One-Hoss Shay

Have you heard of the wonderful one-horse shay,
That was built in such a logical way
It ran a hundred years to a day,
And then, of a sudden, it--ah but stay,
I'll tell you what happened without delay,
Oliver Wendell Holmes "The Deacon's Masterpiece or the 'Wonderful One-Hoss Shay'"

For more that sixty years, my body worked pretty well without much intervention by medical science. No broken bones, not much in the way of infections, not too much routine maintenance. I got fat in my forties, but other than slowing me down a bit, it didn't change my general perception that I was a healthy guy. I ate what I wanted, did what I wanted, and generally felt fine.

Last fall that sense came to a sudden end. Within the course of a few weeks, I was labeled a borderline diabetic and diagnosed with urothelial cancer of my kidney. I had my kidney removed and learned to control my blood sugar by changing my diet. I lost a few pounds. I felt pretty normal, but my sense of immunity was gone.

Now, the cancer has come back in my bladder and I have lost all confidence in my body. It's like Oliver Wendall Holmes's "Wonderful One-Hoss Shay," the buggy that was built to last 100 years, each part equally strong. It ran perfectly for a century and then, on the anniversary of its construction, collapsed into a pile of rubble, as every part failed at once. It seems like a perfect metaphor for my situation, but when I've alluded to it, nobody gets it--apparently Holmes isn't much read any more.

So, follow the link and read the poem. It's funny. And it helps me think about my mortality.

What do you think the parson found,
When he got up and stared around?
The poor old chaise in a heap or mound,
As if it had been to the mill and ground!
You see, of course, if you're not a dunce,
How it went to pieces all at once,
All at once, and nothing first,
Just as bubbles do when they burst.

End of the wonderful one-hoss shay.
Logic is logic. That's all I say.

M.D. Anderson

Yesterday, I visited M.D. Anderson Cancer Center for the first time as a patient. This is the cancer hospital in Houston where my wife was treated for almost 7 years before she died. The hospital has grown (sort of like a tumor)during my 11-year absence, and the clinic building was built since my last visit. Nonetheless, much about the place was familiar and it brought back lots of memories.

My doctor seems very knowledgeable and inspired a good deal more confidence than the doctors who have been treating me in Austin. I hope its not too late.

Positive Thinking

Since my diagnosis with bladder cancer, I have had several conversations with friends who have urged me to "think positive!" This is an admonition to which I respond generally negatively, for reasons that go back to the time when my father was dying of cancer in the mid-seventies.

In those days, there was a popular idea that there was a "cancer personality:" introverted, pessimistic. I found the idea hurtful and unscientific. Cancer, I believed, was strictly a consequence of events in the physical world. The idea of preventing or curing cancer by thinking happy thoughts was superstitious nonsense designed to blame the victim and, perhaps obscure the reponsibility of polluters who were pumping carcinogens ino the environment.

Since then, my ideas about how the mind interacts with the body have changed significantly. Since I conceive of human consciousness as a manifestation of physical events in the brain and since we know that the major function of the brain is to control the functioning of the body, it seems perfectly possible to imagine that how a person thinks and feels can effect how his body reacts to cancer or anything else. The brain is an organ of the body connected to the rest of it by nerve, blood, bone, etc. and the function of the brain effects the other organs just as their function effects the brain.

So, what bothers me now about the admonition to "think positive" is not the notion that positive thinking might help, but my inability to understand what it means for "me" to decide how I will think or feel. If my self, my ego, is, in fact, a consequence of my brain function, how can "I" cause my brain to think about things differently when "I" am, in fact, an idea or sensation produced by the material action of my brain? The causation arrow runs the wrong way. Indeed, it seems that my optimism waxes and wanes with my physical state--I think optimistic thoughts when I have had enough sleep and eaten healthy food.

So, rather than trying to fool myself into believing things that are not true, my conclusion is to try to improve my state of mind by taking care of my physical body by making decisions about what to eat, exercise, etc. Hopefully, that will produce the positive brain activity that will help me survive.

A slight change in direction

It's been almost a year since my last post on this blog and I am sure that no one is still checking to see if anything new has been posted. So, I've decided to revive it for a new and different purpose. Maybe someone will find it and read it, but mostly I'm just writing for myself. If you do happen to come across it feel free to comment.

Last September (2010), I was diagnosed with a urothelial tumor in my left kidney. I had my kidney removed and hoped that the surgery would cure the problem. Within a few weeks I was up and about--about 30 pounds lighter and with a big scar on my belly--but otherwise no worse for wear. However, recently I discovered that the cancer has now manifested itself as multiple tumors in my bladder. Obviously, this new development ups the ante considerably.

Next week I'm off for a consult at the GenitoUrinary department at M.D. Anderson Cancer Center in Houston, the same hospital where my late wife, Helen, was treated for breast cancer for almost seven years, a place that, I fervently hoped, I would never see the inside of again. Having confronted death by cancer in people I loved on several occasions, I have developed some pretty definite notions as to how one ought to deal with the challenge of this life-threatening disease. We'll see if I'm up to it now that it's my turn.

My plan is to post ongoing reports on my journey through life as a cancer patient--a journey I've observed from close quarters but never before from the inside. I hope this will be helpful for me, and, if anyone ever reads this, for my readers.

Oil Business

The blowout of British Petroleum's deep sea oil well in the Gulf of Mexico is a bill come due for the people of the Gulf Coast. For the people of Louisiana and Texas,at least, it is a bill that we thought would never have to be paid.

I have lived most of my life on the upper Texas Gulf Coast, in the midst of one of the largest concentrations of petroleum-related industrial activity in the world. In the sixties, when I lived there, the motto of Port Arthur, Texas, a refinery town situated on the Louisiana border, was "We Oil the World!" In those days, the environmental degradation that accompanied the production of petroleum products was seen as a minor inconvenience that was more than compensated for by the prosperity attendant to the "awl bidness." When I complained to my father about the toxic fumes that permeated the air of Port Arthur, he told me that the putrid hydrocarbon odors that made me gag were "the smell of money." This attitude was widespread among Gulf Coast residents who worked in the industry. As time went on, people became more aware of the environment, the attitude of those in the oil business changed slightly--now the story was that the risks posed by the production, transportation, and refining of crude oil could be protected against by technical means and--not to worry--the industry was doing just that.

At no time in my memory were the people of Louisiana and Texas (the two Gulf Coast states that were most involved in oil) ever told by their leaders that we had made a bargain with the rest of the country to accept the environmental harm inherent in petroleum extraction in return for money. Indeed, here on the Gulf Coast, the evironmentalists on the east and west coasts who refused to allow drilling off their coasts were seen as impractical, privileged aesthetes who didn't have enough entrepreneurial gumption to exploit the resources around them. Occasionally someone would point out the hypocrisy of Yankees who drove SUVs but didn't want to see a drilling rig from their beach house, but this trope was not generally pursued because, if you thought about it very long, it necessarily implied that we Gulf Coasters who welcomed the chance to foul our land and waters in order to provide fuel for Northern suburbanites were, in fact, the suckers in the deal.

Now, the note has been called. The marshes and estuaries of the Louisiana coast are becoming more polluted every day. Hundreds of thousand gallons of crude oil are pouring into the open Gulf and will continue to do so for months. While Texas waters have not yet been affected, they no doubt will be. The beaches of the Florida Panhandle, as white as sugar, will soon be blackened, despite the fact that Florida never sold its soul to the awl bidness. And after a hundred years of serfdom, Gulf Coasters can't afford to extract ourselves from this bargain with the devil. Our politicians demand that the federal government allow continued offshore drilling despite the BP disaster, because that's the only way we know to earn a living. Decisions have consequences, but I wish that had told us what the deal was.

False Positives

Last month, the Preventive Services Task Force of the United States Department of Health and Human Services issued a report recommending a significant reduction in mammographic screening for breast cancer. This recommendation was received with what can only be described as hysteria. While some of the protest was a cynical ploy by those who oppose Obama's proposed health insurance reform and some of it (very little) was a serious disagreement over the Task Force's calculation of the net benefits of mass breast cancer screenings, most criticism of the report centered on the idea that it is immoral not to screen millions of healthy women if, by not screening, there is one life lost that could have been saved. "So what," these critics argued, "if the chances of saving a life of a woman between ages 40 and 50 by screening is 1 in 1900, we should do everything we can to save that life." The problem with this sort of thinking is that it completely ignores or minimizes the costs of routine mammography for the 1899 women who undergo the test but whose lives are not saved by it.

In most of those cases, the x-ray shows no sign of cancer. These women are reassured, but they do pay a price in radiation, money, inconvenience, and discomfort. They receive no tangible benefit from the test; indeed, the radiation exposure slightly increases their chances of developing breast cancer in the future. Most women who are now being screened probably think that the psychological comfort of a "negative" mammogram is worth these risks, but this "benefit" is purchased at a cost, much of it paid by other women.

In a significant number of cases, the mammogram shows a suspicious breast lesion which is biopsied and diagnosed as benign. These are the classic "false positives." These women typically receive more radiation in the form of additional imaging and suffer additional expense and pain. Most importantly, however, they understandably suffer a good deal of anxiety during the time between the "positive" mammogram and the post-biopsy "all clear" signal. Mammography advocates typically dismiss this psychological cost as trivial, but they can't have it both ways. If the emotional reassurance provided by a true negative mammogram is a good reason to do them, then the psychic pain caused by a false positive is a reason not to do them.

The group of women most hurt by being screened are those in whom the mammogram leads to the discovery of a slow-growing cancer, one which, if undiscovered, would never have cause illness or which, at least, would not have metastasized before it reached a size at which it would have been discovered without x-rays. Some of these women will be treated unnecessarily, typically undergoing surgery, chemotherapy, and/or radiation. All of these treatments are dangerous and unpleasant. In addition, these patients are deprived by the screening test of the blissful ignorance which allows them to live their lives innocent of the existence of mutated cells within them.

The same considerations apply to those women in whom mammography finds aggressive, incurable tumors. They will die with or without mammography, but without it they will have more time in which to live normal lives,free of the knowledge they they have a life-threatening disease.

While it is impossible to tell in advance which woman is in which of these groups, it is possible for scientists to make informed judgments about the relative sizes of these groups and to consider these facts in making a cost-benefit analysis of the benefit of screening mammography for different groups. That is apparently what the Task Force tried to do. Others can contest their measurements of costs versus benefits in good faith, but many of those denouncing their recommendations do so without acknowledging that there are, in fact, serious costs to mass screening of healthy people.

The Torture Debate

1. People who torture, or who order others to torture, are criminals under US and international law.

2. People who admit to having ordered torture are confessed criminals.

3. Confessed criminals should be prosecuted for their crimes.

WHAT THE FUCK IS THERE TO DEBATE?