Friday, May 26, 2017

Follow-up to last post; decision made

There are several things I want to say in this follow-up to my previous post. First of all, I'm concerned I may have unduly upset some people with my funeral fantasy. That is the opposite of my intent. It's true that a big part of the purpose of this blog is purely selfish: It makes me feel much better to get these things out in the open. On the other hand, I really do believe that death after a full life is not some kind of tragedy. It is just a part of life and not to be feared. By making light of the situation, I am trying to convince family and friends to share this belief and not worry about me.

Second, the fatalistic tone of some of my blog posts should not be intrepreted as meaning that I'm giving up. Not at all. Indeed my problem is the opposite: Throughout the experience (chemo aside) I have consistently felt so good that without a dose of reality I could easily just ignore the diagnosis and proceed merrily along as though nothing was wrong. I need those dire statistics as a motivator to action. I publicize them in my blog because (a) as already mentioned, it is part of my way of dealing with it, and (b) it's important for other people to know. I don't want to write only a happy-go-lucky blog and then suddenly announce to my daughters ``oh, by the way, I have about three months to live''. I am doing my best to fight the cancer, but with a realistic attitude and without regarding death as some kind of injustice.

In fact another fantasy is that I am the first person to be totally cured by immunotherapy (see below for the decision). This would be very embarrassing, given all my dramatic posts about death. But I suppose I could live with the embarrassment.

Meanwhile, I'm happy, I'm enjoying life and just taking it day by day. You might be surprised to know what Wendy and I did on Wednesday evening, the day we got the scan report. We watched the last three episodes of season 13 of ER! Only two seasons to go...The next day I went to the Honors Luncheon, where a sophomore, junior, and senior from my differential geometry class were all getting awards as top students in their respective years. Another student from my mathematical reasoning class a year ago also got an award, so it was fun. A second top junior who I'd never met was sitting next to me. He's 17 and already taking graduate courses (I'm telling you, it's something in the air around here). Next year he'll be taking another grad course, called ``Manifolds'', which as it happens I will be teaching. At least a couple of these top undergrads will be in the course, which makes me all the more excited about teaching it. It's a year-long course, so obviously I must postpone croaking until at least next June.

After that I took my CRV to the dealer for new tires and a new battery. Hiking season is upon us, and it's no fun to be stuck at a trailhead with a dead battery (it's happened to me just once in my hiking life). However, I really am a total dork: for years I've just been hanging out at the nearby Starbucks doing math while they work on my car, although on sunny days I've wished there was a nice park nearby. Only now, and this is truly the epitome of dork-dom, did it occur to me to just look on my cell-phone map! There is a very nice little park just a block or two away. Never noticed it before. As any Seattle reader knows, Thursday was an absolutely beautiful day. After tiring of math, and with the caffeine wearing off, I just laid down on the grass looking up at the sky and the trees.

In spring quarter I restarted my Italian lessons with Elisabetta. As is our standard procedure now, I come in and tell her about and/or read aloud from my current novel (which Elisabetta recommended to me), ``The Charterhouse of Parma'' by Stendhal (pen-name of 19th century French author Marie-Henri Beyle). It's a good story and a lot of fun because it takes place in northern Italy with many familiar locations; of course for us it us ``La Certosa di Parma''. I use these lessons to deceive the cancer in the same way that the young woman of ``A thousand and one Arabian nights'' deceives the Sultan. After all, I can't stop before the end of the novel! I need to find another really long one, not War and Peace but maybe The Brothers Karamazov. Even the cancer will hold off to see how it ends.

Now, on to my third point: I've decided to go with the pembro. I do in fact have access to the New England Journal of Medicine (I knew this, but as I said, I'm a dork) and have now seen the entire article on the pembro study. Some readers have suggested that I've been overstating the probability of serious side-effects, and perhaps this is true. I do worry about it, but in the NEJM study the percentage of grade 3 or higher ``adverse events'' is 15 percent, which maybe is not so bad. The main reason for my decision, however, is simply that doing nothing does not seem like an acceptable option. I don't want to reach a point where it's too late to do anything---and this really could happen within a few months, conceivably---without having at least tried SOMETHING. The pembro appears to be the best available option. In the study it had about a 20 percent probability of ``objective response'', and in some cases the response lasts up to 12 months. Having liver metastases, however, lowers your odds (here's one of those grim statistics): according to the study, 145 out of 186 subjects with liver metastases are now dead. The bottom line is that to me, pembro is not the great advance that its proponents make it out to be (bear in mind the study is funded largely by the Merck corporation, which markets the drug). Nevertheless, it is recommended by my oncologist and really seems the only option. On the plus side, infusions are only once every three weeks.

Just making the decision is a big relief. Thanks for listening, and have a fabulous day!

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