Happy Thanksgiving from Susan

  Wishing everyone a very Happy Thanksgiving! I love this holiday! Always filled with family, good stories, good food and very good times. I...

Friday, January 31, 2014

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Ben Jones
DESPITE great strides in prevention and treatment, cancer rates remain stubbornly high and may soon surpass heart disease as the leading cause of death in the United States. Increasingly, we and many other experts believe that an important culprit may be our own medical practices: We are silently irradiating ourselves to death.
The use of medical imaging with high-dose radiation — CT scans in particular — has soared in the last 20 years. Our resulting exposure to medical radiation has increased more than sixfold between the 1980s and 2006, according to the National Council on Radiation Protection & Measurements. The radiation doses of CT scans (a series of X-ray images from multiple angles) are 100 to 1,000 times higher than conventional X-rays.
Of course, early diagnosis thanks to medical imaging can be lifesaving. But there is distressingly little evidence of better health outcomes associated with the current high rate of scans. There is, however, evidence of its harms.
The relationship between radiation and the development of cancer is well understood: A single CT scan exposes a patient to the amount of radiation that epidemiologic evidence shows can be cancer-causing. The risks have been demonstrated directly in two large clinical studies in Britain and Australia. In the British study, children exposed to multiple CT scans were found to be three times more likely to develop leukemia and brain cancer. In a 2011 report sponsored by Susan G. Komen, the Institute of Medicine concluded that radiation from medical imaging, and hormone therapy, the use of which has substantially declined in the last decade, were the leading environmental causes of breast cancer, and advised that women reduce their exposure to unnecessary CT scans.
CTs, once rare, are now routine. One in 10 Americans undergo a CT scan every year, and many of them get more than one. This growth is a result of multiple factors, including a desire for early diagnoses, higher quality imaging technology, direct-to-consumer advertising and the financial interests of doctors and imaging centers. CT scanners cost millions of dollars; having made that investment, purchasers are strongly incentivized to use them.
While it is difficult to know how many cancers will result from medical imaging, a 2009 study from the National Cancer Institute estimates that CT scans conducted in 2007 will cause a projected 29,000 excess cancer cases and 14,500 excess deaths over the lifetime of those exposed. Given the many scans performed over the last several years, a reasonable estimate of excess lifetime cancers would be in the hundreds of thousands. According to our calculations, unless we change our current practices, 3 percent to 5 percent of all future cancers may result from exposure to medical imaging.
We know that these tests are overused. But even when they are appropriately used, they are not always done in the safest ways possible. The rule is that doses for medical imaging should be as low as reasonably achievable. But there are no specific guidelines for what these doses are, and thus there is considerable variation within and between institutions. The dose at one hospital can be as much as 50 times stronger than at another.
A recent study at one New York hospital found that nearly a third of its patients undergoing multiple cardiac imaging tests were getting a cumulative effective dose of more than 100 millisieverts of radiation — equivalent to 5,000 chest X-rays. And last year, a survey of nuclear cardiologists found that only 7 percent of stress tests were done using a “stress first” protocol (examining an image of the heart after exercise before deciding whether it was necessary to take one of it at rest), which can decrease radiation exposure by up to 75 percent.

In recent years, the medical profession has made some progress on these issues. The American College of Radiology and the American College of Cardiology have issued “appropriateness criteria” to help doctors consider the risks and benefits before ordering a test. And the insurance industry has started using radiology benefit managers, who investigate whether an imaging test is necessary before authorizing payment for it. Some studies have shown that the use of medical imaging has begun to slow.
But we still have a long way to go. Fortunately, we can reduce the rate of medical imaging by simply avoiding unnecessary scans and minimizing the radiation from appropriate ones. For example, emergency room physicians routinely order multiple CT scans even before meeting a patient. Such practices, for which there is little or no evidence of benefit, should be eliminated.

Better monitoring and guidelines would also help. The Food and Drug Administration oversees the approval of scanners, but does not have regulatory oversight for how they are used. We need clear standards, published by professional radiology societies or organizations like the Joint Commission or the F.D.A. In order to be accredited for CT scans, hospitals and imaging clinics should be required to track the doses they use and ensure that they are truly as low as possible by comparing them to published guidelines.
Patients have a part to play as well. Consumers can go to the Choosing Wisely website to learn about the most commonly overused tests. Before agreeing to a CT scan, they should ask: Will it lead to a better treatment and outcome? Would they get that therapy without the test? Are there alternatives that don’t involve radiation, likeultrasound or M.R.I.? When a CT scan is necessary, how can radiation exposure be minimized?
Neither doctors nor patients want to return to the days before CT scans. But we need to find ways to use them without killing people in the process.

Tuesday, January 28, 2014

Your Cancer Is Not My Cancer: The Danger of Comparison

Posted: 01/27/2014 10:43 am

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Teddy Roosevelt is quoted as saying "Comparison is the thief of joy." I've found this to be particularly true in the area of my own personal journey with cancer. I learned the hard way that comparing my disease to someone else's not only steals my joy, it has the potential to chip away at my resolve. It can keep me awake at night, in a vortex of fearful speculation of my own making.
A little over two years ago, I was diagnosed with Stage IIIC fallopian tube cancer; and I've been managing my cancer and the subsequent side effects of treatment pretty much continuously ever since. In that time, I've learned that staying present and keeping a strong mental attitude are essential to my well being. Having recently been told that my cancer is of the recurrent sort, maintaining this mindset is now more important than ever.
After I was diagnosed, I became connected to a very large and diverse community of individuals whose lives had also been touched by cancer, including others in treatment at the same time as I. What I realized pretty quickly is, not all of us were going to make it. I became bonded with people who, for a wide variety of reasons, ended up dying from the disease. It wasn't because they didn't fight, didn't have a lot to live for, or didn't have a positive mental attitude ... they did. They just didn't make it. And it shook me to my core each time one of my fellow sojourners was lost. It still does.
The first time I lost a new friend in the cancer community, I spent more than a few sleepless nights obsessing over the details of their experience with the disease, trying to find ways to distinguish the facts of their situation from mine. Not only was I grieving the loss of someone to whom I'd been connected, I feared I would be next. And each time another of us died, I felt more like a sitting duck. I could get pretty maudlin, pretty quickly.
A friend of mine observed that I must feel a bit like someone trying to cross a huge field while under sniper fire, watching others crossing that same field -- my comrades -- get picked off one by one while I kept going. Her analogy wasn't far off.
The list of my fallen comrades has far too many names and continues to grow. Currentstatistical evidence shows that one in every three women will get cancer in her lifetime, as will one out of every two men. And of the women, one out of every five will die from cancer; for the men, one out of every four. I don't know what technically constitutes an epidemic, but those numbers feel pretty epidemic-like to me. It's enough to keep one in a perpetual state of panic.
So how do I keep going across that open field in the line of sniper fire when all I really want to do sometimes is just lay down, cover my head and hide?
First, I remind myself that I cannot compare my cancer to anyone else's cancer, even those who appear to have the exact same diagnosis and staging as mine. Their cancer is not my cancer. Their outcome is not my outcome. And no good will come of allowing myself to go down the mental rabbit hole of projecting someone else's outcome onto my future.
The truth is that every single person's cancer is different -- even those diagnosed as the same type and stage -- because that cancer exists in a unique human body unlike no other, with a unique life history and genealogy. I've met people with cancer of a lesser stage than mine who didn't make it, while I've just as frequently met survivors who dealt with higher stages of cancer decades in the past and are still going strong. There's no algorithm that will determine which of us will make it and which of us won't. There are endless factors at play, and cancer is unpredictable and constantly morphing. Burning mental cycles by speculating and comparing my situation to others is a waste of my valuable time and energy.
So what can we do, if not worry and speculate and compare?
I'll pass on the advice I recently gave to a newly diagnosed friend who was feeling defeated and overwhelmed in the face of her diagnosis:
You can fight.
Educate yourself about your particular diagnosis, using reliable, vetted sources (not About.com, blind Internet searches, or message boards). Get genetic testing, if applicable. Make the best possible decisions for your medical care based on the information available to you at the time. And if you get a bad feeling about a doctor, nurse, diagnosis or treatment plan, go get a second opinion. Or a third.
Listen to your gut. This is the only life you have. Find your voice and use it, even if doing so is out of your comfort zone.
Take care of yourself. Be pro-active. Take control of the things you can control. Change your diet. Get clean. Move your body. Go outside. Breathe fresh air. Address side effects of treatment with safe, supplemental holistic treatments like acupuncture and massage and yoga and meditation. Learn about the resources and support groups available to you and then use them. Make YOU a priority, probably for the first time in your life. Self-care is not selfish or a luxury; it's a necessity for you right now.
Connect with others. Surround yourself with positive people, and weed out the ones who aren't ... seriously. Learn to ask for and accept help; you can pay it forward later. Talk about your fears and feelings with someone safe who can handle it (and that person may not be your partner or parent or child). Make friends with the people you see when you go in for treatment, as well as everyone who works in the treatment center, from your oncology team to the receptionists to the phlebotomists. Learn their names and the details about their lives. These folks are now part of your circle.
Set your intentions on the future. A positive attitude alone may not save you, but a negative one will hurt you. Visualize the cancer cells inside your body being killed, one by one. If your treatment plan includes it, think of the chemotherapy drugs or radiation waves as the ultimate cleanse. Document your journey with photographs to share with others later. Keep a journal. Plan for the future and talk out loud about the things you're going to do after treatment. Send yourself the message that you are going to get through this, because your body is listening.
It ain't over 'til it's over. So as tempting as it may be to start preparing for the end, a far more productive use of your time is to prepare for what's next. And if you catch yourself comparing your situation to someone else's, remember:
You are on your own journey. Your outcome has not been decided. You are unique; you are radiant; you are alive; and you are here. So be here.
 

Follow Joanna_Montgomery on Twitter: www.twitter.com/hellojomo

Terminally Ill Dad Writes Awesomely Sweet Daily Notes to Daughter

Richmond Times-Dispatch via Garth Callaghan/FacebookYou'll want to call your dad after this one. A Virginia man who has been diagnosed with cancer three times and has been given an 8 percent chance of survival has concocted an incredibly sweet plan to stay in the heart and mind of his 14-year-old daughter after he's gone: He's writing her one note a day until she graduates from high school.
Garth Callaghan, a 44-year-old business development manager at an IT staffing company, has been writing daily notes for his daughter, Emma, and leaving them in her lunch bag for the last nine years. The notes began as a way for the father-daughter duo to stay connected throughout their busy days, but they took on new meaning after Callaghan was diagnosed with prostate cancer and kidney cancer (the latter twice) starting in November 2011. While Callaghan is staying positive, he knows there's a chance he won't live to see Emma graduate and has decided to make the notes his legacy, in the hopes of leaving his daughter with the best guidance possible. So far, Callaghan has written 780 notes and has about 40 more to go (since he's stockpiled so many). He gives Emma one per day and has stockpiled the rest for her to read either in one sitting or one every day after he's gone.

More on Yahoo Shine: Awesome Dad Styles Daughter's Hair, Breaks Internet 

Napkin Notes/Facebook"These notes are my safety net," Callaghan tells Yahoo Shine. "I hope to be around long enough to write Emma's own children notes, but if that doesn't happen, my promise to her is that she'll always have a note." In addition to Callaghan's own musings, many of the notes include wise words from people who've had an impact on the world — from Gandhi to J.K. Rowling. (You can check out all of the notes at Callaghan's blog, The Napkin Notes Dad.)

More on Yahoo: Military Dad Surprises Daughter at Gymnastics Competition

"I will easily spend 20 minutes thinking about the specific message I'd like to send her that day," he says. "They always relate to something she's going through, whether it's a sports event, a test at school, or a conflict she's having with a friend. I love that she's in eighth grade and she's not embarrassed to get a note from her dad."
Emma has been saving the notes she's received so far in an album and has recently begun to return the favor, writing her first note to her father in January. That one read, "If my friends really did jump off a cliff, it's because it was my idea. Sincerely, your daughter is a leader, not a follower. PS. I think you used all the napkins <3."
But as amazing as Callaghan's relationship with his daughter is, he insists that his story is less about him and Emma — or even the decisions he's made in the face of cancer — and more about the importance of parents' relationships with their kids. "We all lead such busy lives, so it's important to take time each day to connect," he says. "I want parents to know that it's as simple as taking time out to write a quick note." 

http://shine.yahoo.com/parenting/terminally-ill-dad-writes-awesomely-sweet-daily-notes-004900455.html

Monday, January 27, 2014

Basic Information About Cancer Survivorship

Who Are Cancer Survivors?

Photo of an African American woman taking care of her mother
The term cancer survivor refers to a person who has been diagnosed with cancer, from the time of diagnosis throughout his or her life. The impact of cancer on family members, friends, and caregivers of survivors is also acknowledged as part of survivorship.

How Many People Are Cancer Survivors?

Nearly 12 million Americans with a previous cancer diagnosis are living in the United States. People are living longer after a cancer diagnosis because of advances in early detection and treatment. About two out of every three people diagnosed with cancer are expected to live at least five years after diagnosis, but disparities in health care impact survival. Low-income men and women and members of minority groups who have little or no health insurance coverage are more likely to be diagnosed with cancer at later stages, when survival times are shorter.
Cancer survivors often face physical, emotional, psychosocial, spiritual, and financial challenges as a result of their cancer diagnosis and treatment. Public health professionals strive to address survivorship and quality of life issues such as the coordination of care, patient-provider communication, health promotion, support services, and fertility preservation through research and collaboration with public, non-profit, and private organizations. In light of these concerns, public health initiatives created to understand and prevent secondary disease, recurrence, and long-term effects of treatment are essential.

Promoting Health After a Cancer Diagnosis

Cancer survivors are at greater risk for recurrence and for developing second cancers due to the effects of treatment, unhealthy lifestyle behaviors, underlying genetics, or risk factors that contributed to the first cancer. The following factors can help maintain health and improve survival and quality of life after a cancer diagnosis—
  • Quitting Tobacco Use
  • Being Active and Maintaining a Healthy Weight
    • Obesity may be related to poorer survival after breast, prostate, and colorectal cancer.
    • Regular physical activity (at least 150 minutes of moderate activity or 75 minutes of vigorous activity per week for adults) may improve quality of life after a cancer diagnosis.
  • Discussing Follow-up CareExternal Web Site Icon with a Health Care Provider
    Important topics to discuss—
    • A personalized survivorship care planExternal Web Site Icon that includes a schedule of recommended follow-up visits, screenings, and medical tests and specifies which providers will be responsible for care.
    • Possible delayed effects of treatment.External Web Site Icon
    • The importance of seeking timely care in response to certain signs or symptoms.
    • Emotional wellnessExternal Web Site Icon after cancer and identifying available resources for additional support, if necessary.
    • Lifestyle changes recommended for improving health and well-being after cancer.
    • Developing an effective support system that meets survivors' medical and emotional needs.
  • http://www.cdc.gov/cancer/survivorship/basic_info/

It’s Not a War. It’s Not a Football Game. It’s Cancer, and It’s Scary, Okay?

The Zohn Zone

Soccer player, survivor, humanitarian, canzer crusher

Posted in: Cancer

It’s Not a War. It’s Not a Football Game. It’s Cancer, and It’s Scary, Okay?

Published Jan 23, 2014
I’m 691 days, 8 hours and 15 seconds in remission from Hodgkins Lymphoma–not that I’m counting!–and I’m assuming you’d like me to answer the same old question that is hurled at every cancer warrior and cancer survivor on a daily basis: “How are you feeling?”
How am I feeling? Oh, how I love to hate this question. No matter how vast and deep one’s support network may be, everyone with cancer goes through it alone. No one can ever really understand what that experience is like because it’s unique for each person. I have a good idea how most people would like me to answer that question, but let me be blunt: If you have cancer, you feel like shit. If you had cancer, you are scared shitless that it may come back. That’s it, folks. Short and sweet.
The general perception of cancer–especially in this rugged-individualist, pull-yourself-up-by-your-bootstraps country–is that there are winners and losers. We prefer to see it like football game: you either beat cancer and win the Superbowl; or you lose to cancer, and sayonara, shiny trophy/life! There is no in between. The reality of my situation is that I did everything in my power to beat cancer, and I did. But the cancer came back, and my life got blown apart at the seams all the same. And I think that’s okay, too. There are millions of people out there living with cancer, longing for stability, and functioning with the reality that this horrible disease may come back.
The emotional weight of my two-year scan is slowly approaching like a chubby three-toed tree sloth. When I reflect on my heinous journey – and don’t worry, this will not be a grisly, depressing blog about cancer – I’m excited to share that there are some “good” sides to cancer. For example, I lost weight, I got to wear really cool hats, and I can now pee in Morse Code.
I have come to realize, however, that people tend to join your regiment during the arms race build-up between a cancer diagnosis and the execution of the treatment protocol. But afterwards, once the immediate danger (as they presume it) has passed, they tend to forget all about the “war,” their shiny “weapons,” and they slip back into their normal, civilian lives. And my point isn’t that they are thoughtless, because they aren’t. They just don’t know. But those of us who do know don’t forget. The psychological hangover is long and dark. Of course good news deserves a euphoric dance party, but it’s important to remember the post-remission patient because there are dump trucks full of uncertainty and invisible scars that need healing.
My generation of survivors is more open about our cancer experience than ever before. We don’t hide our status. We are openly looking for support and connection. We like the gritty honesty, the real time information, and instant support. Recognizing ourselves in others can help us all feel more connected. It is comforting to know that when you feel really alone, like devastatingly alone,you can connect with someone out there who was having a similar experience. The incredible friends I have made during this plunge into the big sloppy sea of cancer is what helped keep me alive. To me, that is a blessing, and I am forever grateful.

Saturday, January 25, 2014

http://www.nytimes.com/2014/01/25/opinion/sunday/how-long-have-i-got-left.html?emc=edit_tnt_20140125&tntemail0=y&_r=0
AS soon as the CT scan was done, I began reviewing the images. The diagnosis was immediate: Masses matting the lungs and deforming the spine. Cancer. In my neurosurgical training, I had reviewed hundreds of scans for fellow doctors to see if surgery offered any hope. I’d scribble in the chart “Widely metastatic disease — no role for surgery,” and move on. But this scan was different: It was my own.
I have sat with countless patients and families to discuss grim prognoses: It’s one of the most important jobs physicians have. It’s easier when the patient is 94, in the last stages of dementia and has a severe brain bleed. For young people like me — I am 36 — given a diagnosis of cancer, there aren’t many words. My standard pieces include “it’s a marathon, not a sprint, so get your daily rest” and “illness can drive a family apart or bring it together — be aware of each other’s needs and find extra support.”
I learned a few basic rules. Be honest about the prognosis but always leave some room for hope. Be vague but accurate: “days to a few weeks,” “weeks to a few months,” “months to a few years,” “a few years to a decade or more.” We never cite detailed statistics, and usually advise against Googling survival numbers, assuming the average patient doesn’t possess a nuanced understanding of statistics.
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Tucker Nichols
People react differently to hearing “Procedure X has a 70 percent chance of survival” and “Procedure Y has a 30 percent chance of death.” Phrased that way, people flock to Procedure X, even though the numbers are the same. When a close friend developed pancreatic cancer, I became the medical maven to a group of people who were sophisticated statisticians. I still dissuaded them from looking up the statistics, saying five-year survival curves are at least five years out of date. Somehow I felt that the numbers alone were too dry, or that a physician’s daily experience with illness was needed for context. Mostly, I felt that impulse: Keep a measure of hope.
These survival curves, called Kaplan-Meier curves, are one way we measure progress in cancer treatment, plotting the number of patients surviving over time. For some diseases, the line looks like an airplane gently beginning its descent; for others, like a dive bomber. Physicians think a lot about these curves, their shape, and what they mean. In brain-cancer research, for example, while the numbers for average survival time haven’t changed much, there’s an increasingly long tail on the curve, indicating a few patients are living for years. The problem is that you can’t tell an individual patient where she is on the curve. It’s impossible, irresponsible even, to be more precise than you can be accurate.
One would think, then, that when my oncologist sat by my bedside to meet me, I would not immediately demand information on survival statistics. But now that I had traversed the line from doctor to patient, I had the same yearning for the numbers all patients ask for. I hoped she would see me as someone who both understood statistics and the medical reality of illness, that she would give me certainty, the straight dope. I could take it. She flatly refused: “No. Absolutely not.” She knew very well I could — and did — look up all the research on the topic. But lung cancer wasn’t my specialty, and she was a world expert. At each appointment, a wrestling match began, and she always avoided being pinned down to any sort of number.
Now, instead of wondering why some patients persist in asking statistics questions, I began to wonder why physicians obfuscate when they have so much knowledge and experience. Initially when I saw my CT scan, I figured I had only a few months to live. The scan looked bad. I looked bad. I’d lost 30 pounds, developed excruciating back pain and felt more fatigued every day. My tests revealed severely low protein levels and low blood counts consistent with the body overwhelmed, failing in its basic drive to sustain itself.
For a few months, I’d suspected I had cancer. I had seen a lot of young patients with cancer. So I wasn’t taken aback. In fact, there was a certain relief. The next steps were clear: Prepare to die. Cry. Tell my wife that she should remarry, and refinance the mortgage. Write overdue letters to dear friends. Yes, there were lots of things I had meant to do in life, but sometimes this happens: Nothing could be more obvious when your day’s work includes treating head trauma and brain cancer.
But on my first visit with my oncologist, she mentioned my going back to work someday. Wasn’t I a ghost? No. But then how long did I have? Silence.
Of course, she could not stop my intense reading. Poring over studies, I kept trying to find the one that would tell me when my number would be up. The large general studies said that between 70 and 80 percent of lung cancer patients would die within two years. They did not allow for much hope. But then again, most of those patients were older and heavy smokers. Where was the study of nonsmoking 36-year-old neurosurgeons? Maybe my youth and health mattered? Or maybe my disease was found so late, had spread so far, and I was already so far gone that I was worse off than those 65-year-old smokers.
Many friends and family members provided anecdotes along the lines of my-friend’s-friend’s-mom’s-friend or my-uncle’s-barber’s-son’s-tennis-partner has this same kind of lung cancer and has been living for 10 years. Initially I wondered if all the stories referred to the same person, connected through the proverbial six degrees. I disregarded them as wishful thinking, baseless delusion. Eventually, though, enough of those stories seeped in through the cracks of my studied realism.
And then my health began to improve, thanks to a pill that targets a specific genetic mutation tied to my cancer. I began to walk without a cane and to say things like, “Well, it’s pretty unlikely that I’ll be lucky enough to live for a decade, but it’s possible.” A tiny drop of hope.
In a way, though, the certainty of death was easier than this uncertain life. Didn’t those in purgatory prefer to go to hell, and just be done with it? Was I supposed to be making funeral arrangements? Devoting myself to my wife, my parents, my brothers, my friends, my adorable niece? Writing the book I had always wanted to write? Or was I supposed to go back to negotiating my multiyear job offers?
The path forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d just spend time with family. Tell me one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases. The pedestrian truth that you live one day at a time didn’t help: What was I supposed to do with that day? My oncologist would say only: “I can’t tell you a time. You’ve got to find what matters most to you.”
I began to realize that coming face to face with my own mortality, in a sense, had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. Yet there is no other way to live.
The reason doctors don’t give patients specific prognoses is not merely because they cannot. Certainly, if a patient’s expectations are way out of the bounds of probability — someone expecting to live to 130, or someone thinking his benign skin spots are signs of impending death — doctors are entrusted to bring that person’s expectations into the realm of reasonable possibility.
But the range of what is reasonably possible is just so wide. Based on today’s therapies, I might die within two years, or I might make it to 10. If you add in the uncertainty based on new therapies available in two or three years, that range may be completely different. Faced with mortality, scientific knowledge can provide only an ounce of certainty: Yes, you will die. But one wants a full pound of certainty, and that is not on offer.
What patients seek is not scientific knowledge doctors hide, but existential authenticity each must find on her own. Getting too deep into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.
I remember the moment when my overwhelming uneasiness yielded. Seven words from Samuel Beckett, a writer I’ve not even read that well, learned long ago as an undergraduate, began to repeat in my head, and the seemingly impassable sea of uncertainty parted: “I can’t go on. I’ll go on.” I took a step forward, repeating the phrase over and over: “I can’t go on. I’ll go on.” And then, at some point, I was through.
I am now almost exactly eight months from my diagnosis. My strength has recovered substantially. In treatment, the cancer is retreating. I have gradually returned to work. I’m knocking the dust off scientific manuscripts. I’m writing more, seeing more, feeling more. Every morning at 5:30, as the alarm clock goes off, and my dead body awakes, my wife asleep next to me, I think again to myself: “I can’t go on.” And a minute later, I am in my scrubs, heading to the operating room, alive: “I’ll go on.”