Something Nice

I haven't seen David Saltzman in years, maybe not since shortly after college, although I'd hear about him from mutual friends from time to time. We've exchanged the occasional email, which I suppose put me in his address book.

Then, a while back, I started to get cc's of general emails. They were sober stuff: cancer. Bad cancer.

Not today.

Dear Friends,

This week has been filled by tests at Johns Hopkins confirming that my cancer has, at least temporarily, gone into nearly complete remission! This is the best news I have had since being diagnosed in late 2006 with malignant bile duct cancer (metastatic cholangiocarcinoma), a disease that kills half its victims within three months. After seven months of grueling chemotherapy and a larger number of surgical and endoscopic procedures, the images taken by PET, CT, X-ray and MRI are all in accord that the tumors have shrunk to a “subradiographic” point where they are smaller than grains of rice, though still present. The doctors can't find the cancer because there aren't enough tumor cells left in one place or in total.

…

In equally good news, I can finally breathe deeply without pain or coughing. You cannot imagine what a relief this is after six months of ever-shallower, more desperate breathing. …

My symptoms at this point stem entirely from the chemotherapy, not the cancer. I continue to find this oddly liberating, because I choose to undergo chemo and I can reason with an oncologist… but not with a cancer. Since chemotherapy agents are designed on purpose to be as poisonous as possible without quite killing the patient, and I encouraged my oncologist to cut it very close, the symptoms have been brutal.

…

The chemo has left me a smashed shipwreck of a body: battered, scarred, impossibly drained, and barely holding together. Until a few days ago, just climbing a flight of stairs took me to the limit of my endurance. Some months I spend more time at Johns Hopkins than at home. At least the nurses have stopped wearing burkhas around me. The face masks, gowns and gloves were a bit unnerving.

…

The sky now looks bright again. Admittedly, this respite is likely to be just the eye of the hurricane before the cancer comes blasting back, but for some time ahead the weather looks to be spectacularly and undeservedly clear.

There is a good illustration of the concept if you search for “routine procedure” at cartoonbank.com

Please understand that this is just a temporary victory. Chemotherapy cannot cure me of metastatic cholangiocarcinoma, since the survival charts taper to zero by twenty-four months. Facing no prospect of therapies beyond toxic chemicals is crushing. I wish there were some way to connect this rare cancer to the most modern forefronts of medicine, perhaps as a genetics problem or an opportunity for an immunotherapy (cancer vaccine), but there isn't any evident path on a timeframe available to me.

Nevertheless, this remarkable degree of remission has reset the clock to one helluva good starting point for that inevitable day when one of the cancer's stem cells evolves resistance to the chemotherapy's toxic charms and starts proliferating wildly. Then my oncologist will try out a new chemo recipe and the battle will be rejoined. Unless he runs out of chemo bullets first, I will survive to fight a third round. And so on for a fourth round.

Which brings us to the present. Today's news sets a new high-water mark for the fight against this cancer, though my health is terrible. Seven months of intensive chemo have left me riddled by nausea, with pathetic endurance, poor short-term memory and a miniscule attention span, but I am finally free from pain, and day by day I am starting to get stronger.

In other words, I can now fight this disease from a position of microscopic tumor volume, negligible cancer pain, and increasing stamina (aside from the chemo's horrific side effects). This is the right place to be starting the next round of battle against a malignancy biding its time as it accumulates mutations, waiting to evade the chemo agents and start proliferating wildly.

I plan to enjoy every day of the improving health, spending cherished time with my family and friends …

Winning this first victorious battle in an ultimately losing war has been the hardest time of my life so far, with only family and strong friendships keeping me above water. I am told that my loopiness from pain killers made dealing with me a tribulation at times, hard though that may be to believe. Beth and I appreciate the support and understanding more than words can convey. As for Joel and Michael, they are thrilled to have their father starting, however slowly, to get back onto his feet.

Consequently, Beth and I have decided take the boys to Israel Sunday, leaving anything work-related behind. We needed to do something dramatic. From the questions I get interrogated with, one would think that airlines and hotels had never encountered somebody making arrangements precipitously, at the last minute. They should see my cooking.

Let's hope the news will always be this good.

Let's.