LETTER FROM GREECE #43: Ubre Blanca and mien of oncologists
“English, strictly speaking, is not my first language by the way. I haven’t yet discovered what my first language is so for the time being I use English words in order to say things.” Claire-Louise Bennett
Americans of a certain persuasion and age, my peer group, one could say, have a curious attitude when it comes to the island nation of Cuba, a mere ninety miles south of Key West. At some point in the discussion, sooner rather than later in my experience, they gush, almost misty-eyed, “But they have national health care!” I usually refrain from saying, “Well whoop-de-doo!” But I do point out that every country in the world has a national health care system, except the U.S. Certainly there is a wide spectrum of competence on hand amongst the nations sharing the planet, but that’s what nations do, they organize health care, each in their own peculiar way. And you could make the argument that that is also happening, albeit very late in the game, in the U.S. What with Medicare, Medicaid, the Affordable Care Act (okay, its future is shakey but the Republicans will replace it with something, a voucher sop to the insurance industry most likely), and many States now operating their own state-wide systems. And this reflects the States, where large national projects have long been out of vogue and regional prejudices are sanctified. This means also that if you are in Mississippi or Alabama you are shit out of luck while those in Massachusetts or California are getting cared for.
But back to Cuba and the death of El Presidente for Life, or EPFL, if you will. One of the lingering problems with armed revolutions is what to do with the guy, so far it has always been a man, who leads this struggle. The qualities you want in a leader of armed struggle are not necessarily those needed in building a pluralistic socialist society. Armed revolution brings military leaders to power and the first order of business is securing that power. Get rid of your enemies, reward loyalty and take control of everything. These often charismatic men are used to the power of military command in the field and generally they maintain this as long as they can. Africa has produced plenty of these guys, Mao is classic example. EPFL came to power not as the leader of a Cuban Communist Party but of the 26th of July Movement, a party that he had founded. After several years in power he formed the United Party of the Cuban Socialist Revolution (PURSC), which was completely beholden to EPFL. There wasn’t a central committee to answer to or really, anything else. He could and did rule by ukase, often engaging in micro management: approving the design of uniforms, the fat content in milk.
A good metaphor for rule by Fidel is his attempt to produce a super cow. According to most reports, he was mad for milk and all its by-products: ice cream, cheese, etc. and felt the people should share this passion. Problem was, the cows raised in Cuba were Cebu, great to eat but very low producers of milk. And, your milk machine Holstein can’t tolerate the Caribbean climate. No problem. EPFL was also passionate about animal husbandry and closely oversaw the attempt to produce a hybrid cow that would thrive in the heat and kick out the moo juice. Ubre Blanca (udder white), a record setting producer, was the result. She set a global record when she produced 109.5 litres (28.9 gallons) of milk in a single day. Month after month she produced four times as much milk as a normal cow. Alright, that is whoop de-doo, but alas, she was a one off. They never could get calves from her that could reproduce these results. As on the farm, so with the nation.
Fidel made a revolution, but didn’t establish a system that could thrive. Socialism requires a deep and radical democracy, not paranoid one-man rule. Generations of educated Cubans were shut out of the decision making process by this authoritarian nonsense. One person cannot possibly have the answers, and certainly not over a span of nearly fifty years. I mentioned good intentions last time and certainly we can say Fidel had plenty of those. He wasn’t materially corrupt, didn’t squirrel away billions in foreign accounts, but, he was convinced that fate of the nation was intrinsically woven with his. EPFL would give speeches to the nation for four, five, even six hours. The whole place would shut down to listen to him. The profound vanity of this boggles the mind. He really thought he had that much to say. And finally, take a look at the map; just to the east of Cuba is Haiti, often in the running as the most desperate place on the planet. But there’s no record of Haitians risking their lives to get to the socialist paradise in Cuba. None. Of course, Haitians are very much African in their heritage, which was the wrong color to succeed in EPFL’s Cuba.
Last Monday the fifth we drove to the city. First stop the hospital where I got cut two months ago. We’re here to pick up yet another test result although we don’t have the special request paper signed by an oncologist. This is mostly due to not having met with an oncologist, yet. The surgery department is having a confab in the office we enter. The doctors’ secretary, they all share one, hops to it. Appears we don’t really need anything special. Doctor Brontosaurus arrives. Okay, his name is Brontzakis, which, if you know Greek names, indicates his family is from Crete. The ‘akis’ ending reveals this. So, for instance, Crete’s famous writer Kazantzakis and let’s not forget the ancient composer Mikis Theodorakis, who is still sucking air at 91, still shooting his mouth off about most anything, a hero of the left, except when he is not. A 20th century giant, he will get the full state funeral when he leaves this mortal coil. I call my surgeon Brontosaurus merely to mock the difficulty English speakers have with Greek names. I drop off a single malt gift for Doc Bront and we are outta there.
We check into the Hotel Plaka, which has been considerably upgraded since I last was there, which, admittedly, was many years ago. Before the Olympics in 2004 the government made remodel monies available and most hotels availed themselves of the cheap dough. And then it’s time for lunch. We have a horrible tavern in the village and ten minutes down the road in Sparti dining is limited to Greek and Greek, and most of that is grilled. So when we hit the big city we are ready to Thai on the feed bag. We do Sushi and warmed by the accompanying sake head out for a bit of shopping.
Our ‘appointment’ with the Onc Doc is at five. Once we’re in the city we leave the car in a lot and walk, public transport and taxi. We grab a cab and give the man the address. He doesn’t know and asks, “Do you have GPS on your phone?” Do we have GPS? Dude, might be a good investment for a cab driver. Nevermind, it isn’t far and soon we’re there.
We enter a packed waiting room. Uh oh. When Mirella called the Doc he said come at five, but he didn’t actually take her name or anything. Drat. We sit. M hasn’t brought anything to read so she’s reduced to scanning a fistful of turgid magazines dealing with fashion and celebrity. I, on the other hand, have the poetry of Robert Desnos, French surrealist supreme.
“He has passed near the abandoned house.
He is the man with the drop of wine on his forehead.
At this moment he is dancing in a huge room,
A brilliantly lit room
It’s wax parquet floor glistening
Deep as a mirror.”
Not a very jolly crowd in the waiting room, which is hardly surprising. We kill two hours acquainting our butts with rather hard chairs.
Butt then it’s our turn. Christos Papadimitriou is a diminutive gray haired man with a bushy moustache. He is dwarfed by his big desk. He holds his hands together and asks why we have come. He speaks excellent English and I present the prologue. At the mention of Brontosaurus he smiles and asks whether we were satisfied with the surgeon’s work. Very much so. “We’ve known each other for forty years,” says he, “he’s a good friend and a fine surgeon.” Oh, let’s spread the love around here. I hand over the lab results and surgical report and he takes a couple of minutes to peruse them. When a doctor is looking at data concerning your condition you study their reaction. Does he pause over something, perhaps turn back and reread, check a figure or two, furrow his brow, wince, nod his head knowingly or shake it in acknowledgement of the bitter mysteries of fate? Does he crumple the paper in rage? Tug at his collar? Slap his forehead? Roll his eyes to the ceiling and beseech the gods? I’m happy to report, it was none of the above. How many of these reports has he seen in his oncological decades? Thousands. Perhaps cancer cannot surprise him anymore?
He looks up with a half smile, shrugs and says, “You may be cured. The surgery report and these lab results indicate that you don’t have any cancer right now; none that can be measured, at any rate.” Are we always just waiting for good news? Part of seeking multiple medical opinions is the search for a doctor who will tell you what you want to hear. But what if you like the first opinion? He goes on. “I’d say there’s about a 70% chance that something else, years down the line will kill you, rather than this possible cancer.” Oncologists are given to statistical analysis. It allows them to quote someone else’s figures, it makes it less personal. “You see,” he says, “your case lies in the gray zone of colorectal cancer. Stage two tumor with no evidence of lymph node involvement. We’re not sure chemotherapy is recommended in this instance, often it is not. This happens to be my specialty, this gray zone. I’m lecturing on it in Patras later this week.” He paused. One advantage, besides comprehension, in having the doctors speak English is that they go slower, they have to think their way through it. “I’d like to run one more test that is warranted in this situation. We want to check your MSI, which stands for microsatellite instability. This will help us decide what type, if any, treatment you require.” What the hell is that? We didn’t have him explain it too much but I’ve since found out.
“MSI testing can detect an abnormal number of microsatellite repeats, which indicates that the cancer more likely arose from cells with defective mismatch repair genes. A result of “MSI-high” means that a high number of microsatellite repeats were found.”
The importance here is that if you have a MSI-high reading chemotherapy is not recommended as it doesn’t have any impact on the defective mismatched repair genes. I guess. Like I know what I’m talking about. Obviously the genes don’t know what the fuck they’re doing in there, mutating like muthafuckas, leaping about like mustard seeds in hot oil. Gahmoto. The doctor turns his lap top around and shows me a graphic concerning my condition. Apparently I don’t fulfill the criteria for adjuvant therapy, such as chemo. But this last test will help us determine that. Okay.
We chat a bit about personal histories. My experience with oncologists, limited to European ones, is that they maintain a certain pragmatic detachment, which is understandable given the nature of the disease. And dig it, with oncology there’s not a lot of hands on examination wherein patient and physician might bond a wee bit. No, except for melanoma, it’s all mysteriously inside, microscopic, damn near invisible, you have to trust the science. Similar, I suppose, to riding in an airplane. You get in the plane, you go where it goes. You have nothing to do with any of it and are completely at the mercy of a whole slew of people from ground crew to pilots to air traffic folks. You have to trust that everyone did their job. Yes, with cancer you can alter diet, exercise, and choose from an ever-expanding menu of alternative treatments, but at least with the initial diagnosis, you haven’t a clue. Click to get
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Mirella and I get to our own experiences with things carcinogenic. Somehow we’re all on our feet. I relate my first wife’s demise, after ten years of suffering from sclera derma, at the hands of cancer that began in the lungs and ended in the brain. The doctor asks, did she smoke, even miming the gesture with fingers to the lips. No, she didn’t. He shakes his head in despair. Then Mirella relates her son’s death at the age of 21. What kind of cancer, he asks. Sarcoma, she says. What kind? Synovial. Now he gives a full grimace. Synovial sarcoma is swiftly, brutally lethal. He’s on the verge of tears and is hugging us, planting kisses on our cheeks and patting us on the shoulders as we exit. Are you kidding? We’ll call him nothing but Papadimitriou.
The night air feels fresh and invigorating. What’s a two hour wait if the payoff is this lightness of mood? We grab a cab and soon are walking down Ermou, the main shopping street of Athens and a pedestrian mall. Earlier we had noticed a place right around the corner from our hotel. Vintage Wine Bar & Bistro. We head there and plop ourselves down. We order up a sparkling Reisling from Alsace and a variety of cheese and fois gras and it all comes beautifully prepared with curious and successful flavor pairings. Well, bon ton rouler, y’all. As Elvis Costello once sang, “Don’t bury me ‘cause I ain’t dead yet.”