Test problems

Ah, it can make life difficult from time to time when your basic fear is of annihilation. I'm afraid of my personality being squelched, of my person being killed, of my being being obliterated, not to mention my soul. I went to a Psychic Healer (neuropsych consultant at Plain University) because I'm concerned about my memory loss. I told him and his minions that when I was 16 I had some tests, and I became hostile toward the tester. Later I said I realized why: It was the individual's response to the notion and action of the testing experience, where the tester is trying to capture you in the confines of the test. So of course what happened was, after giving me tests that made sense (repeat this list of words, repeat this list of numbers, recall this image, add these numbers and these numbers, recall the animals in the first list but not the second list, etc., etc.), though were also annoying because they showed a cultural bias, the minion gave me the Minnesota Multiphasic Personality Profile to fill out at lunch. I was hoping to eat lunch at lunch and read about Reconstruction (of the South, not the breasts). Instead I answered True and False to statements like, I believe that working hard mostly leads to success. (In this economy? Among *all* people in this unequal world?) And: I fear earthquakes. I fear snakes. I fear spiders. I'm afraid of flying. I get upset before short trips. (Separate statements.)What is a short trip? I was anxious before driving to Valparaiso because I don't drive on highways much and I had to get myself organized to talk to a class and do a reading and an interview. Is 90 miles a short trip? Is going to Trader Joe's several blocks down? How about going half a mile to B and S's?


I was annoyed at the cultural bias (The world is generally a fair place.) and also at the lack of subtlety. Either true or false. Nothing in between. It was also decidedly archaic: I don't read all the editorials in the newspaper. If I were a journalist I'd like to cover sporting news. I remember that phrase exactly: sporting news. There were several statements about being a journalist. There was none, strangely enough, that said, If I were a journalist I would be depressed to be in a dying profession, and I'd probably be out of work and freelancing for my former employer at one-tenth the pay and without health insurance besides. Another statement was like this: I'm as happy as most people. What does that mean, in this land of foreclosures, in a world of war and suffering? As happy as most people? Even Freud famously and modestly attempted to restore people to ordinary unhappiness. Other statements: I have many brilliant ideas. I could be famous. I know more than some experts. People think my ideas are strange or peculiar. I could be a comedian. I'm assuming that a True would indicate mania and unrealistic ego inflation. But I have had brilliant ideas. Ten percent of the people I went to grad school with are famous. I know three MacArthur-certified geniuses. I was paid as a comedian in grad school. People do think my ideas are strange, and I think that's a positive. I've been analyzing culture through, as they say, feminist and Marxist lenses, for 25 years. I do know more than some experts. (But, Cancer Bitch, what if the statements have more to do simply with self-esteem and in the case of the comedy career, with optimism and sense of humor?)
L and my friend G the therapist say I shouldn't try to out-psych the test. Wanting to do so is probably a sign of a controlling personality and inflated ego. But I could have told you that.
And, said my other friend G: What if Maureen Dowd or Steve Martin took the test? What if a Nobel-Prize winner with truly brilliant ideas?
I decided not to turn in my answers. The Psychic Healer was annoyed. He said that the test helped him in his diagnosis. (Do you want to know what I fear? What I tell myself? What my faults are? If I'm anxious? For $20 I'll sell you any of my books and you can find out in any five pages. Or read this blog for free.) Yes, Cancer Bitch is hostile. Just like when she was 16 years old. Which disappoints her, she who wants to change into a better person. He gave me a test that he didn't like as much, but which I liked better, because there were gradations: False, Somewhat True, Mostly True, Very True.
But the main thing is, probably (and I could have told you this not much after 16), that I am afraid of being pigeon-holed. I'm afraid of a world going on without me. Of that old demon, Thanatos. Who isn't?

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Man speaks for woman

O O O this should not bother me, but after all I'm the Bitch, and so many things can bother me that wouldn't bother a non-bitchy person. There's a woman who was diagnosed with breast cancer at Sloan-Kettering, just one of 200,000 women who will hear that the test was positive this year, and the noteworthy thing about her is that she's the Wife of a Doctor. A Doctor at Sloan-Kettering, and ain't that ironic or crazy or what-have-you, and since this is the age of irony, her husband gets to write about the experience in the New York Times. Am I jealous? Yes. Is that what's fueling my ire? Yes. No. Am I annoyed that he writes in an ungainly fashion and strains when he makes comparisons and isn't very interesting? Yes. Am I jealous? O, we covered that. Sort of. It's in the New York Times blog, not print, and since cyberspace is everywhere and nowhere, in a way you could say that it is not in the New York Times, or you could say it is there and everyplace else in the known world. But even at the blog, aren't there editors? Must not be, otherwise we wouldn't have such sentences as: The late nights along the Seine were as dark and dreary as the sunshine was bright that Wednesday morning on the Upper East Side of Manhattan.

The author is a doctor at Sloan-Kettering. What kind of cancer doctor? No one says. He admits that the white coat has been his protection against involvement and emotion. But anyone who's ever visited a hospital could tell you that. He also has pull, not surprisingly. He tells us that they got an appointment with a friend who's a breast surgeon: When I told him Ruth had felt a lump, he had made room to see us right away.

Which is nice. And I'm sure they have insurance, which is good because I doubt that professional courtesy would pay for all her subsequent treatments. Which is good for them, especially since they seem pretty young and it appears from this first installment that the cancer has spread to her lymph nodes. (Though you've read here that removing cancerous lymph nodes may not be required, after all.)

Of course, a more erudite decision on the part of the Times would have been to tap (virtually) the shoulder of the Cancer Bitch and offer her the blog spot. She could write: When the Cancer Bitch has Blood Cancer, a comedy of manners that has not yet ended. But the tap was not received, no messages were left. And a more relevant and important and serious decision would have been to get an uninsured woman to write about her breast cancer. Or, second best, the husband of said woman. Or daughter. Finding such a person would be easy--it is said in these parts that a scoffing full professor (the kind who hires adjuncts) once said he could spit outside the window of his office downtown and spray any number of PhDs, the point being that those with doctorates in English should be grateful, o so grateful, hat in hand and bowing and scraping, if and when they were offered a couple thousand dollars for teaching a course as an adjunct. So too, unapocryphally, you could walk to to the county hospital here, named for a politician, John Stroger, who spent his last days, comatose, in a private hospital (Fancy Hospital, in fact), and find hosts and hosts of people without health insurance. Interestingly, ABC News told us: Stroger lost a brother who was turned away from a segregated hospital in the South, and the availability of quality healthcare became his pet issue. He struggled for decades -- sometimes alone -- to make sure the Cook County Hospital remained open. There was a libertarian Republican named Tony Peraica who ran against Todd Stroger, son of John, for Cook County Board president, and I didn't like Peraica's politics at all, but I had to appreciate one commercial in which he said he would improve Cook County Hospital so that it would be good enough for John Stroger to go to. Peraica lost and Stroger died and Ariel Sharon remains cocooned in his own coma, and I think no one in Israel has the chutzpah to pull the plug on him. The photo above right is of a sculpture of Sharon by artist Noam Berlavsky.

The transformation implied in the blog, I think, is that a doctor regains his vulnerability and dare we say humanity, not to mention humility, when he is the spouse of a patient, and not a Doctor draped in sanitary whites. This is a tricky concept, because we writers would tell him that the story is his--but if he makes the story too much his own, he will seem like a cad because it's his wife who was stricken. The best thing for him, in order to remain a sympathetic narrator, is to contract a serious disease himself. But such things take time.

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The problem that won't go away

The New York Times today focuses on the difference between Stage 4 and other breast cancers, under an unfortunate headline: "A Pink-Ribbon Race, Years Long." Note to all: Editors, not reporters write the headlines.

The lead is about a woman with metastasis who went to a support group meeting and didn't have the heart to tell the rest of the women, who had stages 1-3, about herself. I was what scared them, the woman, Suzanne Hebert, said.

Let's look at the numbers: some 40,000 people in the US die of breast cancer a year. About a quarter of us who are first diagnosed with early-stage breast cancer end up with metastasis. About 150,000 are living with Stage 4.

The story quotes Dr. Eric P. Winer, director of the breast oncology center at the Dana-Farber Cancer Institute in Boston: All too often, when people think about breast cancer, they think about it as a problem, it’s solved, and you lead a long and normal life.

There was CJ, who was married to my old friend A. She was diagnosed in 2001, six years before I was, with about the same stage. She had a mastectomy, no need for chemo, her doctors said, and the family traveled and she continued working in an underfunded public school library on the East Coast, coaching the Reading Olympics team. Five years later the cancer came back. When I saw her a few years ago, she was getting treatment for cancer that had moved to her spine and brain. In spring 2009, she was losing her sight but still took the Reading Olympics kids to a competition. I didn't see her on a visit around then; I saw A when he drove me to the airport. One weekend in May 2009 she accused him of not turning on the lights. She went to school on Monday and realized that she really could not see and she quit. She died at home in August 2009.

I went to a funeral yesterday of an adult student who died suddenly at 46. She was an accomplished actor, playwright and teacher, and was in our MFA program to learn more about nonfiction writing. Last week she went home after our evening class, and she and her husband had some wine and were watching some trashy TV to relax. He got up to get more wine, and when he came back, his wife wasn't breathing. Her heart stopped before the paramedics got there. A lingering illness, he said, that would have been preferable. I think both are bad, I said. My friend S, who was close to the couple, said that at least with a lingering illness you can say goodbye, you can ask for advice. I don't know what A would say about that. Both ways have their down sides. I've long been against Death, but Death doesn't seem to care.
***
Image above is Pandora [Jane Morris] by Rossetti, which doesn't really fit, except in mood

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"Take two (or so) and call me in the morning (or next week or next month or next year)."

A large study that was just published shows that women with breast cancer who take aspirin are more likely to live longer and to not have a cancer recurrence than women who don't take aspirin.

Doctors at three Boston-area hospitals observed 4,164 female registered
nurses in the Nurses’ Health Study who were diagnosed with stages I, II, or III breast cancer between 1976 and 2002. They were observed until June 2006, or death, whichever came first.

The main outcome was breast cancer mortality risk according to number of days per week of aspirin use (0, 1, 2 to 5, or 6 to 7 days) first assessed at least 12 months after diagnosis and updated..There were 341 breast cancer deaths. Aspirin use was associated with a decreased risk of breast cancer death.

Full report here.

The study says of itself that it's unprecedented: Of several large prospective studies of the association of aspirin use with breast cancer incidence, only one found a protective association, whereas four others did not. The 10-year Women’s Health Study Trial found no effect of low-dose aspirin intake (100 mg every
other day) on breast cancer incidence among almost 40,000 women. However, meta-analyses of either NSAID [non-steroidal anti-inflammatory agents/analgesics such as aspirin, ibuprofen, and naproxen] or aspirin have found a 9% to 30% reduced risk of breast cancer incidence. Despite inconclusive evidence linking aspirin and breast cancer incidence, aspirin may improve survival through various mechanisms.

To our knowledge, this is the first study reporting a survival
advantage among women with breast cancer who take aspirin. Abundant
scientific evidence supports why aspirin may confer this advantage.
More than 2 million US women are living after a breast cancer
diagnosis6 Survival among women with breast cancer is variable, and
risks of dying of the disease are elevated even 10 or 15 years after
diagnosis.

How much aspirin is helpful? I kept reading reports about this and couldn't find the number of milligrams. I'm especially interested because I take 162 mg. for polycythemia vera. What a nice surprise it would be if something I take for one disease would help me survive another. Alas, the researchers admit: We
lack details on aspirin dose. If there is a dose response, the effect size in
the current study may be diminished because frequent aspirin users
may be more likely to be low-dose users attempting to prevent heart
disease. Confounding is always a limitation of observational studies.
We addressed this by adjusting for all relevant covariates and through
marginal structural models.

Another caveat: Our results may be generalizable only to longer term breast
cancer survivors (ie, only women who have lived long enough after
diagnosis to report aspirin use after diagnosis, which is approximately
4 years). Fortunately, almost 90% of women diagnosed with breast
cancer live at least 5 years. Thus, our findings have considerable
clinical importance.

"Take-home message," as they say in business: It couldn't hoit. Aspirin has relatively benign adverse effects compared with cancer chemotherapeutic drugs and may also prevent colon cancer, cardiovascular disease, and stroke.

One skeptic has already pointed out that this is an observational study that does not prove cause and effect.

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