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Death & the Cancer Screen Not Performed

Today’s New York Times has a timely and important article by the respected science writer Jane Brody, a woman with an advanced science degree and a breast-cancer survivor. I always read her articles because they are chock full of information I want and need about health, the environment and all things science/life related. But today’s on whether or not people should continue to get cancer screenings for various illnesses, even those not prone to the cancer, caught my eye. Something has been burning inside my brain for three years now and it’s time for it to come out and the Brody article did it.

One of my beloved sisters was a model of self care in terms of her health. She went for her yearly physical, her yearly mammogram, saw the dermatologist for any suspicious skin spots and exercised daily. No slouch, she rode a bike, helped repair her relatives’ homes, painted, loved all the neighborhood kids and was a ready friend and confident when someone needed one. Honest, straight arrow and always ready to fight for the underdog, she was a champion for all of us.

When we heard she had fallen suddenly at her home and was taken to the hospital, all of us were shocked. She’d never been hospitalized, except for the birth of her children, had no illnesses and only suffered from allergies. That’s all we knew, but there was a dark and dangerous thing taking over her life in a manner which shouldn’t have happened.

Smoking helps people cope with stress and bouts of anxiety in many situations and years ago it was no big deal to smoke. Homes were readily furnished with plenty of ashtrays and cigarettes were everywhere. Teens wanted to smoke. People in films smoked somewhat excessively and famous people all had cigarettes in hand. Look at Edward R. Murrow, John Wayne, Steve McQueen, Bette Davis and Walter Cronkite. They all smoked.

How does smoking help? Nicotine is a natural substance in our body’s nervous system and, in fact, there are special receptors for it in the spinal chord. So it serves a natural purpose, but not when teamed up with the ingredients in cigarettes which make them remain lit or light faster or whatever. Lots of additives to keep those little sticks burning.

Actually, there are benefits from those receptors, but we don’t really have to add to their workload by inhaling cigarette smoke. They work just fine as they are.

Cigarettes, therefore, were ways to introduce extra nicotine into our bodies and they did quell anxiety to a degree. These innocent white sticks were much like anti-anxiety meds but without the need for a prescription. Alcohol serves much the same purpose for some people and that’s part of the process that leads to addiction. The addiction to cigarettes, I’ve read, is as strong as that for heroin.

Social situations where the stress may have been ramped up were always ones where cigarettes were plentiful. They added to our level of comfort and gave us something to do when we found our hands were uncomfortably hanging at our sides. Behavioral cues only helped reinforce smoking in more situations and it became natural to light up their first smoke before they got out of bed in the morning.

My sister was a smoker for over 40 years until family members, concerned about the dangers of smoking, managed to help her rid herself of the “cancer sticks” as we called them. She tried more than once and she did succeed. For over 20 years she hadn’t smoked. Didn’t matter because the fire inside had been lit and it remained a burning, growing ember no one suspected was there.

After the fall, she was in the hospital for a quick exam. The ER physician ordered x-rays and they, according to him, showed nothing. She and her husband went back home where her pain intensified. Back to another hospital where they found a fracture of the hip which would require surgery. The first ER physician had missed the fracture. While there for this evaluation, her family physician passed by and asked, “Why are you here? You’re never sick.”

Never sick because he never did one thing which a smoker with a long history of smoking requires; an occasional x-ray of the lungs. He never did one for her annual exam even though he had been seeing her for over 30 years and knew she had been a smoker. Not one lung x-ray with all those mammograms, colonoscopies and skin exams. Not one.

Yes, they had found some benign polyps on her colonoscopy one year, but it was nothing to be worried about. Our mother died of colon cancer but they told her she was fine. And she believed them because they were the healers and she was only a patient with a family history of cancers of many types; colon, skin, breast, bone and eye. Her family physician knew of this history.

The hip surgery and the pre-surgical medical work-up revealed extensive, metastatic cancer of the lung, bone and perhaps brain. Despite what she had been told, and I have to wonder how much she was told, she decided to have the hip surgery because, as she said, “I won’t be able to walk if I don’t have it.” Did anyone tell her the gravity of the diagnosis and that she wouldn’t have more than two months to walk with her current diagnosis?

After the surgery, she went to rehab and they did more CAT scans and then they wanted to do chemotherapy when the full extent of the illness hit her with one of those “talks” about care. “I’m going to heaven,” she said with an audible choke in her throat and stopped our conversation dead.

She refused the chemo which would have had her sick as a dog for every remaining day of her life. And the days remaining even with the therapy would be short indeed. Home was where she wanted to be and that’s where she went with her pain medication and the hospice care they provided.

No longer would I have my sister as I had known her. Drugged almost to the point of being unconscious, she carried on and was carefully dressed for each of my visits until she could no longer even sit up when I came. Two months after the diagnosis, she died in the care of a family member who is a nurse. She’d stopped eating and could barely take a sip of tea and then she slipped away quietly in the early morning hours.

Not one x-ray with all those other exams. I’m not advocating for x-rays because we know they’re not totally safe (as isn’t extensive plane travel or dental x-rays). But I am advocating for more care on the part of people who have knowledge of family and personal history–family physicians. One x-ray may have saved her life but we’ll never know.

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