Wednesday, November 13, 2013

Civil War

My friend had posted a blog, whose point was that some people object to the use of war terms in describing cancer, for a variety of reasons.

I had tried to respond to this some time ago, but lost the technological war going on with my Internet on that particular day. In honor of Sherman's march to the Sea, which began 149 years ago this week, I thought that I would post this today.

So, I think that if you were to consider cancer in warlike terms, I believe that it would be best compared to our own civil war, rather than a traditional war of invasion.  This was alluded to above in the arguments against using the war metaphor, but I think embracing these parameters, it really does work.  We need to bring under control elements of our own cellular population that are not functioning according to the rules.  Cancer runs rebel.

Also, the traditional therapies, or weapons, are not so discriminating, affecting healthy tissue and cancer cells alike. We all know that the theory behind chemotherapy lies in the hope that the poison selected will kill the cancer cells faster than it kills the patient.  Thus, cancer is the ultimate war of attrition, not unlike our own civil war, where the north concluded that it had a significantly larger population, and thus could outlast the Confederate south.  Horrible, horrific bit of calculus working there.

I think, either because we have been blessed with a short memory, or cursed with horrible sense of history in this country, most do not have a decent understanding of the nature of the conflict that ended nearly 150 years ago. There were more American deaths in that war than all other conflicts combined. The total number of American casualties during those four years, civilian  military alike, were mind numbing.  When you consider the number of casualties relative to our much smaller total population at the time, it was even more appalling.

Cancer, within the human body, carries a similar burden.  Pediatric cancer, even more so.

Cancer also shares uncertainty with regard to outcome.  There were absolutely no guarantees that the North would win.  We assume the Union victory from our current perspective, but it was no sure thing. If it were, Lincoln would have had fewer sleepless nights, hanging out with the telegraph operators, waiting for news from the battlefield.  I am thinking that if the cancer outcome were certain, I would have slept better as well, rather than pacing the halls of the pediatric oncology floor, or crawling out of my own skin waiting for scan results.

There comes a point in a war of attrition, that the damage to a large portion of the population, or the utter destruction of a region is deemed necessary for ultimate survival.  Doctors weigh the costs and benefits differently at the beginning of the cancer war, than they do toward the end. I believe that Lincoln did as well.

What I look to with hope, oddly enough, were the "advances" in adopting total warfare toward the end of the Civil War, specifically, Sherman's "march to the sea." This was a 50 mile wide swath of destruction in the 300 miles between Atlanta and Savannah.  Sherman and his army either used or destroyed every scrap of infrastructure, crops, and private property, leaving nothing that could conceivably be used by the south to wage war.  It was ruthless.  Sherman famously said that he would make Georgia "howl," and howl they did.  I suspect that there are no elementary schools named for this guy south of the Mason Dixon line.

However, the starving and demoralizing of the south in this manner in late 1864 was pivotal to the eventual success of the north, and ending of the war in April of 1865. I think such measures would not have been considered in 1862, when there remained hope that such collateral damage could be avoided.

Against cancer, there are drugs already available that essentially do this same thing, starving tumors, denying them the ability to thrive, to grow, to spread, the most commonly known among them being Taxol.  If cancer is a war, this is a good first step to ending it, and to winning.  

Today's smart bombs, aimed at particular sites are like targeted therapies whereby cancer cells are dosed with a poison payload that does no harm to healthy tissue...even better.  They are currently used and more are being developed.  I am encouraged.

But back in 1864, the Savannah campaign began on November 15, when William Tecumseh Sherman, having burned Atlanta, boldly (some say wantonly) abandoned his supply lines, heading for parts unknown even to his own army, except for a select few.  Sherman had no communication lines either, advising Lincoln that the southern newspapers would tell of his progress. 

For nearly 6 weeks, Sherman put his army of 60,000 on the line, unable to call for supplies, or more troops to support them.  They needed to forage for food in order to survive, and as such, they needed to continue to move, as they stripped the land of everything usable, like a swarm of locusts.  Sherman called this "hard war."  

Cancer treatment is certainly "hard war," and sometimes, like Lincoln, we have to wait for weeks in silence, as we send forth a new army in boldness, or desperation.  We wait to discover what the consequences are, and the degree of the success of the campaign.

We are forced to wait, as Lincoln did.  

Impatiently, anxiously, waiting for news.

Wondering all the while, 'Did it work?'


Finally, on December 25, 1865, "Uncle Billy" as he was affectionately referred to by his troops, resumed communications and sent a telegram to Lincoln stating, "I beg to present you as a Christmas gift the City of Savannah, with one hundred and fifty guns and plenty of ammunition, also about twenty-five thousand bales of cotton."  

It was with great relief that Lincoln learned of this success, which had remained in great doubt. From this, he was able to bring about the eventual end to the long and bloody war, with a Union victory. 

But, there were huge costs, especially to the areas in the south.  There was an enormous effort during reconstruction to make our country whole, and the scars, though faded, remain.  

Some hear echoes of Dixie in residual racism all these years later, which naturally causes concern, and fear.  Is it coming back?  

Scars, rebuilding, collateral damage, fear, uncertainty...

Yes, I thinks the analogy holds.  

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