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Winter Solstice? and the death of cancer?

Friends and readers,

I begin with a soothing video -- surely needed during this season




as a preface to two linked topics: climate change and the spread of cancer everywhere to all age groups.  The chemical manipulation of our environment.

So to the heat:  We are still having shortened daylight here in a mid-Atlantic state of the East Coast of the US, but otherwise he climate is really changing. Well, duh. Summer in winter?  Well in Virginia (not far from DC so by the water) we are having a summery-winter. It's not summer and it's not an Indian summer and it's not fall. It gets quite cold when the sun goes down; dawn is dank and chilled but by noon it's balmy with a chill in the air; waters are higher too (as in the Potomac). The bulbs I planted do not grow as they do in very early spring/late winter (as it once was). You do need some sort of coat or sweater. If I open windows too wide, it gets too cold in my house. The cats sit by the grates still.

In the morning as I awake and the sun creeps into my room (like it did in the older winter) it nonetheless feels hot in the way it does on an early summer day. And at night the house is hot the way it is after it's baked all day in summer. It's just not baked with quite the same high temperatures.

My younger daughter went to the University of Buffalo to become the librarian she is today. She used to talk of small, medium, and big snow events. The first January she wrote us that she would never leave her room again, it has been that cold for so many weeks. She now
tells me it has yet to snow in Buffalo. This has not happened in 150 years. It's a new kind of season.

Then cancer. The New Yorker is not usually stupid or mean or obtuse, as witness this week's cover by Eric Drooker:



But they can be, as witness a peculiarly small-minded essay on Thoreau several weeks ago, spiteful ("pond scum"?), written out of the new certitude that people who retreat are idle self-indulgent fools, living off others, and anyway only social life is life. The moral myopia is Kathryn Schultz's.



I usually don't review reviews, especially when I've not read the book through. But Malcolm Gladwell's dismissal of T. De Vita Jr's admittedly oddly titled The Death of Cancer in the Dec 14, 2015 issue of the New Yorker deserves to be called the ridiculous point of view it is. Gladwell's complaint is De Vita was not a team player. Hence he was didn't last when he reached the prestigious position of physician-in-chief at Sloane Kettering. The chapters' demonstration is that 1) the medical establishment does not look for a cure for cancer; 2) is far more careful to follow protocols lest anyone be sued than try to cure a particular person's cancer; 3) lets people die knowing this is happening and something could have been tried to stop it; 4) carries on with bad policies and procedures known not to help but perhaps harm lest a particular group of doctors (breast cancer folks) or arm of the industry (any of the chemo drugs) make less profit. Gladwell calls all this "deeply unsettling." But clearly he's not unsettled by what DeVita shows the reader. What he doesn't like is DeVita's take on institutional politics. (We may assume Gladwell wouldn't like Thoreau either.) Gladwell's priorities are as screwed up as the people treating cancers who can't predict even what their medical treatment will result in. Read the review by all means. Gladwell is conscientious and gives his devil his due, and reports the important content of De Vita's book.

In the light of some replies I've gotten I want to say that cancer is anything but dead and among the things wrong with this book is the false upbeat framing of it. Cancer is spreading, more kinds are emerging, more rare kinds are becoming common and more and more people develop cancer at an early age: not only is our climate changing, but it and all we eat and drink is more and more poisoned by cancer-causing chemicals.

Miss Drake

Comments

( 4 comments — Leave a comment )
misssylviadrake
Dec. 18th, 2015 04:10 pm (UTC)
Further on DiVitaq, Gladwell and personal experiences of cancer
(Your blog on Gladwell wouldn't let me post without jumping through FB listings that seemed to want not only my name and photos but blood type and DNA --ok, exaggerating a little-- and I have no idea if it finally went up but if not, here is what I wrote:)

I was just ready to email you to see if you'd seen this review, when I saw the link on Wompo. I find Gladwell exasperating elsewhere, but I read the review quite differently than you did. I thought in stating that De Vita's not being a team player was the reason for not staying in positions of medical authority that Gladwell was citing De Vita's opinion and not Gladwell's own. As a matter of fact, I thought Gladwell was doing mostly summary rather than stating much of an opinion.

And I am of two minds on what I think of De Vita, as depicted in the book (which, Gladwell's review aside, is DE VITA'S point of view.) One of the things that bothers me about De Vita's point of view is that it does not seem to take into account the patient's suffering or finances. So the person throws up on the subway? Hey, let him take a cab.

I saw my sister treated by both kinds of doctors, the ones that threw up their hands from the beginning, offered her palliative care, and grudgingly gave her round after round of basic chemotherapy. Then, finally, when she was sent to one of the top specialists in blood cancers in the country, that doctor tried everything in the year and a half (that seemed like five) painful year-long march to her death, which my single mother sister gladly took to spend 18 more months with her four-year-old daughter. It was instructive for me in more ways than one. I wouldn't let them treat my dog with chemo (and, surprise, it wasn't cancer and she lived four more healthy years!) and I wouldn't undergo it for myself.

HOWEVER-- and this is to finish off my story and is far from DeVita's book, I guess-- we will never know what would have become of my sister if her managed health care system had let her have an appointment with her primary care physician five months earlier when she began having pain and asked for an appointment and got antibiotics phoned in and then got antibiotics phoned in four more times instead of an appointment.

Anyhow, it is good to know you are out there reading and responding. I will go back and scan the review.

Diane Kendig
misssylviadrake
Dec. 18th, 2015 04:12 pm (UTC)
Further on DiVitaq, Gladwell and personal experiences of cancer -- a reply
Thank you for the letter and comments very much. I read Gawande, used to assign his _Complications_ regularly to students doing Adv Writing in Natural Sciences and Tech, and his other essays since too.

On doctors' callousness, they are even trained that way (it's mislabled "professional behavior"), and the kind of doctor who goes into surgery is often a jock type who likes power. Who but someone with mighty thick skin could do some of the operations they do? I have an older book to recommend which is a critique of the profession from this point of view: Melvin Konner, Becoming a Doctor. Its one flaw is he does not realize what a masculinist approach he takes to women and women's bodies.

I have similar regrets and I have self-blame. I was given the name of a supposedly super-respected (and expensive) doctor in Boston who instead of giving Jim an operation to remove the cancer in his esophagus would have hit him hard with huge amounts of chemotherapy and right away. My friend who told me of him had a sister who had esophageal cancer and lived -- and had had this monstrous regimen -- very hard for over a year. He said the operation was barbaric.

Well after it was over Jim realized he really couldn't eat very well at all, his voice was half-gone, but worse by the time (4 weeks) we were ready for chemo and radiation the cancer had spread throughout his liver. Now basically Kaiser gave up: they said they would give him chemo and it would extend his life for a few months but he would not live more than that. After a couple of rounds, he said "no more" and chose to die. He starved to death and took heavy medication for the terrible pain.

My regret is I could not get Jim to go. He would not listen, not discuss it, and I never was in life able to influence him when he made up his mind about something. He was a dominating husband. After the cancer spread to the liver another friend gave me the name of someone at Sloane-Kettering who might consider trials (remove parts of the liver, attack it with chemo): this time Jim would not even allow me to finish talking.

I have been told by others that this huge amounts of chemo described in the article can and does sometimes have an adverse response. A friend's husband and the husband of a friend's friend did that and died howling -- just about. In one case he had to be amputated -- and his wife couldn't resist trying for every minute of life. IN the other he got a terrible form of leukemia.

I suspect from what you say I would dislike the book very much. Another book I used to assign -- deeply humane and good medicine -- is by Danielle Ofri -- Singular Intimacies.

Ellen
misssylviadrake
Dec. 19th, 2015 01:21 pm (UTC)
Doctors' callousness ...
I don't know about doctors and callousness. The blood cancer specialist whom Daun had the last year was the opposite, a woman who strode in in these glorious, swishy dresses topped with her white coat and when she had to break the baddest news to Daun, came in with tissues and cried with us for a long time. After Daun died, she drove through a Minnesota snowstorm to speak at a memorial gathering at the house and cried as she spoke. The friends who gathered there were blown away.

I do remember the issues of distancing, though. As teens, we were friends with the top orthopedic doctor in our town, and one of our friends married one of the daughters. My friend recalled the day the dad was called from the table for emergency surgery on a child, tore out of the house, then tore back in, saying, "Forgot my glasses. I'd rip the hell out of him if I didn't have these." Lala!

We have these regrets because much as cancer seems to be so statistics-driven, in fact, every case is different, and no one, not even the doctor, not even the patient, knows for sure what all the right choices are. My husband has been intent from day one that dying is better than suffering, and I know right now that if he has something devastating and if he can, he will commit suicide rather than linger. (We think his father did, though we can't be sure.) I wish I could be that brave, but I think I would not be.

In the final analysis, Jim made his own choice, and though that has been very hard on you, he did not choose it to be hard on you, and the way you have gone on, figuring things out, getting stuff done, getting on-- I am sure he would be pleased.

diane
misssylviadrake
Dec. 19th, 2015 01:22 pm (UTC)
Doctors' callousness ...
Thank you for this letter. I guess Jim and I were not so lucky. Once he was mortally ill, he was dismissed. One doctor sat by a computer all the time; she appeared glad to tell me "I told you so" over something I had said. The other would not even walk to where Jim was to save him pain, no Jim had to be dragged into the doctor's office and the doctor spoke irritably at Jim: "look at you," "other people at this point" are still walking about and strong." You are not drinking the supplement was the next phrase. It was Jim's fault he was so weak and ill. Not trying you see. The surgeon was a jock. All the staff pretended not to see what he was going through when he was made to wait for their blood tests.

Horrible, it was horrible - -but kept just to the edge of decency. One doctor, our primary care guy, did go out of his way to try to save Jim some pain, went down himself to the pharmacy at one point to get medicine.

That doctors don't know what will be the results of what they do shows how deeply ignorant we are of cancer. One test of understanding is predictability. Darwin's theory of natural selection explains and predicts. And nothing is done -- that is part of what DiVita says, and it's not done because it would cut into huge profits.

Yes I'm bitter because so alone now and it is an irritant to see all those who mysteriously live while others die quickly or over a time or in pain. For me it's not the statistics; it's this reality and seeing nothing done seriously or fundamentally. I've read essays where people try to explain from the politics of medicine and how it's organized why no serious progress is made and we are left with nightmare shows of force. I know Jim made his own choice and insofar as he was allowed did control how he died. He fought these people when they tried to put rubber under his sheet. He said "exasperation" gave him strength the couple of time he got up the intense strength needed to fight back.

Danielle Ofri cries with her patients. Her book says doing medicine humanely is is the only was medicine works usefully (finds out what is particularly wrong with this individual quickly out of real concern) and helps them for real too. DiVita's book seems to show the doctor's first concern is with their place in their organizations.

Ellen

Edited at 2015-12-19 01:24 pm (UTC)
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