The Doctor's View: An Occasional Miracle

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Dr. Scott Haig is an Assistant Clinical Professor of Orthopedic Surgery at Columbia University College of Physicians and Surgeons, who has a private practice in the New York City area. Some names in this essay have been changed to protect patient privacy.

Widely metastatic pulmonary adenocarcinoma means lung cancer that is practically everywhere in the body. It's even scary to write the words, since they are invariably written about people who are grey, emaciated and so weak they can't even walk. Their bones break, they slowly suffocate. It's the real reason why doctors are scared of cigarettes. And it's what they wrote about a friend of mine named Charlie.

Here was a forty-ish, high-end suburban finance type — 6'2", with a lacrosse player's build, handsome, funny, gregarious and kind. He loved (and still does, so keep reading) sailing but also, unlike many of his ilk, loved but one wife and one set of great kids. He had smoked, and back pain brought him to the doctor. The chest x-ray showed the oh-my-God shadow, the scans showed it everywhere. The next move is usually hospice — this one is just about impossible to stop, especially when this advanced.

Charlie's logic went something like this: "I'd rather you kill me than this cancer and you might learn something in the process — so bring it on, Doc". He was a very strong, young man and figured he could take a lot more chemo, a lot more surgery and a lot more radiation than most patients. It wasn't that he had the "we're going to beat this thing, Ruff" attitude. He expected death, pretty soon, but he wanted to be the victim of medical target practice, not what the ancients called the crab.

After the first round of "cherry picking" — open-chest surgery cutting out the chunks of his lung that held tumors big enough to see and feel — he started an untested chemo regimen; he carried around a battery-powered pump on his belt that fed the nauseous chemicals into his veins around the clock. It was during this period that he came to my office, told me his story and asked if I could do anything about his limp. He had a painful knee. "You have all this going on and you want me to take out a torn cartilage in your knee?" I asked him. I was a little incredulous — torn cartilages don't hurt that much, especially if you're not active.

"Listen Scott, all I can really do now is walk around a little — for the time I have I would like to walk". I couldn't argue much with this; the arthroscopic surgery was small and not too painful. So amidst quite a few raised eyebrows I brought Charlie to the OR.

After explaining the situation to the anesthesiologist, the nurses, the family — and once again to myself — we had Charlie asleep on the table, his leg a nice iodine brown from the skin prep, antibiotics floating around in his blood along with the Three-Mile-Island cocktail from the oncologists. Boy was his knee full of fluid. You start an arthroscopy by putting a metal tube about the size of a Cross pen into the joint. You then expect to drain out an ounce or so of tannish, slippery fluid when you take the plug out of the tube.

I took out the plug, and fluid just gushed. I don't yell in the operating room and I don't like surgeons who do, but I sure yelled then."Give me a basin, now". The fluid coming out of the tube going into Charlie's knee was fluorescent green, a neon, lime-firefly color that I had never seen associated with anything having to do with the human body. We had to get that stuff to the lab.

After clearing out the mysterious fluid, the rest of the operation was routine, as was his follow up. The knee got better. I asked every oncologist I knew if they ever heard of this as a side-effect of chemotherapy. Some of the chemo they were giving Charlie was cherry-red — the thought was that somehow the tissue lining the knee (synovium, that normally makes the tan joint fluid) had been taking the red chemo molecules and changing them into something fluorescent green. This was just a guess though — the red stuff doesn't go green in any known situations.

My yelling did no good either; the lab didn't help us. They didn't know what to actually test for. Lab medicine obeys rules like twenty questions; they will answer "is it this?" or "is it that?" but not "just what is it?" No matter whom we asked they said they never heard of it.

But there was something else much more important that they never heard of either: Charlie got better. He got stronger, his breath came back, his face pinked up, he gained weight. The big blotches on his x-rays disappeared. It was miraculous. This was about ten years ago. I last saw him about a year ago. He had some nerve damage (probably from the drugs) but he just bought a new boat and was getting along fine.

If you are tempted to draw some hope from Charlie's case be warned — in my experience, it hasn't happened since. That said, it really did happen once, and though recent news sadly proclaims that young, healthy people continue to succumb to lung cancer, progress against the disease, using the drugs Charlie got, has been impressive.

Our vast ignorance about the workings of life is not a popular theme in our media. Experts, and the people who write or talk about them, are paid for their knowledge and ability to communicate it,not for being awed by the vast complexity of the machinery of life or shocked by our ignorance of its most basic parts. But I, for one, am amazed that we're here at all. Look at the night sky — absolute zero of space, 200 million degrees of stars — that's what the great, great bulk of the universe is like. Not too conducive to our kind of life.

What really made Charlie get better? And did it actually have anything to do with the bright green stuff inside him? Every St. Patrick's Day I wonder. Erin go Bragh.