On Both Sides of the Divide

My brother and I are separated by 6890 miles, at least 24 hours of travel, 7 hours of time difference, and a long flight that spans over three continents, two Great Lakes, an ocean and a sea. I live in the Midwest (bad weather, good neighbors) and he resides in the Middle East (good weather, unpredictable neighborhood). Lately, we have been separated by another divide: I am a doctor, and he is a cancer patient.

He tells me that having a doctor in the family can become handy. That is because people who live on both side of the divide between cancer patients and their doctors do not speak the same language. He, for example, speaks both Hebrew and English, while I am also well versed in Medicalese, a language spoken by doctors.

When thinking in Medicalese I use words like: carcinoma, stage, grade, invasive, metastasis, and 5-year survival rate. And he wants to know: Is it cancer? Am I going to survive? How long do I have to live?

The difference between doctors and patients is not merely in the vocabulary they master. For I, as all doctors, have seen the different faces cancer has. And I know how cancer kills: It is not personal! Cancer cells have no face, or emotion, or a grand scheme. They are devoid of motivation or personal drive. They just do what they are programmed to do – multiply. And at times they invade tissues around them, replacing normal cells and preventing them from performing their tasks lung cells can no longer participate in respiration and liver cells can no longer remove toxins from the blood stream. Cancer cells can also push and block one of the many conduits or tubes in the body blood vessels that supply blood, or an air duct that deliver oxygen. Or, cancer cells may just sit there and multiply, quickly, using up nutrients, thereby starving normal cells, until they can survive no longer, live no more.

Shlomi and I were sitting at Ichilov’s Oncology outpatient Clinic in Tel Aviv. We were waiting for the results of his blood tests which would determine if he could receive another course of chemotherapy. He showed me the results of his CAT scan and asked me to translate from Medicalese to ‘normal people’s language.’ At that moment, I did not want to be a doctor. I wanted to forget what I knew about cancer, and the ways it can kill. For once, I wanted to be just a ‘normal person’.

I looked at the report and I knew that the tumor was advanced and that it could not be surgically removed. But there was good news too: the changes from the last CT scan were small, and the spread of cancer was limited. Then the nurse came over, a wide smile on her face, saying that the blood cell count was stable and that Shlomi could proceed with another course of chemotherapy. And Shlomi, he jumped out of his chair, his face alight with happiness. Good news, he said, good news. Minutes later, his chemotherapy, part cure, part poison, was silently, slowly dripping into his body.

At that moment, my Medicalese was totally forgotten. I asked myself: Is he going to survive? How long does he have to live? And then I realize that the hard, cold facts that I knew as a doctor were no longer important, and that no matter how this story was going to end, it was Shlomi’s spirit, facing cancer daily, with temporary defeats but eternal hope that was winning.

This was the second out of three story series about cancer.

Dr. Shahar Madjar is a urologist working at Aspirus Keweenaw Hospital. He sees patients in Laurium, Houghton and L’Anse. Contact him at smadjar@yahoo.com.