NJJN Commentary 11.16.06

Road trip
A journey in three acts


“Fair is foul and foul is fair: Hover through the fog and filthy air.”
— Macbeth, Act I, Scene 1

New Jersey cannot seem to come up with a state slogan to capture its universal essence.

Here’s one that probably won’t make it: “Cancer Alley.”

Columnist Ron CounHarsh, perhaps, but the phrase captures an issue that dwarfs all the issues that provide fodder for Jersey jokes and slurs, from its endless incidents of political hanky-panky to corrupt health care systems, to failed superfund cleanups, to “pay-to-play” loopholes.

“Cancer Alley,” of course, may not be as boosterish as “The Nation’s Medicine Chest”: Nevertheless, the prodigious manufacturing of emollients to attack serious medical disease smacks up against the incubation of some of the worst carcinogenic media in medical history.

Act I: The Turnpike

These cheery thoughts follow as my wife and I barrel down the New Jersey Turnpike toward yet another cancer research center that may possibly offer something beyond the conventional toxin du jour, as I continue to slug out my own bumpy survival issues of the past decade.

This time we are heading out of the state. Eighteen-wheelers push us past the circuitous tangle of airport cutoffs and service roads that bleed into the highway. With the cacophony of Port Newark behind us, the real sideshow begins: tanker farms, chemical plants and their attendant transportation, storage and rail yards, and cities that cannot shake off the grit juxtaposed with shiny refineries urging motorists to “Drive Safely.” Malfunctioning energy plants vent the air with semilethal byproducts, converting the highway into a giant emissions sluice that diagonally bisects the state.

Verdant landscapes and occasional farms have been given over to runaway development. Planned communities reeking of myopic architectural redundancies and ubiquitous golf courses, in the state with the least amount of living space per resident, proliferate like fauna without a natural enemy.

Act II: The Waiting Room

How to capture the myriad of moods and emotions: hope, hopelessness, pain, fear, anger, stoicism, denial, relief, fatalism, random acceptance, and rejection without resorting to cliche and caricature? Still, you sit there and are part of the theater. Commentary is compelling.

Treatment centers have taken exceptional strides to develop an aesthetically pleasing atmosphere. My own facility reminds me of a 1940s upscale Fifth Avenue hotel lobby with beige walls, rich-colored woods, stuffed furniture, and the natural light of wide windows. The check-in area emulates a loan officer’s reception desk for private clients rather than a mass registration counter, although the fiduciary purposes are not that dissimilar. It is an ambiance that is both inviting and off-putting. Ambiguity is so characteristic of this disease and its treatment.

The center staff, at all levels, conveys their understanding of patient concerns and feelings through their empathetic support. The physician class and its acolytes are the usual idiosyncratic, specialist bunch — there, but not there — with appalling responsibilities and, more often than not, a preoccupation with getting it right.

Cancer patients are their own social paradox. They were heretofore, in the main, vigorous communal participants who gradually descended to the never-land of the stricken. In their marginalization, they are removed from the everyday, objectified and viewed in the past tense as victims of environmental neglect or genetic assassination. Nothing to worry about, though — it is not contagious.

After patients leave the main reception lounge, they enter the waiting room, reserved for those who are medically cleared for treatment and are waiting to be assigned to their own private rooms, generally for chemo infusions. The waiting room exposes the hard truth — this pernicious disease does not discriminate by race, class, gender, or age. You never know whom you will regret finding in the waiting room. Unlike the subdued atmosphere of the reception lounge, some patients in the waiting room begin modest bonding attempts. People sit ruminating with those who accompanied them in sub-rosa tones as if they were guarding a deadly secret (which they are). Or they raise their voices to assure that others bear witness to their own ordeal and possibly be drawn into the discourse. Their hope is that others might reveal something of their own misery or develop a momentary rapport and interest in the patient’s trauma.

There are patients who affect a bravado, the almost jovial front of a seasoned survivor, and those who are terrified no matter how seasoned they are. Generally, most patients in waiting rooms are not looking for friendships, but wish to get on with their own private hell and flee the place — at least for the time.

Act III: The Treatment Center

The trip south was the result of a referral for a possible targeted medical drug trial that my specialist thought worth following up, given that the standard toxic fare was having marginal results — albeit, it has kept me alive.

Research centers offer treatment, but one is more likely to be a subject rather than a patient, as the center gathers data from the phases of a trial study. Experimental treatment, first tried out in biolabs on nonhuman subjects, is now tested against the reality of human responses and tolerances under tight conditions. Participation is very selective. Usually, patients in the end stages of their disease are more likely to show up at a research center, but not always. I am willing to throw the dice earlier in the game if the coach says go. These facilities take great pains to be attractive, located on manicured grounds that resemble the upscale institutions that they are. Donor grants are critical.

There is the third partner in all of this — the pharmaceutical industry and its profit-hungry family of biolabs. There are big bucks in successful drug trials and, unfortunately, an endless supply of subjects.

In the waiting areas of the research centers, patients are more likely to be visibly infirm, some disfigured and physically limited in various stages of their disability. Research facilities are a bit more crowded, with less privacy in the overly large big box communal treatment rooms. Patients can appear to be stacked up like cargo on the loading dock of the River Styx — a scene that has nothing on the denizens of Hieronymus Bosch’s The Garden of Earthy Delights. And yet, this is the state of the art. Remarkable breakthroughs for some lucky souls do happen because of the work of those centers and their professionals who chose to ply their skills in this most difficult and marginally rewarding of the medical arts.

Which brings me back to the Jersey paradox, with a formidable pharmaceutical industry and a tolerance for environmental degradation. About that slogan: I propose that we direct our attention to the three witches from Macbeth, concocting their nostrums around a bulbous cauldron with a big “Rx” inscribed on its outer surface. “When the hurly burly is done,” they chant, “come to New Jersey.” Now there is your bumper sticker.

Comment | Print | Subscribe | Webmaster


©2006 New Jersey Jewish News
All rights reserved