American Consequences - September 2018


“Almost everywhere,” the oncologist said. I asked about the Dartmouth-Hitchcock Medical Center, 90 miles from my home but still on the planet New Hampshire. Dr. Marc Pipas at Dartmouth-Hitchcock’s Norris Cotton Cancer Center came strongly recommended. Dr. Pipas is an avid bird hunter and an advocate of reintroducing the prairie chicken to the eastern seaboard. So he and I had something to talk about in addition to my behind. I’d need radiation therapy every day for six weeks. (Every day, that is, Monday through Friday – the radiology department has to play golf, too.) And I would undergo two four-day stints of around-the-clock chemotherapy, carrying a fanny pack of poisonous chemicals to be pumped into my body through a surgically implanted mediport. (Dr. Pipas persuaded the infusions department to install this on the left side of my chest so that it wouldn’t interfere with mounting a shotgun.) In theory I could get my radiation treatments elsewhere, within easy commuting distance. But it’s worthwhile to find out what a doctor himself would do if he had your medical problem. And he probably thinks he does. Several doctor friends have told me you can’t get through medical school without being convinced that you have every disease in the textbooks, including elephantiasis, beriberi, and Guinea worm infestation. Dr. Pipas said, for anal cancer, he’d go to radiologist Dr. Bassem Zaki at Dartmouth- Hitchcock’s Norris Cotton Cancer Center.

At least I had the good fortune to be in Washington, D.C. at the time of diagnosis. It’s a city replete with flaccid old guys like myself who spend their time blowing smoke out of you-know-where and being full of you- know-what and sitting on their duffs. The town is full of medical expertise about the body part in question. What I had was a skin cancer, squamous cell carcinoma. Practically every melanin- deficient (let alone Irish) person who spends time in the sun gets this if he or she lives long enough. The oncologist said, “I call it ‘adult acne’ when it turns up on the face or arms.” But it occasionally turns up where it turned up on me. And why is something of a medical mystery. I mean, I was naked a lot in the 1960s, but not that naked. Even though I had an undignified kind of cancer, there was still a loss of dignity involved in trading the awe-inspiring fear of death for the perspiration-inducing fear of treatment. There is hell on earth as well as hell in the afterlife. Until a generation ago, the remedy for anal cancer was a colostomy. Doctors have gotten over that. Most of the time. Now the remedy is radiation and chemotherapy. Would I have to go to some purgatorial place for this? To Sloan Kettering in New York, a city I detest? Or out to the Mayo Clinic in Minnesota, although I have a phobia about hospitals named after sandwich toppings? “No,” the oncologist said. “The treatment protocol is standardized and is successfully used everywhere.” I named my local New Hampshire hospital (and large animal veterinary clinic).

64 September 2018

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