The next time I see him, I must apologize to
William Shakespeare for taking “To be, or not to be,
that is the question” and modifying it for my own purposes. What I’m doing
can probably be described by some kind of literary term, but because I’m not a
literary writer, I don’t know what it would be. I thought perhaps what I’m
doing might be in some sense an example of synecdoche, but after
reading a comparison
of synecdoche and metonymy
I’m not so sure. Perhaps it’s really metondoche, which in itself is actually a portmanteau, and I’m
quite certain of that. By now those thoroughly trained in literature are
shaking their heads.
Sometimes people try to anticipate what they would
do in some particular situation, like “If I get cancer, then I will….” It turns
out that it’s not always so easy.
Follicular lymphoma is an example of what they call
an indolent cancer. An indolent person is lazy and does whatever is
necessary to avoid physical or mental exertion; an indolent cancer is one that progresses
comparatively slowly. I say comparatively
because my follicular lymphoma is progressing: new lumps in new places, and
they’re growing. But still, if you end up with cancer, an indolent one is the
type to get.
Currently I still have what they call a low tumor
burden, which means that the total amount of cancer in my body is still
relatively low compared to what it could be. On day one my oncologist pointed
out that he could treat my cancer and “knock down” those tumors with
chemotherapy, but clinical experience shows that treating a low tumor
burden patient does not change rates of survival. I’ve dug through some of the
peer-reviewed medical literature on this, and he knows what he’s talking about:
Treating me now would very likely have no effect on how long I will live. And
by the way, it’s not possible to predict with any real degree of confidence how
long it would take for my cancer to kill me—I could die from something
completely unrelated.
This puts one in the unusual position of having to
decide whether or not to get treatment even though I can feel the progression
of the cancer in the lumps in my neck. In case you’re wondering, no, removing
the lumps does not get rid of the cancer. It’s called lymphoma because cancer
cells are constantly circulating through my lymph system, and
cutting out lumps doesn’t get rid of those cells. New lumps will continue to
form and grow, and very likely in my neck (as well as in other places, like the
ones I already have in my abdomen). One estimate that looks reliable to me is
that there are roughly 800 lymph nodes in the human body, and of those about
300 are in my neck. There are lots of places that these cells can park and
divide, and it will be completely impractical to remove all of the resulting
lumps, not to mention that surgical removal runs the risk of damaging some of
the many nerves in the neck.
The standard treatment for follicular lymphoma
involves the usual sorts of side effects from chemotherapy: nausea, vomiting,
loss of hair. These things can be managed. It’s the other side effects that are
more serious: immunosuppression, peripheral
neuropathy, drug
hypersensitivity, and heart failure. I intend to avoid chemotherapy for as
long as it is reasonable to do so. I’m going to continue to do watchful waiting with
my oncologist, and I don’t anticipate deciding whether to take chemotherapy
until my tumor burden is somewhat higher. There’s no way of confidently
predicting when that will be, either.
One could, of course, hope that some kind of new
treatment will become available. We are, in fact, in the midst of what might
turn out to be a golden age of discovering new treatments for many, many
different kinds of diseases, including different kinds of cancers. Some of
these deal with so-called blood cancers, including lymphomas. My immune system
does not recognize that my cancer cells are bad guys, and no, there isn’t any scientific
evidence that dietary modifications or supplements of any sort will under any
circumstances fix this. One promising treatment, however, is called CART
therapy, in which some of a patient’s own immune cells are removed, artificially
re-engineered to recognize the cancer cells, and then injected back into the
patient where they go on a spree eliminating cancer cells from the body. Some experimental
trials with a few patients have been done, and the results have been positively
spectacular. However, even apart from the fact that some patients have died as
a result of those treatments, this therapy appears to be a long way from being ready for use in patients like me.
At the end of the day, I have to decide how I’m
going to confront not only my cancer, but also other issues that I’ve been
facing. Would it surprise you if I said that sometimes those things are more
difficult for me? I’ve chosen to comply with God’s clear direction:
Do not be
anxious about anything,
but in
everything by prayer and supplication with thanksgiving
let your requests be made known to God.
And the
peace of God,
which
surpasses all understanding,
will guard your hearts and your minds in Christ Jesus.
(Philippians 4:6-7 ESV)
Recently I have been thanking God—with an unusually
deep, intense sense of gratitude—that I have cancer instead of my wife, son,
daughter, or son-in-law. Like still waters, the peace runs deep.
