On Cancer

A creative writing teacher told our class many years ago that we should never write about cancer in fiction.  Cancer was cliched, and it conveyed tragedy.  The reader's assumptions and stereotypes would detract from the story.

What will I do, then, if I choose to tell the story of my life through the lens of fiction?

My grandmother died from breast cancer.  My father died from bladder cancer.  My aunt died from endometrial cancer.  My sister-in-law died from brain cancer.  My cousin's son died from bone cancer.  My mother has glandular cancer, my cousin has liver cancer, and I've had three cancers.

As explained by the American Cancer Society, the word cancer comes from the Latin for crab--an unfortunate image that most likely arose "because the finger-like spreading projections from a cancer called to mind the shape of a crab."  In contrast, the finger-like projections from the Cancer constellation are quite lovely:

The faintest of all the constellations in the zodiac, Cancer is hard to find.  

Our writing teacher no doubt said something like this, which I found from the Institute for Writers: "Often writers imbue their ailing characters with a disease to such an extent that they seem like merely an embodiment of the illness . . . It makes for uninteresting two-dimensional characters.  (Insert yawn here.)"

Cancer has become my companion over the years, not a friend of course, but a familiar figure.  I know how it moves and how it acts.  I know not to be surprised.  And if I ever write about the people I've known with cancer, they won't be cliched or two-dimensional.  You won't have to yawn.  For their cancer has never defined them.  Rather, they've defied it.  Their personalities, quirks, and talents have far outlived this disease.  

The crab can scuttle all it wants, sideways hither and yon, but I'll take the image in the sky--whether I can see it or not.

May Monotony

The news this week, I'm sorry to say, isn't interesting to me.  I loved the photos of Chris Christie and Prince Harry, and Angelina Jolie's disclosure was provocative on many levels.  But otherwise, the reporting of this week's events--the IRS, the AP, Benghazi--seems overridden by hyperbole and distortion.  So I'm posting a picture of my columbine instead.

Medical Malapropisms

January and February are big medical months for me, when I immerse myself in the world of doctors and dentists.  Though I find the language of medicine largely unappealing, yesterday I came upon the word "osteopenia" and realized that it was an unusually pretty word whose definition doesn't match the way it sounds.  So here are some proposed alternative definitions for words from my medical records, making the unpleasant perhaps a bit more pleasant:

Osteopenia--an island off the coast of Italy

Phlebotomist--a Medieval botanist

Mammographer--one who charts the migrations of whales

Bitewings--yellow-crested birds native to Belarus

Neoplasm--A premature baby platypus

Cecal polyps--Underwater caverns ringing the Galapagos

Carcinoma--Female Spanish filmmaker

Ileum--A Greek melodic tune

Mucosal--Of or pertaining to the coastline of Muscat

Atypical nevus--A blue star visible only in the southern hemisphere

Medical Malarkey

A headline on nytimes.com last night caught my attention: "Test for Cervical Cancer May Detect Other Types."  I clicked on the article eager to learn which cancers might now be treatable.  The news sounded promising.

I should have known better, for a few sentences later came the usual let-down: "But the research is early, years away from being used in medical practice, and there are caveats."

Sometimes I feel like telling medical researchers to keep their work to themselves until they have proven methods of treatment.  Such thoughts are ignorant, I realize, for disseminating information is crucial to advancing knowledge.  Nonetheless, we read these sorts of stories over and over again, raising false hopes for what's available now.

Medical research and its accompanying reporting are full of misleading, confusing information.  Take this recent one, for example.  After being told for years that most of us need to lose weight, we read in The Times that a "Study Suggests Lower Mortality Risk for Overweight People."  "Fat per se is not as bad as we thought," says one researcher, while another says, "We wouldn't want  people to think, 'Well, I can take a pass and gain more weight.'"

The contradictions are almost laughable.  It's hard to know what to do.  But continuing to view our medical profession as somehow holier than thou is misguided. 

I think the emperor wears no clothes.

A Dog Lover's Life

I had intended to gather interesting quotations from the weekend and post them this morning.  I was prompted by Maureen Dowd's column yesterday in The New York Times, where she rightly applauded Joe Biden's negotiations with Congress and ended by saying, "He knows how to stoop to conquer."  I'm sure I could have found other such observations.  But then life intruded and I got one of those remarks from our dog's vet that makes time stop.  "I'm concerned that he has a brain tumor," he said of our beloved Cassidy.

I've heard similar diagnoses before in my life, sometimes directed at me and sometimes told to me about those I love.  The effect is always the same: the taste of food dulls, the light around me sharpens, and memories flood in.  Life in the moment and on the edge.

In the midst of this, I appreciate above all the kindness of our vet, the love of family and friends, and the wondrous and wonderful companionship of our two dogs, Cassidy and Sundance.  They've brought to my life miracles beyond anything I could ever have imagined, gifts of a lifetime.

Living on the edge is the least I can do for them.

"The Scream"

That "The Scream" sold for nearly $120 million last night at Sotheby's seems fitting.  It is the symbol of our time, after all, and only increases in relevance as life grows more bizarre.  All you need to do is read the front page of any American newspaper or listen to the evening news, and you'll feel exactly like the figure in Edvard Munch's pastel.

The Language of War

How we love to wage war in America. In addition to our war on terrorism, we've initiated wars on cancer, drugs, and poverty. Another war, the one that rages every 4 years, has already begun: our presidential campaign. Consider the language: Which candidate has the bigger war chest? How will the battleground states vote? Who has more field offices established? Have the campaigns enlisted their armies of volunteers?

In one sense the outcome of this war will be clear: either Barack Obama or Mitt Romney will win. But in another sense, the outcome will be fuzzy. For in modern America the winners of wars are those with the most money. Defense contractors, for example, reap victory in Afghanistan and Iraq; drug companies, hospitals, and high-tech medical manufacturers triumph in the war on cancer; drug cartels and weapons manufacturers continue to win the war on drugs; and all of us but the poor sweep the war on poverty.

The winners in 2012? The big donors, the super PACS, the people we don't know and don't elect who dictate how the rest of us live. For in this war corporate America--especially energy, finance, and health care interests--brings out its big guns and mows everybody else down.

I guess we'll just have to wait and see who's left standing when the air clears.

Quotes of the Week

Here's what a few people said this week. We need voices like these when hypocrisy and deception are so widespread:

Reporter Marie Colvin, speaking before she died yesterday about Syrian armed forces: “It’s a complete and utter lie they’re only going after terrorists. The Syrian Army is simply shelling a city of cold, starving civilians.”

Virologist Renato Dulbecco, who died Sunday and whose Nobel Prize-winning research showed that genetic mutations cause cancer: “While we spend our life asking questions about the nature of cancer and ways to prevent or cure it, society merrily produces oncogenic substances and permeates the environment with them.”

New York Times columnist Gail Collins, yesterday, in discussion with David Brooks about the abortion legislation proposed in Virginia: "I’m being driven crazy by people who are obsessed with limiting the scope of government, but feel perfectly free to demand that government get involved in women’s most personal choices."

Former Labor Secretary Robert Reich commenting on the huge sums of money that superdonors are contributing to conservative PACs: "Whoever emerges as the GOP standard-bearer will be deeply indebted to a handful of people, each of whom will expect a good return on their investment. . . Never before in the history of our Republic have so few spent so much to influence the votes of so many."

Food writer Mark Bittman commenting on Procter & Gamble's sale of Pringles to Kelloggs: "[If we didn't process so much real food,]Kellogg’s and P.&G.’s bottom lines might not look so good. We ourselves, however, might look better, as would our health care bills, which in general rise along with Big Food’s influence and profits."

Drug Shortages

The news this week that hospitals face a shortage of the drug methotrexate to treat a form of childhood leukemia sent chills down my spine. Imagine being the parent of a child ill with this disease and learning that, here in the United States, we don't produce enough of this curative drug. You'd think that you were living in a developing country, not in the richest nation in the world.

When I hear stories like this, I feel confirmed in my belief that our nation has its values turned upside-down. If there's one thing we should be able to do well, it is to take care of our sick citizens, especially our children. We have the best research institutions in the world, devoted doctors and nurses with access to the highest-quality equipment, a long-standing tradition of manufacturing, and pharmaceutical companies raking in huge sums of money. Surely this combination of talent and wealth should produce life-saving drugs.

Yet 287 drugs are currently in short supply.

The horror stories are forcing Washington to pay attention, and some effective measures have been implemented. Still, we should demand better for ourselves and for our fellow citizens around the world. Most of us would agree that our family's health is what's most important. Can't we demand that our leaders and institutions follow suit?

The End of the World

I laughed (along with lots of people) at Harold Camping's apocalyptic prediction this week. On Sunday afternoon I told my family I would be leaving them soon, and at 6:00 that night--when the rapture was supposed to start--I said, "I feel like I'm floating." The jokes about these supposed ends of the world are themselves endless.

But then on Tuesday The New York Times ran two articles together: one on Camping's revised prediction that both the rapture and the world's end will arrive now on October 21, and one on the aftermath of the Joplin tornado--the search for the living and the dead. In reading the articles I realized that the monster tornado hit Joplin around the same time that Camping's saved souls were supposed to be ascending to heaven. At around the same time that the rest of us would begin our hell on earth.

Which is exactly what happened in Joplin, Missouri.

We don't need firebrand preachers and Bible-waving soothsayers to remind us that the end of the world arrives every day for someone somewhere on the globe. If we forget, we're quickly reminded by storms or by illness or by death.

If the rapture ever comes, it will surely take all of us for none of us deserves the suffering we endure. It's part of being human.

Golden Oldies

Now I know why I've listened to Oldies radio stations all these years that I've driven up and down I95. They take me back to another time I call simply "BC"--Before Cancer.

Thanks to John Lennon, Billy Joel, Bruce Springsteen, and Queen for reminding me of the good old days.

For Mrs. Edwards

Long after we've finished dissecting the tragic life of Elizabeth Edwards, I will remember her for this: her honesty and courage in living with cancer. Like Michael J. Fox and Christopher Reeve before her, she brought into light the reality of living with advanced, incurable disease.

She didn't try to tie a pink ribbon around her situation, either. She knew this disease would take her life, and she told us so. She knew that her days were numbered, and she reminded us that ours are, too. She knew that cancer wasn't something that she could "beat," but she continued living her life undaunted by death's shadow.

Many people's hearts went out to Elizabeth Edwards over the course of her life--for her son's death, for her cancer diagnosis, and for her husband's infidelity. Unlike many in our ruling political class, she seemed real and human and as vulnerable as the rest of us.

Hers was a troubled journey, though perhaps in truth, her story was ours as well--just played out on a larger, more public landscape. For who among us doesn't experience pain, loss, and betrayal somewhere along the way?

Whatever contradictions may have existed in her personal and public life don't matter in the end. What we have left is the public face that she showed us. And it was a face that accepted life's terms--the hardest terms of all--without flinching.

I'm sorry that Elizabeth Edwards has died. I wish her children well and hope that they are buoyed in the years ahead by the uncommon strength of their mother.

Medical Money

It turns out that a standard treatment for thyroid cancer—swallowing radioactive iodine—could cause problems for people other than patients. According to a recent article in The New York Times, “Scientists have estimated that . . . a secondhand dose could exceed an average American’s annual level from all natural sources, and three or four times the safe level recommended for a pregnant woman.”

Patients undergoing radioactive treatment used to be quarantined in the hospital (as they still are in Europe). But in 1997 our Nuclear Regulatory Commission dropped the requirement; now patients go home, encountering any number of vulnerable people along the way, and some check into hotels, where another group of strangers could be exposed.

Not everyone thinks there’s a danger, however, as the Times article reports. "'We’re talking about really small doses,' said Dr. Henry D. Royal, the associate director of nuclear medicine at the Mallinckrodt Institute of Radiology at Washington University. 'Who is it going to harm?' added Dr. Royal, who is on the executive board of the American Nuclear Society."

Who will it harm? How do we know?

This is one of our biggest problems in medical care today: who do we believe? In this case, do we believe a group of scientists and endocrinologists? Or do we trust nuclear medical doctors? Don’t we at least question the recommendation of those most invested in the status quo?

These sorts of questions arise every day. Is the information gleaned on a CT scan worth the dose of radiation received? Is it necessary for an 80-year-old patient to undergo a colonoscopy? Is the long-term use of any drug unequivocally safe?

The answer to all of these questions is muddied by money. In every case, industries and individuals make a bunch of money from the recommended treatment. In many cases the industries that stand to benefit fund the research itself. Conflicts of interest in medicine can make you dizzy.

We’re left with this fundamental problem of our medical care: As long as our health depends on profitability, we will never be the healthy society that we could be.

Pretty in Pink

Pink is everywhere this month, even on the golf course. But as lovely as this muhly grass looked yesterday, I couldn't help but think of all the breast cancer pink we see in October. It may be too much, and it may not be the right shade of pink.

As Barron Lerner describes in his discussion of Gayle Sulik's new book--Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health--many of the corporate sponsors of Breast Cancer Awareness Month are themselves pharmaceutical companies invested in the manufacture of cancer drugs. With cancer funding heavily weighted towards treatments and awareness rather than prevention, these sponsors may represent a conflict of interest. Indeed, a key part of Sulik's book is her analysis of the “financial incentives that keep the war on breast cancer profitable.”

Lerner does not dismiss the efforts of the Komen Foundation and other fund-raising groups. He captures, though, the frustration that many activists feel with a funding culture that doesn't sufficiently sponsor research into the causes of breast cancer.

Ubiquitous pink is a reminder of a devastating disease. Perhaps someday it can be the symbol of successful eradication.

Karkinos

My hairdresser is offering pink highlights this month, the proceeds of which will support breast cancer research. A friend told me today of two women with ovarian cancer. Family members are ill with this disease. Does it seem to anyone else that cancer is everywhere?

Wondering why the name cancer springs from the Greek word for crab, I discovered that Hippocrates coined the term based on the crab-like appearance of tumors. The website About.com provides us with this additional historical information:

"Today, we know so much about the human body; however early Greek physicians weren't so fortunate. Hippocrates believed that the body was composed of four fluids: blood, phlegm, yellow bile and black bile. He believed that an excess of black bile in any given site in the body caused cancer."

This statement gives me pause. Do we really know much more about the origins of cancer than Hippocrates did? As one who has suffered this disease, I think he's on to something. Cancer often comes roaring out of nowhere with no discernible cause. It follows its own unpredictable course, having stumped generations of doctors and scientists.

An accumulation of black bile in the body seems as accurate as anything else I've ever heard.

Hanging by a Thread

The 18-year-old son of the art teacher died last week in a car accident, along with his good friend. In the past year two other staff at my daughter's school lost their sons, one to a car accident and one to cancer. None of the boys lived beyond their early 20s.

We are--all of us--hanging by a thread. It's only every so often that we're made aware.

Get the Lead Out of Lipstick

My Redken shampoo has over 40 ingredients in it, most of which I don't recognize. The first is water, but it goes downhill from there, with substances linked to cancer, hormone disruption, and immune system suppression. On the front of the bottle, the company highlights one ingredient--grapefruit extract--I guess because this sounds natural and healthy. But guess what? Grapefruit extract is the 43rd, and final, ingredient. I doubt that this small amount offsets the toxicity of the parabens, sulfates, and propylenes that precede it.

Redken and Procter & Gamble and lots of other skin care companies want us to think their products are filled with green, organic goodies, but they're not. Labels are misleading and ingredients are often known to be toxic and carcinogenic. How can this happen? The cosmetics and skin care industry is loosely regulated; FDA oversight is weak, and cosmetics firms themselves determine the safety of their products. Annie Leonard's new video, The Story of Cosmetics, gives an excellent overview of the current, dismal situation.

New federal legislation proposed last month hopes to change this. The Safe Cosmetics Act of 2010 will phase out harmful ingredients, raise safety standards, improve labeling, and fund enforcement. For those who wish to support this legislation, The Campaign for Safe Cosmetics is a good place to start.

In the meantime--while we're still unprotected--consult the Environmental Working Group's data base, "Skin Deep." It provides detailed information about known and suspected problems with a host of chemicals.

I've seen too much cancer in myself and in family and friends to think there's no correlation between our environment and our health. Profiteers will surely not look out for us. If we don't work to protect ourselves and our children, who will?