It Might Get Messy
Gibb’s rule on NCIS is “never apologize, it looks weak”. While NCIS is a well written and acted show, I’m afraid this “rule” must be there simply to generate controversy. I strongly believe that a person should apologize if and when it is right to do so.
But there’s a big gray zone. On Thursday, I met with the reconstructive surgeon for the first time since the operations. He apologized directly for “putting you through so much hell in the hospital”. I told him his apology was accepted but unnecessary (a concept a good friend taught me a while ago). I’m a scientist. I know things can and will crash and burn under the most inopportune circumstances. He insisted—he feels bad because I’m now stuck for a lifetime with no tongue (or grafted-in tongue equivalent) and with no way to breathe except via little plastic tube.
But Dr. B is right about one thing. It’s time to start thinking about the future. And my future, at least, could hardly be cloudier at the moment.
From one perspective, things are pretty optimistic. And I’m surprised about that. For the first week in the hospital, when I realized my tongue was gone, I had to breathe through a tube running with blood and saliva, and my gastrointestinal tract was permanently decoupled from my airway, I was intensely upset. Depressed to the point of being suicidal. As I recovered, I came to grips with the permanent debilitations. Believed I could find ways to function in the real world. If I was cancer-free, I might have considered the tradeoff worthwhile.
But of course I’m not cancer-free. While my lungs are clear, I still have a tumor on my palate, near the entrance to my sinuses. The doctors expect this spot to be as aggressive as the original tumors and the next round that we just excised. This bodes ill for my long term survival.
But cancer survival is a complicated thing, both individually and in the population-at-large.
One study of throat cancer survival rates clearly demonstrates that survivorship has not changed at all, or in some diagnoses, gotten substantially worse since the 1970s. However, the authors presume the cancers in their study are tobacco-related [1], which is not true in my case. Whether or not that matters remains to be seen. Apparently this cancer is so rare in non-tobacco users that very little is known in that context.
More generally, according to the American Cancer Society, overall survival rates have increased for all cancers in recent decades. In the 1970s, 1 in 2 victims survived 5 years, now it’s more like 2 of 3 [2]. Statistics summarized by the National Cancer Institute Surveillance Epidemiology and End Results (SEER) [3] paint this picture of survivorship with time for all cancers combined for all population characteristics combined in the U.S. (remember you can double click to enlarge, at least in my browser):
This shows survivorship increasing with time over the past 50 years.
Ok. In general, things are getting better in the world of cancer survival. In throat cancers, not so much. Given that my doctors and I have to figure out some way to treat my third round of tumors, I’m guessing my long-term prognosis isn’t good. In fact, the docs are already worrying about treatment options. Because I’ve had such high quantities of radiation in treatments past, that may not be an available avenue. For the moment, here’s the medical team’s best guess. We’ll wait a couple of months while my present devastated infrastructure heals. After that, when the residual throat tumor becomes symptomatic, we’ll start chemotherapy.
That’s it. That’s as far as the planning goes at the moment. Personally, I’m hoping for an outcome like the movie “The Guitar”. On being diagnosed with terminal throat cancer, the protagonist retires from the world, teaches herself to play rock guitar, and the cancer disappears.
THERE’S an outcome I could live with!
Notes
[1] http://www.ncbi.nlm.nih.gov/pubmed/18427002
[2] http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer/the-history-of-cancer-cancer-survivorship
[3] http://seer.cancer.gov/faststats/selections.php?#Output
No comments:
Post a Comment