On “Celebrating Small Victories”

A fable of our time by a black-pilled Debbie Downer

Therefore the princes said unto the king, “We beseech thee, let this man be put to death; for thus he weakeneth the hands of the men of war who remain in this city, and the hands of all the people, by speaking such words unto them; for this man seeketh not the welfare of this people, but the hurt.” — Jeremiah 38:4

Illustration by Anthony Freda

[NOTE: This is a fable – it does not necessarily reflect actual medical practices.]

Once there was a beautiful, fun-loving, and gregarious woman named Jane. Sadly, at the age of 62, Jane was diagnosed with metastatic cancer of unknown origin. Scans showed she had cancer in her bones, in her breasts, in one of her kidneys, and possibly in a lung. She had severe pain, was losing weight because she had no appetite, and felt too tired to get out of bed most days. Luckily, Jane had many loving family members whom she trusted to get her the best possible medical care.

The first specialist the family consulted about Jane’s condition was a breast cancer oncologist, Dr. D.

Dr. D had just recently received a patent for a new treatment that, when injected directly into the breast, could kill cancer cells in the area of the injection. Jane had a big growth of cancer in her right breast that was causing pain, and Dr. D said the injections could shrink the mass and make Jane feel better.

Some of Jane’s family members thought this sounded like a good plan. Others, who read about the potential side effects and limited effectiveness of the newly patented breast cancer injections, were not happy with Dr. D’s approach. They thought it was more important to relieve other symptoms: Jane’s trouble urinating and the pain in her lower right back. So they consulted Dr. R – a kidney cancer specialist.

Coincidentally, Dr. R had just patented a radiation protocol designed to reduce cancer masses in the kidneys. He recommended that Jane receive a month’s worth of radiation treatments to improve her kidney function and reduce pain in that area.

The family asked if it was safe for Jane to get both Dr. D’s breast injections and Dr. R’s kidney radiation. Unfortunately, said the doctors, the two treatments could not be given simultaneously. They could, however, try alternating months, and as long as each intervention succeeded in treating its body part, they could continue alternating indefinitely.

But which to try first?

A big family feud ensued. Dr D’s fans argued that the breast was more painful and therefore required more urgent treatment. Dr. R’s admirers wanted the kidney radiation first, due to the urination issues. Finally they decided to start injecting the breast and, after a month, switch to irradiating the kidney.

Every day during the first month, the family members who supported Dr. D’s breast approach crowded around Jane’s bed to find out if it was working. “Do you feel less pain in the breast?” they inquired. “Is it a lot better? A little bit better? Better at all?” When Jane mumbled what sounded like a yes, they cheered. They started bringing balloons and flowers every day to celebrate the success of the treatment. They even brought champagne and raised a glass to the brilliance of Dr. D.

Some days, Jane was so weak she couldn’t answer the family’s questions about her breast. Then the family members who were on Dr. R’s team shook their heads and clucked their tongues and said: “See. We should have started with the kidney radiation.”

The entire family became obsessed with assessing every aspect of the tumor in Jane’s breast. They requested extra tests and scans, and they all spent hours and days analyzing how much the cancer in the breast had shrunk (according to Team D) or not (Team R). Even though they were engaged in vicious arguments nearly 24/7, the family felt strangely united, because they were all monomaniacally focused on the outcome of each day’s breast injection.

Some of the members of Team D even went so far as to invest in the biotech company that made Dr. D’s injections. They followed the ups and downs of the company’s stock nearly as closely as the shrinkage or non-shrinkage of Jane’s breast mass.

A month of breast injections passed. Jane had lost 20 more pounds and rarely got out of bed, even to go to the bathroom. Her room was full of flowers, balloons and empty champagne bottles. Scans showed the cancer in her breast may have shrunk, or may have just stayed the same. Or maybe it grew a tiny bit. But not a lot. Most critically, the stock price for Dr. D’s treatment company was up. And Jane nodded feebly when asked whether her breast was less painful. Team D declared victory.

As planned, Jane’s treatment now switched to Dr. R’s kidney radiation. The same rituals happened in reverse: The family members who supported Dr. R’s approach crowded around Jane’s bed to ask if she felt any relief in her lower back or if she had less trouble urinating. If she seemed to nod, they rejoiced. Team D pounced on any indication that Jane was not actually being helped by the treatment. Team R bought stock in the company that made the kidney radiation devices. The old flowers and balloons and champagne bottles were removed. New ones were brought in.

Jane was growing thinner by the day and could no longer get out of bed at all or eat by herself.

One day, while the family was huddled around trying to get Jane to blink her eyes if the treatment was working or wiggle her nose if it wasn’t, Jane’s youngest nephew, Jeremy, who was just 9 years old, slipped into the room (where he wasn’t supposed to be) and snuck up to the bed. When he saw the limp, emaciated body lying there, he forgot he was trespassing on adult-only territory and exclaimed: “Aunt Jane! What’s wrong? Are you dying?”

A unanimous gasp erupted from the huddled family cluster.

The “d word” had never been uttered in Jane’s room before. The family felt it would lower Jane’s morale and reduce her trust in Dr. D and Dr. R’s treatments. Plus, why be all doom and gloom when you could celebrate the daily successes in the breast or kidney?

The family stopped staring at Jane’s eyes and nose and directed furious glares at Jeremy’s mother, who, flush with embarrassment, shushed her son and ushered him out to the vending machines in the hallway.

“Mommy, mommy,” cried Jeremy. “What’s wrong with Aunt Jane?”

“Shhhh, don’t worry Jeremy,” his mother tried to soothe him. “Aunt Jane is very sick, but she has wonderful doctors taking care of her.”

“Can they make her better?” Jeremy tearfully inquired.

Jeremy’s mother started to say that if Jeremy’s stubborn cousins would just stop forcing her to get useless kidney radiation and go back to breast injections, she’d be fine, but she caught herself mid-sentence. What was she saying? How was anything they were doing helping Jane stay alive?

Jeremy’s mother felt overwhelmed with guilt and despair.

Without telling anyone, she decided to consult Dr. W, a retired doctor who had been a friend of her father’s. Dr. W was an old-school oncologist who did not know much about all the fancy new-fangled injections and targeted radiation treatments. He said the only way to treat metastatic cancer was systemic: You have to find a way to shrink or stop the growth of the cancer all over the body. Focusing on just one organ or the other can provide temporary relief in that area, but does nothing to treat the actual disease.

“So what can we do for Jane?” Jeremy’s mother pleaded.

Dr. W said there were several types of systemic treatments: old-fashioned chemotherapy, and some newer systemic approaches. Dr. W added that Jane could only survive these treatments if she also received extensive psychological, cognitive, and spiritual support in addition to physical, occupational, and nutritional therapy. And even with all that, he admitted, there was no guarantee that the treatments would work. It may be too late. Jane’s cancer, he said, may be too advanced. But, he concluded, systemic treatment was the only way to potentially save her life.

Dr. W said all the systemic choices were difficult for the patient, painstaking for the medical staff, and may not yield immediately apparent results. The family might have to move Jane to a less luxurious facility, where such un-patented, non-lucrative treatments were administered by doctors and practitioners who were considered backward-thinking or downright loony.

When Jeremy’s mother brought Dr. W to the hospital to meet the family and explain about the potentially life-saving but very difficult approach to treating the cancer all over the body, they were apoplectic. The breast injections were working! half of them shouted. The kidney radiation was successful! the others screamed.

Why in the world, they asked, would we try to look at so much cancer in so many different places, when the breast and kidney treatments were working so fabulously? Not to mention that the stocks of both companies were soaring. How could it possibly be useful to switch to treatment protocols so difficult and so tedious, with no patents or commercial viability, and without any idea whether they would succeed or not?

The family started throwing wilted flowers and empty champagne flutes at Jeremy’s mother and Dr. W. While they were violently pushing them out the door, Jane took her last breath.

Only Jeremy, who had snuck in with his mom and the old doctor, was there to notice.

[The End]