The Point of No Return
We had just buckled ourselves into our seats when a distinctive purring voice came over the loudspeaker. It was the captain, who congratulated us on being the first group of passengers to fly from New York to Tokyo via sub-orbital space travel.
“Folks, when we reach our cruising altitude of 55 miles I’ll turn on the seat belt sign so that no one floats off down the aisle.” We all chuckled at the thought, and settled in for the most exciting trip of our lives.
No one really remembers where we were when we got the announcement. I know that someone had previously remarked that the Earth looked quite distant to her. The flight attendants had been flying quickly back and forth from the cabin to the cockpit, and an uneasy buzzing in several languages could be heard throughout the spacecraft. When the captain spoke again we stared out the window in disbelief, full of stupidity and repentence:
“Folks, we’re still trying to figure out what happened, but it looks as if we have left Earth’s orbit, and unfortunately we don’t have enough fuel to return. We can steer though and we’ll just have to keep flying until we come up with a plan. We’ll keep you posted.”
When medical oncologists decide to start patients on treatment they seek to reverse the course of the illness known as cancer, to bring patients back from an unhappy journey that is sending them further away from normal life and closer to uncharted worlds where suffering awaits and beyond that the mystery of the grave. Some patients who begin chemotherapy will quickly turn about and re-enter our atmosphere. Others will alter their trajectory so slowly as to elicit despair from their families, only to finally circle back toward the anxious faces.
Some patients continue on their way despite our best efforts to detain them, straining the necks of those who dare to follow their path in the sky, becoming a distant glow that seems a star before vanishing forever. No matter how sophisticated our prognostic panels are we oncologists cannot predict with certainty which patients will respond to treatment and which are irreversibly chained to the ship traveling toward oblivion.
This tends to annoy us.
As an example, I offer two patients from my practice, both with the same diagnosis and both with liver metastases. One was old and frail, the other middle-aged and still working. Both were treated with the most promising of treatments available. Both tolerated the chemotherapy and biological therapy well. I was certain that only one of the two had a realistic chance for remission, and I was right. I was also wrong.
The vigorous younger patient died as quickly as the last rose of summer. The elderly patient’s tumors are melting away as smoothly as a cruise ship pulling into a hibiscus-scented tropical port.
Tonight I sit in a chair on the screen porch, feeling the night breeze, attempting to focus on page 24 of an excellent novel, but instead whirling about on a merry-go-round of questions and more questions. Over my right shoulder I hear the rumble of a jetliner as it sails across the blackness. It is invisible against the sky but its sound reverberates throughout the neighborhood, as if announcing a final flight now departing. The large country clock hanging on the wall silently counts out the seconds remaining until it is time to return to work.
