Tag: cancer

Dr. Henry Marsh’s And Finally: Matters of Life and Death


Am reading Henry Marsh’s And Finally: Matters of Life and Death. Marsh is a retired brain surgeon, who recently was diagnosed (2021) with advanced prostate cancer, presently in remission, but with a 75% chance of reoccurrence.

His previous books include Do No Harm and Admissions: Life as a Brain Surgeon, both well received. Professionally, he has published 179 papers in peer reviewed journals and performed 50,000 surgeries over a 40-year span.

In his fulsome writing, Marsh reminds me of the late neurosurgeon Oliver Sacks, gifted in eloquence, humble, and unfailingly compassionate.

Perhaps I’m stereotyping, but he’s unlike many in the medical sciences, consumed by professional interests and profit motive, insensitive or ignorant of the arts and, professionally, objectifying their patients rather than seeing them as individuals, each with gradients of need and longing.

One of his cherished accomplishments is the creation of two balcony gardens for neurological patients at St. George’s hospital

Impressively, he’s been working pro bonum with colleagues in Ukraine since 1992. Neither cancer nor the Russian 2022 invasion of Ukraine has deterred the good doctor visiting the country regularly to consult and advise colleagues.

At home, Marsh is an assisted dying activist.

Of his previous Do No Harm, now translated into 37 languages, The Economist wrote that it’s “so elegantly written it is little wonder some say that in Mr Marsh neurosurgery has found its Boswell.”

Marsh reads widely, owns several thousand books, keeps a garden, raises bees, and enjoys woodcrafting.

I’m early in my reading of And Finally, so I’ll delay full commentary for another post when fully read. But let me share a passage I read this morning that amplifies Marsh’s writing talent infused with observation and an affinity for nature, under assault by climate change:

The {COVID} lockdown coincided with perfect spring weather – so fine, prolonged and warm that it spoke of climate change. The bushes in the little paradise of my back garden almost all burst into flower all at once, and the trees went from being bare winter skeletons to towers of spreading green leaves in a matter of days. The bees came rushing out of their hive in front of my workshop and shot up into the sunlight, rejoicing in vertical zigzags. And the lockdown brought complete peace and quiet. The air felt as fresh as if you were in the countryside and the sky was a clear and deep blue. The only sounds were of birds singing, children playing and the wind in the trees. And at night, at first there was a full moon, looking down kindly on the suddenly silent city, and you could see the stars. It was a vision of heaven, here in London, SW19. Time had stopped. Eternity is not the infinite prolongation of time but instead its abolition.

The silence and clear air, and the return of birdsong, reminded us of what we have already lost with cars, pollution and the changing climate, and the unnaturally fine weather told us that Nature is out of joint, and that there is much, much worse to come.

I feel it in my bones. This is going to be a great read.

—rj

 

The war on cancer: New treatments lock-out most of us

trialsDeath has many doorways, none of them particularly pleasant, but some downright gruesome, cancer for instance.

My father died from lung cancer at age 79. That’s a generous portion of life, when you consider the mean is several years less. Nonetheless, I remember his final hours at the Veterans’ hospital in Chelsea, MA, strapped to his narrow bed, and the moaning that even massive morphine couldn’t assuage.

And then there was my brother, Donald, so full of life, with robust talent and zeal to harness success. I had been doing a seminar at Claremont Graduate School in California that summer in 1979. Weekends I’d spend with him and his lovely wife, Barbe. Six months later, the devastating news of brain cancer, immediate surgery that made him no longer Donald, and death seven months after–cruelly, on his birthday. He had turned 47.

Then there’s my niece, Denise. She passed away several months ago from myeloma dysplasia (considered a blood cancer malady). I had spoken with her on the phone several months earlier. She’d been eagerly looking forward to her upcoming bone marrow transplant from brother, Richard. Initially, it went well, then relapse. She was 57.

Two of my siblings survived cancer. Ruth was experiencing intestinal distress suggestive of colon cancer, but doctors at the local hospital failed to find anything wrong after administering a CT. Thanks to my niece’s insistence on a second opinion, doctors at Massachusetts General, doing their own CT, found a baseball size tumor, diagnosed as Stage 3 cancer. They seem to have got it all in the surgery the very next day.

My brother David received chemotherapy and radiation for his colon cancer, following surgery. Proving the cure can be as devastating as the disease, radiation destroyed his digestive capacity, subjecting him to a hugely diminished quality of life.

I realize this is painful reading, but cancer insidiously invades our life premises in one way or another despite our efforts to wall it out. We get nowhere “crossing the street” to ignore it.

One thing about cancer is it is impartiality. It respects neither age, wealth, nor origin; the pious or the amoral.

One of its monstrous cruelties is when it ravages children. It’s what the Jimmy Fund is all about.

I remember how, in 1971, President Nixon, meaning well, declared war on cancer. Now, forty-five years later, it continues to assault many millions. Recently President Obama renewed that war in this year’s State of the Union address, pledging $1 billion for new research.

Each year, more than 500,000 Americans succumb to cancer.

That surpasses by more than 100 million the toll of American deaths in all of WWII!

In this year, 2016, an estimated 595,690 deaths will occur.

Even more ghastly, 14 million Americans have the disease right now!

But there’s good news to be had as well: a 21 percent drop in cancer mortality from 1991 to the present.

This may result from a more knowledgeable public, making lifestyle changes that include giving-up smoking, exercising more, eating healthier foods, undergoing yearly physicals, and taking advantage of screening venues that include colonoscopies and mammograms.

What’s more, there’s a plethora of new drugs along with innovative trial therapies that utilize one’s immune system, potentially bypassing radiation and chemotherapy protocols with their often serious side effects. In early phase 1 trials, we’ve seen B-cell leukemias and lymphomas disappear.

The problem is that these trials are often highly specialized, focusing on rare, sub-category cancers.

Additionally, there are all too few trials available even for those who qualify.

Frequently, doctors contribute to the dilemma, refusing to recommend patients for inclusion in a trial or committing to a new approach until the traditional cancer options of chemotherapy, radiation, and surgery have proven ineffectual. In short, it’s imperative we advocate for ourselves, keeping aware of new methodologies and of doctors and cancer centers on the cutting edge.

Former president Jimmy Carter, however, lucked-out. On August 20, 2015, he made public that he had melanoma induced cancer that had metastasized to his brain. With a 3-5 pound tumor, experts gave him only several months to live.

Along with radiation, his treatment protocol included infusion of pembrolizumab (keytruda), one of several of the new immunotherapy drugs employing the immune system and endorsed by the FDA for those having exhausted other therapies.

On December 6, 2015, Carter shared the good news that his recent brain scans were negative for cancer.

This would seem to bode well for the rest of us that the day may be coming when we’ll see the scourge of cancer pushed back, sparing ourselves and our loved ones.

But keytruda doesn’t come cheap at $150,000 for a year of treatment. For seniors, the most prone to cancer, Medicare, which won’t even pay for your glasses, hearing aids, etc., isn’t likely to cough up money for your treatment any time soon. Same story with private or employee insurance.

Fame and fortune access, as always, the best medical care. The poor and minorities needn’t apply.

But let me add another caveat to all of this: immunotherapy, while promising, is hardly around the corner as a standard protocol any time soon. Was Carter actually cured, or is this simply cancer’s quirky finesse to tease with remission rather than resolution?

Beware media hype! In the trials for keytruda, 76% of 173 patients receiving the drug didn’t see their tumors shrink.

In the follow-up on those who did experience tumor shrinkage, the time element was a paltry 8.5 months. Normally, we’d like to view things in a five-year context.

As I see it, however, it’s the prohibitive cost factor that largely hinders the delivery of effective cancer treatment, delaying the finding of a cure.

In summing up, though life and death are inextricably bound together, we prefer avoiding any discussion of death and do our best to masquerade its occurrence.   On the other hand, when we confront our mortality we enter into the larger, more important question as to how then ought we to live?

We may not have an an answer to the riddle of cancer in our lifetime, but we can defy it with courage and living out our destiny with human sympathy and loving kindness,   indulging  in each new day as unique in its capacity to enthrall with the cornocupia  of life.

–rj