Battling Cancer

Over the years, whenever I have read an obituary of someone who died of cancer, it invariably has seemed to state some variation on the theme that the deceased died after a valiant battle with cancer. While I have never doubted that anyone who died of cancer suffered terribly and bore his or her ordeal heroically, I have often found myself wondering if in every case the deceased fought his or her cancer, rather than sought some sort of accomodation with it?

If given an initial diagnosis of curable  cancer, most cancer patients probably choose to battle their cancer for at least as long as it is still regarded as curable. Even though cancer treatments involve poisoning, cutting, and burning with both temporary and permanent side effects-- some of which are disfiguring-- and risks of potentially fatal complications, the possibility of cure is sufficiently motivating for patients to undergo almost any horrors and humiliations. 

In my own experience, having been classified as incurable, then possibly curable, then incurable, I think that the risk/reward ratio of undergoing draconian treatments is quite different for the curable and the incurable. For the incurable, all cancer treatments are palliative. Speaking as an incurable, I doubt that I would choose to undergo many of these debilitating treatments in hope of extending life for some short period of time; and I have no intention of doing anything voluntarily to drag out active dying. "To suffer unnecessarily is masochistic rather than heroic." (Frankl, p. 136.)

For the incurable, the struggle may not be so much with cancer as with a medical establishment pushing in good faith, if sometimes mindlessly, the next treatment; as first one, then another treatment loses its efficacy. Fortunately, my medical oncologist seems to be honoring my decision to seek quality of remaining life rather than quantity of remaining life. 

Since my diagnosis and re-diagnosis as incurable, my struggle has been primarily with myself, not with cancer or the medical establishment. I must seek to use my remaining time wisely, to conduct myself appropriately, and to become a better person. If you read an obituary of me that says that I battled cancer bravely, you will know better.

Hiatus

Today, I had a regularly scheduled appointment at MSKCC to have blood tests and to be examined by Dr. Saltz and his associates. Then, if I were deemed to be in good enough shape to withstand another round of chemotherapy, I would go to MSKCC's chemotherapy suite. Although the blood tests indicated that my platelet count was at the borderline of being high enough for me to undergo another round of chemotherapy, Dr. Saltz decided for another reason not to proceed with the chemotherapy for at least a week.

Since early March, my belly has been growing more and more distended. It is now so large that the skin over it is stretched taunt-- like a woman's in her third trimester. Even though I have retained my sense of taste and a fairly good appetite, I can now eat only small meals because of the ensuing pain if I stretch my stomach more than minimally with food. I no longer exercise beyond taking walks of less than a mile, as the slight rotation of the torso that is part of each step generates both moderate internal pain and a shifting of the cloth of my shirt that irritates the hypersensitive skin over my belly. The reduced caloric intake and lack of exercise are causing me to lose muscle mass steadily, yet I am gradually gaining weight. Although the pain is not intense enough to interest me in pain medication, the only position in which I am now pain- free is sitting. Even my back hurts in other positions, presumably from supporting the big belly.

Dr.Saltz and his colleagues have not seen a similar case and have no idea why my belly is growing. They have scheduled me for more blood tests and a CAT scan and then for appointments on Tuesday, May 25, with Dr. Jarnagin, the surgeon who operated on my liver, and with Dr. Saltz.

There is nothing that I can do about this mysterious complication other than be practical. For the last few weeks, I have been relegated to wearing low-cut jeans. Consequently, I decided to send my clothes to my tailor with instructions to enlarge the waistbands of the trousers and the waists of the jackets to the maximum extent that there is spare cloth in each garment. I hope that some of them turn out to be wearable. With no chemotherapy, I may feel good enough this week to go somewhere that requires clothing more formal than jeans. 

Complaining

Because it is difficult to view one's own actions objectively, I may complain a lot more than I realize about my cancer-related physical sufferings. A great many cancer patients are enduring torments that are much worse than anything that I have experienced, and I assume that my own physical trials will continue to increase in severity. Thus, while I am far from stoic, I hope that I am not complaining much.

Economics 101

Recently, I was chatting with an economist and asked him what he thought about the U.S. dollar.

"I think it will be the world's reserve currency for a long, long time."

"Why are you so sure?"

"Because, we have the only thing that really counts."

"What's that?"

"The most nukes."

Misspent Youth

The Preakness Stakes, the second leg of racing's Triple Crown, was run today in Baltimore at Pimlico Racetrack. I have journeyed four times, though not in recent years, to that dilapidated facility-- known affectionately in its glory days, such as the era when Alfred Gywnn Vanderbilt was its president, as "Old Hilltop"--  to attend the Preakness. 

When I was a sophomore at Princeton, I won a daily double (i.e., I picked the winners of the first two races) at approximately 240-1 odds on a single bet at Pimlico on Preakness day, then followed up the next Saturday at another track with another big daily double on a single bet. Thereafter, I had a small following of freshmen who would cut class to take my bets to the tracks. Ah, misspent youth! 

Like most of us of a certain age, my powers of concentration are not what they were when I was an undergraduate. I made a single bet on the winner of today's Preakness, and I was lucky enough to win the exacta in the Preakness (i.e., I bet on the first two finishers in order) at 93-1 odds. Because I made two exacta bets, not one, the odds on my total exacta bet were cut in in half. As my bets on the Preakness were my only bets today, I did well: so well that I won back about half of what I lost betting on my own horses, Hot Money and Mustang Island, last week.

Aftershocks

The aftershocks of the financial crisis of 2008 are shattering complacency. Some of the pillars, or basic assumptions-- on which the civilization of the West in general and of the United States in particular currently rest-- look shaky. Among the pillars that never made sense to me that are now undergoing stress tests:

Sovereign debt of countries with mature economies, aging populations, and escalating social-welfare obligations is a sound investment;

Fiat currencies, subject to devaluation in order to stimulate exports or "repay" debt denominated in a debtor-nation's currency, are a storehouse of value;

The Euro, with no central fiscal authority and culturally limited mobility of labor, can survive sharply diverging member-country economic needs;

Governments have unlimited resources on which to draw to support domestic institutions and one another;

Because the dollar is the world's reserve currency, the United States is not constrained by the fiscal and monetary discipline required of all other nations;

The United States can conduct its foreign policy and military activities without fear of retribution within its own borders.

Eventually, it is reasonable to expect other pillars to undergo stress tests:

With a steadily declining percentage of world economic activity, the United States can continue to account for over half of the world's military expenditures;

The United States will not have to ration healthcare;

The social contracts that depend on working-age populations supporting retirees can survive declining birthrates;

With universal suffrage and largely uneducated populaces, democracies can make difficult decisions.

I have liked the world, with its convenient fictions, in which I have lived. I doubt that the reconfigured world will be nearly as privileged and comfortable for Americans like me. Nevertheless, I wish I were going to be around to see what happens.

Malcolm Gladwell

A friend brought to my attention an article by Malcolm Gladwell in the current (May 17) issue of The New Yorker, entitled "The Treatment: Why is it so difficult to develop drugs for cancer?"

The article uses Synta Pharmaceuticals as a case study.

 

Clearly, Gladwell appreciates the crudeness of extant cancer therapeutics and the difficulty of discovering new ones. My own reaction to his fine article is that we know a lot more about biology and cancer than we did even a few years ago, and we can't let ourselves get discouraged. We have to keep putting resources into basic research. And even though the classic venture capital model is broken, we have to find some way to keep financing small biotech companies like Synta (which is now publicly traded).