Motivational Mortality Speaker

Getting an A in Cancer

“You always try to get an A in everything”  she said.  “You can’t get an A in Cancer.”

It was a challenge to me.  “Can I at least get an A in dying of cancer?”  Ambitious.

It started slowly, like the cancer.  I made friends with cancer.  Some died.

I couldn’t be with them, couldn’t look them in the eye, couldn’t hold their hands.

In my head, they were already dead.  I wanted to scream, “You’re dying, don’t you know?”

You can’t say that to someone.

So I didn’t say anything, didn’t reach out.

I was ashamed.

If I were in their shoes, they would’ve been there for me, looked me in the eye, held my hand.

How could I do better?  I started to learn about dying.  I talked about death, read about it, and started to sit with it.

I visited more dying friends, slowly learning to be with them.  Learning to have normal conversations, to look in their eyes & hold their hands.

For extra credit, I started speaking about death & dying at conferences.

Now I’m trying to teach others to be more comfortable with dying.

I’m still learning, reading, writing, and speaking about death & dying.  More friends have died.

Soon it will be my turn.

I’ve convened a “circle of care”, an amazing group of friends and family to be there for me when I’m sick, which is most of the time these days.

I asked them to help me when I can’t help myself.  When I can’t speak for myself.

I didn’t know I would need them so soon.

I’m going to get an A in dying of cancer.

Side effects of side effects of treatment flow chart

I made this flowsheet on google docs, don’t know how to post it directly on wordpress.  Just a preliminary model of how I’ve been dealing with ridiculous side effects lately.   Here’s some links to it.

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Science vs a compelling story

Human nature is inquisitive.  We are also creatures of community and story telling deeply threads our communities together. 

Some say Galileo in the 1600’s was the father of the scientific method.  Others attribute it to ibn al haytham (Alhazen) around 1000.  The basic tenants of scientific theory are:

  • Question
  • Hypotheses
  • Predictions
  • Gather data (test)
  • Analysis – check validity of data
  • Repeat.

The more data the better the results.
Your tests must be reproducible.

I grew up steeped in science, math & medicine.  I was never a good scientist, I didn’t have the patience to gather data & analyze it, and I didn’t ask good questions.  I wasn’t a good mathematician for the same reasons.  I understand science & math, I recognize well done experiments and errors in data collection, I can apply statistics & use math appropriately.  I’m just not the one making new discoveries or theorems.  One thing I excel at is translating science & math to others.  I like solving puzzles and helping others solve their own.  So I went into medicine.

At heart I am a people person, I wanted to interact with different patients every day, to help them navigate the world of illness & health.  As a pediatrician my job was mainly teaching parents how to raise their children, through the stages of development and independence.  For the most part I had a very healthy, thriving population.  I can count on one hand the number of times I had to give really bad news or was seriously concerned about a patients survival.  In 10 years of practice I only had 3 patients die.  That is truly incredible.  We stand on the shoulders of some mighty advances in public health that makes us take childhood survival for granted.

Let’s look at the history.  From my favorite publication, the Morbidity & Mortality Weekly Report, affectionately known as the MMWR, put out by the CDC well, weekly… a chronicle of infectious disease outbreaks, incidence, and mortality.  This is one of the bibles of infectious diseases. 

Looking back at the last century from 1900-1999, mortality under age 5 dropped from 30.4% in 1900 to 1.4% in 1997.  And average life expectancy increased by 29.2 years!  Why?  Control of infectious diseases.

3 major things that we must not throw away:

1. Public sanitation & hygiene:

a.  Clean water – yes, chlorinated & fluoridated in proper amounts.  Dental hygiene deserves its own kudos in this list.

b.  Hand washing – with soap

c.  Sewage disposal – plumbing & waste water treatment

d.  Animal & pest control – widespread dog vaccination for rabies; rat control for Plague; mosquito control for malaria

2.  Vaccinations – eradicated smallpox, nearly eradicated polio but still active in unvaccinated areas of Iraq, Nigeria, Pakistan.   DTP vaccine was licensed in 1949, followed by many other safe & effective vaccines that we take for granted, having never seen a toddler actually die of pneumonia or sepsis.  It makes the news when a child dies from an unexpected infectious disease these days.

3.  Antibiotics – penicillin was developed in 1928 but not mass produced until 1940s for soldiers in ww2.  It was a miracle drug and saved thousands of lives.  Clearly it doesn’t treat everything, and resistance has made it less effective, but good old penicillin will still heal your strep throat.  We are working on antimicrobial stewardship to use antibiotics more judiciously, rather than throwing them at every upper respiratory infection & sore throat.

Here’s the lovely, succinct article I am quoting from:

It makes me so sad to see people not follow these practices that gave us the good health we take for granted today.  These don’t make us weaker.  They help us survive to push the envelope further.  The concurrent rise in heart disease & cancer are only made visible because of the remarkable decline in infectious diseases over the last 100 years.

The organic food vs GMO & pesticide debate is insignificant compared to the above list.  Sure, go eat the “ugly veggies”.  I like them too.  But they aren’t going to increase our lifespans by 30 years or decrease the childhood mortality rate.

We do need to take (and prescribe for you physicians reading this) less antibiotics, and I believe eat more probiotics.  The jury is still out on the effects, types & dosing of probiotics but my gut feeling is they will be helpful to future humans.

Human nature is also social. 

We have been telling each other stories since the beginning of time, sitting around the fire.  Lore passed generation to generation by memory long before the written word.  There was much truth and goodness in these stories.  For example the 10 commandments taught us to live together in communities.  The stories of Sodom & Gomorrah taught us to treat each other justly, fairly, and kindly or we would be destroyed by our own evil natures.  Noah & the Ark was a story of survivalism during major ecological upheaval.  And those are just from the Bible.  History does repeat itself.  Our evil natures still exist; ecological upheaval is coming; and the 10 commandments still hold true as basic tenets we must live by if we are to get along as a society.

Today, stories abound on the internet and 3rd hand told from friends.  “I heard about a woman who drank her own urine and cured her cancer.”  Or who drank only carrot juice; or took IV Vitamin C; or Ozone; or superheating; or supercooling; or marijuana/CBD; or meditated and stayed positive and prayed away her cancer.  Thanks to modern science, we can test these hypothesis, and many of them have been tested – like IV Vitamin C, and juicing, and meditation.  And they have been found no different from placebo – or no treatment at all.  I believe each modality may be helpful if you believe it is, but it will not cure your cancer.  Acupuncture and meditation may help relieve your stress & pain, studies show some validity in that.  Marijuana/CBD certainly can relieve symptoms such as nausea, anxiety and pain as well.  Again, they will not cure your cancer.  The best chances you have of curing your cancer are following the data driven, empirically based treatments, and some damn good luck.

I must remind you, even if you cure this cancer or that infection, something will kill you.  Life is terminal.  Mortality is still 100%.

As my mentor and dear friend Merijane Block said:  “May you live as long as you want and want your life as long as you live.”

With You music video by Thousand Days

Partnering for Cures Nov 15 2016


Exponential Medicine Oct 2016

ARC Fusion Nov 1 2016

STATnews Endnotes Feb 2 2017

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