Twelve Patients: Life and Death at Bellevue Hospital by Eric Manheimer Page B

carcinoma, SCC, was well known to me from decades of contact with patients. It would not have been my first choice at the Bureau of Tumor Assignments; nor would I have guessed it in a million years for me, as it usually showed up in heavy smokers and drinkers.
I am fucked
is the first thought that crossed my mind. The SCC had lodged in my buccal mucosa. My entire aerodigestive tract was vulnerable: trachea, esophagus, the whole works. “Cancerization,” Nick, thehead and neck specialist, had called this as he explained the radiation treatment designed to attack the entire area. That was a new word for me. So it wasn’t
Why me
, but
Why this particular disease?
I could have been sipping aged tequila or hundred-dollar-a-bottle single-malt Scotch and drawing in deeply on fragrant Cuban cigars for the last thirty years while looking at the snow-covered volcano Popocatépetl from the terrace in Tepoztlán. At least then there would have been a reason.
    Squamous cells were common skin cells or lining cells of the mouth or reproductive organs whose DNA had gone independent of all controls. They were resistant to treatment if not removed surgically, but slow to metastasize or spread beyond their original rogue cell. All it took in my case was one cell that had gone “viral.” That’s what cancer is: A rogue cell replicates, unresponsive to the internal signaling system that tells it to stop. If untreated, the errant cell duplicates relentlessly and eventually spreads through the lymphatic system to regional lymph node collection centers, where the independent cells continue to reproduce and spread again. Cells then escape into the blood and are carried to the lungs, bones, and brain, where distant metastases will flourish. Different tumors have their own predilections for different areas.
    The most common SCC cancer is cervical—at the cervix, or opening of the uterus. If a Papanicolaou (Pap) test picks up a case, then freezing the tumor cells or a surgical approach is curative. Unscreened populations of poor women delay diagnosis, leading to a miserable death. The discovery of the relationship of the HPV virus and cervical cancer and the subsequent development of an effective vaccine was scientific medicine at its best. The endless debates over the vaccine, however, have been politics at its worst. The issues of affordability and dissemination, false fears of the vaccine having some connection with autism, and teenage sexuality quarrels were raised by opportunistic politicians who ignored history. Vaccines work. Think of polio, tetanus, and measles.
    SCC had changed a lot in recent years. It wasn’t confined to alcoholics and tobacco abusers. Younger patients with no risk factors were presenting to physicians and dentists. A teenage girl in the hospitalwith this disease had a metastasis to her foot. She didn’t respond to chemotherapy and died rapidly. We were stunned by this new incarnation of an old disease. It defied the smug thinking of the careful, clean-living, safe-sex-practicing among us who equated cancer with bad habits, lifestyle excess, personal (ir)responsibility, or a suspect genetic pool. Cancer is never neutral. It’s fully loaded when it comes out of society’s closet—an unmitigated failure next to the current complex heroic ideal of survivorship through a valiant “fight” or a valiant death. The reality is much more complex and nuanced.
    I knew this disease well but didn’t know its newest incarnation. No one did, really. But I knew I did not want SCC.
    As I lay on the table, I reminded myself that daily doses of radiation were just one part of the assault on my cancer. The course of treatment had come together quickly after the diagnosis. David Hirsch, my surgeon, looked at Diana and me. He said I had cancer but that I would be fine. We sat in his office at the university hospital.
    “This cancer is not only treatable,” he said, “it’s curable.”
    We would hold on to those words like a life