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.
Dr. C (for cheerful)
Your questions you are asking yourself are the same ones Bernie Siegel, MD asked himself 20-some odd years ago. Why do some thrive and even survive against all predictable odds? Many other physicans scoff at his work, though many are at least letting the possibility of the notion that a person’s attitude and thoughts may have a positive or negative impact on thier health. I don’t mean to say that one can ‘think away’ cancer. I do, however, believe that a faith in ourselves, God, if you are so inclined, in science, in your medical team, participating in drum circles, or in the proven healing affects of petting your dog…. whatever it takes to put you in a place of calm and healing can and does positively affect your body.
Some call the stories of spontaneous remission or those who win against tremendous odds ‘anecdotal’. In my opinion, as long as the alternative treatment does no harm, I’m happy to be an anecdote.
Of course, every life ends, and many young people die, and it is never, never the fault of the cancer patient that they have a disease. But what they perceive does affect them.
A recent study at the University of Michigan proves that believing a pain reliever works is enough to release endorphins to ease the very real pain.
(read the August 24 article in the Journal of Neuroscience by J.K.Zubieta)
It has also been proven that stress has a negative impact on the body in many ways: raised blood pressure, heart problems, ulcers) The thinking impacts the body.
Perhaps your two patients perceived their illness in a different way. Or perhaps it was just fate. I don’t pretend to have all the answers, and bad things certainly do happen to good people….but IF our thinking can affect our bodies, why not with cancer?
I think the that adding this element to the regular course of treatment appropriate for the patient’s particular cancer should be encouraged by oncologists.
It just can’t hurt.
(I am just a patient, not Bernie’s publicist or marketing person. I speak only for myself)
Lynne aka Feisty
Comment by Feisty — September 1, 2005 @ 2:36 pm
The fact is that drum circles, a positive state of mind, or drinking green tea with mint may in fact cure cancer, I mean really, why not? Remission happens sometimes for reasons that are totally unfathomable, and maybe these things do work for people with situations and circumstances we do not understand. Are they all worth trying? I suppose if you’re dying and you’re otherwise focused on making if through the next chemo or radiation treatment why not? I mean really, who can tell you it’s a waste of your time when the fact is that we cannot definitively pin down why some people die and others thrive, and in fact we cannot even predict who will most likely live or die. I mean does that suck or what? Which I guess is why at this point in our knowledge and understanding medical practice, especially the sort practiced by an oncologist, is more an art than a true blue science, and fortunately for you, based on what I read in your blog posts, you have the heart of the artist.
The artist doesn’t always know
Instead does what feels right
And in the end hopes for the best
Not such a hot Haiku, but sums up being an artist or, in many instances, a doctor.
Comment by James — September 2, 2005 @ 3:10 am
I don’t know about the green tea and the “faith” part, but I can personally attest to having seen people “live” or rather, “hang on” through sheer will power. I have had 2 family members who were not diagnosed early hang on and on and on during the last days so they could meet small goals and/or say “goodbye.”
Dr. C, be at peace in knowing that you do all you can, the best you can. It takes an inner peace to continue to be a warrior. And I believe cancer is worth fighting, don’t you?
Comment by ThirdDegreeNurse — September 4, 2005 @ 11:54 pm
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