Cancer - the in thing?

Another one of my friends had succumbed to Cancer. Another one bit the dust. When I told my partner about this, his reply was "It's the In Thing".

On my trip to Europe last July, I had bought my copy of "THE EMPEROR OF ALL MALADIES: A Biography of Cancer" by Siddhartha Mukherjee at Fully Booked, for the long haul read. The 571 pages (actually 472 pages of an excellent dissertation and approach to the origins and current knowledge of cancer and 99 pages of references and bibliography) provided a radically new approach to understanding the malady that has afflicted humans since time immemorial.

Cancer is not something new. Siddhartha writes with poetic brilliance as he describes his own insight into patients he currently sees and then intertwines the history of cancer to its first documented beginnings. He truly deserved the Pulitzer Prize for the writing of this book.

"Recall Atossa, the Persian queen with breast cancer in 500 BC. Imagine her traveling through time - appearing and reappearing in one age after the next. She is cancer's Dorian Gray: as she moves through the arc of history, her tumor, frozen in its stage and behavior, remains the same. Atossa's case allows us to recapitulate past advances in cancer therapy and to consider its future. How has her treatment and prognosis shifted in the last four thousand years, and what happens to Atossa later in the new millenium?...In 500 BC, in her own court, Atossa self-prescribes the most primitive form of a mastectomy, which is performed by her Greek slave. Two hundred years later, in Thrace, Hippocrates identifies her tumor as a karkinos, thus giving her illness a name that will ring through its future..."

Perhaps the literary ingenuity of Siddharta in this non-fiction novel is how he has pored through voluminous published literature and historical facts on the origins of cancer and managed to write it in a way wherein even laymen that read this book would be highly engrossed in the vivid explanation of cancer diagnosis, treatment options, drug discoveries and outcome.

Advances in cancer have come a long way since Queen Atossa. It has taken centuries to reach where we are in the science of oncology, and we still have a long way to go. While we slowly discover that there are risk factors that eventually cause cancer (some of which was the normal "trend" decades ago, such as smoking and binging on alcohol), we also now discover on which type of patients are at highest rate for cure and who are genetically predisposed to poorer treatment outcomes.

"Cancer, then, is quite literally trying to emulate a regenerating organ - or perhaps, more disturbingly, the regenerating organism. Its quest for immortality mirrors our own quest, a quest buried in our embryos and in the renewal of our organs. Someday, if a cancer succeeds, it will produce a far more perfect being than its host - imbued with both immortality and the drive to proliferate. One might argue that the leukemia cells growing in my laboratory derived from the woman who died three decades earlier have already achieved this form of 'perfection'."

"Taken to its logical extreme, the cancer cell's capacity to consistently imitate, corrupt, and pervert normal physiology thus raises the ominous question of what 'normalcy' is. 'Cancer', Carla said, 'is my new normal', and quite possibly cancer is OUR normalcy as well, that we are inherently destined to slouch towards a malignant end. Indeed, as the fraction of those affected by cancer creeps inexorably in some nations from one in four to one in three to one in two, cancer will, indeed, be the new normal - an inevitability. The question then will not be IF we will encounter this immortal illness in our lives, but WHEN."

And as man fights to survive aging and strive for longer lives and search for the fountain of youth or the drug for immortality, so will the cancer cells that live normally in our bodies, waiting for the time to take us to be part of the next in thing.

This is a must read for all, especially my students and all students and practitioners of medicine. It makes you understand and realize the wealth of knowledge in the discovery and researches in an aspect of medicine that we see in our daily lives.

Alone

I have an uncle who has advanced prostatic cancer.

He's been battling with it for the last 2 1/2 years. And he is single at the age of 66.

Initially, he was in denial, but a few months ago, he accepted his fate. A tad too late, though.

Some of us in the family have chipped in for his medications for palliative relief from the pain and the infections that have come and gone.

In the meantime, his condition continues to deteriorate.

Last Saturday night, I received a call from my resident informing me that he was in the ER. He was conducted by ambulance. He had passed the house of his brother to ask him to accompany him. My other uncle declined. So my uncle ended up in the ER alone. My resident had called me to ask me if I was willing to sign consent for procedures and other responsibilities for him. I told her that my relatives should be contacted for this as I am his nephew and not the primary person responsible for his welfare. Understanding the legalities and ethics of medical practice, my remaining unreliable relatives might end up suing me for taking care of him.

The remaining living relatives residing in the Philippines had actually abandoned all care for my uncle. It was not a matter of caring for him in his time of need. It was about financial matters. (I will not delve on the complicated issue and story of the life of my relatives. That is not worthy of this blog.)

The following day, I went to the hospital to check on him.

It was sad that he was sitting in a hospital bed all alone. When I saw him, I was drawn by so much pity. He was very ill and all alone. I asked my resident Osang to accompany me to him. I was touched by the fact that the clerks, interns, and Medical Residents at UST had taken the time out to buy him food and lend him their mobile phones so that he could contact his siblings. But they all did not want to come. And I had to break the news to him. No one was coming. Then he became teary-eyed and held my hand.

This was the scene I wanted to avoid.

I could not imagine how flesh and blood could abandon someone who is dying.

It was not about the finances. That was the easier part. Parting with hard earned money was something that could easily be replaced. But the emotional support to someone who is your brother at a time when he would need all this family support seemed to have broken down completely. While my other relatives may have financial difficulties at this time, the responsibility of caring for him emotionally was theirs. Providing consent to procedures was theirs as well. It blew my mind that one of my uncles had called me that morning to ask me to just go there and see what he needed and settle everything. Their excuse was that they didn't have the time.

Didn't have the time...

After settling all the accounts at the hospital and giving him money to buy medicines and some other things he may need, he could be sent home.

I blog about this because a part of me died that day.

It pained me to see that even family had little meaning when it came to financial challenges like these. We can always prepare for a life of luxury, but when an illness strikes us, where is our family? How can we be so selfish?

That Sunday morning, I wondered where my uncle drew the strength to continue his battle with cancer in spite of how his brothers treated him.

That Sunday morning, I found the real definition to the term ALONE.

I pray that everyone who leads a life like my uncle, will somehow draw strength from the others like my clerks, intern, nurses, and residents...who took the time to care.

Strangely, it is the nameless people in the crowd who cared more than those who you lived your whole life with.

Being alone is the worst kind of exit we have in this life. Being alone, means losing meaning to everything we lived for. It is the ultimate taste of hell while still being alive.

One day more

I have a friend who's dying.

At the prime of his life, he has been diagnosed to have cancer. Non-smoker, non-drinker, a family man - good provider, husband and father. It started as a bad cough. It must have just been a cold that wouldn't go away. In a recent trip abroad, the symptoms worsened. He experienced difficulty in breathing.

A few days after his return, the cough worsened. His wife was worried but he didn't get to see a doctor until he collapsed at work.

At 30 years old, it was a shock to his family that he was diagnosed to have lung cancer. There was bone metastasis already.

The doctors and family huddled together to talk about chemotherapy, radiotherapy, and surgery. The prognosis was poor, but technology was advanced. They could prolong his life and the new protocols for this type of cancer were promising.

In the confines of his hospital, my friend was asking many questions. Why him? What did he do wrong? What did he do to deserve this? Was he not a good person? He wanted to live. He wanted to see his little 3 year old girl enter nursery school this coming school year. He wanted to experience more out of life.

Ironically, he was not asking about the treatment protocols.

He was asking why him?

Then tears began to flow. Normally, my talkative self would give a lot of heart warming advices on being strong, putting yourself together, hang in there, fight for your life and all that rah-rah perk up your spirit talk.

But he made sense. Why him? All these talk about treatment protocols and options would only prolong the agony, not to mention the financial burden it would put on his family. The truth of the matter is - science cannot explain everything. And science cannot have a solution to everything.

Truth be told, the prognosis was grim. Even with the new protocols, the chance for survival with metastasis was less than 10% for 6 months.

He comes from a well-to-do family. And they can afford the treatment protocol. His parents were at his bedside, providing encouraging words. That it would be alright. That this was simply a setback. The doctors were explaining the treatment regimen to him.

He simply looked away. He was staring at space and at the blank walls.

My friend has never left the hospital, a month after his diagnosis. He has undergone chemotherapy and radiotherapy. When I went to visit him the other day, he was all shriveled, pale, and gaunt. He was hanging in there.

He gave me a smile, a tear, and I couldn't help but smile back and shed a tear as well.

I told him to hang in there. Take one day at a time. You have come this far, one day more my friend.

He smiled and weakly said thank you. And then replied,

"I want to die..."