Cancer and Terrorism

6-5-2004

Bill Keller, Editor

 My wife, Susie, began to experience severe pain in her upper right leg beginning in early October 1982. The pain gradually worsened until, one afternoon, I received a call from her saying she could no longer stand on it and I needed to come pick her up from work.

 This was just one more little symptom that had been grinding away at her.  She felt tired, had no real energy for life, was grumpy and cried easily. These complaints had been growing over the previous year, but they had never tripped any alarm bell.  They just seemed to be the normal complaints of a working mother with a working husband and a very energetic 4 year old daughter.

 However, the sever pain demanded attention and an appointment was made with our family Physician, Dr. Ahn.  Dr. Ahn had been our Physician for a very short time, beginning with our 1980 move to Iowa.  However, his friendly approach, his willingness to speak directly and his confident actions soon granted him our complete trust.  An appointment was made for the next day and soon I was setting on a chair in the exam room watching Dr. Ahn examine Susie’s thigh and abdomen. His confident process was reassuring, but the look of concern frightened me.

 After thoroughly probing, prodding and questioning he stated the though my wife had a herniated ovary. He did not feel sufficiently skilled to make a final diagnosis and said the best next step was for him to make an appointment with an internist to get his opinion.

 Dr. Brimmer was a completely different personality.  While he was very direct and concise, he definitely lacked the “softness”” of Dr. Ahn. However, he was a very skilled surgeon and highly recommended by Dr. Ahn.  I again found myself sitting on a stool next to the exam table while Dr. Brimmer examined Susie and tried to confirm Dr. Ahn’s diagnosis of a herniated ovary.  Finally, he explained he could definitely feel a solid mass protruding near the area of her ovary and that he concurred with Dr. Ahn that there was indeed a herniated ovary.  He explained the seriousness of this and recommended immediate surgery.   Looking at my wife as tears rolled down her face, both from fear and pain, we agreed and surgery was set a few days later.

 It was our luck that her mom, Helen had been visiting and she readily agreed to extend her stay to lend a hand with our daughter and just to provide love and support to my wife.

 All too quickly I found myself sitting yet again on a stool in yet another exam room.  However, this time there was a team of nurses prepping my wife for surgery.  The usual words of comfort were said to each other. “It’ll be fine!”  ‘You’ll feel better in just a few days!”  “I’m glad we finally know what the hell has been going on!” In no time, I was being asked to go to the waiting room with my Helen and Susie was being rolled out of the room towards surgery.  I have never felt so helpless as I did at that moment.  I have never been one to feel comfortable while out-of-control, and at that instant I was as out-of-control as I had ever been.

 Time passes incredibly slowly when the person who has been the love of your life for the past 18 years is undergoing surgery.  It feels like they are in danger, threatened and you simply want to see the Doctor walk through the door, tell you all is well and that you can see them shortly. Her mom and I waited for that conversation for what seemed like an eternity.  And, finally after nearly 2 hours, the elevator doors at the end of the wall opened and the surgeon walked towards us.  As I expected from this Doctor, the conversation was brief and direct.

 “When we opened your wife’s abdomen up, we found that it was not a herniated ovary.  It was a fairly large tumor.  It is about the size of a grapefruit and a portion of it has grown down your wife’s leg and wrapped itself around her sciatic nerve, that’s what has been causing her pain.  The tumor is so well integrated into her body that we can not surgically remove it.  I am going to perform more extensive explorative surgery to see if I can determine how far it has spread.  That should take a few more hours.  I will give you more information then.”  And, he turned and walked back the way he had come. No real time for questions, answers, reassurance.  And, my world collapsed. 

 A kind of surreal world existed for the next few hours.  Helen had lost a sister to cancer decades earlier.  In her heart she knew her daughter was going to die of this disease and her grief was total.  For myself, I needed facts:  just what kind of cancer was it, exactly how far had it spread, what was the survival rate, what the hell was taking so long. 

 Finally, two hours after the Doctor disappeared back into the elevator, he reappeared.  His words were not reassuring.  My wife’s lymphatic system has been involved.  He had explored her abdomen and chest and found lymph nodes that were significantly enlarged indicating a fairly widespread cancer. He still had no exact diagnosis as to the type of cancer we were dealing with, but biopsies had been taken and sent and we would have our answer shortly.  Meanwhile, my wife was in recovery, would be in her room shortly and then I could see her.   And, my world began to turn again.

 Meanwhile, calls needed to be made.  Her family and my mom knew of the surgery and all were anxious to know the outcome. The call to my mom began in tears. I could only get out:  “Mom, she has cancer.”  My mom, always tough and loving simply said:  “Don’t worry hunny, I will be there in the morning, it’ll be fine.” This from a woman raised on the farm during the depression, widowed when I was seven, herself the patient in a number of surgeries, simply rolled up her sleeves, reassured me and headed our way. She reaffirmed in me that while crying and feeling helpless are natural at times, they resolve little.  Action is the solution.  So, I stiffened by back, finished my calls and headed off to see if I could see my wife.  Meantime, my wife’s mom also found strength, gathered her self together, and waited for word from me on how her daughter was doing.

 By the time I got to her room, she was beginning to recover from her anesthesia.  She had heavy wrappings across her chest, IVs in her arm and a worried look on her face.  “How am I?” were the first words out of her mouth.  “Not so well”, I said.  “You have cancer; the Doctor could not operate on it.  The biopsies will be back in a few days.”   At that instant she was simply too tired to react.  Tears flowed, her eyes closed and she was asleep quickly.

 Early the next morning, yet another Doctor appeared, Dr. Gesme.  It was a name and face that both Susie and I would become intimately familiar with.  He was an oncologist and was highly recommended by both Dr. Ahn and Dr. Brimmer. The stay was brief.  If we would have him, he would take Susie on as a patient. It would still be days before the biopsies would be back and then we would map out a strategy to give the best outcome.  While I desperately wanted to hear the word cure, he would not use it.  Outcomes depend on so many variables he said, that were no guarantees, but he would do the best job he knew how to do.  Susie and I liked his honesty, directness and his warm personality.  We agreed that if we were going to bet her life, he was the Doctor to do it with.

 Days later, after Susie has begun to heal from her extensive incisions, Dr. Gesme returned.  The lab had identified and staged her cancer.  It was Non-Hodgkin’s, Level III cancer.  The words meant nothing to us.  However, they were good news to Dr. Gesme.  “This is a very aggressive cancer, it spreads quite quickly.”  I took little comfort in these words.  “That makes it very treatable.”  He must have seen the puzzled looks on both our faces.  “The preferred regimen of treatment for this type of cancer is chemotherapy.  Chemotherapy differentiates which cells to attack by their growth rate.  Cells that grow quickly – Non-Hodgkin’s Cancer – for example, are easier to target.  Therefore, the effectiveness of the treatment is greatly enhanced.  This is a very treatable cancer.”

 “But” he continued, “it must be treated very aggressively, and these treatments should start as soon as possible.  We will give your wife a week to mend, then begin the treatments.  The first three will be received in the hospital, the remaining will be delivered over six months by trips to my office.  You are going to feel very sick, but the prognosis is good.  As long as we are aggressive, I am very hopeful.”

 His words frightened and comforted in the same breath.  But, we had an initial direction, a plan and my world began to regain focus.  Susie as well had looked inside, steeled her soul and was ready for a fight.

 We were back in the hospital within 2 weeks on the oncology floor.  We were surrounded by patients, each with their own battles to fight. Over the next six months we would see many win their battles and a number lose them as well.  While surreal might be an over used word to describe strange situations, it is the only one that fits our existence for the next six months.

 The first three treatments would be given in the hospital.  Each would be five days long during which an IV cocktail of Bleomycin, Adriamycin, Cyclophosphamide and Prednisone would be delivered via IV drip. We were given cards to read describing possible reactions to each of these drugs.  Many cards said something roughly like “If patient’s heart stops, discontinue use”  “If patients breathing stops, discontinue use”.  I read the first two, then set the rest aside.  For Susie, 10 years as a pharmacist brought her a deeper level of understanding as to what was about to be injected into her body.  Yet, to treat this cancer with anything but the most aggressive path possible seemed foolish to both of us.

 To say the treatments were brutal would be a severe understatement.  Susie vomited nearly continuously for the entire five days of each treatment.  Feeding finally had to be done by running various broths into her stomach through a small tube inserted through her nose.  Nothing helped the nausea, it could only be endured.  And she did, three times, five days each time.

 It had other effects as well.  One cell that grows very fast in your body are white blood cells.  So, while the chemo killed cancer cells, it also hammered her white blood cells, a body’s primary defense to fight off infections. So, we limited exposure to people between treatments.  It would be very dangerous to travel anywhere that had large gatherings of people. Including funerals.  In December 1982, our nephew Paul was killed coming home from his first semester of college in an auto accident.  We were unable to attend the funeral, something that hurts to this day.  But, our priorities were clear and the risks to high.  So we stayed home and awaited her third and final hospital treatment.

 At the end of the hospital treatments, Dr. Gesme was very hopeful of the final outcome.  While the word “cure” never passed his lips, words like “remission”, “good progress”, “the tumor has shrunk significantly” did, giving us hope for the future and strength to continue the process.

 From the end of December until the last treatment on the 12th of April, 1983, we would visit his office every five or six weeks depending on her blood count.  We would take a bucket along in the car and try our best to make it home before the vomiting began, most times we made it.  Three days of nausea and weeks of low blood counts would dictate our actions and our life until the next treatment when all was repeated yet again.

 However, after the last treatment we got solid news.  Our willingness to act aggressively, to set out to kill this invader and destroyer had paid off.  The tumor had dissipated.  And, while some scar tissue remained, it was not an active tumor and we were at the point that only time would tell if the process was successful.  That was 21 years ago on April 12th that the last treatment ended, proving that aggressive reaction to disease was the best way to go.  In August we will celebrate our 32nd wedding anniversary.  I am grateful to the choices and direction of Dr. Gesme all those years ago.

 You would think that after one experience like this in a family, it would be enough.  However, that was not to be.

 About two years ago, I began to notice difficulty urinating.  Over the past 20 years, our nation has done much to increase cancer awareness.   Males can hardly turn on the TV or radio without hearing how, if you are over 50, you need to be screened for Prostate cancer. Well, at the time I was 52 and a small alarm bell was ringing in the back of my head.  Finally, just to prove to myself that all was OK, in August 2002 I went to Dr. Richardson, an urologist for a PSA test.  It came back a 5, which was “slightly high”.  He presented a number of options and we settled on the old “lets try it again in 4 months to make sure it wasn’t a fluke” choice.  And so, in December I was again in the presence of Dr. Richardson.  His news was not happy news.  The PSA test repeated a 5 reading.  While it was borderline, he was concerned and wanted to take the next step of doing a biopsy on my Prostate.  With holidays and a new year in the offing, I did not see him again until February. 

 The process, while unpleasant, was not particularly painful.  While lying on my side, a fairly large ultrasonic probe with a hole in the middle of it was inserted rectally.  The ultrasonic end was used to position the probe while fairly long 18-inch hollow needles were injected through my bowel into my Prostate to extract ten tissue samples. Again, Susie and I found ourselves waiting for the results of a cancer biopsy.  There was an uncomfortable tendency to flashback 21 years to our earlier experiences bringing with it all the fear and concern, even though this was indeed an entirely different situation, the central word – cancer – had not changed.

 While Susie had to work, the following week found me, once again, sitting in an exam room, on a little stool, waiting for the news on whether someone in my family had cancer, me. I was again faced with a warm and direct Doctor.  His news was not good, I did have very early stage prostate cancer.  He took a quick pass through treatment options -  radiation, freezing and removal.  He discussed his pros and cons of each and asked that I take a few days and think about it.  An appointment was set for Susie and me at his office the following week.

 I had to make a call to Susie to tell her the outcome of the appointment.  It was very odd to be on this side of the fence, telling her that I had cancer.  And, the result was as I expected, it scared the hell out of her.  Even though I told her that only about 10 percent of one lobe was affected, her husband still had cancer!

 The Internet is a wonderful invention!  Twenty years ago, when I was trying to research Susie’s cancer, my greatest resource was the public library.  While trying to research my cancer, the best medical centers in the world were available online to glean information from.  After days of searching and reading, I decided that removal of the prostate offered the best long-term survival rate.  This, as with Susie, was the most aggressive approach.  However, it had major risks:  impotence, inability to achieve an erection and both urinary and rectal incontinence.  A forty percent chance actually.  However, radiation and freezing did not seem to offer the level of cure that removal did and that is the decision I made.

 There was one other consideration on my mind.  I had a backpack trip to Philmont with our scout troop scheduled for the end of July. So, whatever was done, I wanted assurances that I would be ready to roll by then.  Dr. Richardson assured me I could recover in plenty of time so the surgery was set for the day after my 53rd birthday, April 15th. 

 Susie was lucky enough to have her best friend Phyllis come along to keep her company.  It was her turn to sit on one of those little round stools in an examination room waiting for me to get prepped to go into surgery. All too soon, I was being rolled into the operating room and meeting the staff.  The anesthesiologist was talking to me saying the injection he was putting into my IV would have me asleep shortly.  I noticed the view turn a bright red and suddenly I was being rousted in my room, the surgery complete.  Dr. Richardson arrived shortly and said all had gone as well as he could have hoped.

 Recovery was quick and by July I was completing our 60+ mile hike through the mountains New Mexico at Philmont.

 Today, after over a year, there is no trace of cancer.  My PSA count remains zero.  Due to Dr. Richardson’s skill, I am not incontinent and my ability to achieve an erection has improved significantly.

Today, due to our very aggressive and direction action in response to our cancer, we are both healthy. We didn’t wait to see how it would go, we didn’t choose the “easy way” – we acted.

 Just how does our family experience with cancer relate to terrorism in the world?  Lets see what both experiences have in common.

 Small symptoms:

 As in our cancer, there have been any number of small symptoms that this global cancer has been growing. There have been global aches and pains regarding the rise of militant Islam.

 The 1972 Munich Olympics.

The 1979 Islamic Revolution in Iran.

The 1979 Iran hostage crisis.

The 1981 Papal Assassination attempt.

The1983 Bombing of U.S. Embassy in Beirut

The 1983 bombing of the Marine barracks in Lebanon.  

The 1985 hijacking of the Achille Lauro and the killing of American Klinghoffer. 

The  1988 bombing of Pan Am flight 103 over Lockerbie,Scotland.

The 1993 World Trade Center bombing.

The 1996 Khobar Towers bombing in Saudi Arabia.  

The August 1998 bombings of  the U.S. embassies in Nairobi, Kenya, and Dar es Salaam, Tanzania.

The 2000 bombing of the USS Cole.

 The full spread of the cancer was revealed on September 11, 2001 with the bombing of the WorldTradeCenter in New York City resulting in the death of 2700 global citizens.  It was the civilized world, sitting across from their doctor on one of those little stools, being presented with the diagnosis – you have cancer.

 Reaction to the diagnosis:

 Once the planet was given the diagnosis, a treatment regimen needed to be determines.  There were those who supported the point of view that it was our fault we had cancer.  If only we had eaten the right foods, stopped smoking, exercised more – all would have been well.  The problem with this view is that, while all may be true, the cancer none the less was here and had to be dealt with.  To ignore the cancer would be to passively submit to death.

 There were those who wanted to target the cancer in a limited way.  By example, one of the concerns my wife had was loosing her hair. By March, 1983 she was completely bald and she had heard that some patients had protected their hair by using cold packs during their chemo treatment.  The only problem is that many of these folks later had reoccurrences of their cancers.  Apparently some of the cancer cells hid there until the coast was clear.  By the same token, these folks wanted our strikes to be limited to specific global targets while the cancer flourished elsewhere.

 Some wanted to bargain with the cancer.  If only we understood it, we could change its direction and save ourselves.  Sadly, cancer is mindless and only wants to kill.

 Aggressive Treatment:

 And, there was a select number of “doctors” who said, no, the only way to save the world from cancer is to aggressively go after it, no matter where it may hide.  It has become known as the “Bush Doctrine”. 

 With the treatment underway for over two years, much progress has been made.  Tumors in Afghanistan have been removed and the remain cells are slowly but surly being killed.  Much of the world community has begun attacking cells in their countries as well. Iraq, for all the whimpering of the main stream media, has had many success and some setbacks.  But, or doctor, President Bush has clearly stated that we will not leave until the cancer has been removed.

 For the civilized world, what does cancer-free look like?  For cancer patients it is no recurrence for five years.  That would mean no terrorist attack anywhere in the planet for five years.  Unreasonable? Can we hope for anything less?? Do our children deserve anything less? If we choose not to kill these cancerous animals anywhere, any time, they will surly regroup and once again go about the job of killing the civilized world.