May 29, 2011– Back to the Unknown

Best video I’ve seen on general cancer survivorship issues. Link courtesy of Dr. Wendy Harpham, who provided it on her survivorship blog a few weeks ago. It’s a little long – 17 minutes - but worth it:

From Cancer Patient to Cancer Survivor: Lost in Transition from The National Academies on Vimeo.

One of the survivors interviewed describes her experience as going "back to the unknown.” During treatment, in a certain sense you know what you’re up against. Afterwards, you try to reclaim the life you had before, but you find it’s no longer yours. For better or for worse, cancer has transformed it. The life you take up again has been permanently altered by the cancer experience, and there’s a certain amount of grief for what had been hoped for, but will never be. There’s also fear of what could happen, down the road, by way of recurrence.

It’s not all negative, of course. As the video points out, lots of people who go through the cancer treatment ordeal find themselves stronger as a result. That’s certainly been true for me.

I’d love to hear from some survivors, in the comments area, about what you think of the video.

May 28, 2011 – Another 11th-Hour Cancellation

After a rickety wooden footbridge toppled Catherine of Siena into a muddy stream, she is said to have offered up this exasperated prayer, in the hearing of her sisters: “Lord, I know you promise never to give us more than we can handle, but sometimes I wish you didn’t trust me so much.”

I'm beginning to wonder if the Almighty trusts me especially well when it comes to handling last-minute surgical cancellations. It's happened to me twice so far.

The first time was when Dr. Aron Gornish was getting ready to do an excisional biopsy of a swollen lymph node at the base of my neck. I got all the way to the Operating Room that time, when he discovered he could no longer palpate the lymph node (feel it with his fingers), so he decided the better part of valor was to send me home and schedule an ultrasound-guided needle biopsy with an interventional radiology specialist.

I didn’t make it quite that far at Memorial Sloan-Kettering. Just as far as the pre-operative suite. One of Dr. Boyle’s associates had already marked my neck with a felt-tip pen. The nurse was getting ready to insert my IV line, when she noticed a blotchy red rash on my arm.

“Do you have this elsewhere?” she asked.

“Yes,” it’s all over my body. “Claire noticed it this morning.”

“Does it itch?”

“No, I wouldn’t have known it was there till she told me.”

They already knew about the low-grade fever and the general feeling of malaise I’d been having since Wednesday afternoon. After some back-and-forth on the telephone Thursday afternoon, they’d advised me that the fever wasn’t high enough to be of concern. I was supposed to call them immediately, though, if my fever got higher.

It didn’t. But, in 20/20 hindsight, I wish I’d called them back before we’d left for New York, to tell them about the newly-emerged rash. Maybe it would have saved us the better part of a day in the car.

It was interesting to watch how rapidly this safety concern shot up to the top of the pre-surgical pecking order at MSKCC. Within the space of 15 or 20 minutes, two or three nurses had stopped by to examine my rash, then the anesthesiologist, then Dr. Boyle’s associate, then finally the big man himself. I don’t think it’s usual for the principal surgeon to see patients on the day of surgery until they actually enter the Operating Room. When the associate said he was going to get Dr. Boyle, I figured this was serious.

His lighthearted greeting to me was, “Hello, Red Man.” I had to agree it was an accurate description. As soon as I heard that, I figured the decision to cancel had already been made – although Dr. Boyle took me very kindly and gently through the decision-tree he typically worked through to make such a call. After he’d explained all the pros and cons, he’d actually gotten me to ask him to postpone!

This guy’s bedside manner is awesome.

So, after a restorative stop by the basement cafeteria (I hadn’t eaten or drunk anything since midnight, although a side-effect of my mysterious ailment is not having much appetite), Claire nosed the hood of her car into the mean streets, and we began heading home to the Jersey Shore – close to Rush Hour on Memorial Day Weekend.

It took us over 3 hours – even after judicious use of some back roads that, if New Yorkers ever heard any of us locals breathe a hint of their existence, we’d have to kill them.

While sitting in the traffic gridlock, I called both Dr. Cheli's (family practice) and Dr. Lerner’s offices (oncology/hematology), to tell them what was going on and see if they suggested any urgent action. Dr. Cheli’s office was already closed for the long weekend, and the outgoing voicemail greeting spoke of someone calling me back “tomorrrow,” if I left a message. I was quite sure that meant Tuesday. It also gave me an “emergency” number I could call for more immediate attention. I left a non-emergency message, asking for a callback about an appointment as soon as the office is open.

After that, I called Dr. Lerner’s office – which I knew would still be open on a Friday afternoon, even on a holiday weekend. They put me through to the nurses’ voicemail, and I got a call back from Janet, who’s done a lot of my monthly port flushes. She explained that Dr. Lerner had asked her to call me back and tell me it sounded to him like a classic allergic reaction to something, that it was probably unrelated to my lymphoma, and that I should just wait it out.

After thinking about it and discussing it with Claire, I decided not to call Dr. Cheli’s emergency number, and also not to go to the local emergency room. Diagnosing this mysterious ailment – if, indeed, we’ll ever know what it is – is probably going to require a lot of blood work and similar sleuthing. Not something that’s likely to happen on a holiday weekend. Until the problem is identified (viral, bacterial or allergy), nobody who isn’t already thoroughly familiar with my medical history would likely prescribe me any medicine anyway.

So, it’s watch and wait and feel lousy, here at the homefront. I already told Linda, our associate, that I don’t intend to change my former plan to sit the worship services out tomorrow. I’d be not much good to anyone, and besides, I could be contagious.

We’ll reassess on Tuesday, Lord willing and the creek don’t rise.

May 26, 2011 – The Last Drink

Here I am, staying up till midnight, guzzling water. It’s the last liquid I’m allowed to have until after my thyroid surgery tomorrow, which is scheduled for 2:45 pm.

I wish they’d give me a later time for that last drink, when surgery is scheduled for later in the day, as mine is. I’d be willing to set the alarm and get up in the wee hours, if that would mean I’d spend less time tomorrow feeling like I’m crossing the Sahara.

Today some uncertainty arose about whether or not I’ll even have the surgery tomorrow. The reason is that I’m running a low-grade fever. I don’t know what bug I’ve got or where I got it, but I’ve been having intermittent headaches, joint stiffness and feeling general malaise for a couple days now.

After taking Tylenol, I’m only a degree over normal, so the resident from Memorial Sloan-Kettering I spoke with today said we should proceed. He said to keep taking the Tylenol if I still have a slight fever, and call them if it gets any higher.

I sure don’t want to postpone this. Too much mental preparation has gone into it – not to mention clearing my calendar. If the fever proves to be an obstacle, though, so be it. It's up to the docs to make that call.

Not that I’m looking forward to a surgeon cutting my throat, of course. But I know it has to be done. I also know the odds of a successful surgical cure are about as high as they get - close to 100% - so that makes it a lot easier to contemplate.

The later time also means Claire and I will have the distinct pleasure (I’m being sarcastic, of course) of driving across Manhattan in the late morning. The original estimate was for a very early operation, which would have meant – with us having to be there two hours early – that we would have been crossing Midtown around 3 or 4 a.m. New York may be “the city that never sleeps,” but at that hour it would mostly be the Yellow Cabs and the occasional delivery truck we'd have to contend with. Oh, well.

The surgery should last about an hour. Then, it’s an overnight stay in Memorial Hospital, with a return home by car sometime on Saturday. After that, the prediction is for a day or two of recovery, then a return to normal activities.

More details about the surgery may be found here, in my March 28 blog post.

May 10, 2011– Parenting With Cancer

Here’s a new blog that’s worth checking in on from time to time. Parenting With Cancer is the brainchild of a New Jersey NHL survivor, Jen Singer. Her two sons are now in junior high. At the time she was undergoing chemotherapy and losing her hair, they were in elementary school.

A cancer diagnosis is devastating at any age, but for parents of young kids it’s especially hard. What do you tell them? How much will they understand? How to cut back on day-to-day responsibilities and concentrate on healing, when there are young lives depending on you 24/7 for care and nurture?

Our son Ben was in college and our daughter Ania was in high school when I was diagnosed. It was tough enough figuring out how to break the news to them, at that comparatively older age. I can only imagine what it must have been like for Jen, and others in similar circumstances, to tell their much-younger children they’d soon be seeing their mother without any hair.

Kids may not comprehend all the medical details, but at every age they do tend to pick up on the general emotional tenor of the household. I wouldn’t advise parents in Jen’s situation to try to hide the news from their young children. Better to tell them a little, in as non-anxious a way as you can, then wait for them to tell you if they want to know more. Now, here’s the tricky part. Young kids may not be equipped to ask you, in so many words, to tell them more, but even if they aren’t, kids will generally send non-verbal messages that they’re either satisfied or unsatisfied with the briefing you’ve just given them.

I also think it’s OK to get emotional in front of them, if that’s what it takes to be honest and real. You can’t use a young child as your therapist, of course, but for them to see mommy or daddy cry or express anger – and thereby learn that the sky doesn’t fall when that happens – is not a bad thing. Just remember, strength comes in many different packages. Clint Eastwood’s patented squinty-eyed, stone-faced, curled-lip impassivity is only one way of showing it (and probably not the best, in such circumstances). Just think of what a learning it could be for kids to watch their parents wrestle with how to adapt to a really tough piece of news, and come out at the other end of the struggle with an accommodation to the new normal.

Jen talks of listening to a priest’s homily about how wonderful heaven is, a message that she, as a parent and cancer survivor, was not ready to hear. In light of the glories of heaven, the priest was saying, how do we account for human fears of death, except as a stubborn fear of the unknown? Jen’s response:

“Not me. I have a fear of the known. And here’s what I know: If I die and go to Heaven today, I will not be here to raise my children — something I came awfully close to four years ago when doctors found a tumor the size of a softball in my chest.

I wanted to interrupt the priest’s homily, to tell him and the entire congregation that while Heaven sure sounds lovely, I have responsibilities here on earth — two of them — and they aren’t done being raised.”

She also admits to feeling a bit of survivor’s guilt, as she attends the funeral of a neighbor (another young mother), who died of ovarian cancer:

“As I snaked my way through the crowd, hugging person after person that I recognized from town, I realized, This could have been my funeral. And suddenly, I stopped walking. I stopped hugging people. I stopped looking at photos of my neighbor on vacation, on Christmas, at the school where our sons were in kindergarten together.

I stopped and thought about my own kids four years ago, when I was just two months from what could have been my own funeral.

And yet my neighbor is gone and I'm here.”

A cookie-cutter approach to coping with cancer is impossible. We’re all of us different, in one way or another, so we’ve got to chart our own path.

Still, Jen Singer describes herself as a “cancer sherpa.” Like those legendary Himalayan guides, she’s offering her mountain-climbing savvy to others setting out on the journey for a first time. For cancer survivors with young kids, her blog is well worth bookmarking.

May 4, 2011 - Tests, Tests, Tests

On Monday I hopped a New Jersey Transit train for New York City. The destination was Memorial Sloan-Kettering Cancer Center’s midtown outpatient facility, the Rockefeller Outpatient Pavilion. The purpose? Pre-surgical testing, in advance of my thyroidectomy coming up on Friday, May 27, at MSKCC’s Memorial Hospital on the main campus.

My appointment was for 11:15 with Dr. Anna Rita Marcelli, an internal medicine specialist who does pre-surgical screenings. Dr. Jay Boyle will be doing my surgery, but evidently the protocol at MSKCC is for the big surgeons to farm out the prep work to other physicians. These doctors are specialists their own right. Their task is to ferret out any pre-existing conditions that could potentially cause trouble in the operating room. It’s one of the benefits of going to a comprehensive cancer center.

I suppose that means that, if Dr. Boyle is the executive chef, then Dr. Marcelli is the sous-chef. This is not to detract in any way from Dr. Marcelli's abilities; in the world of haute cuisine, a sous-chef is a well-respected role. In fact, in her spare time Dr. Marcelli is a Professor at New York's Weill Cornell Medical College.

I quickly discovered she’s really, really good at what she does – mainly because she uncovered a potential problem in my case that led to a whole lot of additional tests. It also extended my stay in the city from what I’d guessed would be a couple of hours till about 6:30 p.m.

The first thing they did was send me for an electrocardiogram (EKG). Then, I went into a little examining room where a nurse checked my vitals prior to Dr. Marcelli’s examination. As she was taking my blood pressure (which was a little high, but on a subsequent test turned out fine), the nurse inserted my finger into the pulse oximeter, the little clamp with a glowing red LED that always makes me feel like E.T. The pulse oximeter measures the percentage of hemoglobin in the blood that’s saturated with oxygen.

In my case it read 90%, which is borderline for the condition known as hypoxia (abnormally low oxygen level). A normal reading is considered to be 97% or 98%.

I do have obstructive sleep apnea, and use a bipap machine to augment my breathing every night. The negative airflow of the bipap keeps my soft palate from sinking down and blocking my airway, which means I sleep much better with it than without it. One of the side effects of sleep apnea can be hypoxia, so I do want to be sure to talk about it with Dr. Gustavo De La Luz, my pulmonologist, when I get a chance.

As Dr. Marcelli came in, she gave me a thorough physical, but kept coming back to that less-than-stellar oximeter reading. After repeating the test a couple of times, she told me she wanted me to undergo some further tests, right then and there.

Earlier I had told her I’d had a problem last fall with a blood clot in my lower leg, for which I’d had a few visits with Dr. Franklin Frasco, a local vascular specialist. He’d determined that the clot was in a minor artery, and was therefore not in a position to break off and cause an embolism (arterial blockage) in one of the lungs. He told me to lose weight and get more exercise, and also to start wearing compression stockings (all of which I’ve been doing, although more sporadically than I should have). He released me from his care, saying I didn’t need to see him anymore.

Dr. Marcelli told me that, with the combination of my blood-clot history and the borderline oximeter reading, she wanted to rule out an embolism prior to my undergoing anesthesia on the 27th. Now, here’s where the power of a major cancer center like MSKCC comes to bear. Even though the Rockefeller Pavilion is an outpatient facility and not the main hospital, it’s state-of-the-art. They have the capacity, even at that location, to deliver just about any standard diagnostic test you could imagine, on very short notice. Between noon or thereabouts, and the time I finally walked out of the building about 6:30, I’d had an echocardiogram, a CT scan of the chest, an arterial blood test and a series of pulmonary function tests.

All of them I’d had before, except the echocardiogram and the arterial blood test. Still, most all my local experiences of such tests have involved several days of waiting. At MSKCC, once the doctor ordered it, the tests were stacked up one after the other in no time, and I swiftly went from each one to the next.

Dr. Marcelli had told me that, if there were any sign of an embolism, she would recommend that I confer immediately with another doctor, to determine “what to do next.” I took that to mean immediate hospitalization, and probably treatment with blood-thinners. At the end of the day (literally), no one suggested anything so drastic. Several subsequent pulse oximeter readings were at 96%, a considerable improvement from earlier in the day, and evidently no one saw anything worrisome in the CT scan or echocardiogram results, so I was cleared to go home.

I closed the place, being the last patient to leave the busy pre-surgical testing area.

I’d kind of expected to hear back from Dr. Marcelli in a day or two, summarizing her findings, but I haven’t as yet. So, tomorrow I think I’ll give her office a call and see if she turned up anything I need to know about.

My assumption, though, is “no news is good news,” so I’m not worried.

April 30, 2011 – Living Hope

Came across this little gem of an article today, in the online edition of Coping With Cancer magazine. It’s by Anne Lawton, an oncology nurse, and it’s about hope.

Hope, she's come to realize, is “the only word that matters” in her business.

Anne’s learned that, from the patients’ standpoint, the nature of hope changes over time. At first:

“People hope their doctor is good. They hope they make it through surgery, and they hope their cancer is treatable. They hope they can tolerate the chemotherapy.”

Later on in the cancer journey, many find themselves hoping for different things:

“They hope for a cure. They hope for a nice, full head of hair, eyelashes, and eyebrows. They hope the neuropathy and the other side effects go away. It's no longer just survival they hope for; they want their life back. They have a lot to do, and they hope the cancer never comes back.”

And if it should happen that the cancer does come back? Hope changes yet again:

“They hope for a life worth living, with few cancer-related side effects. They hope to live long enough for graduations, grandchildren, weddings, or that trip of a lifetime. They hope to complete their "bucket list.”

Finally, in some cases – though Anne doesn’t go there – when patients opt for hospice care, the hope is for freedom from pain, a clear mind, the opportunity to say farewell to loved ones and to know they’ll be provided for. A good death, in other words. When the time is right, no apologies are necessary for hoping for that.

Viewing hope as a continuum, can we really say it’s the same hope at the end of such a journey as at the beginning? I’d say yes, it is – although the hope has changed and matured. It’s grown, just as the patient has grown all through this troubling, painful, emotionally-taxing – and, yes, sometimes even spiritually-uplifting – journey.

1 Peter 1:3 celebrates how God “has given us a new birth into a living hope through the resurrection of Jesus Christ from the dead.” Living hope. I think that ol’ apostle was onto something.

By God’s generous grace, hope is alive. It grows and changes as we grow and change. Hallelujah!

April 27, 2011 – This Is the Life

This Easter, I preached on the topic, “This Is the Life.” While, for many, it’s a phrase that conjures visions of shady cabanas on tropical beaches, shrimp cocktail and umbrella drinks close at hand, I was thinking about something different.

And no, I wasn’t thinking about what this guy means by the phrase, either:



“This is the life” is Jesus’ promise to his disciples in John 10:10, as he proclaims, “I came that they may have life, and have it abundantly.” It’s a promise they wouldn’t begin to understand until after the resurrection.

This whole matter of abundant life takes on a different cast when that life includes cancer. What does it mean to “have life abundantly” when that life, for a cancer survivor, includes a low-level sense of foreboding that’s always lurking somewhere?

I think Matthew’s account of the resurrection supplies an answer. It employs a curious turn of phrase, describing Mary Magdalene and “the other Mary” (probably Jesus’ mother), as they rush from the tomb, having heard the angel tell them Jesus has been raised from the dead. Matthew says, “they left the tomb quickly with fear and great joy...”

Whuzzat? With fear? And great joy? Sounds like an oxymoron.

No, it’s no oxymoron. Our emotions are seldom simple and elemental. They’re often mixed.

Actually, there are times in life when fear and joy do coexist. Try to imagine the first time you fell in love, and realized that person you loved felt the same way about you. Did you ever feel more alive than in that moment?

And wasn’t it also true that, having asked that special person (or having been asked) to go out on a date, and having heard that person say yes (or having said yes yourself), the thought suddenly occurred to you that you would have to actually participate in said date, and you would somehow have to avoid making an idiot of yourself? Fear and great joy!

Or, think about the most significant graduation ceremony of your life, that highest level of education you’ve completed. If you were able to attend such a ceremony, recall the joy of accomplishment you felt that day, in cap and gown, looking around at the grinning faces of all your classmates. Remember, too, the other thought that came to you at that moment: “What am I going to do tomorrow?” Fear and great joy!

Brides and grooms on their wedding day, first-time parents driving that baby home from the hospital – on these and many other occasions in life, fear and joy coexist. Not without some tension between them, perhaps, but there it is. This is the life.

The two Marys were likely feeling something similar, because the first thing the risen Jesus says to them is “Do not be afraid.”

This has nothing to do with whether or not they may happen to disbelieve what they’re seeing, or whether or not they suspect it may be some sort of ghostly apparition, some wraith vomited up from dark places to bedevil them. No, I think they realize who it is, and can at least grasp the bare outlines of the paradigm-busting wonder that’s taken place. I think the two Marys are afraid because they realize what the resurrection is going to mean for their lives.

Surely these wise women realize that, if they continue on as Jesus’ followers, and go tell the other disciples the good news they’ve just heard and seen, they’re going to unleash into the world a powerful force that there will be no stopping. From this day onward, they’re going to be riding a mighty wave that will propel them onward with terrific force – and at times that position on the crest of the wave will be a dangerous place to be.

Yes, of course they’re going to do it, of course they’re going to bring the good news to their companions. But their fear and their joy are intermingled.

This is the life. This is the new life God has given them. Yes, perhaps they recalled hearing Jesus say he’d come that they might have life, and have it abundantly, but until this moment those had been nothing more than inspiring words, a rhetorical flourish. How could they possibly have known that new life would come to them through the nail-pierced hands that now rest on each of their heads, and through the nail-scarred feet they are even now washing with their tears?

The Danish theologian Søren Kierkegaard once described this aspect of the Christian life using a very vivid image. He said that sharing the Christian faith with others is like handing them an extremely sharp knife.

A sharp knife is a useful tool. The greatest chefs, in fact, take meticulous care of their knives, sometimes even packing them into special carrying cases and bringing them home at night, so no damage will come to them. No one, Kierkegaard goes on, would think of handing a sharp knife to another person as one would hand over a bouquet of flowers. It’s just not done.

One of the first things we teach kids, in our church’s Cub Scout Pack and Boy Scout Troop, is how to safely hand a knife to another person. The boys don’t earn their “Totin’ Chip” – the special wallet card that allows them to carry a pocketknife – until they learn how to hand an open knife to a fellow Scout handle-first, and not let go of it until the other person says, “Thank you” – indicating he’s got it safely in hand. That’s because a knife is a useful implement, but it’s also dangerous. You’ve got to have a healthy fear of knives before you can use them safely.

Faith is just that sort of tool for living life as a cancer survivor. Most of us aren’t going to be cured, physically, by our faith. For whatever reason, God doles out complete spiritual healing only rarely, and according to no logic we can understand. Yet, if we’ve learned how to take this elegant tool in hand and use it safely - preventing it from slipping and causing further injury - we’ll find ourselves much better-equipped for living through days and years of remission and relapse, of tests and treatments.

Christian faith doesn’t put an end to fear. It does, however, take the natural, human fears we all have and puts them in perspective. Without the inner peace that comes of faith – which we Christians describe as knowing the risen Christ – the ordinary fears of human life can rage out of control, wreaking havoc in our lives, and in the lives of those we love.

The crucial difference comes from the other part of the equation: the “great joy” that counterbalances our very human fears. We can still seek it, even in the midst of cancer. Even a cancer-burdened life is still life, and Christ has promised that, in him, we can live abundantly.

I’m No Healthcare Consumer

Yesterday's New York Times contained a very sensible column by Paul Krugman. He asks a question that’s really rather obvious – so obvious, in light of our national healthcare-funding woes, it’s escaped the attention of a great many who ought to be asking it:

“Here's my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as "consumers"? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car - and their only complaint is that it isn't commercial enough.

What has gone wrong with us?”
– Paul Krugman, “Patients are not Consumers,” New York Times, April 21, 2011.

This is more than a mere quality-of-life question. It’s got big implications for economics, as we continue to struggle through our national healthcare-funding debate:

“Consumer-based" medicine has been a bust everywhere it has been tried. To take the most directly relevant example, Medicare Advantage, which was originally called Medicare + Choice, was supposed to save money; it ended up costing substantially more than traditional Medicare. America has the most ‘consumer-driven’ health care system in the advanced world. It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.”

The problem is that there are an awful lot of people out there who profess an unquestioning, fundamentalist faith in what economist Adam Smith called, way back in 1759, “the invisible hand” of the market. For him, it was probably just a metaphor, but for his latter-day followers, it’s become a virtual deification of free enterprise. Attached to that invisible hand, in their fantastic imaginings, is a new Olympian god, who effortless regulates human affairs through astute transfers of capital.

That would be of little significance, were not living, breathing human beings mightily affected by such transfers.

That makes it, as Krugman correctly points out, a moral issue.

April 21, 2011 – Radiation Pill?

It seems lymphoma treatment isn’t the only cancer-treatment field that’s rapidly changing. Today I come across an article on my other cancer – thyroid cancer – indicating that one treatment that’s been talked about for me is currently being reconsidered by the experts.

I’ve been hearing all along that, once my thyroid is removed surgically, I’ll probably need to follow up with a single radioactive-iodine treatment. This is a dollop of radioactive material encased in a small pill, that I would swallow several weeks after surgery. Because thyroid tissue thirstily slurps up iodine, if it should happen that there’s any thyroid tissue remaining in my body after the surgery, the radioactive iodine would zap it.

Now, it turns out the radioactive iodine is risky in itself, and is possibly the cause of some secondary cancers. Recent studies indicate that a more nuanced treatment decision now needs to be made, weighing the likelihood that there is indeed any remaining malignant thyroid tissue against the slight – but real – risk of the radioactive iodine running amok and causing another cancer elsewhere.

The American Thyroid Association is now saying that radioactive iodine “should be used selectively and [only] in patients with intermediate and high-risk thyroid tumors.”

So, with a nodule presently at 1.5 centimeters, how’s my tumor classified? I didn’t ask Dr. Boyle about precise staging, so I can’t be sure.

That’s one thing I’ll need to remember to ask the doctor about, as the time of surgery draws near.

In the meantime, it’s Holy Week, and I’ve got a whole lot of other things on my mind. Sermons to write!

March 28, 2011 - Surgery Is Scheduled

Time to bring you all up to date on my decision-making about the thyroid surgery.

Last Wednesday I drove up to Memorial Sloan-Kettering Cancer Center’s satellite outpatient facility in Basking Ridge, New Jersey for a consultation with otolaryngologist Dr. Jay Boyle, who had been recommended to me by my lymphoma second-opinion physician, Dr. Carol Portlock.

Everything went smoothly at the Basking Ridge facility, which is in an impressive new building located a convenient one-hour drive from our home. After the usual filling-out of forms and a quick interview with an intake nurse, Dr. Boyle came right in and gave me all the time I needed to ask my questions.

I asked about whether I’d need to have the whole thyroid removed or whether a lobectomy (removing one lobe, or half the gland) would be a possibility. He said the scan results confirm there’s malignancy in both halves of the thyroid, so it all has to come out.

A follow-up radioactive iodine treatment is a possibility, but he wouldn't be able to say for sure about that until after the surgery.

Because it's a slow-moving cancer, we'd have a little time to think about it and choose a convenient date.

It’s highly unlikely that my thyroid cancer is in any way related to my lymphoma. Seems I’ve had a bad roll of the dice, two times running.

Dr. Boyle was very upbeat about the prognosis, as well he should be. Thyroid cancer is one of those rare malignancies that’s nearly 100% treatable with surgery. The surgery itself – while somewhat delicate, due to the thyroid’s location in the neck – is not very invasive, since the gland is very close to the surface. He explained there would be some stitches, but they’d all be internal and would dissolve on their own. A bright red scar, which he endeavors to hide as much as possible within naturally-occurring fold lines in the skin of the neck, would be visible for about a year or so, but would eventually fade so it’s only visible upon close examination.

An overnight stay in the hospital is a given, but nearly everyone goes home right after that and is able to resume normal activities in a few days. (I learned later, from one of the nurses, that MSKCC is starting to do some thyroid-removal operations as same-day surgeries.)

I do have a slight concern about a possible side-effect from the surgery, which is damage to the voice. This sometimes happens as a result of damage to one of the nerves that controls the functioning of the vocal cords, which are nearby. I explained that I may be more concerned about this than most patients, because I use my voice for a living. Dr. Boyle assured me that the national rate for this sort of complication is about 1%. “With me,” he said, “it’s a great deal lower than that.”

He dropped that statistic into the conversation in a matter-of-fact way that sounded in no way boastful (although I suppose it may appear that way, upon reading those words).

Afterwards, I spoke with one of the nurses about long-term issues, and she confirmed what I already knew, that I’ll need to take synthetic thyroid-hormone medication for the rest of my life. “If you miss a day or two, it’s no big deal,” she explained. “If you go on vacation for a couple weeks and forget to bring your pills with you, you need to find a pharmacy and get your prescription filled. Go six months without taking it, and you’re dead.”

Well, that doesn’t leave much ambiguity, does it?

I liked Dr. Boyle. There’s no doubt he’s one of the foremost thyroid surgeons around. While it’s a relatively simple operation, with a very high chance of success, why shouldn’t I go to one of the top-ranked surgeons, as long as he’s relatively close by and can fit me into his schedule?

It doesn’t hurt that he’s a Presbyterian, either. When he learned what I do for a living, he mentioned that he’s a member of the Westfield, New Jersey church.

A little while ago, I called Dr. Boyle’s office and confirmed a surgery date of Friday, May 27, at MSKCC in Manhattan (they don’t do surgery at the Basking Ridge facility). I’ll go into the city on May 2 for pre-admission testing.

I feel good about this, like I’m making good progress in dealing with it. As I said to someone else recently, when it comes to dealing with a new cancer diagnosis, it’s a real advantage to be a veteran.

March 26, 2011 – New Follicular Lymphoma Treatment Guidelines

Here are a couple of big changes in standard treatment guidelines for follicular NHL. According to the National Comprehensive Cancer Network, Rituxan plus Bendamustine (a single chemotherapy agent) is evidently replacing R-CHOP, the cocktail of Rituxan plus four chemotherapy agents I received, as the standard, first-line treatment. Bendamustine is more easily tolerated and doesn’t typically lead to alopecia (hair loss).

There’s also a change in the NCCN-recommended treatment for relapsed follicular lymphoma: Rituxan maintenance and chemotherapy followed by radioimmunotherapy.

If I were presenting as a newly-diagnosed NHL patient today, I don’t know if this new first protocol would apply to me; nor do I know, were my NHL to come back with a vengeance, if the second option would be what Dr. Lerner would order up. That’s because my initial diagnosis was not follicular, but diffuse-mixed-large-and-small-cell. The small-cell type I now have has many similarities to follicular lymphoma, but it isn’t exactly the same.

Still, it leads me to wonder if this news story is significant for any treatment I may one day need.

It’s interesting for me to hear that both Rituxan maintenance (that’s Rituxan administered not only along with chemotherapy, but also on its own, as a monthly maintenance infusion over a couple of years) and radioimmunotherapy (Bexxar or Zevalin) are moving up in the medical world. I've written about both of these in the past, as I've become aware of discussions about their possible usefulness. Now these treatments seem to have moved to the head of the pack - at least for follicular lymphoma.

March 22, 2011 – Another Cancer

It’s official: I have to undergo cancer treatment again. Only this time, it’s not for lymphoma. It’s for thyroid cancer.

Ever since my chemotherapy ended, I’ve been having routine scans every 3 or 4 months to monitor my NHL. Two scans ago, a PET/CT scan flagged an area at the base of my neck as a possible malignancy. Then, an ultrasound turned up a nodule on the left side of my thyroid gland.

It was too small to biopsy. Dr. Jay Sher, the endocrinologist I consulted, recommended “watch and wait.”

Several months later, I had a follow-up PET/CT scan. The nodule had doubled in size, to around 1.5 centimeters. I contacted Dr. Sher, who sent me for another ultrasound, then a needle biopsy.

The results are now in: papillary thyroid cancer. I learned the results not from Dr. Sher, who didn’t phone me soon after receiving the results, but from our family-practice physician, Dr. David Cheli, who called late last week. He’d received a copy of the pathology report and phoned to tell me what’s in it. He reassured me that this form of thyroid cancer is highly treatable.

A few minutes later, I called Dr. Cheli’s office back and asked them to fax me a copy of the pathology report, and I’m glad I did. If I hadn’t done that, I would have waited a long time to learn of the details. Dr. Sher’s office staff told me on Wednesday they’d received the pathologist’s narrative report, but he didn’t actually call until yesterday – and then, only after I’d left two messages for him and faxed his office my own copy of the pathology report, as a back-up.

On the phone, Dr. Sher was upbeat and jocular. This is the most treatable of all cancers, he told me. “We just pop your thyroid out, you come back a little later and take a pill, and you’re all done.” Absolutely nothing to worry about.

Around here, it seems, it’s harder to get through to an endocrinologist than any other kind of doctor. (Medical Student Alert: if supply-and-demand makes a difference to your career choice, maybe you ought to think about endocrinology).

Dr. Sher told me he often works with a Dr. Sean Houston, an otolaryingologist who does the actual thyroid surgery. He suggested I phone Dr. Houston and set up a surgery date, then let him know when it’s going to be.

Dr. Lerner had mentioned a Dr. Alexander Shifrin, a well-regarded local surgeon who does a great deal of thyroid operations. I mentioned Dr. Shifrin’s name to Dr. Sher, but he suggested Dr. Houston instead, explaining that all his patients go to him, with very good results.

My situation seems so cut-and-dry, with a clear treatment protocol and a very optimistic prognosis. I actually thought for a minute or two about not bothering with a second opinion, but then I reminded myself of my own advice to so many others. Yesterday, I called Dr. Carol Portlock’s office at Memorial Sloan-Kettering, then faxed them a copy of my pathology report.

Dr. Portlock’s assistant, Ernestine – one of the most friendly and efficient people I’ve ever had on the other end of a telephone line, bar none – explained that the doctor would surely want to refer me to a colleague in the thyroid department at MSKCC. That was exactly what I’d expected, but I figured it was best to start with my established connection, so as to get an internal referral.

This morning, Ernestine phoned back with the name of Dr. Jay Boyle, an otolaryngologist at MSKCC. I phoned for an appointment, and learned that he has an opening for a consultation tomorrow morning at their satellite location in Basking Ridge, NJ. Because that’s a much more convenient location than Manhattan, and because the next opportunity would be a week later in Manhattan or two weeks later in Basking Ridge, I jumped at it.

A flurry of phone calls later, and I’ve got all my ducks in a row to pick up my PET/CT disks from Dr. Lerner’s office this afternoon, and my pathology slides and ultrasound disks from Jersey Shore first thing tomorrow morning. From there, I’ll drive straight to Basking Ridge. They can't seem to locate the disk from my January 31 PET/CT scan, but that's not so important. It's the thyroid ultrasounds and the needle biopsy slides that Dr. Boyle will probably be most interested in.

Thank goodness, I know how all these systems work. If I’d been a cancer newbie, I’d never have been able to gather all that material together in such a short time (and I’m grateful to some very understanding people at Jersey Shore’s pathology department, who waived their usual 24-hour waiting period for getting pathology slides ready for release).

So, here we go again. Because of the highly favorable prognosis, I’m far less worried than I was at the time of my lymphoma diagnosis. If I have any anxiety other than the normal jitters about going into an operating room, it has to do with the delicate nature of thyroid surgery in general. I use my voice for a living, so I want to make sure any surgeon messing around near my larynx and vocal cords is very experienced indeed. Where and when I’ll go for the surgery remains to be seen, but the next few days will tell.

March 11, 2011 - Needle to the Neck

Today I go to the Ambulatory Care Center at Jersey Shore University Medical Center for my thyroid biopsy. I have to say, I’ve been pretty nonchalant about the whole deal, figuring that even if there is a malignancy, the nodule is very small. My online research has reassured me that treatment of thyroid cancers is likely to be highly effective.

The one thing that’s given me pause is the thought of sitting there, conscious, while somebody sticks a needle in my neck.

They’ve told me they’ll numb the area – and I’ve had plenty of needles before, with my endless blood work – but this is the neck, and somehow that seems different from the inside of the elbow or even the area by my collarbone where my port is located.

Earlier, when I spoke on the phone with the scheduler from that department of the hospital, I asked if patients reported much pain from the procedure. “Everyone’s pain threshold is different,” she replied, cagily.

Well, isn’t that reassuring?

As it turns out, I’ve got nothing to worry about. Dr. Wahid Girgis, the interventional radiologist, comes into my little cubicle in the waiting area and begins by telling me, “Of all the procedures we do here, this is by far the easiest.”

I ask him if patients report any pain from the procedure, and he replies with a smile, “I haven’t had a complaint yet.”

A remarkably un-cagey response, for a doctor.

Turns out he’s right. They wheel me on a gurney into the interventional radiology room. I eye a hulking machine to my left, that hangs something resembling an overturned drum-head over an operating table, but it turns out they don’t need to use that contraption on me. The only thing Dr. Girgis uses the operating table for is to spread out his gear. A nurse wheels an ultrasound machine on a cart over to my gurney, and they get busy right there.

Off to one side is a “cytologist,” with her own equipment-filled cart. I ask the nurse what a cytologist is, and she says, “a cell specialist.” Turns out her job is to take a look at the tissue sample and make sure it’s got enough thyroid-nodule cells in it to send off to the lab, before they send me packing.

It’s all over in less than 5 minutes. I honestly say I can’t feel any pain, just a little pressure.

A band-aid on my neck, and I’m good to go.

Results are supposed to be here by Tuesday

More waiting. But, what else is new?

February 22, 2011 – It Pays to Shop Around

Here’s an eye-opening statistic: “Most Americans will spend more time comparison-shopping for flat screen TVs than searching for the best doctor possible.”

Kairol Rosenthal, an author who cites this statistic, is a cancer survivor who proudly tells of how she works the system:

“I approach the challenges of the system as if I’m on a personal vendetta. I crush the system like a superhero who has grown a hundred times my size. I sleep at night knowing I have done everything within my power to influence my outcomes. This is my definition of well-being.”

That’s beyond proactive.

Not everyone would put it so zealously, but she’s got a point about the importance of getting second opinions. We don’t survive cancer by just sitting back and waiting for medical professionals to do things for us. We’ve got to question, to research, to learn. We’ve got to insist that our doctors give us the time and information we need to make informed decisions. We’ve got to learn the art of negotiating with insurance companies. We’ve got to keep track of those test results and make sure they get forwarded to the proper specialists. We’ve got to become our own best advocate.

I’ve been fortunate, that way. I feel blessed to have the sorts of doctors who give me far more than the time of day, and aren’t put off by talk of second opinions. But that doesn’t mean I can slack off on my homework.

There is an alternative, of course. We could just sit home and watch that flat-screen TV.

February 19, 2011 – Incidentaloma

A couple weeks ago, I had another of my periodic PET/CT scans, which are becoming as routine as that sort of thing can possibly be. When I called Dr. Lerner’s office for the test results a week later, the nurse called me back and said the PET scan had revealed some unexplained “uptake” on the left side of my thyroid gland, in the area of the small nodule detected last time around.

On that earlier occasion, Dr. Lerner had referred me to Dr. Jay Sher, an endocrinologist. After subsequent tests, Dr. Sher pronounced the nodule too small to be concerned about, and not large enough to biopsy. He did say it bore watching, though.

Well, it’s no longer so small. On Wednesday I had a follow-up CT scan and ultrasound. Yesterday, I got a call from Dr. Lerner, who informed me it’s doubled in size, from about .80 cm to about 1.60. A centimeter and a half still sounds pretty insignificant to me, but I suppose in the world of endocrinology that calls for a closer look.

So, that’s what we’re going to do. As soon as I hung up after Dr. Lerner’s call, I phoned over to Dr. Sher’s office – it was just before closing time – and left a message. Dr. Lerner’s staff is faxing the scan results over. Someone from Dr. Sher’s office wil call back on Monday, presumably with a referral for an ultrasound-guided needle biopsy.

Dr. Lerner assured me there’s nothing to worry about just yet – most thyroid nodules are benign – but, still, it’s not something to leave unexamined.

Doing a little online research, I came upon a retrospective research study that calculated a malignancy rate of 28.8% in small thyroid nodules discovered in this way. I even learned there’s a name for this phenomenon. Abnormalities that show up on scans ordered for some other purpose are called incidentalomas. As high-tech scans proliferate, more and more of these tiny, mostly benign tumors show up – tumors that would, in an earlier era of medicine, have gone unnoticed.

That’s both a good thing and a bad thing. To the extent that incidentalomas turn out to be something truly serious, early detection is a fortunate – sometimes even lifesaving – coincidence. Yet, most of the time they’re just benign growths. Still, they trigger anxiety in patients who would otherwise go through life blissfully unaware of their existence.

I’m not feeling especially anxious about it, myself. I’m more annoyed, I suppose, that I have to go through this whole biopsy thing again. Having stumbled over the rock, though, we’ve got no choice but to turn it over and see what may be crawling around underneath it.

Be Your Own Advocate

"Can you make me better, Doc?"

When we're first diagnosed, that's the question many of us may find rising to the front of our minds - whether or not we ever voice it. We look to our doctors to be healers, to cure our illness, to make us better.

Few of us travel very far down Cancer Road before coming to realize there's a lot more to it than that. There's so much to learn about the disease and its treatments.

I can remember the hours I spent reading Elizabeth Adler's Living With Lymphoma: A Patient's Guide (still the most informative book I've found about the biochemistry of this disease). Suddenly I found myself reading, with great interest, all about the chemical components of human lymphatic fluid - a topic I never dreamed I'd have the least interest in. Having cancer changes that in a hurry!

Today my friend and fellow lymphoma survivor Betsy de Parry published an article, "Candid Cancer: An active role in your care matters." Reflecting on her experience as a long-term survivor, Betsy asks:

"So why not just tell the doctor to fix it? The short answer is that medicine has come much too far and become much too specialized for us to simply be passive participants. In many cases, there are treatment choices, and we can only make sound decisions if we understand them. And aside from cancer's physical impact, there are emotional, practical and day-to-day challenges that we need to face and address....

In fact, if there is one thing I've learned from all the survivors I've talked with over the years - survivors of many types of cancer - it's that many of them are healthy because they became their own best advocates and learned everything they could about all treatment options. Many were told they'd be 'lucky' to be alive in a few years. Others simply refused to accept the next recommended treatment and searched for different options. They talked with other survivors and got second or third or fourth opinions."

So, don't be shy. March into your doctor's office with a notebook in your hand, and demand all the time you need to get your questions answered. Bring a friend or family member if that will help you remember what's said. Four ears are better than two.

Don't be overly considerate of your doctor's ego. It's no insult to say you want a second opinion. Good oncologists are used to this. Those who bristle at the suggestion are the ones you need to watch out for.

Don't be passive. Let your doctor know you want to be a full participant in treatment decisions. Ask for full explanations of why one treatment may be better than another, and ask for time to consider the various options, if that's appropriate. Go to the library or onto reputable websites (like www.cancer.gov) to get the full story (or as much of it as your non-medical mind may be able to comprehend). There are lots and lots of good resources out there that seek to explain cancer so ordinary folks like us can understand it.

Jesus tells an odd little tale in Luke 18:1-8 that's often called the Parable of the Importunate Widow. That's an old-fashioned way of saying, "the Parable of the Pushy Broad." In the story, a poor widow is seeking justice from an unjust judge. He's a jaded bureaucrat who can't be bothered with shuffling case files from his inbox to his outbox any quicker than he absolutely has to. This widow, though, makes a pest of herself. She just keeps knocking on his door until he's obliged to rule on her case. Jesus ends by saying something to this effect: "If even a pushy broad like that can get some action out of a corrupt judge, won't our God of mercy pay even more attention to your prayers?" It's a word to the wise.

So, speak up for yourself. If you don't do it, who will?

Your doctor will respect you for it.

An "N" of 1

I ran across this reflection today, in a Chicago Tribune article, from breast-cancer survivor Catherine Drew Gilpin Faust, President of Harvard University:

"I [remember] my meeting with my physician after the results of the exploratory biopsy. He was telling me what they found and what his thoughts were about what I ought to do.... I'm trying to digest this news, and I start peppering him with questions. What are the percentage chances of this? What are the percentage chances of that? And he answered all my questions, then he said, 'But just remember, whatever you have you have at 100 percent.' And that was such an important comment for me, because I realized, you know, whatever I learned, I was an 'N' of 1, and I had to figure out what that meant within this larger framework of all this information. I also thought it was an interesting thing to have a physician [who was] in a research medical center who was obviously a doctor doing clinical work as well as treatment to be able to remember that, that a patient is an 'N' of 1, not just one in a whole line of statistics. I've often thought of that as I've faced health challenges."

That's a rather perceptive comment on the part of her physician: "Whatever you have you have at 100 percent." Lots of us get stymied by statistics. We get preoccupied by the question, "What are my chances, Doc?" - and by whatever percentage answer the doctor may be so bold as to give us.

I don't fully understand the "N of 1" business. That's mathematics-speak, and I'm not so fluent in that language. I take it to mean, though, that each case is unique. There's no sense buying trouble by assuming someone else's cancer experience will turn out to be our own. Our experience is bound to be different in some way or another, because we're different.

I remember meeting with a friend not long ago, days before he succumbed to his cancer. He was recalling some of the treatment decisions he and his doctors had made along the way. Before deciding on some rather invasive surgery, the doctor had said he felt obliged to tell him that the chances of the surgery being successful were only about 5 percent.

"That's OK, Doc," my friend told him. "I figure I'm going to be in the 5 percent." (He wasn't, as it turned out, but he exercised his prerogative to think that way.)

That was his decision. Other patients in similar situations may decide differently, and I figure that's OK, it's their road they're traveling and no one else's. Yet, my friend chose to exercise his freedom of choice and not let statistics rule him.

He intuitively understood what President Faust is talking about. He knew he was an "N of 1."

The same would go for someone making the opposite choice, even if the odds looked very much better. I've known older patients who declined surgery or treatment when the chances of success were as high as 50 percent. The explanation went something like this: "I've lived long enough, and at my age, I can't expect to live much longer. I choose not to accept the harsh side effects and long recovery the doctors are talking about. Quality of life is important to me. I want to enjoy the days I have left."

According to "N of 1" thinking, that's OK, too.

Yes, there's a lot of science involved in the treatment of cancer. But there's also an art to it.

It's the art of living.

"If I take the wings of the morning
and settle at the farthest limits of the sea,
even there your hand shall lead me,
and your right hand shall hold me fast."

- Psalm 139:9-10

Not the Best Health-Care System

A few minutes ago, I happened to catch a few minutes of news coverage from the U.S. House of Representatives. Members of Congress were taking turns reading from the U.S. Constitution. This was the first time in history, the newscasters informed us, that the entire Constitution has been read aloud on the floor of Congress.

It took me back to my old Sunday School days. Our teacher used to ask us kids to take turns reading through a passage of scripture aloud, with each person reading a single verse.

Have we come to this? I know remarks have been made about the Tea Party movement treating the U.S. Constitution as a fundamentalist might treat the King James Version of the Bible, but when I saw it in action just now, the effect was chilling. John Calvin called the human race "a perpetual factory of idols." It would seem we've found ourselves a new one.

The U.S. Constitution is a remarkable historical achievement, and a model for democracies the world over. It is worthy of our respect and honor. But, to treat it as holy writ? I think there's a reason why this is the first time in history this stunt has ever been pulled: because previous generations - including the framers of the Constitution themselves - had better sense. I can imagine Ben Franklin rolling over in his grave right about now.

One commentator has estimated the cost to taxpayers of this little publicity stunt at $1.1 million.

Let's see, now... what does this story remind me of? Could it be when, in Nehemiah 8, Ezra the scribe reads the law to the people of Israel, freshly returned from exile to a ruined Jerusalem? Isn't it just a wee bit of hyperbole to imply that a mid-term change of party leadership in one of the two houses of Congress is a parallel situation of nationwide repentance from apostasy?

"And Nehemiah, who was the governor, and Ezra the priest and scribe, and the Levites who taught the people said to all the people, 'This day is holy to the Lord your God; do not mourn or weep.' For all the people wept when they heard the words of the law." (Nehemiah 8:8)

Oh, pull-eaze!

What really concerned me, though, was to hear the new Speaker of the House, John Boehner, lambasting the recently-enacted healthcare reform legislation and vowing to repeal it. I don't recall him ever mentioning the words "healthcare reform" without prefixing it with "job-killing." I lost track of the number of times he said "job-killing healthcare reform."

Is that all they've got? Just take their talking-point and repeat it again and again, ad nauseam? I don't recall potential loss of jobs being a major debating point when the legislation was first passed. Why didn't the opposition make a point of it the first time? Even if a significant number of jobs were to be lost because of this legislation - seriously doubtful, but let's grant the point for a moment - is preserving a modest number of jobs worth it, if most of working America continues to be just one medical crisis away from destitution?

Come to think about it, in making the job-loss argument, isn't Mr. Boehner conceding that the healthcare-reform legislation is, in fact, creating a system that's more cost-efficient than the one we've presently got? Wouldn't the elimination of a limited number of administrative-support jobs be, sadly, necessary, in order to accomplish the financial efficiencies that everyone agrees must be the goal if healthcare is to become affordable again?

Mr. Boehner, by the way, is the same man who, in the midst of a debate on tobacco-growers' subsidies in 1995, personally distributed campaign-contribution checks from tobacco lobbyists to his fellow members of Congress on the House floor.

Yes, he did. On the House floor. (He later apologized for it, explaining that it wasn't technically against House rules, then led a campaign to reform the House rules to prohibit what he'd just done. To protect the country from people like himself, I suppose.)

Mr. Boehner went on to repeat another phrase endlessly: "the best healthcare system in the world" - as in "they are trying to take down the best healthcare system in the world."

Mr. Boehner can be admired, perhaps, for his patriotism, but it's blind patriotism when it ignores the facts. The last time the World Health Organization published a healthcare-ratings table of the nations of the world, in 2000, the United States ranked 37th. France was number 1 - something even the conservative magazine Business Week admitted, in 2007, is a pretty impressive achievement.

In claiming the U.S. healthcare SYSTEM is the world's best, our new Speaker of the House is at best mistaken, and at worst engaging in a baldfaced lie. Yes, the healthcare available to certain people in the United States, and to certain well-heeled foreign nationals who fly here for treatment, is among the world's best. Yes, our nation is at the forefront of medical research. But our healthcare system - the overall structure whereby healthcare is delivered to the citizenry at large - is costly, inefficient and just plain broken for huge numbers of sick people. Worst of all, the sicker you get, the more you pay.

(That, by the way, is one thing the author of the Business Week article cited above admires about the French system. In France, the sicker you get, the less you pay.)

I don't seriously think this move to repeal last fall's landmark healthcare bill will succeed. There are still enough votes in the Senate to protect it. Contrary to the anti-healthcare talking-points, a huge majority of the American people still favor it. This is mere political posturing, just as reading the Constitution aloud on the floor of the House is political posturing.

Yet, those of us who are concerned for the health of all Americans - not just the holders of Cadillac medical-insurance policies like members of Congress - ought not to be complacent. This move is a major threat to the health, happiness and survival of millions of hardworking people. It seeks to perpetuate a corrupt system whereby big-business interests siphon off billions of dollars in profits, while poor and middle-income people die unnecessary deaths.

Remember, this is the man who once handed out checks from tobacco lobbyists on the House floor. That shows whose side he's really on.