Marcus was thoughtful enough to send me The Emperor of All Maladies, which I had meant to get months ago, but with everything going on, it slipped the brain. I was barely into the book, tears in my eyes, thinking “yep, yep, yep” and identifying with so much. It’s a truly riveting narrative, and it’s what the very best books always are – an opportunity to learn.
One thing which really struck deeply home was when the author talked about how it’s difficult to think of cancer as a thing, it’s more on the person side, and that’s so true. I don’t think of my cancer as random cells happily cloning and evolving at the expense of the rest of me; I don’t think of it as a nebulous disease; I don’t think of it as a thing. It’s more like you separate, and there’s a shadowy self staring you down, a dark charcoal swipe of a doppelgänger, challenging you to wage war for your life, and cancer cells are much better at the whole evolution business than we are, which is why you get poisoned and radiated to what feels like an inch from death. All that said, and given the recent nightmare of treatment, I found myself profoundly grateful for the current stage of medical and technological advance when I read this:
The sixteenth-century surgeon Ambroise Paré described charring tumors with a soldering iron heated on coals, or chemically searing them with a paste of sulfuric acid. Even a small nick in the skin, treated thus, could quickly suppurate into a lethal infection. The tumors would often profusely bleed at the slightest provocation.
Lorenz Heister, and eighteenth-century German physician, once described a mastectomy in his clinic as if it were a sacrificial ritual: “Many females can stand the operation with the greatest courage and without hardly moaning at all. Others, however, make such a clamor that they may dishearten even the most undaunted surgeon and hinder the operation. To perform the operation, the surgeon should be steadfast and not allow himself to become discomforted by the cries of the patient.”
I’d dearly like to be able to go back in time and smack the fuck out of Heister, and a host of others. Misogyny seriously sucks, and boy, is it ever present in cancer treatment. It’s certainly lessened a great deal, but it’s still more than present. Sigh.
Anyroad, highly recommended, for everyone.
ETA: Feeling better, got my anger and FUCK ITs back. Yeah.
my partner went to school with siddhartha, and speaks very highly of him. i’ve been wanting to read this (it’s one of many in the stack of “someday i’ll have free time”) and i’m finally going to pull it out tonight and MAKE some damn time. as a survivor (lupus-related lymphoma over here), a hearty FUUUUUUUCK cancer, and hugs if you want them.
oh, and i meant to recommend “the immortal life of henrietta lacks”, if you haven’t read it already, for an amazing story that also deals with many historical and modern aspects of systemic misogyny and racism in the medical establishment.
Thank you very much, and you won’t be sorry for reading it! Hugs right back atcha. I have read the Henrietta Lacks book, that was infuriating all over.
i meant to recommend “the immortal life of henrietta lacks”
Let me second that; it’s a fascinating and eye-opening book. Anyone who reads it should know that Hopkins Hospital has done some things (IMO probably not adequate because of their tardiness) to compensate Lacks’ relatives for the ghoulish use to which her cells were put.
The sixteenth-century surgeon Ambroise Paré described charring tumors with a soldering iron heated on coals, or chemically searing them with a paste of sulfuric acid.
… Should cheer up ever cancer patient, right!?!
Marcus:
Or give them nightmares. :Laughs: All I could think about when I read that was this Medieval medical image I’ve seen, regarding the treatment of hemorrhoids. One of them was inserting a heated iron rod into the anus. Can you imagine what they would have done with a tumour like mine? Auuuuugggh.
Brings to mind Norman Spinrad’s short story, “Carcinoma Angels“.
I’ll look that up. Thanks, Rob.
Dangerous Visions strikes again.
To say the least when it comes to the history of mastectomy. Those are some of the most horrifying bits so far. There’s also this:
Had to look up happed, means covered up. So much rage engendered by that brief description. FFS, has anyone ever expected a man to behave that way after having a body part lopped off without effective anesthesia?
Caine
Yes. Somewhere in there is a need for gratitude.
to someone somewhere sometime
And then there’s this:
There are several graphic descriptions of such surgeries in the book, and they are nauseating, to say the least. This was reserved solely for breast cancer, there was never even a thought to doing such a thing for testicular or prostate cancer. Hundreds of thousands of women were subjected to this unwarranted mutilation, based on the hubris of one surgeon, who spawned generations of rigid disciples, true believers in radical mastectomies.
That theory is fundamentally correct as far as the spread goes. Surgery however does not “arrest” the spread. More aggressive surgical resection does not increase cure rates. Surgery has become more and more limited in the modern age with organ preservation, if possible, the goal. We still call those first lymph nodes, sentinel lymph nodes.
Yeah, I know, Halsted’s legacy lives on, he’s permanently enshrined as a fucking saint. *spits* Close to 500,000 thousand women were mercilessly butchered because of him, and he refused to even consider that he might be wrong about his precious “theory”. And no, he was not right about the spread -- after barely grasping the notion of metastasis, he went very wrong because all he cared about was ‘carving’ cancer out.
Halsted and his followers ruthlessly mocked anyone who was going for a non-radical approach, even when it was shown those approaches worked, and they obstructed inquiry into non-radical mastectomies for a very long time. I have no respect for Halsted at all. He was a man so caught up in his own legend, he was hideous in his misogyny.
Caine@#14:
Yeah, I know, Halsted’s legacy lives on, he’s permanently enshrined as a fucking saint. *spits* Close to 500,000 thousand women were mercilessly butchered because of him, and he refused to even consider that he might be wrong about his precious “theory”.
I assume the mighty building where I worked is still named after him.
I read The Emperor of All Maladies back-to-back with The Demon Under the Microscope and a book about the spanish flu of 1910. It’s hard not to come away from that with a bit of sympathy for Josef Mengele, who probably felt unfairly calumnied by his peers -- medicine was a bunch of horrible hacks and quacks and a few woo-woos and monsters thrown in.
I do feel that medicine has gotten much better in general, though it seems certain to me that every 2 generations of patients will look back and whatever was being done 50 years ago, and want to scream.
One place where we’ve really made progress is diagnostic tools. MRI and CT are really good stuff. Being able to analyze breaks and cancers without requiring “exploratory surgery” is good stuff (the first generations of that were happening down the hall from systems administrators’ cave in 1986 and it’s hard now to understand how awe-inspiring it was to see back then) The big break-through was when Eliot Fishman’s 3D rendered fly-through of a pelvic break allowed a patient to be back on their feet a week later, in spite of a nasty bunch of splinters that were threatening an artery. And then there was the poor prisoner who “gave his body to science” after he was executed, and they sliced him into thin slices to render together on a computer… When I first encountered that data-set I threw up.
Marcus:
Oh, I couldn’t agree more. I think the advancements in tech are truly awesome. One thing I actually enjoy about some tests is getting to scope out the equipment, it’s amazing. (The CT remains my fave). With the recent ultrasound added to all the various tests, I think I’ve seen about all of them now. Haven’t seen radiation yet, but I’ll get there.
The lack of invasiveness was, and is, a stunning revolution in treatment of all kinds. Surgery, in spite of improvements, is still fraught with risk, especially with people who are already compromised. And, in spite of constantly having “it’s minor surgery” (laparascopic) tossed at you all the time, it doesn’t feel minor and it’s still a major bodily assault. There’s a great deal of dependency on the tech now, because it leads to better and easier treatment, as doctors can monitor what’s going on, quickly, and have updated information all the time. The tech is a pure win, all the way around.
Regarding Halsted, I forgot to mention that for most of his career, he was addicted to morphine and cocaine, but was against providing his patients and those of other surgeons opiates, because they’d become addicted y’know.