Academic

Living and Surviving--Stuntz

By David Skeel and Bill Stuntz

Last week, I got some very good news?but it didn?t feel good at all. This week?s news was medically neutral, as these things are usually judged. But it felt incredibly sweet.

That sounds strange, so let me try to explain. Last week, I learned that the past two months of chemotherapy has been working: the latest round of films showed that two tumors on my lungs have shrunk slightly, and that no new bits of cancer are visible?not on my liver (which is where late-stage colon cancer tends to migrate), and not on my lungs. That doesn?t mean I?m cancer-free save for those two lung tumors. As I understand it, the odds remain high that there are small bits of cancer out there, including at least some on my lungs. But the films suggest that my chemo regimen can either kill those incipient tumors or stop them from growing. Which means my life expectancy just got longer by at least a year, and maybe more.

Like I said, it?s very good news. What?s not to like about a longer life expectancy when faced with a killing disease?

Actually, the question isn?t as crazy as it sounds; it all depends on what happens in that extra time. Medical care is usually about maximizing time itself, about keeping the patient?s heart beating as long as possible. But time isn?t what I want to maximize. Longevity is fine, but life is what matters. And those two words are definitely not synonyms.

Which leads to a crucial characteristic of chemotherapy, at least as I?ve experienced it. Chemo is a strange beast: it restores life by first killing it. If you want a picture of the experience, think of the difference between what used to be called carpet bombing?destroying a military target by destroying everything in its vicinity?and the use of so-called ?smart bombs,? which place the bomb?s destructive power in precisely the place the military seeks to obliterate. Five or ten years from now, oncologists may have the capacity to give cancer patients the chemical equivalent of smart bombs: drugs that kill cancer cells and nothing else. But for now, chemotherapy is akin to slow poison: when it works, it works by killing all it touches.

?Killing? is the right word. Forget the many side effects that are too gross to describe. Chemo drains the life from its recipients. I thought I knew what it was to be tired down to my bones?to feel utterly spent?but I?ve never been tired like this. The fatigue envelops me like a blanket; after awhile, it ceases to be a sensation and becomes something akin to an identity. I?m told that the lost energy returns: I hope so, though when you?re in the midst of the process, it?s a little hard to believe.

One of the few sure things in cancer treatment is this: if a chemo regimen works, the patient will see more of it. Often, a lot more. I?ve read and heard a good many stories of stage 4 cancers over the past few months, and in more than a few of them, the patient spends his or her last years?the number of years can be considerable?oscillating between yet another surgery to remove the latest tumor, and more months of chemo to slow the cancer?s spread. They call it ?extending life,? and sometimes, that?s what the treatment does?but other times the label misleads; patients survive but don?t really live. Which is why this week?s news seemed so joyous: my oncologist told me that, when I resume chemo after this summer?s thoracic surgery, the dosages of the drugs can be dialed back, and if I so choose, dialed back a lot. Thanks be to God: I can do more than survive; I still have some living to do. Before I heard that news, I was starting to wonder.

American medicine is an amazing enterprise, filled with creative and talented people who seem to work miracles for a living. I?m more thankful for the doctors who care for me than I can describe. But for all the medical system?s accomplishments, it still suffers from a key misunderstanding. Doctors see their job as fixing the broken places in our ailing bodies. When it comes to the kinds of brokenness that can be repaired, that is as it should be. But there is another set of medical problems that cannot be fixed: cancers that won?t disappear, pains that will last as long as life does. When it comes to those problems, repair is not the proper goal. A better word is redemption: the enterprise of carving out some space, however small, for life?not mere survival?in the midst of diseases that seek to squelch it.

Oncologists are better on this score than most doctors, probably because they see the destructive character of the treatments they administer up close. Even so, the tendency to equate success with survival is strong. Too much so, I think: that tendency needs resisting. I suspect I?m far from alone in saying that survival holds little appeal for me. I want to live?for as much time, or as little, as I have left.

That mind-set follows naturally from my faith, I believe?but a good many of my fellow believers seem to disagree. One of the more surprising aspects of Christian culture in our time and place is the widespread embrace of longevity and survival not just as moral goods, but as moral imperatives. That embrace seemed all too evident in the Terri Schiavo controversy of a few years back, and in the long-running conversation about medical treatment of dying patients. I?m no fan of euthanasia, but I?m also no fan of the idea that physical longevity is a morally proper goal in circumstances like Schiavo?s?or in circumstances like mine. Just because medicine can sustain the body for awhile longer, that doesn?t mean it should always do so. Life is more than a beating heart. And life is what we should be seeking. The good news is, if you look in the right places, it?s usually there to be found.

Full post as published by Less than the Least on June 05, 2008 (boomark / email).