The Long Goodbye

Posted in Cancer at 10:00 am by George Smith

The shields are all destroyed and the battles have been lost. What started as a struggle to buy more livable time against the onslaught of an incurable cancer has been over for awhile and the oblivion presses close.

Like the majority of people cursed by a terminal disease, my friend did not video blog or Facebook his plight. But he was never alone or unloved and I will insist on believing that just a few warm hearts are what everyone needs in their darkest time rather than thousands of likes and empty virtual gestures from passersby.

More later. Or possibly not.


What do they want??

Posted in Cancer, Decline and Fall at 8:30 am by George Smith

This was the question that someone asked me last week.

While I was in the cancer ward helping someone through a hard bout of chemotherapy.

We had been sitting there and if you know anything about people, you know you can help alleviate exhaustion or general feelings of great illness with mild conversation. It helps to have a friend there to take the mind off things, to feel the warmth of it.

And we had been discussing the week’s news in passing including the protests and the police firing of teargas rounds.

Another patient — chemotherapy is an automated group out-patient experience these days — overheard and asked me “But what do they want?”

It was a much older individual. And I just said OWS was protesting economic inequality, the economic collapse and Wall Street greed and massive unemployment.

Which brought the response that yes, greed was a problem in the US. But it was the greed on the part of people who all got home loans they did not deserve and could not afford. And that this, in turn, had caused the economic collapse. And, finally, it was Bill Clinton’s fault.

I said little. One doesn’t argue with cancer patients. It’s not graceful or human. It would have been excruciatingly bad to not be on their side right then.

There was a brief pause and then another person joined in. The mass joblessness was caused because people had no skills.

Eventually the talk petered out. Even in the cancer hospital, the walls are high and people can’t let the class differences and embedded animosity for the young or different appearing slide for a minute.

Which brings us for a brief moment to Krugman’s column today on oligarchy and one of the same arguments:

Anyone who has tracked this issue over time knows what I mean. Whenever growing income disparities threaten to come into focus, a reliable set of defenders tries to bring back the blur. Think tanks put out reports claiming that inequality isn’t really rising, or that it doesn’t matter. Pundits try to put a more benign face on the phenomenon, claiming that it’s not really the wealthy few versus the rest, it’s the educated versus the less educated …

The most popular argument right now seems, however, to be the claim that we may not be a middle-class society, but we’re still an upper-middle-class society, in which a broad class of highly educated workers, who have the skills to compete in the modern world, is doing very well.

It’s a nice story, and a lot less disturbing than the picture of a nation in which a much smaller group of rich people is becoming increasingly dominant. But it’s not true.

Workers with college degrees have indeed, on average, done better than workers without, and the gap has generally widened over time. But highly educated Americans have by no means been immune to income stagnation and growing economic insecurity …

That is, the protesters who portray themselves as representing the interests of the 99 percent have it basically right, and the pundits solemnly assuring them that it’s really about education, not the gains of a small elite, have it completely wrong …

His argument is that this disparity threatens the nature of our democracy, making it one “in name only.”

As for those who slough it off to a lack of skills, essentially he’s talking about the Niall Fergusons of the country.

But because Krugman so obviously has a conscience I can’t help but think he would not have had the heart to argue in the cancer ward, either.


Notes from a bystander in the cancer ward

Posted in Cancer at 12:09 pm by George Smith

Use of corticosteroids induces persistent hiccups.

Have you had or known someone with persistent hiccups? As a side effect of cancer treatment it’s fairly unpleasant.


Notes as a bystander from the cancer ward

Posted in Cancer at 7:35 am by George Smith

One of the signal failures in US health care is too many doctors.

That’s not meant as a comment on the absolute number.

Instead it refers to the saddling of patients with multiple doctors, their staffs and infrastructures. It’s all part of the long-standing US obsession with hyper-specialization and the expansion of a massive buzzing edifice of health technology.

Even when the doctors are in the same building, or even on the same floor of the same building, there’s friction. And this friction comes at a time when the person getting the services is very unwell.

Even someone with no health problems would find it challenging.

With so many involved you get opinions and interpretations on disease and results that are never all completely on the same page. Outlooks differ.

So one minute you can get a statement that’s very unfavorable. The next, down the hall, something almost opposite, depending on the state of mind of the physician.

It’s incurable, says one. The survival figures are very bad.

Next up: You’re going to be treated. It’s going to work.

Surrounding every doctor is a staff, sometimes shared. Even with everything committed to a computer network, so many people guarantee that data entry and communication is fraught with mistakes.

Daily. Error correction is a constant part of the experience.

The doctor tells a patient, by phone, that a test has been canceled. The next day, at the same facility, a nurse comes along with an appointment for the tests that have been canceled.

No, no, the patient is mistaken. Fifteen minutes later the nurse is back. Turns out, the patient was correct.

Off-site, another series of scans is done. The next day, one of the staffers at the cancer center asks when that new scan, already done, will be done.

This is straightened out on the spot.

There is a request made for the new results to be faxed over. When they arrive, they are either the wrong papers or those of another patient.

Eventually this is sorted, too.

But it all takes time. And it’s a constant reminder that this system of hyper-specialization is not efficient.

It’s not an admirable feature, not something the American health care system can be proud of, yet it is entrenched.

And in Pasadena, CA, it is discovered that all the cancer doctors in questions are hard asses about the use of medical marijuana.

It’s a cognitive disconnect in a state that went out of its way to legitimize the use of the drug because it was thought to be of use to the deathly ill.

Have these people been flustered by the federal government? Do they just not like the mini-industry of potheads and hippies that furnish it from storefronts here? Were they read a secret riot act by someone?

Who knows? Why do they even care to condemn such a small thing while easily handing out prescriptions to much stronger palliatives?


More whoopie cushion Big C news

Posted in Cancer at 7:39 am by George Smith

David Muir delivered a bog standard news media whoopie cushion last night for ABC. A new imaging technique was said to be a potential “game changer” in cancer treatment.

I flinched again, wondering about the people with cancer who’d see it and get all the implications wrong.

It concerned studies in which scientists at Purdue had come up with a fluorescent technique for dyeing cancer in living tissue, increasing resolution “thirty times.” It’s an order of magnitude but not the breakthrough it was billed as.

The problem is a simple one as lots of people who go through cancer treatment know.

If you’re slated for surgery, the doctors already assume the cancer is more widespread than they can see with whatever imaging they have used. And they take everything they think prudent.

Increasing the resolution only makes the target bigger. And while it may result in some early diagnosed cancers being eradicated, it does not alter the basic outlook for a disease in which one mostly assumes the worst — that somewhere imaging may have missed a microscopic clump of metastatic cells, or even a single one.

This is what happened to my father. Suffering from bladder cancer, he went to Sloan-Kettering in Manhattan. They took just about everything they could out of him. It left him with a hole in his abdominal wall, to be used for the next five years as an outlet.

And at the five year mark, although he’d been scanned and rescanned many times in the intervening period, the cancer returned with a vengeance.

It had been in him, somewhere. Invisible to various techniques, immune to chemotherapy, slow growing until it reached some point at which it began turning over very swiftly. Faced with a terminal diagnosis he went to the Bahamas for a quack cure that had been publicized on 60 Minutes and died there.

As for those who suffer widespread metastatic disease, the kind of diagnosis that all too often presents very late because of lack of symptoms, the method described on ABC does nothing at all. It may give some satisfaction in knowing where more foci of disease are located.

But in widespread disease surgery is no longer a cure.

And such is the case with something like stage IV esophageal cancer.

There is no surgery because the disease is widespread.

Imaging has determined where it is. In the brain, a regimen of radiation therapy — and all that entails — is undertaken.

This is followed by chemotherapy to attack the disease in the rest of the system.

The statistics are grim.

From the wire, a more accurately presented truth:

An explosion of new technologies and treatments for cancer coupled with a rapid rise in cases of the disease worldwide mean cancer care is rapidly becoming unaffordable in many developed countries, oncology experts said on Monday.

With costs ballooning, a radical shift in thinking is needed to ensure fairer access to medicines and address tricky questions like balancing extra months of life for patients against costs of a new drug, technology or care plan, they said.

“The cancer community needs to take responsibility and not accept a sub-standard evidence base and an ethos of very small benefit at whatever cost,” said a report commissioned by the Lancet Oncology medical journal …

The new cancer imaging dye described by David Muir on ABC News Sunday night falls into the category of treatment described in the Reuters piece.

Off for the waiting room of the radiation ward, hoping my friend gets the best from it.

Posting will continue upon return.


Not like on TV

Posted in Cancer, Culture of Lickspittle at 8:19 am by George Smith

Here’s another downer post. So maybe you ought to skip it if you’re only into Norman Vincent Peale’s world. (Which uncovers the question, “Why are you here, anyway?”)

Commercials for American corporate “innovation” in the field of heath become personally antagonizing when you get an immediately life-threatening diagnosis. (Not mine.)

A close friend of DD’s has been handed a bad slate. Even with a good health plan it’s been a tough haul getting through the discovery and diagnosis period.

It contrasts starkly with the idiot commercials, now running on primetime, about tech breakthroughs in healthcare, commercials made to make viewers feel happy about American corporations adding good things to life.

The most odious is General Electric’s “healthimagination” spot with the little girl musing about her unusual mother with wiggly toes and dancing fingers, a fun lady who will only eat her eggs with hot sauce. The final bit of it is that GE has produced some technology that will customize and help make a unique cellular-level diagnosis of whatever cancer she may face.

As anyone who has had to recently go into an up-to-date oncology center in Pasadena/southern California, this is pretty much revealed as total shit.

There’s no revolution going on, no magic devices. There is lots of imaging technology. While powerful, it tells you only certain things, never enough. There’s no techno-magic personalization, there is no particular swiftness of diagnosis, no impressive victories which have been won against cancer because of it. They are tools, part of a blindingly complicated process. And while there have been some victories in the fight against cancer in my last three decades, they have not been strategic wins.

Another commercial, by AT&T, would be laugh out loud hilarious were it not for painful personal framing.

This is the one were the friendly voice informs that your medical information and history will follow you on your smart phone, through the smart network, a place where even that which is imagined impossible becomes possible.

I have news for the gullible or for any people who made the commercial or AT&T’s smart network brains. When and if they get cancer they’ll perhaps notice there is no obviously “smart network,” that one fills out a lot of old-fashioned paper, repeated over and over, for a variety of health agencies and physicians and that coordination is often slow, inexact and fraught with frustration.

It will be part of the challenge, as the seriously ill person, to help guarantee everyone is on the same page. And it must be done the old-fashioned way, speaking face to face on numerous trips to the hospital or out-patient treatment and diagnosis center, or on the telephone.

Smart network! One might just as well have made a commercial showing little fairies, borne on fluttering pink wings, flying your medical information to the team of physicians and consults.

Americans have always been acutely vulnerable to this manner of sappy thinking.

Indeed, an entire news industry has grown up to cater to it, one in which journalists in health and technology sections scan press releases in order to write stories trumpeting what are thought to be the latest milestones and revolutions in health care.

Read them regularly and if, through unfortunate circumstance you actually become seriously ill, you immediately discover how they depart from reality.

Not to put to fine a point on it, my Dad died of cancer on Grand Bahama Island many years ago chasing delusion manufactured in a similar way.

Having been given a terminal diagnosis for bladder cancer, the family was desperate.

60 Minutes had aired a story on a miraculous cancer doctor in Freeport, Grand Bahama, a man supposedly suppressed in the United States for his revolutionary treatments.

His name was Lawrence Burton and he had developed something that sounded very impressive — Immuno-Augmentive Therapy.

60 Minutes furnished tremendous publicity, giving the cancer treatment a solid patina from authority.

And it all ended very badly, Burton and his therapy going down in history as a notorious case of quack medicine.

Medicine does not advance, cancer does not yield, because the sales imagery appears triumphant.

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