Pessimist: The glass is half empty.
Optimist: The glass is half full.
Engineer: The glass is twice as big as it needs to be.

We returned Wednesday from a lightning trip to the Southland, where we lingered just long enough for Lina to have her “staples” removed (she was rather dreading the procedure, which proved in the event, she reports, no more painful than eyebrow-plucking—I wouldn’t know), her fifth and presumably penultimate dose of chemo, and followup consultations with young Dr. P, her oncologist, and old(er) Dr. M, her surgeon. The two men had discernibly and interestingly different takes on the patient’s status.

The operation a month ago went, as previously reported, very well. Once the surgical team opened her up, they could see that the foe had been dealt a thorough beat-down in previous months by the forces of modern chemistry, and that of the growths formerly spreading their tentacles along the peritoneum there was barely a residue: “We could see where the tumors were, but no trace of where they are,” as Dr. M put it at the time. All to the good. Liver, lungs and gastrointestinal tract, at one time occasioning various levels of concern, proved clean as a whistle, as three whistles. The entire reproductive apparatus was extracted, along with a few lymph nodes, and sent to the lab for analysis. It is reported that the cancer was uterine in origin (better news, apparently, than had the ovaries been the seedbed) and that the lymph nodes were clean (excellent news, because the lymphatic system typically serves the forces of the disease as a kind of Ho Chi Minh trail, a reference that will be lost on some of our younger readers). So the news, as previously conveyed from North Hollywood, was all to the good, and Lina was beginning to describe herself as “cancer free.”

“Not so fast,” (figuratively) said apologetic Dr. P on Monday in the course of his consultation. He reminded Lina that he’d said all along that the objective of the treatment was to send her into remission and delay the inevitable return of the disease for as long as possible. He outlined a programme of quarterly bloodwork and MRI scans to monitor her status. As I’ve previously had occasion to observe, the guy has a good “bedside manner,” for all that he looks like a college sophomore, and I’ve always appreciated that he’s never attempted to sugarcoat the situation. Still, Lina left the meeting feeling a bit deflated.

Then, Tuesday, for staples, chemo and a chinwag with Dr. M. It bears mentioning here that when Lina first brought up the possibility of incorporating HIPEC (interesting aside: my old freshman roomie from 1970, who went on to make his living as a medical radiologist at the University of Colorado, was the first to suggest that we look into “hyperthermic” therapies), Dr. P was lukewarm, heh-heh. “It’s gone in and out of medical fashion,” he said. “Lately it’s out.” Enter Dr. M, who aligns himself with a dissident faction of the medical establishment, believing that HIPEC has up until now not been deployed effectively: generally it’s used as a last-ditch delaying tactic against the final onslaught once remission lapses. Nein, says the Doc, you want to hit it early, not wait until the Red Army is shelling Berlin. HIPEC delivers the same cancer-thrashing chemicals that are administered in conventional therapy, but cuts the circulatory system, as intermediary, out of the action and takes the fight directly to the foe in conjunction with heat (109°F), and cancer hates heat. The idea, if I may be permitted again to switch martial metaphors, is not to permit the Taliban to retire to its mountain redoubts to regroup, but rather to bathe all the affected surfaces with scalding poison and take out any stragglers before they can go forth and multiply. His take on Dr. P’s gloomy prognosis was in the way of a spirited dissent, in effect—I am of course taking some dramatic liberties here, not having been present for the actual consultation—“Who you gonna trust, some snotnosed punk fresh outta residency who’s merely like, felt you up, or the ol’ trouper here, who has got up close and personal with more abdominal cavities’n you could shake a scalpel at, including, let’s not forget, your own? I say we’ve killed the fucker, and you’re gonna get through this, and to hell with Doctor Bringdown.” Well, you know, conflicting takes and confirmation bias, and I’m sure Doc M’s pep talk was expressed more delicately than I have rendered it here, but we’re both in sunnier spirits following this second take. It’s nice to think, based on reasonable authority and not on wishful thinking alone, that there remain grounds for hope.

It is sobering to reflect that if Lina does survive this, it will owe entirely to her opting for Cedars-Sinai over CaesarCare, which explicitly (indeed, “vehemently” was the word the CaesarCare oncologist used) refused to consider HIPEC: ice cold rather than lukewarm. They pretty much planned to put her on a “palliative care”/hospice path. This appears to be, at the moment, the conventional thinking about this flavor of cancer, and who knows but that Doc Feelgood might be over his skis—but I give Cedars points for its willingness to depart from the fatalistic orthodoxy regarding which CaesarCare, to all appearances, was rigidly aligned and unwilling to brook any deviation therefrom. And of course, thank the FSM and Saint Franklin for Medicare parts A and B, and for the supplemental insurance Lina purchased last year. The present ordeal would have beggared us ten years ago, whereas our out-of-pocket outlay to Cedars thus far has been—wait for it—about thirty dollars at their pharmacy.

cordially,

CaesarCare has been pestering us for years to sign up for “Medicare Advantage.” Yeah, right: advantage CaesarCare. It would have locked us into their system, and Cedars-Sinai, rather than being underwritten on Medicares A and B, would have been entirely on our dime, and by now I’d be typing this entry from a residential hotel room in the San Francisco Tenderloin with our socks drying on the radiator, since we’d have had to sell The Crumbling Manse™ to meet the expenses.

cordially,

We’ve been greatly impressed with him all along, even though I have grandnephews close to his apparent age. He’s given us his best evaluation of L’s situation from where he sees it, and although he was initially skeptical as to the efficacy of early HIPEC, he heard out Doctor M and was persuaded to incorporate it in the course of treatment. Particularly because he’s fairly young, I expect that should M’s approach yield the outcome we all hope for, he’ll not assume the stance of “this is how we’ve always done it”—CaesarCare’s attitude,* which would have slotted the wife on a highway to hospice care—and will countenance or even recommend early HIPEC into patients’ regimens going forward.

Doctor M, who is very confident that he and his medical faction have hit upon what amounts to a cure for L’s condition, hopes to cite her successful outcome as he lobbies for the wider adoption of this approach. Me, I hope that one of these years he name-checks her as he makes a speech in Stockholm.

cordially,

*I may have mentioned this before: CaesarCare absolutely (“vehemently” in the oncologist’s words) refused to contemplate HIPEC in their course of treatment. They were not prepared to deviate from SOP to give L a chance of surviving what they assumed by default to be a terminal condition. Fuck ’em.