So we had maybe two weeks to figure this out after his diagnosis in September and honestly it felt like drinking from a fire hose. We live in Tampa but we knew right away we weren't staying local for this. Our oncologist Dr. Patel was great about it, she didn't get defensive or anything, she just said "if you want to go somewhere with more meso experience that's smart."
We looked at three places. One was in Houston, one in California, and we ended up choosing MD Anderson because it's only four hours away in Orlando and Joe could come home between treatments. But the real reason wasn't the location.
I spent like 20 years teaching and I learned that you want someone who does the thing a LOT, not someone who does it sometimes. So we called around and asked straight up how many mesothelioma cases they do a year, how many pleural surgeries specifically, and what their protocol was. The place that said "we do about 40 cases a year" sounded way better than "oh we see some of those." Four of our initial consults the surgeon basically read from a script the whole time and didn't answer questions, just kept talking at us.
The surgeon at our final choice actually looked at Joe's scans for like 45 minutes before we even met with him and he had specific thoughts about staging and what surgery would look like. Not generic stuff. He also didn't push us toward treatment, he laid out options and what the data actually showed.
Second thing... cost does matter but don't let it be the only thing. We had to fight with insurance but that's a separate battle. What mattered more was whether they did immunotherapy, surgery, and had follow-up care all in one place so we weren't coordinating between hospitals.
Third thing is honestly the support staff. The nurses, the schedulers, the financial people. Joe's immunotherapy started in November and there were times where we had questions on a Sunday and someone called us back on Monday. That stuff saves your sanity.