Mortality

the doctor tells us they don’t know but what the side effects may be worse. You know: the big C. My figuring is, take the chance, they’re just about ready to lick cancer anyway and with these transplants pretty soon they can replace your whole insides.

—Mr.Angstrom Sr. in John Updike’s Rabbit Redux (1971)

UPDIKE’S NOVEL WAS SET IN WHAT MIGHT BE called the optimistic years of the Nixon administration: the time of the Apollo mission and the birth of that all-American can-do expression that begins, “If we can put a man on the moon…” In January 1971, Senators Kennedy and Javits sponsored the “Conquest of Cancer Act,” and by December of that year Richard Nixon had signed something like it into law, along with huge federal appropriations. The talk was all of a “War on Cancer.”

Four decades later, those other glorious “wars,” on poverty and drugs and terror, combine to mock such rhetoric, and, as often as I am encouraged to “battle” my own tumor, I can’t shake the feeling that it is the cancer that is making war on me. The dread with which it is discussed—“the big C”—is still almost superstitious. So is the ever whispered hope of a new treatment or cure.

In her famous essay on Hollywood, Pauline Kael described it as a place where you could die of encouragement. That may still be true of Tinseltown; in Tumortown you sometimes feel that you may expire from sheer advice. A lot of it comes free and unsolicited. I must, without delay, begin ingesting the granulated essence of the peach pit (or is it the apricot?), a sovereign remedy known to ancient civilizations but now covered up by greedy modern doctors. Another correspondent urges heaping doses of testosterone supplements, perhaps as a morale-booster. Or I must find ways of opening certain chakras and putting myself in an appropriately receptive mental state. Macrobiotic or vegan diets will be all I require for nourishment during this experience. And don’t laugh at poor old Mr. Angstrom above: Somebody has written to me from a famous university to suggest that I have myself cryonically or cryogenically frozen against the day when the magic bullet, or whatever it is, has been devised. (When I failed to reply to this, I got a second missive, suggesting that I freeze at least my brain so that its cortex could be appreciated by posterity. Well, I mean to say, gosh, thanks awfully.) As against all that, I did get a kind note from a Cheyenne-Arapaho friend of mine, saying that everyone she knew who had resorted to tribal remedies had died almost immediately, and suggesting that if I was offered any Native American medicines I should “move as fast as possible in the opposite direction.” Some advice can actually be taken.

Even in the world of sanity and modernity, though, it often cannot. Extremely well-informed people also get in touch to insist that there is really only one doctor, or only one clinic. These physicians and facilities are as far apart as Cleveland and Kyoto. Even if I had possession of my own aircraft, I would never be able to assure myself that I had tried everyone, let alone everything. The citizens of Tumortown are forever assailed with cures, and rumors of cures. I actually did take myself to one grand palazzo of a clinic in the richer part of the stricken city, which I will not name because all I got from it was a long and dull exposition of what I already knew plus (while lying on one of the fabled establishment’s examination tables) a bugbite that briefly doubled the size of my left hand: completely surplus even to my pre-cancerous requirements but a real irritation to someone with a chemically corroded immune system.

Still and all, this is both an exhilarating and a melancholy time to have a cancer like mine. Exhilarating, because my calm and scholarly oncologist, Dr. Frederick Smith, can design a chemo-cocktail that has already shrunk some of my secondary tumors, and can “tweak” said cocktail to minimize certain nasty side effects. That wouldn’t have been possible when Updike was writing his book or when Nixon was proclaiming his “war.” But melancholy, too, because new peaks of medicine are rising and new treatments beginning to be glimpsed, and they have probably come too late for me.

For example, I was encouraged to learn of a new “immunotherapy protocol,” evolved by Drs. Steven Rosenberg and Nicholas Restifo at the National Cancer Institute. Actually, the word “encouraged” is an understatement. I was hugely excited. It is now possible to remove T cells from the blood, subject them to a process of genetic engineering, and then reinject them to attack the malignancy. “Some of this may sound like space-age medicine,” wrote Dr. Restifo, as if he, too, had been rereading Updike, “but we have treated well over 100 patients with gene-engineered T cells, and have treated over 20 patients with the exact approach that I am suggesting may be applicable to your case.” There was a catch, and it involved a “match.” My tumor had to express a protein called NY-ESO-1, and my immune cells had to have a particular molecule named HLA-A2. Given this pairing, the immune system could be charged up to resist the tumor. The odds looked good, in that half of those with European or Caucasian genes do have that very molecule. And my tumor when analyzed did have the protein! But my immune cells declined to identify as sufficiently “Caucasian”. Other similar trials are under review by the Food and Drug Administration, but I am in a bit of a hurry, and I can’t forget the feeling of flatness that I experienced when I received the news.

Best perhaps to get these false hopes behind one quickly: It was in the same week that I was told that I didn’t have the necessary mutations in my tumor to qualify for any other of the “targeted” cancer therapies currently on offer. A night or so later I was emailed by perhaps fifty friends because 60 Minutes had run a segment about the “tissue engineering,” by way of stem cells, of a man with a cancerous esophagus. He had effectively been medically enabled to “grow” a new one. I excitedly contacted my friend Dr. Collins, father of genome-based treatment, who gently but firmly told me that my cancer has spread too far beyond my esophagus to be treatable by such a means.

Analyzing the blues that I developed during those lousy seven days, I discovered that I felt cheated as well as disappointed. “Until you have done something for humanity,” wrote the great American educator Horace Mann, “you should be ashamed to die.” I would have happily offered myself as an experimental subject for new drugs or new surgeries, partly of course in the hope that they might salvage me, but also on the Mann principle. And I didn’t even qualify for the adventure. So I have to trudge on with the chemo routine, augmented if it proves worthwhile by radiation and perhaps the much-discussed CyberKnife for a surgical intervention: both of these things; near- miraculous when compared with the recent past.

There is an even longer shot that I do propose to attempt, even though its likely efficacy lies at the outer limits of probability. I am going to try to have my entire DNA “sequenced,” along with the genome of my tumor. Francis Collins was typically sober in his evaluation of the usefulness of this. If the two sequencings could be performed, he wrote to me, “it could be clearly determined what mutations were present in the cancer that is causing it to grow. The potential for discovering mutations in the cancer cells that could lead to a new therapeutic idea is uncertain—this is at the very frontier of cancer research right now.” Partly for that reason, as he advised me, the cost of having it done is also very steep at the moment. But to judge by my correspondence, practically everybody in this country has either had cancer or has a friend or relative who has been a victim of it. So perhaps I will be able to contribute a little bit to enlarging the knowledge that will help future generations.

I say “perhaps” partly because Francis has now had to lay aside a lot of his pioneering work, in order to defend his profession from a legal blockade of its most promising avenue of endeavor. Even as he and I were having those partly thrilling and partly lowering conversations, last August a federal judge in Washington, D.C., ordered a halt to all government expenditure on embryonic stem-cell research. Judge Royce Lamberth was responding to a suit from supporters of the so-called Dickey-Wicker Amendment, named for the Republican duo who in 1995 managed to forbid federal spending on any research that employs a human embryo. As a believing Christian, Francis is squeamish about the creation for research purposes of these nonsentient cell clumps (as, if you care, am I), but he was hoping for good work to result from the use of already existing embryos, originally created for in vitro fertilization. These embryos are going nowhere as it is. But now religious maniacs strive to forbid even their use, which would help what the same maniacs regard as the unformed embryo’s fellow humans! The politicized sponsors of this pseudoscientific nonsense should be ashamed to live, let alone die. If you want to take part in the “war” against cancer, and other terrible maladies, too, then join the battle against their lethal stupidity.

IV