When Hitchens Watch posted my interview with my oncologist friend nearly seven months ago, I realized there were questions that I had forgotten to ask him.
In his written pieces and television interviews, Christopher Hitchens described symptoms that I found baffling, given my ignorance of esophageal cancer.
For instance, Hitchens reported afterward the sensations he felt shortly before his diagnosis:
“I couldn’t really move, and my whole chest cavity seemed to be filled overnight with some kind of cement. And I wasn’t sure that I was breathing or that my heart was beating, very frightening…And I discovered that my pericardial sac, the bit around my heart, the liquid that protects your heart, was swollen up to the point that my heart couldn’t move very well, if at all, which may or may not have been related to my malady.”
Was the swelling of his pericardial sac related to his malady? Once again, I turned to my friend, who said that esophageal cancer could cause such a problem. “Cancer cells enter the pericardium,” the oncologist explained. “More fluid would collect around the heart, and compress the heart.” Can only esophageal cancer affect the pericardium? “Any kind of cancer can do it,” my friend replied.
Several months later, Hitchens experienced other unpleasant symptoms. Appearing on C-SPAN in January of this year, the journalist told his host, Brian Lamb:
“I had a very bad episode a couple of weeks ago. I crashed…I had a meltdown in my bone marrow, that can happen with chemotherapy. I had a crisis with white and [red] blood cells, at the same time as my gall bladder went rancid and I was in terrible pain. I thought I had a burst appendix, so I was really flat-out, but I’ve now lost the gall bladder, and I’ve gained some blood transfusion, so I’m back, hanging on.”
What happened to his gall bladder? Was the loss of that organ related to his cancer as well? The oncologist said that chemotherapy can lower immunity, causing inflammation of the gall bladder, even without the presence of stones. Inflammation of the gallbladder is known as cholecystitis.
The continued media coverage of Hitchens’s health has created even more questions in my mind. This spring, Hitchens mourned the loss of his elegant speaking voice. Yet, he was able to speak in faint tones at the annual convention of the Atheist Alliance of America last week. Why did he lose his voice and then regain it? Patients can lose their voices for different reasons, including infection, my friend answered. Most commonly, however, esophageal cancer can entrap or damage the recurrent laryngeal nerve, “which provides nerve supply to the voice box.” For sufferers of esophageal cancer, “it is often irreversible, but sometimes it is not.” The oncologist said that the recovery of their voices is a good sign: “That generally means their cancer is responding to treatment.” That meant it could a good sign for Hitchens in particular: “It looks like he is fighting it well, and he may continue to live.”
Readers of Hitchens Watch are familiar with the journalist’s legendary consumption of whiskey. Therefore, I was surprised to read that the placement of a feeding tube in his stomach had eliminated his thirst for the stuff. “That’s the most depressing aspect,” Hitchens said at the convention. “The taste is gone. I don’t even want to. It’s incredible what you can get used to.”
Why does he need a feeding tube now? “You need a feeding tube for a variety of reasons,” answered my friend. Since patients undergoing chemotherapy often lose their sense of taste, they do not eat or drink enough. Providing them with adequate nourishment enables them to “more easily tolerate chemotherapy.” If feeding tubes do not directly improve survival rates, they can “indirectly improve the ability to survive.”
One subject I neglected in my original piece was gene therapy. As Hitchens said to Brian Lamb:
“I have some wonderful oncologists working with me, and we’re on the verge of a whole number of new treatments, some of which may apply to me… I’ve had my genome sequenced, for example…Thanks to a wonderful American, Dr. Francis Collins, who’s the head of the National Institutes of Health, which includes the National Cancer Institute, who did the Human Genome Project…He’s taking a very kindly interest in my case, has helped me have my genome sequenced to try and look for a more perfect identifiable match for any mutation they can find that’s peculiar to me, that can be targeted by a special drug…I hope to try that, if I’m strong enough, if my bone marrow’s recovered enough, and that involves six million…no, excuse me, six billion DNA matches of my tumor set against six billion DNA matches of my blood to look for something that was individually mutated, that wasn’t in my genes.”
“I don’t know why some will have the whole genome mapped,” the oncologist said. “It has to be absolutely experimental…I’m just guessing. I don’t see anything even in the horizon that gene mapping is able to do.” Although my friend was impressed by the involvement of Dr. Collins, “there are 5,000 people under him who are doing the work.”
What is key is finding the causative gene, the oncologist told me. Thanks to an article provided by Dizzy, a Hitchens Watch reader, it seems that such a specific mutation has been found in Hitchens’s case. My friend referred to a study of one gene therapy that extended the average survival rate from nine months to thirty-four months. Again, the oncologist stressed that this particular gene therapy was only experimental, and he was speaking in terms of averages.
In my original article, which ran in March, my friend had predicted that Hitchens would survive less than six months. The oncologist made it clear that he does not know Hitchens, and was merely engaging in speculation. Hitchens’s possible response to experimental treatments made my friend somewhat more optimistic, though.
Esophageal cancer remains an incurable disease, but some of my friend’s patients have survived for three years. “Some will live longer than three years,” the oncologist stated. “If they live that long, newer treatment will be available and they may live even longer. Five years ago, these patients did not survive much at all.”
The oncologist’s work has made him philosophical. “I always say we are all terminally ill,” he reflected. “We are all going to die.”
“The enemies of intolerance cannot be tolerant." • "If it is an offense to justice to hold people who may have been victims of mistaken identity or of vendettas by other factions, then it is also an offense to justice to release psychopathic killers who believe that they have divine permission to throw acid in the faces of girls who want to attend school." • "Don't be such a lesbian!
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