I sincerely appreciate all the notes I have received since my last post. I will try to answer each of you.
Here are some updates.
The quality of my life has dramatically improved in the past week. I have continued to recover from the crisis in which I lost my voice. My pain is under much better control, and many of the side effects of immunotherapy are now gone. I’m profoundly tired, but I plan to rest as much as possible, do some yoga each day, and then start to ride my real and exercise bikes. I’m writing again and spending time with visiting family and friends.
I’ve also had another visit with my oncologist, and I can give you more information on my likely future. I had been told that palliative chemotherapy had a 40% chance of producing a favourable tumour response for 6-8 months. A favourable tumour response is a measurable shrinkage in the tumour.
I asked my oncologist, what happens then?
“We would expect the tumour to begin growing again.”
And?
“Your health and quality of life will likely deteriorate.”
What are the treatment options then?
“We don’t have many options. We’ll have to look and see if you qualify for a clinical trial.”
And in the 60% chance that the tumour does not respond to my current palliative chemotherapy?
“All of the above starts to happen sooner.”
That’s grim, although nothing is certain about cancer. But Every Single Remaining Hour will be a gift. I am happy to be alive, grateful for this time, and looking forward to the time I have left.
My article on MAID in COMMENT Magazine is out. In that article, I wrote,
You would expect mental health care to be well-integrated with cancer care in every cancer centre. But you would be wrong. Since my diagnosis, I have had scores of visits to cancer clinics. No one has screened me for suicide risk. No one has evaluated my mental health.
That was true when I wrote it, but I am glad to report that, three years into my care at the Centre, that statement is no longer correct. The nurse took a long patient history when I switched to my new palliative chemotherapy protocol. In it, she began asking a series of mental health screening questions. I stopped her and said I was glad someone had finally recognized these questions’ importance. She was surprised and mentioned that the Centre had a (seemingly well-hidden) psycho-oncology program.
It is good that this cancer centre has this service, but the substance of my point still stands. You have not integrated mental health care into cancer care unless you evaluate every patient for mental health problems and suicide risk and deliver evidence-based mental health care to those patients who need it. We have not solved the complicated problem of integrating mental health and cancer care.
I get many calls from old friends, and I welcome them all. But some of them are amusing.
“I was so sorry to hear that you are sick. How are you doing? (chipper voice)”
I summarized my situation and prognosis.
Silence.
Then the caller began 30 minutes of urgent stream-of-consciousness talk about his experiences with illness. Really, though, it was about his terror of death.
I just listened. I mentioned that I had an appointment, and we had to end the call. I could tell he was embarrassed that he had spent the entire call talking about himself.
But that was totally okay. He called; that’s what matters.