Necessita c'induce, e non diletto.*
-Dante Alighieri, 1265-1321
I almost dreaded walking into the exam room. Behind the door sat an elderly woman who had been diagnosed with an aggressive non-Hodgkin lymphoma earlier this fall. Among the scores of things I said to her during our initial counseling session was that her malignancy, unlike an indolent lymphoma, had to be completely eradicated in order to save her life.
"Either you get rid of it, or it gets rid of you," was my comment then. She understood perfectly what this meant but as all oncologists know, just because patients realize the seriousness of their situation doesn't mean they will sign up for a trek into the catacombs of chemotherapy. Just last week I had a much younger patient refuse to take an adjuvant treatment which would have reduced the risk of recurrence by 50%. My lymphoma patient was also concerned about side effects, but agreed to take the standard protocol for her illness. Feeling like a general sending his troops into the inferno, I wrote the orders for the first cycle.
We set off together then, her as the supplicant and me as her guide, beginning our journey down into the darkness. Only one of us walked, though. The other one floated beside her like a diaphanous Vergil leading his charge into the strange world of misery known only to those who have had to rid themselves of cancer.
To the casual onlooker the next several weeks of my patient's life seemed a reasonable mix of good days and bad. Her nausea was controlled with the usual medications and her fatigue was not continuous. She did develop a fever during one of her nadirs but did not require hospitalization. The growth factor shots we gave her certainly helped, even though they left her with rather nasty hip and back pain. On the day of her last treatment I hesitated for one second, then opened the door and glided into the room with that peculiar blend of jauntiness and serenity doctors seem to ooze with.
She sat there in a wheelchair, wearing a turban made by a former patient of ours, her chin in her hands. It was as if I could sense her delicate soul struggling to fly away. As I listened to the details of her life in the past week I held her white hands, touched her neck, strained to hear the wind whispering within her chest. She was in complete remission, but still had one treatment left to receive - today's. After calculating the damage done from the last cycle I informed her that in my opinion it was safe to take this last treatment, but at a reduced dose.
"A lower dose? But won't that hurt my chances for cure?" she asked. I smiled at her as I found the words to respond.
"Your chance for cure is excellent and won't be any less with this lower dose of chemotherapy. Think of the past four months as running a marathon - only this race is special. No time is kept. The only thing that matters is reaching the end of the race, whether you have sprinted the entire way or crawled in desperation for miles.
"After today you are done with your treatment. As with all patients who make it through this, first place belongs to you now, and I hope that someday the only memory you have of your ordeal is the congratulations we give you now for crossing the finish line."
*"It is necessity and not pleasure that compels us."
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Very good. I had to look up the word diaphanous, though. And there is nothing like a reference to Dante's Inferno to nourish the soul.
In a field like oncology, patient and physician both can use as much Dante as they can get. Once the chemo is done, do you skip ahead from "Interno" to "Purgatorio"?
There's also the whole "comedy" thing you get to if you take Dante's whole *Divine Comedy* seriously, rather than sticking with the fun (OOPS, did I say that out loud?) parts with the good stories.
But I doubt most of your patients really want to think about being in the settings of any part of the work, eh?
Maybe there's a better analogous work? (I'll hate myself for sayig this but...) Something Joseph Campbell-ish, might do.
This is all about you. Why, on top of everything else, do the ill have to bear physicians who view devastating illness as a chance to test their considerable urge but infinitely lesser ability to be poetic.
Pony, you are so full of it. Let me tell you something, in January of this year, I was diagnosed with lung cancer, I posted it on my blog and it was picked up by Glenn Reynolds. One of the people that made a comment on that post was a fellow by the name of Craig Hildreth. The same poet that you now denigrate. I was scared sh--less at the time. Holding my head up high and saying I would fight was one thing, keeping my head up through six month's of chemo-therapy was something else. But you know what, that same poet kept encouraging me via his writings here and occasional e-mails letting me and others know that the fight was worth fighting regardless of the nausea, the weakness, the difficulty in staying warm and the pittying looks from those who knew why you had no hair, no eyebrows or eyelashes and why you looked everywhere you had to step to make sure you didn't stumble because your peripheral neuropathy made walking difficult.
You Pony, are an ass. Dr. Craig has helped far more with his flights of fancy than you have with your cynicism and inability to enjoy the poesy of someone else.
Dr. C... I only come here occasionally now, but I ALWAYS enjoy my visit. Thanks for everything over the last year.