The Cancer Diaries, Part 26

Scene from New Amsterdam

Cancer changes everything — and nothing at all.
Rabbi Skillman

That’s a profound comment, coming from a TV character. The “rabbi” in question is a fictional patient in hospital, played by George Wyner in the TV series, New Amsterdam (Season 1 Episode 8). He is talking to the hospital’s medical director, Dr. Max Goodwin (played by Ryan Eggold).  Cancer — its diagnosis, treatment, and impact on people — plays a pivotal role in the series, and offers some food for thought for viewers. This episode stayed with me for quite some time.

Skillman suffers from terminal pancreatic cancer. It’s a nasty cancer with a mere 9% five-year survival rate.* Max wants Skillman to undergo a risky surgery. The oncologist, Dr. Sharpe (played by Freema Agyeman), recommends he go home and live the remaining year or so of his life in comfort there, with drugs to ease his deteriorating condition. Either way, Skillman doesn’t want to remain a patient in the hospital to die there.

Helen warns the rabbi, “There’s a 90% chance of dying during surgery.’ Max chimes in, saying, “Or a 10% chance that you’ll live.” Skillman looks bemused and says, “Not good odds.” He chooses to go home. But sometime during the episode, Skillman opts for the surgery. When Max asks him why, Skillman says, with a certain Stoic shrug, “Tomorrow I’ll be better or I’ll be dead, but I won’t be a patient.”

I suspect every patent diagnosed with cancer has to come to terms with similar decisions, whether it be surgery, radiation, chemotherapy, or a combination of them. I certainly did. You have to weigh whether the treatment offers a better chance of survival than the discomfort or disability it will cause. But for many cancers, there is no effective treatment, only palliative care. Or dying in hospital.

Given a mere 10% survival chance, would I have opted to undergo surgery? I’m not sure. I can only say with the hindsight granted by my survival that, given the choice of dying now or later,  I probably would have said yes to it, and taken the risk. We all die: that’s inevitable. Why not roll the dice?

I watched my father’s life drain away in hospital as he slowly died of esophageal cancer, and saw my closest friend waste away from the same disease in palliative care. While my father got the best care the hospital could give, it’s not a place to be when your life is ending. There’s a coldness about it, an air of bureaucracy and mechanization compared to a facility designed for palliative care. I understand Rabbi Skillman’s reluctance to remain a patient.

Every weekday for seven weeks, I drove to the hospital for my radiation treatment. I soon recognized and was recognized by several of the people I saw daily and was even greeted by my first name by some towards the end of the treatment. Everyone was friendly and welcoming, doing their best to make the process comfortable, easy, and quick. But still, there was always the feeling I was part of a machine, just a number or a statistic in the charts, on the treatment conveyor belt. I was always a casual visitor, a stranger: never as comfortable as I am at home, no matter how many of my books I carried to read in the waiting areas.

And there was never anyone to talk about the bigger issues with. With hundreds of patients going through treatment at any time, there probably isn’t anyone who has the time to sit down and talk about one patient’s concerns, fears, or philosophic views. And you certainly don’t have much time to talk about them with the other patients in the waiting area. At least in palliative care, there are people who can stop, get off the treadmill, and listen.

It’s been several decades since I sat down with any rabbi or to discuss deep issues like the end of life, so I can’t really comment whether the TV character presents a realistic view based on modern faith (it isn’t said whether he’s Reform, Conservative or Orthodox, but the lack of a kippah while he’s bedridden suggests it’s likely one of the former two). Still, he reminded me of a rabbi I knew back in my younger days (except that he didn’t answer every question with another question…).

When I heard Wyner’s character say that quote about cancer changing everything and nothing, I grabbed a pen and wrote it down. Being diagnosed with cancer — any cancer — is life-changing. It is a personal forest fire, a tsunami, a magnitude 7 earthquake. It staggers you. It shakes you. It has as dramatic an effect on you, as if you were suddenly swept off the streets by Kafka-esque secret police, thrown in a cell, and charged with crimes against the state. You feel abandoned, incarcerated, suspect, adrift.

But it also changes nothing, because the world goes on around you, for the most part without comforting or even noticing or your distress. You and everyone around you still needs to buy groceries, walk the dog, get up in the morning, shower, make a pot of tea; do all the little daily things you did before the diagnosis still carry on. The cashier doesn’t care. The dog doesn’t notice. After you get over the shock of the diagnosis, you still have to put your pants on, one leg at a time, and brush your teeth. Your cancer doesn’t affect the weather or the sunrise.

Skillman recounts the biblical story of Abraham and the sacrifice of Isaac to Max, a metaphor to explain how he arrived at his choice. The story is about making difficult, even impossible choices: enjoy what you have now, or take a risk for something better. A wild, dangerous risk. A better future is promised by someone else, or some other agency, and not within your own control, while appreciating what you have already attained is easy. Roll the dice?

Skillman took the chance and appeared comfortable, even happy with his decision, but it was Max (who is also diagnosed with squamous cell carcinoma, aka throat cancer) who admits he’s not a good patient because he is scared. And I get that too: cancer is scary whether you’re a doctor or a patient, and all your choices seem to lean on agencies outside your control. There are too many variables, too many unknowns to feel comfortable.

How Max manages his own fears about his cancer, and his reluctance to get treatment, is a big part of the show’s character development and plotlines. I sometimes sympathized, sometimes rejected his feelings, trying to see myself in his mirror. Cancer is, as I said, scary and every patient has to come to his or her own comfort level with the diagnosis and your own future. I didn’t fear the radiation but felt the weight of its inevitability every day I drove to Barrie for treatment. I was, however, worried about the debilitating effects of chemotherapy if I was found to need it (I still might). That kept me awake more than a few nights. Hormone treatment wasn’t scary to me, but it’s proven a  source of discomfort and mild distress I simply have to live with.

My mortality… well, that leviathan rose to the forefront of my thoughts for quite a while. It has since subsided back to its benthic depths, but may yet resurface, depending on future diagnoses.

Max is actually based on a real-life doctor: Dr. Eric Manheimer, formerly of Bellevue Hospital. The TV series is based on his 2012 memoir: Twelve Patients: Life and Death at Bellevue Hospital. Manheimer also suffered from throat cancer in real life. He’s also a writer and consultant for the show, so there is realism in the portrayal of Max and his fears about cancer.

The episode, by the way, is titled “Three Dots,” which refers to the three tattooed dots a patient gets when having radiation treatment. Those dots allow the technicians and therapists to align your body in the same position and place each session. I have them on my lower abdomen, a daily reminder (as if the surgery scar wasn’t enough) of what I went through.

~~~~~

* According to cancer.net:

If the [pancreatic] cancer is detected at an early stage when surgical removal of the tumor is possible, the 5-year survival rate is 37%. About 10% of people are diagnosed at this stage. If the cancer has spread to surrounding tissues or organs, the 5-year survival rate is 12%. For the 53% of people who are diagnosed after the cancer has spread to a distant part of the body, the 5-year survival rate is 3%…

For prostate cancer as I had (and I still don’t know if it has spread further):

The 5-year survival rate for most men with local or regional prostate cancer is nearly 100%. For men diagnosed with prostate cancer that has spread to other parts of the body, the 5-year survival rate is 31%.

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