Chapter 28: Looking At The Parallel Universe

Reflections on choice, regret, and acceptance in medicine and life

Just as a reflection in the water is not perfect, a parallel universe carries its own unknown vagaries.

When I was in high school, I loved reading science fiction novels. They took me into worlds of space travel, time travel, and multiple dimensions of reality. Those stories opened my mind to the vastness of the future and to ideas about time, possibility, and consequence. Over the years, I’ve watched our real world change, and it’s striking how many of those once-fantastical concepts have become part of everyday life.

But others felt too abstract to ever be possible. I was especially intrigued by the idea that a single, small decision could alter not only one person’s life but ripple outward to change the whole world.

Years later, during my urologic practice, I began using a phrase with my patients, the Parallel Universe. The Parallel Universe, as I explain it, is what happens when a small or large change is made by a person. It might be something as simple as leaving the house five minutes later, or as significant as choosing a different cancer therapy. What follows from that single decision can affect the person making it, their family, their community, and eventually the world around them.

When caring for patients with treatable prostate cancer, we had many options aimed at achieving a cure: radical surgery, several types of radiation therapy, cryotherapy (freezing), high-intensity focused ultrasound, and laser therapy. And, of course, there was always the option of observation, watching the cancer to see whether it grew fast enough to warrant treatment at all.

I often told my patients that the good thing about prostate cancer is that we have many choices for treatment. The bad thing is that we have many choices for treatment. Too many options can make people second-guess themselves, wondering whether they picked the right one. Part of my job was to explain each option, the likelihood of cure, and the long list of possible side effects that might follow.

After making the difficult decision between watchful waiting or one of the treatment options, success was always a reason to celebrate. But when the outcome wasn’t ideal, when the cancer wasn’t cured or when a known side effect became harder to live with than expected, patients often began to question their original decision.

It was at this point in their care that I introduced the idea of the Parallel Universe.

When patients or families were unhappy with the outcome, they might say, “If only I had chosen another option. Maybe I’d be cured. Maybe I wouldn’t be impotent.” They naturally assumed that the road not taken, the treatment they didn’t choose, would have given them the perfect outcome.

But life doesn’t work that way. The patient who chose surgery might imagine that radiation would have spared him side effects, yet he could have been in a car accident on the way to his first treatment. The patient who chose radiation might imagine that surgery would have cured him, yet he could have had a stroke on the operating table. The list goes on. A single decision can change a life in countless ways, and not all of them are for the better.

And as we’ve seen in science fiction novels, a small change for one person can create a ripple effect that alters the destiny of many others. The person in the car accident might injure someone else, who then can’t work and whose family has to move, affecting the neighborhood. Someone else takes the job that opened up, changing that person’s future and the life of their family. And these changes ripple outward, touching everyone in their world as time marches on.

I eventually had to make the decision about my own care for prostate cancer. One might think it would be easy for me; after all, I had treated patients for years, understood the options as well as anyone, and knew the potential side effects. But it wasn’t easy at all. I had to look deep into my own heart and decide based on both the likelihood of cure (which was similar for all treatments) and the side effects I might have to endure.

In the end, those side effect profiles guided me to choose surgery. Unfortunately, surgery wasn’t successful, and over the years I’ve had radiation twice, chemotherapy, and hormone therapy. I could have spent time imagining my Parallel Universe, the “what if” world where I chose differently, but I didn’t. I know too well that every path carries its own risks and potential disasters.

Am I unhappy that things didn’t turn out the way I hoped? No, just disappointed. But I am not angry. Everyone did the best they could, in making decisions and in carrying out the treatments. I refuse to let the fact that I am not cured, and that I live with side effects, keep me from continuing to explore my world.

I believe that imagining a parallel universe in any part of our lives can be an interesting exercise. But for me, picturing another universe doesn’t change the one we live in. What I — and we — have is this world, imperfect yet still full of meaning and light if we take the time to look for it. I choose acceptance, and to make the best of the life I have.

Acceptance isn’t giving up. It’s finding peace in the life we have rather than the one we imagine.

Parallel lines etched in stone are formed in ways we can’t even imagine.