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DARSHAK SANGHAVI

Keeping cancer real

FOR ELIZABETH Edwards and Tony Snow, both recently diagnosed with metastatic cancers, the problem probably started years ago with a single cell and a single strand of DNA. Somehow, somewhere, a mutation in one cell in each of their bodies created a totalitarian monster that devoted all of its energy to a single goal: to multiply and spread. And now, despite all the efforts of modern medicine for Edwards and Snow, the cancers are still advancing.

In the end, the cancers will probably kill them. Like confetti, microscopic cells are dispersing now throughout their bloodstreams and lodging in the liver, bones, lungs, and other tissues. These evil cells resisted the chemotherapy, the surgery, and maybe even radiation and lay dormant for years, waiting for the opportunity to emerge. Now their time has come; the barbarians have surged past the gates.

Perhaps that is why metastatic cancer is so frightening; its advance seems so merciless. For example, the cancer cells of a woman named Henrietta Lacks, who died in 1951, are so relentless that they survive in laboratories around the world today and still reproduce at a breathtaking pace.

And yet Elizabeth Edwards said at a news conference, "I don't expect my life to be significantly different." She calls herself "incredibly optimistic." About his press secretary Tony Snow, President Bush said, "He is not going to let this whip him, and he's upbeat."

Of course all people need hope: hope for a good day today, hope for a normal life, and possibly hope for a cure. But that brings us to a painful and necessary question: Is there such a thing as false hope?

As a physician, I've watched more than my fair share of innocent children and adults die from cancer, often badly. It's hard to maintain optimism after that. Part of me wants to hear that not every moment with cancer can be handled with understated grace; sometimes, a primal scream would be more honest. It seems disingenuous to pretend otherwise.

The key is finding the right kind of hope. It's tempting to whitewash cancer as a spiritual, transformative experience. We say it makes people stronger, leading to, as one writer claims, "greater awareness of the important things in life." Some patients and doctors no longer talk about cancer; they talk about "cancer experiences."

On some level, cancer can be constructive, even in the most unlikely settings. Consider mustard gas, a hateful substance in World War I that blistered the lungs and skin of young soldiers. But the same gas was modified for use as the first chemotherapy for cancer. Similarly, studying the effects of atomic bomb radiation helped us develop bone-marrow transplant techniques to cure deadly leukemias. On some plane, cancer forces us to take evil things like chemical weapons and transform them into something that honors and preserves life.

Still, that's at best an abstract comfort. Edwards and Snow probably won't be able to beat their cancers. As Edwards indicated, although her cancer cannot be cured, it can be treated. For now, she and Tony Snow can hope realistically, month by month, and year by year, for good days, one by one.

But as the metastatic cells continue their inexorable advance, I'd prefer if we didn't pretend that was part of some productive, transformative experience. We should call it what it is: an extraordinary biological sadness, largely devoid of meaning, tempered only slightly by human grace.

Dr. Darshak Sanghavi is an assistant professor of pediatrics at UMass Medical School and the author of "A Map of the Child: A Pediatrician's Tour of the Body."  

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