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I've got a number of friends in the casino business. Ask them about the odds and they'll tell you the same thing. Sometime you can come out ahead. Sometimes you can even win the big payout. But, eventually, the house always wins.

As I've written previously over the past few weeks, I've had the honor of a wonderful relationship with a wonderful woman for almost a year and a half. That relationship began with the knowledge that she was on borrowed time, two years into a diagnosis of Stage IV breast cancer.  But on the whole, her health has been good. She's faced some pretty awful odds before, and come out a winner every time.  Recently, though, her condition took a pretty unpleasant turn.

Every day we've had together has been worth it. Ten days ago, on the 15th, she accepted my proposal. Tonight's update isn't quite such good news.

We've known for weeks now that the problem was with her liver. The cancer had spread there a year ago, but a rotating assortment of treatments had been doing an admirable job at holding the line.

We had hoped the problem was gallstones (or any of a handful of other gallbladder diseases), because, hey, who needs that stupid organ, anyway? But that wasn't the problem.

When she stopped the mTOR inhibitor, we had hoped that this one of the forms of drug-induced cholestatic hepatitis with a prompt recovery after cessation of the drug. It's not.

Assuming her platelet count stays up enough for the procedure to be performed at all, there will be a direct liver biopsy next week, in part in case something has been missed that might afford a path to recovery. One last throw of the dice to try to cheat the house. But those odds are beyond slim. A meaningful recovery from here would get her star billing as a medical journal case study.

Barring the medical equivalent of a million-dollar payoff at the nickel slots, there is a difficult choice to make. Her remaining oncology drugs are holding the lesions in her bones at bay. They're doing an amazingly good job of it, too -- that's one of the ways we were beating the odds for a long, long time. But those same drugs are hastening the demise of her liver. If she stops the oncology drugs, she has three to six months before the cancer wins, much of which will be spent bedridden due to the involvement of her spinal column. If she doesn't stop the oncology drugs, she might have that long, or maybe a little less, until her liver fails entirely (the primary goal of the biopsy is to get a better estimate for the timeframe), a slowly increasing percentage of which will be dominated by abdominal pain.

I have no idea what decision she will make. She has my support whatever she chooses, for as long as we have together, no matter what may come to pass.

I know that a lot of folks here will be curious about the wedding plans. There's a good chance that there won't be one. She currently carries an enormous medical debt burden, and before this is over, that number is going to get a lot higher. Our state recognizes the "Doctrine of Necessities" and, in general, has considered that all medical care, including end-of-life care, is necessary. Should we marry, I would become responsible for the costs of her medical care (or, at a minimum, the costs of her medical care beginning at the time of our marriage; that's the sort of difference that creditors can and would file suit over). The intersection of health care and financial law is an abomination greater than the sum of its parts. She's made it very clear for some time that she won't allow her situation to endanger my long-term financial stability, whether I'd be willing to make the sacrifice or not. And let's be blunt here, I'm firmly in the middle class, but my income is the wrong order of magnitude to touch her outstanding debt, or what's likely to come. So that's probably that.

We love each other. She wears my ring. We will be together, literally until death does us part. It's sadly pretty likely that we won't get to officially use the word, and won't have the piece of paper that proves these things to the rest of the world*. But if there's anyone out there who thinks that's somehow insufficient, well, they can fuck right off... unless they're debt collectors, politicians, or anyone of similar ilk who thinks the doctrine of necessities is a good idea; in that case, the piece of paper is clearly the only important part, but they can still fuck right off.

*And yes, I'm deeply appreciative of the irony that I've been a support of the same-sex marriage rights for well over a decade in part because that word and that paper really are that important, and yet I'm using exactly those arguments to justify this being okay. It turns out the price of my hypocrisy has seven digits. Meanwhile, in the broader sense, I know I'm a terrible activist. For those of you who aren't, and who are trying to effect change in the medical arena, consider that family medical debt is a target-rich environment for reform.

Originally posted to Serpents Choice on Mon Feb 25, 2013 at 09:14 PM PST.

Also republished by Community Spotlight and Monday Night Cancer Club.

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