From His Life's Work
For nearly three decades I've practiced medicine, treating and studying cancer, blood diseases, HIV and hepatitis C. During much of that time, I did not consider the impact of hope on my patients' illnesses. In fact, the fairy-tale claims about hope caused me to flee from the subject. Then something happened that changed my attitude forever. On a summer evening in 1987, I went to the hospital to visit an ill colleague. George Griffin -- Harvard professor, revered and beloved chairman of our department of pathology -- had been diagnosed with stomach cancer, the worst type that one can have. In cases like his, only two to three percent of patients live six months. At nine months, survival is less than one percent. The bitter irony was that stomach cancer was the disease that George had made his life's work. No one knew more about the malignancy and its dire prognosis than he.Nonetheless, George had insisted on receiving aggressive treatment combining high doses of chemotherapy with intensive radiation, despite the absence of evidence that such toxic therapy could change the fatal outcome of a cancer as advanced as his. It was clear his treatment risked hastening his demise, or at least robbing him of the last tranquil days at home with his family and friends. I would not ordinarily treat a patient with George's prognosis this way. But I was not consulting on his case.
I entered George's room. The sheets were drawn to his neck. His eyes were closed and sunken, his skin ashen, his lips blackened from dried blood in deep ulcers. For a moment, I wondered if he had died. Then he slowly turned his head and noticed me. With tears in his eyes, George struggled to speak.
"Don't talk," I said. His eyes closed in assent. George had suffered a severe side effect of the treatment; essentially the delicate lining tissue from his lips to his rectum was scorched, ulcerated and bleeding. I spent a few minutes with him, and as I departed, I thought how I would usually offer a patient words of encouragement, saying how vital it was to keep fighting against the cancer. I knew that in some cases if the patient could endure the harsh treatment, the cancer might be eradicated. But in George's case, such words seemed hollow. So instead I left with platitudes, saying how much everyone missed him, how we all were thinking of him and hoping that soon he might find some relief.
For days I could not get George out of my mind. I sought to replace the awful images from my last visit with memories of George Griffin in full health. Sixty-one years old, a wiry man of middle height, with thinning gray hair and sharp features, he had ventured into the most remote corners of Asia studying the epidemiology of stomach cancer. George was particularly interested in Korea and in rural China, where the incidence of the disease was high. This interest deepened after his first wife died of colon cancer and George had married Eunha, a Korean pathologist.
Despite Eunha's pleas for him to rest, George came back to work two or three hours a day once the chemical burn from the high doses of chemotherapy and radiation had subsided. He had lost nearly 30 pounds.
Then one day news moved like a shock of electricity through the clinical staff: George was scheduled for surgery. "Why not just put a gun to his head?" one colleague said bitterly.
A CAT scan did show some decrease in the size of the mass and surrounding lymph nodes, but such changes in response to radiation and chemotherapy are almost always transient, and do not alter the ultimate outcome. Moreover, a surgeon's scalpel could not remove the multitude of cancer cells that already had entered George's blood vessels and were deposited throughout his abdomen like buckshot. Within weeks, they would regrow and spread again. Ultimately major surgery only risked stealing more days away from the few that remained for George.
All names have been changed to protect privacy.
A Medical Miracle
The operation turned out to be even more extensive than expected: After removing the portion of the stomach with the tumor, the surgeon discovered the cancer had also extended its tentacles into the esophagus, and its lower third had to be sacrificed. The surgeon grafted a piece of intestine between the remaining esophagus and stomach stump to serve as a surrogate channel, so that George could eat.In the laboratory, pathologists began their work with George's removed stomach. The tumor was dead; cancer cells were nowhere to be seen. The textbook explanation was that the cancer was merely hiding. While many cells had been destroyed by the radiation and chemotherapy, many others would circulate in the blood and lymphatic system. New masses would soon appear. The cancer would fill his intestines and occupy his chest, until it killed him.
But George would not acknowledge this. Not long after the surgery, he had himself again admitted to the hospital to undergo another round of even more toxic chemotherapy. I was deeply saddened. If I were George's doctor, I told myself, I would have taken Eunha aside and questioned the decision to resume chemotherapy and radiation. Wasn't that the doctor's role, to protect George from more pointless treatment?
Thirteen years after George's cancer diagnosis, on a chill December day in 2000, I was sitting in the atrium café of the hospital. I rose from my chair as I spied George. Even after all this time, he was still gaunt. But his eyes were animated and his voice strong as he greeted me warmly.
I carried a gnawing sense of guilt. After all, I had written George off. He would not be alive if my recommendations had been heeded.
I asked him if he had insisted on the radical treatments by ignoring the grim statistics.
"I knew exactly what the numbers were," he said. He told me that when he returned home, he planted some daffodil bulbs that would bloom the coming spring. "I told myself, Maybe I'll get to see them flower, but likely I won't. Then they will be for my grave."
"Did you know that I and virtually the entire medical staff disagreed with the treatment?" I asked.
"I did." George paused gravely. "And I knew the arguments made in cases like mine. Treatment would cause unnecessary suffering -- for me and for my family. Add in that it throws away society's money on a doomed person." His eyes narrowed. "I find these arguments patronizing. I did even before I was ill. It was my right to choose to do what I did.
"Even if I didn't prevail," he went on, "it was my only chance. I deeply wanted to live and had to fight. Then I could tell myself that I had done everything possible."
How could we, ultimately, understand his case?
"It is a medical miracle," George said, emphasizing the word medical. "What it says is that even the most aggressive and gruesome cancers can sometimes be stayed. Sometimes the unexpected happens."
George's remarkable recovery was a turning point for me. Since then I have come to believe that hope, true hope, is as important as any medication I might prescribe or any procedure I might perform. To hope under the most extreme circumstances is an act of defiance that permits a person to live his life on his own terms. It is part of the human spirit to endure and give a miracle a chance to happen. Hope, I have come to believe, is as vital to our lives as the very oxygen that we breathe. George Griffin knew this long before I did.