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So, a quick update: When I last posted, the docs had found a cluster of tumors in my abdomen, plus one tumor on my liver. I started chemo immediately. Three weeks ago, I received news of my latest set of films: the tumors haven't shrunk, but they haven't grown either. That's good news—though, as always in Cancer World, news is double-edged: it means I'll be on chemo for at least several months longer. When (I'm past the stage where it's appropriate to say 'if') the tumors resume growing, the docs will try a modified chemo regimen. Whenever that fails, we will look either at clinical trials or palliative care.

 

Those films also turned up a blood clot in one of my lungs, which the doctors found worrisome. I'm giving myself daily injections of a blood thinner, a small piece of unpleasantness on top of cancer treatment.

 

As Americans debate reform of the health care system, I increasingly wonder at the cost of my own medical care. At this point, chemo can extend my life only modestly; there is only a slight chance I will live more than eighteen months. Less is more likely.  The tradeoff seems worth it to me, for now: I want to be around to pay more of our youngest child's college tuition, so that Ruth need not pay those bills out of life insurance money she may need for herself. I'd also like to finish my book, and spend more time with family and friends. But while those desires are perfectly legitimate, it is also perfectly legitimate for others—my colleagues whose insurance premiums pay for my medical care or the taxpayers who would do so under a government-funded insurance plan—to conclude that my preferences do not merit the huge costs required to (possibly) extend my life a few months. How best to negotiate that gap between my preferences and the public interest, not just for me but for the many patients in circumstances like mine, is a mystery to me. But I doubt we will ever get control of health care costs if preferences like mine continue to govern in cases like mine. Which makes me wonder whether I have a moral obligation to cease chemo sometime in the near future, and let my cancer take its natural course. Not a pleasant thought, but not a foolish one either. At least, so it seems to me.

 

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