Even in this modern age there is something fundamentally barbaric about cancer treatment. Given, we are not talking about the extremes that earlier cancer treatments achieved: high-dosage chemotherapy sessions where patients would spend the entire session vomiting convulsively and surgeries intended to remove all trace of cancer, but that left patients mutilated and had varying degrees of success in preventing a relapse. Treatment has evolved significantly over the past 20 or 30 years, as has the medical community’s understanding of this disease, and with it an improvement in prognosis for cancer patients – including Mario, thank God. None the less, the basic elements of cancer treatment remain the same – surgery, chemotherapy, radiation – but now applied more precisely, and where possible with limited collateral.
My mother-in-law said to me the other day, “You know, 25 years ago a cancer diagnosis was synonymous with death; having cancer was like walking around with a sign on your forehead that read ‘DEAD’.” She was telling me about the comments people would make, the pity-filled looks. And of course, the weight and hair loss only made it that much more evident. Thankfully, that’s not always the case now, and it’s not always necessary to subject patients to the extremes of earlier times. That does not mean, however, that oncologists have lost sight of the deadly nature of the disease they are helping their patients to battle. In the many doctor’s appointments I’ve participated in over the past few months, I’ve been reminded several times of their order of priorities: survival, function, cosmetics. So, if you’re a cancer patient, your doctor’s mission – their first priority – is to save your life, at any cost. Everything else is secondary to that primary goal.
The fight against cancer is personal in a way that fighting other diseases is not. Compare, for example, any kind of bacterial infection, the common cold, HIV/AIDS – the disease is caused by something foreign to the body, an outside aggressor that can be identified, named, and persecuted using medical and pharmaceutical technology. Psychologically, we have a target for our frustration and anger; something to hate. In the case of cancer, it’s your own body, your own cells, that have betrayed you, and that is precisely why it is so difficult to come up with a treatment that doesn’t make the patient feel like crap, or worse – the treatments attack healthy cells along with the cancer cells because they can’t distinguish which is which. Genetically, they are the same. The result of course, is that chemotherapy – taken to an extreme – is basically killing both the cancer and the patient in the hope that the cancer will be eradicated while it is still possible to bring the patient back from the brink of death (remember, I’m talking about an extreme here). This basic principle is barbaric, but also illustrative of the oncologist’s dedication to the primary goal – survival at all costs – the implication being that it doesn’t matter how bad things get in the inter.
Mario has been lucky – and by extension so have I. His cancer was diagnosed and treated before it spread, which so far has meant a milder chemotherapy regimen. He was able to find a surgeon specialized in the type of cancer he had, who was able to perform a non-invasive surgery to remove any remaining tumor and scar tissue following the initial chemo and radiation treatments. By and large, he and I and the rest of the family have been able to maintain a normal life – Mario never stopped going to work, even in the last couple of weeks of treatment. We continued to spend time with friends, eat out and go to the movies on the weekends, in spite of the nausea and exhaustion. Following the surgery, he’s basically all in one piece and the doctor gave strict instructions to walk 3 hours a day, starting the day after surgery. We have been so lucky in so many ways throughout this process, and yet even in these given-the-situation-fortunate circumstances, I see how Mario is suffering following the surgery.
For the first time since his diagnosis, he can’t go to work, much less to work out – his routine has been affected, the consistency of which helped him to keep his head above water in this sea of uncertainty and fear. There are tubes coming out of places they shouldn’t be, allowing blood and fluid from the surgery to drain away. There is pain, sometimes more, sometimes less, sometimes much more when a tube gets pulled on or I drive over a pot hole on the way back from a follow-up appointment – you can imagine how awful I felt. He doesn’t talk much about it, but I can tell how difficult it is for him to experience this, and I can’t help but think about how before the surgery he was fine – he could run and work out and go to work, and on the surface he was a picture of health.
Oncologists are brave souls; they are the ones who tell their patients, “It’s going to get worse before it gets better. I’m going to have to make you sick to save your life.” The women and men who stare down this disease every day make life-changing decisions for their patients: life, function, cosmetics. They’re the ones who have to explain after the surgery, “I’m sorry, I had to remove _____ it was too risky…” – just to be clear, by risky they mean life threatening. And then the patient has no choice but to find a way to cope with this change, this new version of life after cancer; to find a way to make due with the life the oncologist has permitted him or her to have, and that’s not always easy. There is something barbaric about waking up from surgery to find that something in your body has been fundamentally altered.
Now, before you get the wrong idea, please don’t confuse my description of cancer treatment as barbaric – which I do think that it is, and one day I am sure we will find a better solution, like the one discussed in this recent article in the Washington Post – with a claim that oncologists are barbarians, because they are most certainly not. They are remarkable individuals with nerves of steel who are doing their very best under some of the very worst circumstances, with tools that we all hope will one day be much better and more precise. It’s the treatments that are barbaric, not the people who administer them in good faith.
When Mario was first diagnosed I didn’t know what to do with that news – he was the first person close to me to face this particular form of evil, and I had no context for interpreting what his diagnosis would mean for him or for us. A friend recommended a book – The Emperor of All Maladies by Siddartha Mukherjee – about cancer but written for a lay person. It provided me with all the context I have about how cancer treatment has developed and where we stand today – mostly oncologists are very busy and don’t have that much time to explain how modern cancer treatments have been discovered and refined. It’s well written and an interesting read, but if you are dealing with this disease in your personal life it’s more than just interesting. It provides useful context and information – particularly useful if you cope by trying to understand, as I do.
RoseAnna
Mexico City, May 2017