Tuesday, December 5, 2006

I’m Sorry, Did I Miss Something?

As my British–born girlfriend might say: I ’ad a bit o’ a row with me dad, las’ night, I did. Actually, she ain’t no Eliza Doolittle; I can’t imagine her speaking like that other than theatrically, let alone in Cockney. Especially considering her parents are American and her accent after years in the U.S. is rather slight—other than saying “naught” as in “Brian, I am naught amused.” Yes, she really does say that!

Anyway, so my father and I engaged in several intense rounds of verbal fisticuffs, with my mother our audience. The issue? His life.

As I wrote before, I’ve read the NCI (NIH) statistics: 50% of lung cancer victims are dead within eight months of diagnosis and 98% within five years. Contributing factors to longevity being robust health and youth, neither of which my father possesses. I was in the room with my parents when my father’s oncologist, Dr. Cainin said that it was small cell lung cancer (SCLC; very fast spreading and particular to smokers), that it had metasticized (extremely bad), and that on average, chemotherapy extends the lives of similar victims by just 2–3 months. We already knew it was stage 4. In sum, a death sentence, the only variable being when but, clearly, the odds are very dim that he’ll be around to see the completion of the new east span of the San Francisco–Oakland Bay Bridge. Even if we had heard only the chemotherapy statistic, it would have been immediately, abundantly clear: My father’s cancer is extremely aggressive and virulent.

Yesterday I talked about the M.D. Anderson Cancer Center at the University of Texas at Austin. It is one of the two top cancer research centers in the country (the other being Memorial Sloan–Kettering in New York). In addition they are one of the original three of twenty National Comprehensive Cancer Centers (both UCSF and Stanford are also members). NCCC members collaborate and share research.

But Sloan and Anderson are the best. (My mother’s sister, my aunt Gloria, went to Sloan earlier this year for treatment for her stage 4 SCLC earlier this year.) Anderson has the best diagnostic tools. Anderson sees more than 60,000 cancer patients last year. They have access to medications and treatments often years before other facilities, including UCSF. And I know they coordinate treatment with other facilities: a friend of mine’s uncle was being treated at UCSF. He took a trip to Anderson where they re-diagnosed him and changed his chemotheraputic cocktail. He then returned to the Bay Area and continued to receive his chemo treatments at UCSF. Oh, and his lung cancer went into remission. (Not that I am trying to fool myself.)

The foregoing begs the question: If you wanted the best diagnosis and treatment plan for your life–threatening disease, if only to ensure your comfort, where would you go? If it were me, I’d have been on a plane to Anderson as soon as I knew about it. Which, we did, shortly after my father’s original diagnosis. Independently, my father and I both researched Anderson—or so he claimed. And yet his first stop was Kaiser in Walnut Creek, CA for a biopsy and subsequently refined diagnosis. Okay, notwithstanding the apparent incredible swiftness of the onset of his cancer, this seems like a reasonable step. But once the diagnosis was at hand, why wait? Call United Airlines and cash in some of that mountain of frequent flyer miles (from all that world traveling) for two first class tickets to Austin Texas! It was/is certainly worth the expense since he may not be around to use them otherwise.

But instead they scheduled an appointment at UCSF’s oncology department. Which, admittedly, is very good. But it’s just not Anderson. Hence my argument with my father last night: I want him to go to Anderson. Now. Today. I see no reason to wait. The cancer grows within him every day he delays. And he grows weaker, and less able to withstand the rigors of flying. Inexplicably, to me at least, he finds cause to not go right now. Indeed, possibly not at all. His primary excuse was that he doesn’t want to offend Dr. Cainin “who has been very nice” and graciously took him on as a patient. To which I retorted that yes, Dr. Cainin has been very nice, very generous and it is clear he is very competent. But such personal feelings are completely irrelevant relative to my dad’s rapidly waning life and comfort.

He supplemented the prior ‘issue’ by adding that he would require a physician’s referral to get to Anderson (meaning Dr. Cainin). Not so, I countered, pointing out that a prospective patient can refer himself simply by filling out a form on the Anderson Web site. So much for my dad’s claim of having thoroughly researched Anderson.

Another argument is that there is today’s appointment at UCSF. Well, okay. But it is a preliminary appointment. They will almost certainly want to run tests on their own, which will take time. And they are still not as good as Anderson.

Finally, my father seemed to demonstrate complete ignorance as to the virulence of his cancer, suggesting that he thought it had been growing in him since 1995. He gave a series of completely laughable supporting statements. My mother looked at me and rolled her eyes. Now I know math and I’ve recently studied mathematical models of cancer growth. SCLC grows and spreads among the very fastest. It would need just a few months to reach the severity at which it was first detected. When I pointed out these facts a few minutes later, after my father let me get a word in, he then retorted that he had never said the cancer started growing in 1995, that to think such a thing was ridiculous! At which point my mother assured him that yes, he had made that claim minutes before. Clearly, my father is being irrational about his fate and the care he deserves.

My dad has said that he will consider discussing the idea of going to Anderson with Dr. Cainin and, perhaps, the UCSF physicians. And that he might consider going next week, following his next chemotherapy session, before which they will also review whether the first had any effect. Meanwhile the cancer cells continue to divide every 18–19 hours, growing and spreading within him.

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