See the source image
Last stages of glioblastoma. Image from MD Anderson Cancer Center.

Almost six years ago my older brother Gerry died of glioblastoma, a cancerous tumor of the brain. Today I had lunch at Crystal Bridges Museum of American Art with an old friend, Bob, though not as old as I am (he’s a mere 64), who recently was diagnosed with the same malady. As he says on social media, “I’ve now started a non-drug, electrical field treatment called Optune which offers the possibility of extending my life for several more years.” This treatment consists of an electronic device inserted in a pack hanging at his side, from which wires go up through the shaved and gauzed head into the brain, where they  are used to “disrupt cancer cell division.”

Good luck with that, Bob. The Optune and the continuing chemotherapy.

Optune has been around since 2011, he told me, though few doctors even now apparently know about it.  It was certainly not something offered to my brother in 2016 when his tumor was discovered and a craniotomy performed. (Gerry died within four months of the diagnosis.)

Northwest Arkansas, says my friend, is not somewhere where you want to get a brain tumor. (Or anywhere else, I would think.) According to him, his NWA doctor has been ignorant and feckless, and it’s only through the intervention of a  neurosurgeon based in Little Rock that he came to know of the Optune treatment and the (limited) hope if offers him. (According to the Optune company, “Nearly half of people using Optune + chemotherapy were alive at 2 years compared with 31% of people on chemotherapy* alone,” while another source suggests that the malady is “Very rare (Fewer than 20,000 cases per year in US)” (data from Focus Medica cited on Bing search).

Not encouraging data, all in all, I would think, though Optune, as in opportunity, may temporarily help preserve unity of body and mind, or prevent separation, before the final decision is handed down by the fates.  So where would you put brain cancer, friends, in the list of the top 100 maladies by which you might choose to die? Up there at the top? Down near the bottom, just above drowning and fire and torture in an Iranian or Russian prison?

This unhappy malady, at any rate, leads us to wonder what it is and where it comes from as well as the course it takes. According to a quick look, I see that the exact cause is not now known, though it appears to be associated with a gene that also causes early childhood cancers.

And according to the Moffitt Cancer Center it may spring from

    • Inherited DNA defects
    • Cumulative effects of exposure to chemicals and other carcinogens
    • High-dose exposure to ionizing radiation

My friend Bob told me his great grandfather died of a cranial malady not known or appreciated at the time, which may well have been glioblastoma. Not sure about any genetic factors in my own family.

Do chemicals and carcinogens include marijuana? My brother indulged lustily and often. But I may be off the mark here.

And as for ionizing radiation (say what?), see the Biology Dictionary, which suggests that occupational factors are just one source.

All definitions and etiologies, however, are technical and don’t help shield us from the effects of cancer. Nor reconcile us to them. For that we might need philosophy or poetry. Some way of continuing to be in the world without being overwhelmed by horror and hopelessness.

Any ideas? Any of us might be struck, at any time, by such dread disease, after all, or another form or putting our existence into sudden question.

At the doctor’s office

Young woman at front desk brisk, efficient, almost abrasive.

Waiting room maybe 15′ x 40′, 7-8 groups of fake leather chairs with stainless tubing.

6 or 7 masked patients, patiently waiting, widely spaced, half of them on their phones, the others also bored.

Rain, rain outside the window and the door, go away.

The wait, the usual interminable wait. 

The doctor, remember, wears no watch and is conscious of no time. He simply works, he says, non-stop till the work gets done.

The prospect of beer, later this afternoon, in the rain, just out of the rain, at Crisis Brewing, during this Covid crisis, with the brewery’s comforting outdoor propane heaters at all tables.

Beer with a buddy I rarely see, whom I have tempted or tugged off the mountain, where he lives in an old stone cottage the wind blows through.

Then I’m called and weighed, 188, good gods what have I been hogging these last months without exercise, with the pandemic raging all about and fatalism rooting down.

Mattha, she says, the nursing assistant who weighs me and then works me up, as they say. How was your Christmas? Hers was fine, a husband and four boys, she wouldn’t know what to do with girls. The same problem I have had all these years. She’s tall and thin, her hair long and straight and in a ponytail.

This patient room maybe 10′ x 10′ — examining table, two fake leather chairs, a sink, a rudimentary desk with stool, and on the walls two sentimental poems, in script, re Daddy’s girl and do you want to grow up some day, sonny, just like Daddy? Big print of cowboys whipping their horses through meadow and creek, and a calendar with a verse from Romans. 

Several years ago he saved me from death via prostate cancer, the good physician, sending me to a urologist, and from thence to surgery, while a distant friend of mine this summer, in a distant place, died with a PSA of over 600. 

In the X-ray room a hulking cold machine and a table where the technician arranges my right knee. Overhead, then turned to the side. You’re done, she says. Take two rights, and you’ll be in room 7 once again.

Where the doctor, the good physician, finally enters and probes with questions, briefly palpates the knee where I tell him the shooting pains originate. He’s had them, too, he says, two years ago. X-rays show no bone damage, but can’t reveal ligaments and muscles. Why not take it easy. If you’re hiking and it hurts, ice it afterwards. Use ibuprofen or Aleve. Don’t pivot on that foot but step away, turn in steps.

Meniscus tear
Medial meniscus tear.

The same good doctor I left, last time I visited, with a copy of my book of poems, but he doesn’t remember or it doesn’t impress, and he says nothing except soothing words and to the point and is sorry, he says, my friend died like that. No one really has to, in his view.

Medial meniscus tear, he says. Baby it. Ice it. Pop a few pills. May the God of hope fill you with joy and peace as you trust in him.