Friday, January 16, 2015

In praise of chemotherapy

I love chemotherapy.  Too much? Mostly I feel this way because I am a sucker for the underdog. Poor chemotherapy has such a bad rep. It strikes fear into both those who are about to go into it and to those who merely hear about it. And those in the middle of receiving it gag at the mere thought.  There is something about dumping poison into the circulatory system that feels out of control and just wrong.

Take the recent story of Cassandra, A Connecticut teen with a curable form of deadly Lymphoma who wanted to choose no treatment.  The State wanted to force her to undergo chemotherapy treatment.  Now I have mixed feelings about this.  I don't like the State forcing its will on someone but at the same time, I'm not sure an adolescent has the maturity to make this kind of decision.  Cassandra is not fully aware of the potential for a life full of interesting possibilities.  Could a brush with toxicity really be that bad that you would forgo the potential for future love, beauty and brilliant life? Looks like the State won out in Cassandra's case and I truly hope she will come to appreciate the overreach.

As someone who has embraced chemo as a partner, it is easy to identify the much sexier alternative.  It is the story of some natural substance that has miraculously cured  the incurable.  It is an herb only found in South American jungles, a vegetarian diet or perhaps a marijuana extract.  Everyone knows someone who knows someone who was told they would die but instead they went on living due to their trust in this natural substance and their eschewing of scientific standard methods.  Boy, I would love to believe this.  Chemo is a bitch of a partner after all.  I'd much rather consume a beneficial herb, eat delicious, organic foods and get high than hook up to a toxic drip, experience nausea  and feel my hands and feet go numb.  And while the former has great second hand stories, the latter has numbers and measurable results.  Which would you choose?  I would not blame anyone for going with the dream.  My embracing chemotherapy is going with reality.  And my choice to love effective  chemotherapy helps me to see it as a battle partner.

Cancer is not like a virus or bacteria.  It is not easily recognized by my immune system as a foreigner.  It is me.  It has my DNA.  It is mutated Chuck Peterson cells that have a gift for replicating themselves.  Anything good for Chuck Peterson is probably good for my cancer cells too.  That is why it is such a difficult disease to fight.  It needs to be tricked.  It has my immune cells fooled.  They can't figure out where normal Chuck Peterson ends and where mutant Chuck Peterson begins. My body naturally gives cancer cells what they need to survive and thrive; blood supply and waste removal. Chemotherapy is the science of making mutant Chuck Peterson stand out from healthy Chuck Peterson so those cells may be identified and killed by natural or chemical processes.

How the battle is waged also depends on the stage of the cancer.  It took me a while to understand this.  Stage 1 is very localized. Stages 2 & 3 are cancers penetrating margins and reaching out to spread to other parts of the body, often using the lymph system as a highway.  Stage 4 is considered incurable as it has moved to other organs and the mutant cells are spread far and wide.  The battle is to remove every single mutant cell.  In early stages, surgery is the gold standard.  It is very direct removal of the baddies. Radiation is good for picking up stragglers in the region.  Chemo is a whole body approach that can kill off farther flung stragglers before they have enough mass to reconstitute as a tumor.  Chemo can also keep a tumor from growing larger.

The battle metaphor often works for me.  In particular, I often visualize my stage 4 battle as the "Battle for Helm's Deep" from The Two Towers by J.R.R. Tolkien.  It is from the the second of the Lord of the Rings trilogy and I'm visualizing the scenes from the movie version, by the way.  Helm's Deep is this awesome fortress which is ideal for repelling a long siege.  The good guys are stuck inside, well protected but with finite supplies.  You can see the endless lines of orcs marching toward you.  They can only get so close and you can kill off one wave at a time.  But sooner or later you will run out of supplies.  Your only hope is that unexpected reinforcements or secret weapons will descend from the hills with the sun behind their backs and somehow manage to kill off every single orc.  It is a long shot but you are on a heroic mission so there is always hope.

I wish I could believe in a magic cure metaphor rather than a battle metaphor.  Just click my heels together 3 times and I will be transported to safety. Who wouldn't want that?  But it feels pretty good to have made peace with chemotherapy.  Maybe love is too strong a word.  Maybe the word is trust.  At least for now I am grateful that this chemo is repelling "orcs"  and leaving me enough strength and feelings of well-being to establish something that feels a bit like normal.