Archives of The Cheerful Oncologist, Volume 2

I received a disturbing shock last week while walking through a local shopping mall. It involved the ghost of one of my patients who had recently died. The horror of the situation didn’t hit me at first, but within seconds I was overcome with panic and hurried my pace, afraid to turn around and look again. After I recovered my senses I spent the rest of the afternoon pondering the significance of the event. My emotions alternated between embarrassment and dismay until I finally reached a reconciliation with myself and was able to move on to the remainder of my day.

You see, what happened was not that I saw a ghost, but that I wanted to see a ghost but couldn’t.

While strolling down the hall I saw the wife of a patient of mine who struggled for months to live with metastatic cancer. He was a weekly visitor to my office before finally succumbing to his disease, a patient whose suffering was heartbreaking to observe - truly a memorable patient.

Or so I thought. As I crossed the path of his wife that day, walking just fast enough to be past her before my brain could identify her place in my memory, I suddenly realized that I could not recall the name nor the face of her husband. Too humiliated to turn and call out to her, I wandered on aimlessly, searching and searching for a face to go with hers, the face of a man I once knew well, a face that withered before my eyes and then, like a mask left behind after an elegant affair, was placed inside an old trunk, forgotten forevermore.

Eventually I remembered him and how he sat quietly next to his wife through all those visits, full of misery and apprehension. Now he exists only in the mind, a ghost who can only appear if summoned from the tangled nest of names and faces that, no longer noticed, have faded from memory.

Wherever my patient is now I want him to know that he has not been forgotten - he is welcome to haunt me at his leisure, which I assume is limitless. Like Hamlet pacing on the ramparts of Elsinore, doctors also need to see ghosts. It reminds them of the gravity of their work, of the sorrow that strangles a woman as she walks alone down a corridor crowded with strolling lovers.

“Marijuana Use Does Not Raise Lung Cancer Risk”

[Editor’s Note: In keeping with the policies, rules, regulations, voluntary self-flagellations, edicts and Ouija board messages of this website, upper management has instructed me to remind the gentle reader that neither The Cheerful Oncologist nor his staff, minions, roadies, ancestors or anonymous love-letter-writing admirers condone the use of illegal drugs.]

I remember the day as clearly as if it was today. The sun gloated in the pale cream sky as it baked a gaggle of kids lying around the city pool. I was dazzling the girls (or so I thought) with a recap of last night’s episode of “All in the Family,” which was our favorite show as well as a national phenomenom back then. Inevitably our conversation turned to forbidden activities, as it did frequently during our junior high school years, and the topic of marijuana drifted into sight. Only the roughest kids in school were awarded the distinction of being bad-ass pot smokers, which in those days was unquestionably acknowledged as the highest caste in our rigid social system. The rest of us just jabbered about marijuana like a busload of women on an Elderhostel tour. I would be lying if I said we never wondered what the feeling was like to be high. Most of us never got the opportunity to find out, and those who did never really took up the habit, mainly out of fear of breaking the law. We had a vague uneasiness about smoking marijuana, the same feeling one gets when touching a match to charcoal soaked in lighter fluid.

Some of us grew up to be doctors. At least one of us became an oncologist who, among other duties, implored his patients and friends to make healthy choices. One of the choices he advocated was to minimize the risk of getting lung cancer by not smoking cigarettes - or marijuana, which is known to contain the same carcinogens found in tobacco. In fact, most doctors assumed that marijuana smoke was more harmful than tobacco, and it would only be a matter of time before scores of long-term pot smokers would march out of their homes like the zombies in Night of the Living Dead, mortally stricken with lung cancer.

Now this report appears: “In the study, the heaviest smokers were those who had smoked more than 22,000 marijuana cigarettes, or joints. Moderately heavy smokers were those who had smoked between 11,000 and 22,000 joints.

“The heavy marijuana smokers did not have an elevated risk of developing cancer. People who smoked more marijuana did not seem to have a higher risk than those who smoked less or none, the study found.”

We are not just talking about lung cancer:

“Even in those heavy, long-term marijuana users, the risk of head and neck cancers including cancer of the tongue, mouth, throat and esophagus does not seem elevated compared with that in those who did not smoke.”

The cause of this surprising conclusion is still under study, but according to the lead author “tetrahydrocannabinol (THC), an active substance in marijuana smoke, may promote earlier death of aging cells, preventing the injured cells from becoming cancer cells.”

Great Caesar’s Ghost! Where do you suppose this line of research will lead to?

I must emphasize, as do the study authors, that smoking both marijuana and cigarettes increases the risk of getting lung cancer or head and neck cancer, so to you smokers out there who think they can protect themselves by playing an old Cheech and Chong album while toking up, my advice is this:

Enjoy the comedy, but foreswear the coffin nails - and go easy on those cosmic brownies!

“Forsan et haec olim meminisse juvabit.”

After 20 days and 20 nights without television, internet access or an answering machine the ship finally arrived at Plymouth Rock and unloaded such goodies as cows, maize seed, farm implements, broadband cable access, bolts of gingham, four satellite T.V. receivers, corn whisky (who ordered that??), apple seeds, geese (complete with little knives in which to slice pate de fois gras - hey, we can dream can’t we?), Hudson Bay blankets, Sirius satellite radio, leather boots (in reasonably good shape, although one black pair seems to have the initials “H. G.” inside them - ?), barrels of flour and sugar, and a new answering machine.

Yes, the C.O. is back online at home, striking fear into the hearts of those who have vowed to devote their life to wiping out bad prose. See you soon…

As I type this a highly trained team of specialists is at my house diligently trying with all their might to hook us back up to the universe known as the internet.

It has been a trying 19 days, 7 hours and 28 minutes with no home access to all of the extremely vital web sites that I need to keep the Cheerful Oncologistic ship of state, laden with a trove of linguistic treasures, sailing faithfully toward your port.

In the meantime I shall continue to blog here in the office (after my clinic is over, of course).

[Editor’s Note: We recommend that you read this interesting letter to the editor all the way through before clicking on the footnotes.]

To The Editor:

I want to bring your attention to two recently published scientific studies that have health implications for us all. The first study found that incarcerated females who are exposed to hazardous doses of ultraviolet B radiation and have around-the-clock access to exercise (using the typical machine offered in prison [1]) are less likely to develop skin cancers compared to a control group exposed to the same UVB, but without access to exercise (those cruel prison guards [2] - may they drop dead)!

Forgive me for getting emotional [3]. In the second study, individuals with a genetic mutation that puts them at a very high risk of developing colon polyps (which can progress into cancer) were sold into slavery [4] and given access to a similar exercise program as mentioned above. Shockingly, these poor citizens were fed the same amount of food [5] and water as the control group (also afflicted with the genetic mutation) who did not have access to the exercise machine, thereby ensuring that the more physically active group went into a negative energy balance (again, a horrific crime against murinity [6] if you ask me).

Pardon my editorializing. Well, as you might guess, those subjects who exercised all lived, whereas one fourth of the poor comrades who were confined to their cell died - within ten weeks, I might add.

I appreciate your efforts in relaying this exciting bit of news to the general populace. If more of us would just get out and exercise, we will not only reduce our risk of acquiring skin and colon cancer, but decrease our chances of being captured by the Evil Empire [7]. After all, none of those fatsos [8] could ever catch us in a foot race, let alone fit through the doorway of our home [9].

Jerry [last name withheld for privacy reasons],
Mus Musculus, Mississippi

footnotes:

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

Yesterday a fine representative from our local cable company pulled up in his van, got out, walked up to our front door and left a hand-written note there. He did not knock, ring the doorbell, pass gas, light a firecracker, give out a Tarzan yell or perform any other act designed to get the attention of the person inside our house (who at the time happened to be my wife). He then drove off.

The note, which was discovered later that day stated that he, the cable guy, was not going to be able to run a line from the pole to our house, thereby ensuring that our little homestead (which rests in a part of town that has no access to DSL) will continue to have the same opportunity to access the World Wide Web that is enjoyed by residents of the moon, not to mention Mars and various other planets not beginning with the letter “E.”

Not one to be discouraged, I shall call them back and, using a well-known technique of persuasion, get someone from this billion-dollar company to come out and hook us up to all you wonderful folks out here in the blogosphere. Courage.

“25 Steps to Better Health“

A consortium of health organizations, pharmaceutical companies, insurance providers and state health departments called The Partnership for Prevention has released a list of what it considers to be the top 25 health services available to prevent the development of disease. The list is based on the impact these services have in preventing illness, injury and death, plus their cost-effectiveness. Of course as we all know, no preventive health measure has ever been able to reduce the death rate below 100%. Keep that in mind as you consider tearfully tossing your Cuban cigars into the trash.

Included in the list are such well-founded services such as daily low-dose aspirin use, colorectal cancer screening, blood pressure checks, vaccinations, tobacco and alcohol counseling, Pap smears and treatment of high cholesterol. Since the list was ranked according to importance some health preventive services were considered by the Partnership to be less valuable than others. Listed below are some of the preventive measures actually ranked lower than “vision screening for adults aged 65 and older.”

Obesity screening (given the status of the population this is also known as “opening one’s eyes”)

Hearing screening (a complete waste of time in most men, who are afflicted with acquired selective deafness syndrome)

Injury prevention screening (talk about a Sisyphean task - who is going to tell Grandpa that he has to give up driving, or ask Dad to give up his weekend hobbies?)

Diet counseling (Excuse me for one second - “No, I said supersize the entire order, not just the fries, you moron!” Now, what were we discussing?)

I can understand putting a hearing test below a vision test, but obesity screening and diet counseling? Come on now, everywhere we go we are bombarded with the news that American kids and adults are too fat, which leads to health problems, which leads to an early grave, and who would ever want us to suffer that fate?

Not me - I’m eating healthy! In fact, I’m so committed to following the 25 Steps I think I shall go home and exercise right now.

What’s that you say? Exercise is not on the list?

Oh, okay. I feel so much better now. See you on the couch.

What do you say when a cancer patient wants to know the details not just of the treatment being given now, but of any and all possible future treatments of a different nature (e.g., radiation therapy)?

Notice I said “possible” treatments. This implies that the patient may or may not receive a certain anti-cancer therapy in the future, depending upon the clincal course. Some patients, however, insist upon hearing about every conceivable counterattack available should the cancer not respond to primary therapy. This is called (not surprisingly) speculation, and woe to the doctor who gives in to the temptation to play this game. The only guaranteed result from trying to guess what will happen to a patient is that the patient will suffer unnecessary distress.

So don’t speculate about someones’ life - it’s not fair to put them through such agonizing rumination over things that may never come to pass. Rather, say this the next time a patient asks about what will happen if such-and-such occurs:

“Don’t worry so much about the flight plan. We don’t know where this plane is headed, but just make sure that your pilot knows how to land safely, wherever that may be.”

AIN’T GOT NO INTERNET AT HOME UPDATE: Yesterday, after the twelfth consecutive day without internet access I made what I believe was the 24th phone call to the cable company. This time the call was quite brief, and when the voice on the other end of the line asked me why I was cancelling my installation appointment [scheduled for December 25th, 2017] I replied as follows:

“Andate tutti a ‘fanculo!”

Ten years ago I treated an 84 year-old gentleman for an aggressive lymphoma that was desperately trying to kill him before being blown away itself by chemotherapy. Too bad for the cancer - it lost (har de har har). I saw him recently and after chatting with him discovered that he has lost all recollection of the ordeal he went through. I joked with him about this:

“So you don’t remember taking chemotherapy, eh? Well, it’s not like you’re missing out on fond memories of your Academy Award acceptance speech. Take this as a blessing, that you can’t remember all the suffering you went through.”

He gave me a blank stare. I soon realized that his mind is not just weak - it is as desolate as a burned out Ozark mountain forest, with nothing left to walk through but the unrecognizable ashes of his former life. Because he did not die from cancer, he has lived long enough to develop Alzheimer’s disease.

I guess this is what my 9th grade English teacher was referring to when she asked me to define the term irony. I pray that my patient forgives me for my help in cursing him with a long life.

CABLE COMPANY CAPER UPDATE: “No, we can’t string a temporary line from the pole to your house. If we come out there, we’re going to bore under your patio and put in the permanent line.” “Look, I’m a doctor and need internet access at night to care for my patients. When can you do this?” “Let’s see…it looks like our first available appointment is on the 15th.” “Oh, the fifteenth of this month?” “I’m sorry. I do mean the 15th of May, but it will be in 2014. Hello? Hello? Are you still there?”

“FDA Rejects Health Claim for Green Tea“

Those !(#$!(%!?*!

You know, out here in mainstream America we’re all trying our best to reform our wicked ways and adopt a healthier lifestyle. I myself have made a personal commitment to eat no more than one chocolate bar per day…to run vigorously several times a week…to eschew the devil’s temptations as righteously as a prairie pastor. We all want to do the right thing. Some of us have even taken up tea drinking as a way to consume crucial compounds contained within (called polyphenols) that have been considered counteractive against cancer. Why, even the prestigious National Cancer Institute has a page on its website devoted to tea polyphenols. In the laboratory it has been proven that these compounds “may reduce abnormal cell growth and inflammation; help the body get rid of cancer-causing agents, and restore communication between different cells in the body.” Sounds great - now what the heck is the deal with this peremptory headline?

Wait a just a second - did that quote from the NCI state the polyphenols do reduce or may reduce cancer cell growth? Is there any doubt as to whether or not a nice cuppa is brimming with miraculous cures for our assorted ailments?

Yes, Virginia, there are some dandy flaws - flaws in the proof that green tea reduces the incidence not only of heart disease as mentioned above, but of colon cancer as well. A report from the University of Minnesota using a meta-analysis of 25 different studies concludes that “despite the strong evidence from in vitro and non-human in vivo studies in support of green and black tea as potential chemopreventive agents against colorectal cancer, available epidemiologic data are insufficient to conclude that either tea type may protect against colorectal cancer in humans.”

Well, that’s certainly encouraging - if you live inside a Petri dish or if you’re non-human (please, no cracks about ex-boyfriends), you can sip away in confidence knowing that your cells are all safe and sound from the Big Bad Wolf. In the meantime the humans and humanoids on this planet will have to decide whether it is worth it to continue brewing green tea, which in my opinion tastes similar to a steaming mug of freshly boiled caterpillars. I guess this is where research comes in, that someday some scientist will find a salutary use for the stuff. In the meantime I’ll imbibe a cup on faith alone, and read a happy line or two about our friend Camellia sinensus.

INTERNET DISRUPTION UPDATE: Flash! What jolly cancer doc still has no access in his home, due to the lassitude of the local cable company? Will our hero leave his office today and return to a darkened cave, where no human contact is possible, or will his beloved home computer sing with news, blogs and emails offering the finest products available for purchase since the invention of the home-brewing kit? Stay tuned!

[Editor’s note: there ain’t no chance his cable is hooked up yet, the poor shlimazel…]