— J.R.R. Tolkien, The Return of the King
Yesterday, before leaving Seattle for Portland, Lisa Costello and I visited with a friend whose cancer is more advanced than mine. They are already in that state which I am approaching of having outrun all the available treatments in the normal clinical path, and are currently depending on drug trials to keep them alive. As it happens, this friend's family has emotional difficulty in engaging with their treatment and prognosis, so they don't get to talk about the disease and its discontents in frank and clear terms very often.
We are both dead men walking, this friend and I. Formally classified as incurable. Looking to treatments that might keep us alive another few months or a year or two. Hoping the metastases don't recur quite so quickly next time. Dreaming of a cure which, while still theoretically possible, is unlikely to the point of vanishingly so.
When two people in this situation know each other well enough to speak freely, the conversation quickly grows brutal. The three of us had met in a coffee shop in a Seattle suburb, and the lady at the next table kept glancing up at us with a horrified expression on her face. I'm honestly not sure how Lisa kept her composure as well as she did.
But there are home truths that occupy your mind and soul when you walk the paths of the dead. And this is a very expensive game of diminishing returns. Cancer is smart, and adaptable. A new drug which works for six months or year then loses its effectiveness. And treatments are horrifically expensive. In my case, we are closing in on a lifetime cost of a million dollars, at adjusted insurance contract rates. January alone was a $100,000 month for me, thanks to surgery and hospitalization. My friend commented that their current drug trial, which is fairly successful for them, requires out of state travel every two to four weeks to the research center, and when the trial ends, they will probably have no access to that drug at any price, as its not yet FDA-approved. That moves things from the category of "expensive" to "impossible".
So, like Odysseus seeking Ithaca, late stage cancer patients voyage from island to island, risking being turned into pigs or drawn into the sirens' fatal embrace for the sake of one of more hit, one more high, one more extension on our tenuous and already cancelled lease on life. We are junkies desperate to stay in the light just a little longer before we descend so deeply into the paths of the dead that no pharmaceutical Orpheus will ever be able to sing us back to the lands of the living.