Now that Ana is stable, I’ve had some time to look back on this whirlwind hellish experience and reflect. Before I get into that, here’s the latest update on her health.
She’s doing great! She had blood drawn on Tuesday of this week and Maria at Columbia emailed yesterday that the labs look good. Her liver enzymes are still elevated, but they’re coming down. Her potassium and renal function are normal. I am assuming the labs aren’t showing any signs of infection (e.g., elevated white blood cell count) or they would’ve said something. Her Tacrolimus level (the anti-rejection drug she’ll take for the rest of her life) is still too low so they did increase that, but it does not mean another pill to take, just a different dosage. We already have a two month supply of the higher dose capsules – so hooray for the foresight of Amanda, the physician’s assistant who was on call when Ana was discharged last month.
So, back to reflection. I admit that sometimes I play certain moments of the last seven months over and over in my mind, and I have constant unanswered questions that I never even thought about before Ana got sick. How did we end up with the healthcare system we have now? Who invented chemotherapy? What, exactly is cancer? How did people deal with it before x-rays and anesthesia and antibiotics. Who named it?
I spent some time meandering around on Amazon.com and found a book called “The Emperor of Maladies: A Biography of Cancer” written by Siddhartha Mukherjee, a cancer physician and researcher. He’s also an excellent writer. I thought it was an autobiography from cancer’s perspective which is why I bought it (I learn best through story telling – even when it comes to something as complex as cancer). But it reads like a biography- just like the title says.
Are you ready for your mind to be blown? Here are a couple of passages I highlighted (and I’m only like 45 pages into the book):
“Cancer is a phenomenally successful invader and colonizer in part because it exploits the very features that make us successful as a species or as an organism. Like the normal cell, the cancer cell relies on growth in the most basic, elemental sense: the division of one cell to form two. In normal tissues, this process is exquisitely regulated, such that growth is stimulated by specific signals and arrested by other signals. In cancer, unbridled growth gives rise to generation upon generation of cells.”
I found this description of cancer terrifying. I (think) I understood that cancer was the unchecked growth of cells, but the fact that cancer operates via the same mechanisms that regular cell growth operates from is what scared me. Cancer breaks all the rules – it twists them – and it mimics our own cells which is why it’s so hard to treat. How do you go in and attack cancer without attacking yourself? Oh, and there’s this:
“Every generation of cancer cells creates a small number of cells that is genetically different from its parents. When a chemotherapeutic drug or the immune system attacks cancer, mutant clones that resist the attack grow out. The fittest cancer cell surives.”
What? Cancer adapts? Like the Borg? (don’t pretend you don’t know what I’m talking about) – I had no idea.
But what about timing?
The first chemotherapeutic agent was tested by a physician named Sydney Farber in 1948. He was a pediatric pathologist at Boston Children’s Hospital (he is the “Farber” that “Dana-Farber Cancer Institute is named after). The practice of Oncology as we know it today, did NOT EXIST before this time.
Apparently Dr. Farber got tired of studying specimens from dead children – he wanted to try and apply what he learned from tissue samples to the actual prevention of cancer via a chemical substance (e.g., a medicine) which was unheard of back in 1948. His first experiment was disastrous. He injected a synthetic form of folic acid into children with leukemia. His intention was to stimulate the growth of normal blood cells in these children whose bodies were producing cancerous white blood cells to the exclusion of healthy cells. Folic acid stimulates the production of healthy blood – but in children with leukemia it ended up stimulating the growth of the unhealthy cancerous white blood cells – which were already furiously reproducing. The end result was to hasten the progression of the disease, rather than halt or reverse it. Already something of an outcast, Dr. Farber’s experiment did not go over well with the big wigs at Children’s Hospital.
Still, he was driven to continue this work and his next experiment was much more successful. He figured that if folic acid could stimulate cell growth, then something like the opposite of folic acid could suppress cell division and, thus, halt the cloning of cancerous white blood cells. This would theoretically allow healthy blood cell growth to return. And he was right! Farber used another synthetic version of folic acid – a decoy – which tricked the body into binding to the wrong molecule, thus inhibiting the absorption of folic acid and thus cell growth. He called this substance “antifolate.”
He injected it (without parental consent) into a 2-year-old patient with Leukemia and this child experienced the first clinically significant remission in history. The image of a half-crazed scientist running around the basement of Boston Children’s Hospital (that’s where they stuck his office) and injecting children, CHILDREN, with this stuff is absolutely incredible to me. I mean, that this went on to become the foundation for oncology is mind boggling. There should be a movie about this (Eric, are you listening?) Seriously.
I could go on and on, but I’ll stop. I only know a drop of what there is to know about cancer – not even a drop, a tiny, fragment of a drop of a drop. Well, you get the picture. I’m also reading a book about the history of the healthcare system – and the political bullshit that created the system we have today is very much tied to the way medicine is practiced.
The scary part is that it all seems so subjective – based on the opinions of one renowned, historically significant doctor or another. For example, for years radical mastectomies were performed on women with breast cancer even if they weren’t needed. And by “radical” I mean that tissue above, below and around the breast was removed – in one instance, a woman’s entire collarbone was removed. There was no proof that this actually prevented the cancer from returning, but it made this one surgeon feel really good about “conquering” cancer. Well, that’s my interpretation anyway.
It’s all mind blowing stuff.
What is all this information doing for me? Well, first and foremost, it’s making me appreciate the miracle of modern medicine with all its frustrations and imperfections. Cancer is old. I really had no idea how old it was and how comparatively recent these treatment options are. There is so much more to this story than chemotherapy too – radiation therapy and modern advances in surgery have all combined to make cancer much more treatable (if not actually curable) than it ever was before. It doesn’t make it any less scary. I guess it just makes me feel a little better to know how hard people have been working on this problem of cancer. It makes what happened to Ana seem a little less random.