A Yankee Notebook

NUMBER 1824
July 4, 2016

CANCER, THE UNWELCOME GUEST

MONTPELIER – A few years ago, when I signed up with a new personal care provider (PCP) in central Vermont, she asked, “What are your goals for your health care in the coming years?” She didn’t say it, but I knew what she meant, which was “in the few short years you have remaining.” Didn’t matter; my goals haven’t changed for decades. “I just don’t want to get snuck up on,” I answered. “If you see any hints or have any suspicions, I want to check ‘em out. No surprises.”

I must say that in the years since then I’ve been pretty well taken care of. My PCPs (who are occasionally replaced by substitutes) have run the gamut from spotting calamity in every wheeze or swelling to waving off symptoms as the natural products of aging and/or hypochondria. But I, too, have run the gamut – from a 19th-century pharmacist grandfather who dosed colds with potions rich in codeine or opium, and ringworm with carbolic acid neutralized with olive oil – and have been most favorably impressed with the progress in medical treatment.

In spite of the increased sophistication and effectiveness, Mother and I did get snuck up on, after all. She’d had surgery at the Hitchcock Clinic to try to clear up some spinal stenosis that was really hobbling her, and in the rehabilitation facility began passing blood – not a usual result. She went through two courses of antibiotics before she insisted somebody take a look at her bladder, which might have been injured by a catheter during surgery. Back to Hitchcock we went, where they did a couple of tests. Then a really sharp nurse in the urology department sat her down and announced they’d found cancer cells in her urine. Surgery was in her immediate future.

If ever there was a moment for the expression, “Hope springs eternal,” that was it: How bad is it? Has it spread? Is it treatable? Mother and I are from the generation that considered cancer an almost certain death sentence – that, in fact, never used the word in polite conversation. It was referred to instead by raised eyebrows and the euphemism, “The big C.” But that was then; and it’s difficult nowadays, surrounded by state-of-the-art equipment and specialists to match, to face the diagnosis with anything but optimism, guarded and qualified though it may be.

The surgery removed a cancerous growth in her bladder and revealed the existence of further complications, not least of which was that the cancer, a Stage 3, had invaded the muscle walls of the bladder. My response was a silent “Uh-oh,” but without fear of mortality; it was more, “Here we go. This is going to be a summer!” Hers – though I can’t tell you what she didn’t say – was, “Okay. Let’s get it done. What do we do?”

The answer to that, as it happens, isn’t all that simple. She was now in the care of the Norris Cotton Cancer Center, attached to and interdependent with the clinic, but devoted to one thing, and not in only one way. Treatment, from what we’ve gathered so far, is a highly individualized protocol, recommended by a gathering of specialists called the “tumor board.” We got several lectures – never were lectures listened to better! – and paperwork reiterating what we’d just heard. We got a three-month schedule (I was right: It was going to be some summer) and poop sheets about the various drugs she’d be infused with through her “port,” an opening they made in her upper chest, connected by a short tube under her skin to her vascular plumbing.

I’ve long considered myself a bit of a logistician (specializing in transportation, food, and equipment for Arctic canoe trips); but I’m utterly blown away by the apparent ease with which the Cancer Center handles the cases of at least dozens, and perhaps even hundreds of patients a day. Everything is computerized, of course, and two nurses must sign off simultaneously with a multitude of numbers after each procedure – rather like the surgeon who, before the patient is anesthetized, marks the spot of the operation with the concurrence of the patient and at least one assistant. At lunchtime in the infusion unit, volunteers deliver sandwiches, drinks, and ice cream to not only the infusees, but their patiently waiting companions, as well. A Reiki massage specialist circulates, offering free treatments. My only complaint is the magazines – really boring – but I’m beginning to introduce a little liberal intellectual content into the assortment each time we return.

We’re looking at a summer of roughly biweekly chemical and iron infusions, various blood tests to gauge our progress against the nasty cells, and finally a major surgery that will no doubt introduce a set of permanent changes to our life together. But we’re sanguine about the outcome, and I can’t help but reflect that this is the sort of thing we signed up for almost sixty years ago, when we blithely swore to stick together through whatever should come to us.

The biggest surprise to us, though, has been the atmosphere at the Cancer Center. You can always tell, for example, a lot about the manager of a McDonald’s by the attitude of the kids on the counter. Somebody managerial at the Center must have said, “We’re going to be as cheerful and supportive as possible for the folks who come here to us for treatment.” There are half-completed picture puzzles here and there on tables for anybody to pick at. There’s a library. There are dozens of other patients of all ages in various stages of their disease, some cheerful, others not. But the staff is almost uniformly upbeat. Mother says it’s almost like going to a spa; I fancy it’s what it must be like flying first-class. But it’s neither. It’s a bunch of people who are really onto their jobs working in concert to produce a result much to be desired: the defeat of a killer whose persistence must be matched by never-ending creativity in treatments. We’ve never till now appreciated how much the annual Prouty fund-raising event run by the Friends of the Center – coincidentally occurring this week – could mean for those with the disease. Now we know.

Photo by Willem lange