#5 The Planning Fallacy

There is a phenomenon in business and life called a “planning fallacy” in which predictions about a future project or task display an optimism bias and underestimate the time, expense or resources needed to complete it. And, while I am pretty good at spotting the planning fallacy in my role as a business owner or executive coach, the phenomenon showed up in my world this week.

Becky and I have been deluged with a torrent of information from meetings with the team of doctors, and the results of the many tests initiated by my recent cancer diagnosis. It's compounded by the additional Doctor Google monsoon unleashed by our own research on everything related to rectal cancer, the treatment side effects, chemotherapy drugs, radiation therapy and more. This information overload left me full of data, but in a somewhat delusional state, despite my best efforts to know everything about what would transpire over the course of this cancer eradication project.

Last week Becky and I scheduled a follow-up visit with Dr. W, my surgeon, as a way to make sure we could clarify our concerns and finalize any questions we had before my treatment began.

Earlier this week we were ushered into the treatment room. I was asked to get on the awkward exam table/chair contraption and Becky sat in the regular chair. The nurse took my vitals and declared I was "where I needed to be.” I felt like a little kid sitting there as my legs hung off the table, not long enough to reach the ground.

Becky and I had a plan for this meeting. I had two pages of questions. I would ask the questions, Becky would document the answers. If something didn't make sense, we both agreed to stop Dr W. and try to make sense of it.

Dr W arrived, closed the door, logged into the computer and then leaned back against the door. It seemed this was not her first inquisition by extremely “prepared” patients. I started with the first question on my list. And the discussion proceeded.

I felt much more present at this meeting than I did the first one. Dr W didn’t seem to be talking so fast. We understood more of the terms she used during this meeting than we did in the first one.  Our "deer in the cancer headlights" shock was no longer present, so we were taking it all in as best we could. We were moving into my second page of questions, when it happened -  I realized I'd fallen victim to the planning fallacy.

I had employed my own optimism bias around the complexity and implications of my treatment. I’d also under-estimated the timelines associated with it. As Dr W answered our questions and gave additional information to support her answers, it became very clear that I needed to get real and drop the assumptions.  I had to get out of my planning fallacy. So, I made sure Becky and I understood as much as we could, not only about our questions, but also any other things I might be missing.

As a result, this is the most likely treatment plan I’m anticipating, along with the explanation, order and expected timing.

  • Meet Dr X, my Oncologist. This happens next Wednesday. We’ll officially decide on the chemotherapy treatment plan.
  • Book a time to do the intake for radiation treatment. This means I need to get measured for the radiation treatment. As best I understand it, this is where they line up the "lasers" to zap you with radiation. I then wait approximately a week while the radiation doctors and physicists program the “lasers” for my radiation treatment.
  • Start the combined chemotherapy and radiation treatments. It’s an oral chemotherapy which means I take all the pills at breakfast and dinner. This happens on the same day I get radiation, which is every weekday for 5 1/2 weeks. Saturday and Sunday are off as a break. The radiation sessions last about 15-20 minutes each day. Thankfully, the radiation center is about 15 minutes from both our home and office. Each week I will also have blood tests and scan to monitor my situation.
  • At the end of combined treatment period, there is a 6-8 week recovery period. During this time I rebuild my strength to get ready for surgery. At the three week mark in this recovery period, I’ll be scheduled for another scan with the radiologist to help them know the results of their work. If all goes as planned, we should be into the Christmas season by now.  One month after I’m done chemo and radiation, Dr W schedules the surgery, which we anticipate will happen in late January or early February.
  • A day or two before surgery, we go back to meet with Mandy, the ostomy specialist. She figures out where on my body the stoma will be placed for best fit and comfort of the ostomy bag and tattoos my skin so Dr W will know where to connect it.
  • Then, the surgery. I’ve learned it is a pretty significant operation. Dr W plans on doing it laparoscopically, using the robots if they are available. The surgery includes the removal of most of my rectum, along with the fat and lymph nodes surrounding it. Lymph nodes and other substances removed will be biopsied for any remaining cancer. My colon then is attached to the remaining parts of the rectum and sewn together. The stoma is also added that links the small intestine to my stomach skin in order to add the ostomy bag. This bag will be my companion for anywhere from 3-6 months. There are 5-7 days of hospital recovery from surgery.  Once I am released from hospital, Dr W suggested that my recovery from surgery will last anywhere from 3 to 5 weeks.
  • Depending on the biopsy from surgery, there is also the possibility that I will start more chemotherapy in anything is still cancerous. This will most likely be the more intense drip IV or pump version of the treatment. This usually lasts anywhere from 5-6 months.
  • At the end of this period - either 3 months of recovery or 6 months if the additional chemo is needed - there is still another surgery to go, the removal of the ostomy and stoma. This is also a much bigger surgery than I was expecting. Hospital recovery lasts another 4-6 days. Then more recovery time at home as my digestive track learns to operate again.
  • Finally, there are ongoing tests, exams, blood work and scans to monitor and watch my ongoing condition.

All of this is subject to things going as well as they can. Complications are part of the risk. But, now I know what to expect, as best I possibly can, without the planning fallacy. I hope this helps you as well, if you were in any way stuck in the thinking with me.

There’s something calming about knowing the reality. Yes, it’s not always pleasant, but at least I know what I am up against. And I am ready to get on with it.

Thanks for your unquenchable support.

PS. If you've ever watched the movie, The Princess Bride, you might see the connection. As we were chatting with Dr. W, and I had that realization of my planning fallacy, the words of Vizzini came to mind.

"You just fell victim to one of the classic blunders, the most famous of which is 'Never get involved in a land war in Asia.' "

This was just after they had all scaled the Cliffs of Insanity and Vizzini and Westley were engaged in the battle of wits to save the princess.   Here is the small replay for your enjoyment.

3 Comments

  1. Jan Easton on October 17, 2016 at 4:32 pm

    Dear Tom and Becky,
    Doug and I read your blog with concern and shock! We send our care, love and prayers to both of you!
    Tom, thank you for your explanations and honesty! It helps understand your battle ahead and gives us lots of specifics to pray for!
    We are cheering you on!
    Love, Jan and Doug



    • Tom Adams on October 17, 2016 at 5:25 pm

      Thanks Jan and Doug,

      We really appreciate it. We are still trying to make sense of it all so your support means a lot to us.

      Tom + Becky



  2. Karen Donley Poston on October 18, 2016 at 4:19 pm

    Wow! So much to take in. At least you now know what is ahead of you and you can tackle each day with the positive attitude I know you have. My thoughts and prayers are with you both. May our good Lord wrap his arms around you both.
    Hugs,
    Karen Donley-Poston