A cancer patient addresses patients, part two


Part two in a three-part series by Pulitzer Prize-winning poet Rae Armantrout on overcoming cancer.  

There’s a part of my case history that is particularly unorthodox. Sometime before my appointment with the surgeon, I spoke with an old friend of mine, an emeritus professor in Literature. He told me that a friend of his, who happened to be a radiologist here at the university, was close to an oncologist in private practice, a Dr. Nigourney, who had a clinic in Long Beach. Dr. Nigourney was prescribing chemotherapy based on what’s known, if I remember it right, as “chemical assay.” In other words, Dr. Nigourney was asking patients to send samples of their tumors to his lab, “Rational Therapeutics,” where he presumably cultured them and tested various chemotherapy agents on them to see which drugs, if any, would kill that particular tumor. Now I know that this is not a   widely accepted diagnostic technique and I know why. As one oncologist later told me, “If that worked, we’d all be doing it,” which, of course, makes perfect sense. My current oncologist says that cancer is harder to kill in the body than it is in a Petri dish. And that sounds reasonable too.

But my literary friend told me that his friend, the radiologist, was having his own cancer treated with drugs suggested by Dr. Nigourney. Given the very discouraging things I’d read about my cancer on the internet, I was willing to take a chance. The fact that a radiologist apparently vouched for Dr. Nigourney made me feel like this approach couldn’t be a complete hoax. That radiologist, whom I won’t name, has since died – though I’m told he died not of his cancer, but of an infection. Who knows? But I’m getting ahead of myself. I want to tell you first about my experience as a patient. 

My husband accompanied me to my appointment with my surgeon. She impressed us as confident, upbeat, almost strangely so. I’d even say that she seemed  enthusiastic about my tumor. She pulled up my scan on her computer and asked if I wanted to see it. I declined. I did ask which side of my body it was on because, oddly, I couldn’t feel it at all. I was not in pain and the tumor, which was under my rib cage, couldn’t be palpitated. It was on the left side, too near my heart and my arteries for comfort.

Dr. Salem discussed the difficulty of the operation the way an athlete might discuss a coming tournament. When I asked, wishfully, if it might still turn out to be benign, she said, “It doesn’t matter what it is because I’m going to get it all.” And, amazingly, she seems to have done just that. I asked her whether she would be willing to preserve a slice for Dr. Nigourney’s assay and she said she was willing if that’s what I wanted to do.

A few days later I walked into the hospital with my husband and my son, who had flown down from Seattle, where he was a grad student at the Fred Hutchinson Cancer Research Center. I had had a full night’s sleep. Oddly, I wasn’t particularly frightened. I don’t know why. Much smaller things frighten me frequently after all. Was I resigned or was I in denial? A bit of both, I suppose. I had been told that the operation itself carried some risk with it, partly because of the location of the tumor.

The first thought I remember having when I woke up from surgery was something like, “Oh damn, now I have to die of cancer.” I imagined a drawn out, painful death. At that moment, my surgeon walked in with my husband and son. I asked if she had gotten it all and she said she had. We made arrangements for a friend to drive the tumor slice to the lab in Long Beach on ice.

I was sent to the ICU and I took a notebook with me. Writers write, I told myself. It was a core part of my identity. Of course, I was on heavy pain killers and somehow, too, I had a build up of fluid around my lungs which made it difficult to breathe, but I did take notes. In fact, I started a poem called “Own” there which ended up in my book, Versed. There was plenty of material at hand.

The first section of the poem quotes something I heard. It goes, “Woman in a room near mine moans, “I’m dying. I want/to be fine! It’s my body/Don’t let me! Don’t touch me!”  Maybe doctors and nurses hear things like this all the time, but, in my condition, the woman’s irrational desperation resonated through me. I thought that might be me in six months or a year. Of course, I don’t know if she was actually dying or if she was just hysterical. The nurses seemed to find her irritating.

In the middle of my first night in the ICU, the fire alarms sounded repeatedly, maybe four or five times. After the second time, it was clear this must be some sort of electrical glitch, yet each time it happened the nurses were forced to race through their drill, moving equipment and closing doors. This was so gratuitously awful that it was almost funny. 

During my second night in the ICU, I developed a cardiac arrhythmia. A nurse tried to administer an electro-cardiogram to me in bed and, after what seemed like a long time, called my surgeon at home. My doctor seemed to instantly realize that I needed cortisol. My remaining adrenal gland, it turned out, had completely shut down because of the overproduction of its cancerous mate. It turns out this is not unusual. I’m a bit surprised, in retrospect, that no one consulted an endocrinologist before my surgery. If they had done so, this incident would have been averted. 

I was in ICU for three days and in the hospital for another three weeks. I won’t describe that blow by blow, but I do think there’s something you should know. When you discuss a patient’s condition or prognosis right outside their door, or even a few steps down the hall, they can hear you. I was seen by many doctors and medical students while I was there. One of my lowest points was when I heard two doctors, strangers to me, discussing my case before one of them entered the room. The first asked the second, “What’s the prognosis?” The second said, “Good, in the short term.” On another occasion, I heard  someone ask my surgeon whether she was really behind my chemical assay scheme and she said something on the order of, “Of course not. I’m just trying to keep her calm.”

I was released with appointments to see an endocrinologist and an oncologist. The endocrinologist was a nice young resident. I don’t know why I wasn’t referred to a more senior doctor. She seemed to be mainly concerned with monitoring my cortisol level. Meanwhile, I was focused on my first visit with the oncologist and with beginning some sort of chemo regimen.  The oncologist, however, explained, on my first visit, that, although it was natural for a person in my position to want to take action, there was really nothing to be done. There is no chemotherapy agent known to treat adrenal cortical cancer. A drug called mitotane is used on the cancer, but it hadn’t been proven effective in an “adjuvent” or preventative setting, he said. I heard “There is nothing I can do” as a death sentence which, of course, I didn’t want to accept.

By this time I had received a written report from Dr. Nigourney’s lab. Apparently Gemzar and Taxoterre had been effective against my tumor cells in the laboratory. But the university oncologist was presenting the mainstream position. Such analyses, he said, might tell you that a drug wouldn’t work, but not that it would. I don’t blame him at all for this, by the way, though it wasn’t what I wanted to hear. Still, I decided to get a second opinion. At the time, I thought this first oncologist was a rather detached, even cold person – but I later learned that such was not the case at all. I asked you at the start of my talk whether you could imagine what it was like to suddenly learn you have a deadly cancer. It turns out I needed to learn more about what it’s like to be an oncologist.

  1. That was the best article I’ve read in a long time, including the op-ed pieces in the times. I’d try to have that published somewhere Sam.


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