”

In the days since, I have started Round 7 of my present regimen (Kyprolis plus dex) without any changes. Even my Mayo oncologist recommended delaying adding Pomalyst at this time. This is the busiest time of my work year, and he was concerned that I would not be able to work right away.

Yes, you read that right. "He was concerned that I would not be able to work right away." Houston, we have a problem.

I have talked at length about my quandary – with Warren, with my youngest brother, and with close friends, some of whom live in Cancerland themselves. None of them has told me what to do or what they want me to do. All have expressed great concern. Yes, I might gain more time, but it might be time of such poor quality that it in and of itself poses new threats to me. Once I choose that path, I will never recover any lost ground of overall health and well-being.

Let’s face it. Time is seductive. Those of us with terminal illnesses get lured by its siren song. We forget, however, while Time is crooning away, that time is an illusion. It is not as if I am being handed a cure, only a potential extension without any way to project or gauge what it will do to me.

Going back to the questions that Atul Gawande posed in Being Mortal: What are my goals, and what I am willing to do or not do to try to attain them?

I turn 60 in a few more weeks, a milestone I never anticipated reaching when I was first diagnosed over 11 years ago. Pat’s family ended life support on his 60th birthday; the symmetry of our ages gives me cause to pause and reflect.

I think I know now what I am not willing to do. I stay the course and roll the dice. I may be numbering my days, but they are mine to spend as I want and that is enough for now.