01.23.12
Posted in Cancer at 12:39 am by George Smith
“Hey George!”
That’s how I’ll always remember my friend Don Hunt’s voice. It had a slight Texas lilt to it whether picking up the phone or walking toward his car just before going on one of his guided walks in Pasadena.
In fact, I still find myself squelching the urge to call after reading something I thought he might be reading or seeing on tv only twelve days after his death. He’s gone and it brings a pang. But that was one of the patterns of friendship, the sudden brief chat to laugh and gossip about football or a political figure.
Of course, that’s not all we did.
Don Hunt showed me Pasadena in a way I’d never appreciated. In fifteen years here I’d never walked the neighborhood of the Rose Bowl and its playing fields. Don showed me the route from houses above, down into the ravine and back up as one of his favorite morning things.
There was the stroll of the Caltech campus, too, always ending at the turtle pond, regularly done at those times when the student body could be counted on to be away for the summer or on holiday. Perhaps we’d find a good taco truck, he’d say. We didn’t but that never stopped us from having a proper lunch afterward.
There were many trips into the Pasadena arroyo, my favorite being the time we went to a horse paddock for the swells, buried deep in it near the border of South Pasadena. I told him we needed to sneak in some sugar or carrots the next time.
One hot morning early last year Don decided we’d walk the upper-upper class district on Pasadena’s west edge. We somehow lost our bearings a little and wound up in Eagle Rock. At which point I asked if maybe we should take a taxi back so as not to wear him out or get to lunch too late.
Don laughed. A taxi was never a serious consideration although we had to ask for a directions from a lady jogger, one we’d seen an hour and a half earlier, thankfully spied circling back toward us. She laughed and told us what street to go up to get back where we belonged. This was after we’d seen peacocks at somebody’s mansion and been hailed by one of the local noblemen who was driving an old orange Volkswagen Thing.
The Thing-driving fellow had spied Don’s T-shirt, which advertised Brophy Brothers, a restaurant/bar on the Santa Barbara marina and come screeching to a halt. It was a place we’d been many times. Don liked it so much that, in addition to purchasing a T-shirt, he stole one of its menus so he had something to jog fond remembrances of fried clam and beer-boiled shrimp dishes past.
But at first I thought we were about to be questioned on what we were doing in the area. Interlopers! Pretenders! But no, the man only wanted to tell us how great it was to see another guy who loved Brophy Brothers and that he wished he was there that Saturday morning. He had judged the quality of character, and done rather well I might add, in eyeballing the nature of Don Hunt’s T-shirt.
Don Hunt liked food and drink with his friends. It was how you shared the day and fed the social animal. He convinced me I could grill anything and, as a consequence, for years — 9 months each, late afternoons on Monday or Sunday were reserved for cookouts in a backyard a few blocks north of Pasadena City College.
These do’s went on for a few hours with the grilling usually not taking place until just after sunset. Don always stood near the cooking meat. He loved being part of the action, smelling the smoke, and if a floodlamp had burned out and not yet been replaced he’d occasionally hold a flashlight so none of the beef was charred or went onto the ground. Important details!
In those months when cooking out wasn’t the best idea — believe me, it does occasionally get too cool for it in Pasadena — we’d be inside. At which point our friend Beth would take over most of the food preparation in the kitchen. And we’d stand around, in close proximity, just soaking in the bonhomie that comes from making a meal we’d enjoy together.
Don Hunt was born in Austin, TX, in 1944. He was over a decade older than me and apparently knew early on what he wanted in life, which was to be a journalist. He edited the high school newspaper, got an interview out of Carol Burnett through the Austin city newspapermen’s club and went on to the University of Texas.
From there, four years and he was off to West Palm Beach in Florida as a sportswriter. Then to Norfolk and the Virginia-Pilot and, finally, recruited to the Los Angeles Times.
I met Don late in his career. He was the weekend editor for Los Angeles city edition/front sections and was a friend of a friend who worked with him and whom I’d come to southern California with almost twenty years ago.
She invited Don to dinner. I have never made pals quickly or easily but I liked Don at once because of two things. Unlike many, he did not immediately talk too much. And he was never nosy. He was always a gentleman with a subtle and dry wit that flashed more as he got to know you.
Don was a veteran editor at the Los Angeles Times when I came to know him, very highly regarded by his colleagues. This was at the beginning of the newspaper’s long period of slow decline and an ever-changing cast of just bad and/or quixotic publishers from the world of corporate predation. Regular layoffs/mass firings and tricky acquisition ripoffs and divestiture business practices had become the rule.
Eventually, in 2008 he took a buyout and early retirement. It was time to leave the newspaper and get on with better matters. It left him free to enjoy travel and what everyone thought would be a great last long act. It was, almost.
You never really think about losing such a friend in a flash.
However, in August of last year Don had a sudden spell, first attributed to an adrenal insufficiency of some kind. There was testing. We thought the problem would eventually be solved, perhaps by a long regimen of supplemental pills.
But the testing went on, more scans were ordered. Suspicious-looking anomalies got more suspicious. Finally, one part of the disease — its origin in the esophagus — was photographed and biopsied.
It was a heavy blow. There had been no symptoms and Don was still quite strong.
But that’s how the disease presents. Too late to cure, spread throughout the body, the horses long gone from the barn.
That survival figures for Stage IV esophageal cancer are abominable. The choices one can make are few.
Don asked me to be his advocate, of sorts. I’d hear what the doctors said and ask questions and make requests for more information if he forgot important things to ask. Which happens when you’re getting a steady stream of bad news about your mortality.
I told Don that I figured he’d fight the disease, small battles and steps at a time. And when we got to a year we’d have a chance to reassess how it had gone.
Don didn’t have nearly that long. None of us knew it. Maybe the doctors did but they hadn’t quite plotted the entire slope of the life line in early September.
The important thing was to get into radiation therapy to get some tumors in the brain under control. The battle was joined and it was the only victory, for awhile. Don came through it. No neurological symptoms
showed. The cancer there was arrested leaving opportunity for the rest of it in the system to be hit with chemotherapy.
We still had time to enjoy some restaurants, to get to the Huntington with Beth on a sunny day, to think a little about a future when, maybe, the first rounds were behind him.
However, some cancers don’t respond to chemotherapy. In these cases your healthy bits are not at all spared from the poisons. And this was what happened.
Chemotherapy — platinum compounds, from the start, made Don way too ill. So sick, the coordinating doctor had to stop them after two rounds, the second greatly diminished in dose, just before Thanksgiving.
Well, wait, I’d say. Maybe some of your strength will come back and then they’ll give it another whack.
We could still make jokes.
Don had been losing weight at a constant rate, but not catastrophically, yet. He’d say, “My friends say I look good.” And “I could lose some, anyway.”
To which I replied: “You have my official permission to stop the diet.”
We laughed.
And there was the radiation doctor at the center. She had little or no patient skills. And if one didn’t actually have an appointment to see her she would not acknowledge your existence in the halls.
In fact, she’d quicken her step, perhaps to escape.
Don noticed and we’d smile as she scurried by. The woman was very short, too, and we starting saying, once out of earshot: “Next time we’ll ask ‘how’s the weather down there.’”
But the cancer advanced. Finally, there were no more treatments, no more tests. The bad effect from chemotherapy was a prognostic sign. The loss of five pounds a week, invariantly. The gradual diminution of appetite and always increasing weakness.
They were the mileage signposts, all bleak. There was nothing left to do except palliative care — hospice.
The cruelest thing was the taking of Don’s enjoyment of food.
This is common in cancer patients. Since social gatherings are linked by food and drink, not being able to do either, to be even sickened by it, is very depressing. As the amount of cancer increases the biochemistry of the body becomes deranged. Familiar tastes are suddenly nauseating. The person cannot eat because ill-defined neurochemical messages are giving the sensation of fullness, a deadly feeling which cannot be bypassed or ignored.
Doctors, the entire medical profession, know it happens to everyone. Great effort has been made to elucidate and treat this process, without any success.
Still, Don was very much himself. We could watch college and professional football (Texas beat the hated Aggies for the last time!), old movies and tv. Friends could be enjoyed and conversation had, even as the daily time in which he had strength grew shorter by increments.
This is how it would be, the doctors said.
Quality of the time left was important. There would be a period of slow decline but conditions would be stable. Eventually, though, there would be a dramatic change and the end would come.
And that is how it happened.
Don almost made it to the finish of the college football season. On the day of the Rose Bowl and parade, he was enthusiastic. It was glorious and sunny. Friends came by and we watched games together. He was even able to take in a little more nourishment than usual — awful liquid diet things called Ensures. (The refrigerator at his house in Sierra Madre is still full of them.)
The day after he needed a small refrigerator in the viewing room so he did not have to use the stairs. One was gotten in and set up. A fast fulfillment of a real need, a small win for control in the preservation of equilibrium, it was something that made everyone happy.
There were still a few more days of games. “You know, I’m really going to miss football,” Don told his friend, Carlos.
Technically, Don did make it to the end of the season.
He died on Tuesday, the tenth. The Alabama-LSU game had been Monday night. But he was so sick he missed it. It was lousy, anyway.
When it ended a few were there to bear witness and extend the heart, as much as each could in the final minutes. And it was OK.
Don Hunt didn’t beat the merciless statistics but he met them with courage. During the battles there was depression, great sorrow and lots of tears. But even through it there were times of joy and small happinesses. There were no regrets, no apparent anguish over a life not properly lived, of business left unfinished, of words left unsaid. Only the dismay that there wasn’t more time.
On Saturday, a memorial for Don was held at a friend’s house in South Pasadena. It had been raining in the morning but by the time I arrived the sun was shining brightly. At least fifty were there — brother and cousin in from Texas, close friends, career-long colleagues and neighbors. It was wonderful if frequently bittersweet.
We will all miss him so.
SoCal sunny days. Don Hunt, 1944-2012. Photo: Carlos Lozano
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01.22.12
Posted in Cancer, Culture of Lickspittle at 10:19 am by George Smith
“If you ever worry about the future of America, there is no need: it is in good hands,” reads the lede of a piece from CBS News yesterday.
It’s the beginning of a particularly excessive and aggrandizing feel good “cancer cured” story.
These have always been a feature of the US newsmedia and the care and feeding of our culture of lickspittle. Evidence to the contrary, cancer definitely not being cured in tech-mighty western civilization, is not an antidote or harsh cold shower.
As a result, the sum of the journalistic work is simultaneously heartless, cruel and intelligence-insulting. And it always comes wrapped in shiny packaging, asking you to clap in awe and admire the wonder of something – in this case, the precocious child enrolled at an upper class school in Cupertino, CA. (Its presence in the story serves to underline only how stunning opportunities, spoil and resources are mostly only in those places now in the high end of our economic ecosystem.)
The CBS news piece, complete with video, reads:
Born to Chinese immigrants, 17-year-old Angela Zhang of Cupertino, California is a typical American teenager. She’s really into shoes and is just learning how to drive.
But there is one thing that separates her from every other student at Monta Vista High School, something she first shared with her chemistry teacher, Kavita Gupta.
It’s a research paper Angela wrote in her spare time — and it is advanced, to say the least. Gupta says all she knows is its recipe — for curing cancer.
“Cure for cancer — a high school student,” said Gupta. “It’s just so mind-boggling. I just cannot even begin to comprehend how she even thought about it or did this.”
News of cancer cured, delivered in five to six hundred words, courtesy of the wealth and genius of the human DNA in the Silicon Valley.
Where humble or circumspect are not words found in the dictionary.
Of course, the young girl is cute as a button. There simply would be no other way to present it.
And it is certainly newsworthy that she has won a remarkable prize of $100,000 from the Siemens corporation for her science project.
“Angela’s idea was to mix cancer medicine in a polymer that would attach to nanoparticles — nanoparticles that would then attach to cancer cells and show up on an MRI so doctors could see exactly where the tumors are,” the piece informs.
“Then she thought shat if you aimed an infrared light at the tumors to melt the polymer and release the medicine, thus killing the cancer cells while leaving healthy cells completely unharmed.”
Attaching dyes, poisons and other reagents to malignant cells has been a vigorously pursued avenue of research since … I graduated from Lehigh University in the mid-Eighties.
However, while conceptually simple, the complexities of the genesis and biochemistry of cancer cells and how they spread in the human system remains unconquered.
Infrared light? And how does one get that and the chemotherapeutic agents into a place where there are multiple sites of malignancy, like deep inside the skull?
Or what if the particular cancer being treated just doesn’t care much if bathed in even the most toxic agents because, somehow, it’s aggressively self-repairing?
Well, one could write a book about such things and cancer would still not be finished. In fact, I recall walls of bookshelves upon walls of bookshelves on the matter in the library at the Penn State School of Medicine many years ago.
“It’ll take years to know if it works in humans — but in mice — the tumors almost completely disappeared,” adds the CBS newsman.
Of course, you can cure lots of things in mice. Mice are pretty lucky. Or maybe not, if you read and dig down a little.
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01.21.12
Posted in Cancer at 9:20 am by George Smith
Going to my friend Don Hunt’s memorial in SoPas today.
In his last weeks Pasadena had a run of the sunniest and most beautiful days I’ve seen in late December and January in over a decade. New Year’s Day was spectacular. Today, finally, it’s raining.
Although bittersweet, it does seem right.
Posting will be light or not at all.
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01.10.12
Posted in Cancer at 10:00 am by George Smith
The shields are all destroyed and the battles have been lost. What started as a struggle to buy more livable time against the onslaught of an incurable cancer has been over for awhile and the oblivion presses close.
Like the majority of people cursed by a terminal disease, my friend did not video blog or Facebook his plight. But he was never alone or unloved and I will insist on believing that just a few warm hearts are what everyone needs in their darkest time rather than thousands of likes and empty virtual gestures from passersby.
More later. Or possibly not.
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11.04.11
Posted in Cancer, Decline and Fall at 8:30 am by George Smith
This was the question that someone asked me last week.
While I was in the cancer ward helping someone through a hard bout of chemotherapy.
We had been sitting there and if you know anything about people, you know you can help alleviate exhaustion or general feelings of great illness with mild conversation. It helps to have a friend there to take the mind off things, to feel the warmth of it.
And we had been discussing the week’s news in passing including the protests and the police firing of teargas rounds.
Another patient — chemotherapy is an automated group out-patient experience these days — overheard and asked me “But what do they want?”
It was a much older individual. And I just said OWS was protesting economic inequality, the economic collapse and Wall Street greed and massive unemployment.
Which brought the response that yes, greed was a problem in the US. But it was the greed on the part of people who all got home loans they did not deserve and could not afford. And that this, in turn, had caused the economic collapse. And, finally, it was Bill Clinton’s fault.
I said little. One doesn’t argue with cancer patients. It’s not graceful or human. It would have been excruciatingly bad to not be on their side right then.
There was a brief pause and then another person joined in. The mass joblessness was caused because people had no skills.
Eventually the talk petered out. Even in the cancer hospital, the walls are high and people can’t let the class differences and embedded animosity for the young or different appearing slide for a minute.
Which brings us for a brief moment to Krugman’s column today on oligarchy and one of the same arguments:
Anyone who has tracked this issue over time knows what I mean. Whenever growing income disparities threaten to come into focus, a reliable set of defenders tries to bring back the blur. Think tanks put out reports claiming that inequality isn’t really rising, or that it doesn’t matter. Pundits try to put a more benign face on the phenomenon, claiming that it’s not really the wealthy few versus the rest, it’s the educated versus the less educated …
The most popular argument right now seems, however, to be the claim that we may not be a middle-class society, but we’re still an upper-middle-class society, in which a broad class of highly educated workers, who have the skills to compete in the modern world, is doing very well.
It’s a nice story, and a lot less disturbing than the picture of a nation in which a much smaller group of rich people is becoming increasingly dominant. But it’s not true.
Workers with college degrees have indeed, on average, done better than workers without, and the gap has generally widened over time. But highly educated Americans have by no means been immune to income stagnation and growing economic insecurity …
That is, the protesters who portray themselves as representing the interests of the 99 percent have it basically right, and the pundits solemnly assuring them that it’s really about education, not the gains of a small elite, have it completely wrong …
His argument is that this disparity threatens the nature of our democracy, making it one “in name only.”
As for those who slough it off to a lack of skills, essentially he’s talking about the Niall Fergusons of the country.
But because Krugman so obviously has a conscience I can’t help but think he would not have had the heart to argue in the cancer ward, either.
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10.01.11
Posted in Cancer at 12:09 pm by George Smith
Use of corticosteroids induces persistent hiccups.
Have you had or known someone with persistent hiccups? As a side effect of cancer treatment it’s fairly unpleasant.
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09.30.11
Posted in Cancer at 7:35 am by George Smith
One of the signal failures in US health care is too many doctors.
That’s not meant as a comment on the absolute number.
Instead it refers to the saddling of patients with multiple doctors, their staffs and infrastructures. It’s all part of the long-standing US obsession with hyper-specialization and the expansion of a massive buzzing edifice of health technology.
Even when the doctors are in the same building, or even on the same floor of the same building, there’s friction. And this friction comes at a time when the person getting the services is very unwell.
Even someone with no health problems would find it challenging.
With so many involved you get opinions and interpretations on disease and results that are never all completely on the same page. Outlooks differ.
So one minute you can get a statement that’s very unfavorable. The next, down the hall, something almost opposite, depending on the state of mind of the physician.
It’s incurable, says one. The survival figures are very bad.
Next up: You’re going to be treated. It’s going to work.
Surrounding every doctor is a staff, sometimes shared. Even with everything committed to a computer network, so many people guarantee that data entry and communication is fraught with mistakes.
Daily. Error correction is a constant part of the experience.
The doctor tells a patient, by phone, that a test has been canceled. The next day, at the same facility, a nurse comes along with an appointment for the tests that have been canceled.
No, no, the patient is mistaken. Fifteen minutes later the nurse is back. Turns out, the patient was correct.
Off-site, another series of scans is done. The next day, one of the staffers at the cancer center asks when that new scan, already done, will be done.
This is straightened out on the spot.
There is a request made for the new results to be faxed over. When they arrive, they are either the wrong papers or those of another patient.
Eventually this is sorted, too.
But it all takes time. And it’s a constant reminder that this system of hyper-specialization is not efficient.
It’s not an admirable feature, not something the American health care system can be proud of, yet it is entrenched.
And in Pasadena, CA, it is discovered that all the cancer doctors in questions are hard asses about the use of medical marijuana.
It’s a cognitive disconnect in a state that went out of its way to legitimize the use of the drug because it was thought to be of use to the deathly ill.
Have these people been flustered by the federal government? Do they just not like the mini-industry of potheads and hippies that furnish it from storefronts here? Were they read a secret riot act by someone?
Who knows? Why do they even care to condemn such a small thing while easily handing out prescriptions to much stronger palliatives?
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09.26.11
Posted in Cancer at 7:39 am by George Smith
David Muir delivered a bog standard news media whoopie cushion last night for ABC. A new imaging technique was said to be a potential “game changer” in cancer treatment.
I flinched again, wondering about the people with cancer who’d see it and get all the implications wrong.
It concerned studies in which scientists at Purdue had come up with a fluorescent technique for dyeing cancer in living tissue, increasing resolution “thirty times.” It’s an order of magnitude but not the breakthrough it was billed as.
The problem is a simple one as lots of people who go through cancer treatment know.
If you’re slated for surgery, the doctors already assume the cancer is more widespread than they can see with whatever imaging they have used. And they take everything they think prudent.
Increasing the resolution only makes the target bigger. And while it may result in some early diagnosed cancers being eradicated, it does not alter the basic outlook for a disease in which one mostly assumes the worst — that somewhere imaging may have missed a microscopic clump of metastatic cells, or even a single one.
This is what happened to my father. Suffering from bladder cancer, he went to Sloan-Kettering in Manhattan. They took just about everything they could out of him. It left him with a hole in his abdominal wall, to be used for the next five years as an outlet.
And at the five year mark, although he’d been scanned and rescanned many times in the intervening period, the cancer returned with a vengeance.
It had been in him, somewhere. Invisible to various techniques, immune to chemotherapy, slow growing until it reached some point at which it began turning over very swiftly. Faced with a terminal diagnosis he went to the Bahamas for a quack cure that had been publicized on 60 Minutes and died there.
As for those who suffer widespread metastatic disease, the kind of diagnosis that all too often presents very late because of lack of symptoms, the method described on ABC does nothing at all. It may give some satisfaction in knowing where more foci of disease are located.
But in widespread disease surgery is no longer a cure.
And such is the case with something like stage IV esophageal cancer.
There is no surgery because the disease is widespread.
Imaging has determined where it is. In the brain, a regimen of radiation therapy — and all that entails — is undertaken.
This is followed by chemotherapy to attack the disease in the rest of the system.
The statistics are grim.
From the wire, a more accurately presented truth:
An explosion of new technologies and treatments for cancer coupled with a rapid rise in cases of the disease worldwide mean cancer care is rapidly becoming unaffordable in many developed countries, oncology experts said on Monday.
With costs ballooning, a radical shift in thinking is needed to ensure fairer access to medicines and address tricky questions like balancing extra months of life for patients against costs of a new drug, technology or care plan, they said.
“The cancer community needs to take responsibility and not accept a sub-standard evidence base and an ethos of very small benefit at whatever cost,” said a report commissioned by the Lancet Oncology medical journal …
The new cancer imaging dye described by David Muir on ABC News Sunday night falls into the category of treatment described in the Reuters piece.
Off for the waiting room of the radiation ward, hoping my friend gets the best from it.
Posting will continue upon return.
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09.21.11
Posted in Cancer, Culture of Lickspittle at 8:19 am by George Smith
Here’s another downer post. So maybe you ought to skip it if you’re only into Norman Vincent Peale’s world. (Which uncovers the question, “Why are you here, anyway?”)
Commercials for American corporate “innovation” in the field of heath become personally antagonizing when you get an immediately life-threatening diagnosis. (Not mine.)
A close friend of DD’s has been handed a bad slate. Even with a good health plan it’s been a tough haul getting through the discovery and diagnosis period.
It contrasts starkly with the idiot commercials, now running on primetime, about tech breakthroughs in healthcare, commercials made to make viewers feel happy about American corporations adding good things to life.
The most odious is General Electric’s “healthimagination” spot with the little girl musing about her unusual mother with wiggly toes and dancing fingers, a fun lady who will only eat her eggs with hot sauce. The final bit of it is that GE has produced some technology that will customize and help make a unique cellular-level diagnosis of whatever cancer she may face.
As anyone who has had to recently go into an up-to-date oncology center in Pasadena/southern California, this is pretty much revealed as total shit.
There’s no revolution going on, no magic devices. There is lots of imaging technology. While powerful, it tells you only certain things, never enough. There’s no techno-magic personalization, there is no particular swiftness of diagnosis, no impressive victories which have been won against cancer because of it. They are tools, part of a blindingly complicated process. And while there have been some victories in the fight against cancer in my last three decades, they have not been strategic wins.
Another commercial, by AT&T, would be laugh out loud hilarious were it not for painful personal framing.
This is the one were the friendly voice informs that your medical information and history will follow you on your smart phone, through the smart network, a place where even that which is imagined impossible becomes possible.
I have news for the gullible or for any people who made the commercial or AT&T’s smart network brains. When and if they get cancer they’ll perhaps notice there is no obviously “smart network,” that one fills out a lot of old-fashioned paper, repeated over and over, for a variety of health agencies and physicians and that coordination is often slow, inexact and fraught with frustration.
It will be part of the challenge, as the seriously ill person, to help guarantee everyone is on the same page. And it must be done the old-fashioned way, speaking face to face on numerous trips to the hospital or out-patient treatment and diagnosis center, or on the telephone.
Smart network! One might just as well have made a commercial showing little fairies, borne on fluttering pink wings, flying your medical information to the team of physicians and consults.
Americans have always been acutely vulnerable to this manner of sappy thinking.
Indeed, an entire news industry has grown up to cater to it, one in which journalists in health and technology sections scan press releases in order to write stories trumpeting what are thought to be the latest milestones and revolutions in health care.
Read them regularly and if, through unfortunate circumstance you actually become seriously ill, you immediately discover how they depart from reality.
Not to put to fine a point on it, my Dad died of cancer on Grand Bahama Island many years ago chasing delusion manufactured in a similar way.
Having been given a terminal diagnosis for bladder cancer, the family was desperate.
60 Minutes had aired a story on a miraculous cancer doctor in Freeport, Grand Bahama, a man supposedly suppressed in the United States for his revolutionary treatments.
His name was Lawrence Burton and he had developed something that sounded very impressive — Immuno-Augmentive Therapy.
60 Minutes furnished tremendous publicity, giving the cancer treatment a solid patina from authority.
And it all ended very badly, Burton and his therapy going down in history as a notorious case of quack medicine.
Medicine does not advance, cancer does not yield, because the sales imagery appears triumphant.
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