The curses and blessings of cancer treatment: Ki Tavo

Picture of Rabbi Michael Graetz

My association with this week’s parshat ki tavo has to do with the wandering Aramean (arami oved avi) about which I have written in many places (here).. We are told how to behave when we finally come to the promised land (ve-hayah ki tavo el-ha-aretz) at the end of our wanderings. God has “brought us to this place and given us this land, a land flowing with milk and honey” (Deut 26: 5-10). If we act morally the land is ours. An idyllic start! However, if we misbehave, there is a list of blessings and curses towards the end of the parsha.  This week, I will make a supreme effort to focus on the blessings that we have (even if the curses outnumber them in this parasha) and try to focus on positivity in the face of adversity.

LOOKING ON THE BRIGHT SIDE

My role model for adversity is my life partner, Rabbi Michael Graetz (Ramag). He reeks of positivity—he always looks on the bright side, the cup that is full and not empty. He has been struggling with Basal Cell Carcinoma (BCC) for almost 10 years. When you tell someone that you have BCC, they will invariably tell you that if you have to have cancer, that’s the one you should get.  Normally, you remove the cells; they are on the surface and after the biopsy, the surgeons are pretty sure they have it all. That’s if you catch it right away. What they don’t tell you, is that if you decide not to treat it, there are ramifications.  When detected early, most BCCs can be treated and cured. Prompt treatment is vital, because as the tumor grows, it becomes more dangerous and potentially disfiguring, requiring more extensive treatment.

EIGHT YEARS OF CANCER

We were fairly lucky: Ramag had sores on his head that just did not heal. Since he played golf regularly with his friends in Ga’ash and just as regularly would hit his head on the ceiling of the golf cart, the sores persisted and did not heal. We both laughed at his clumsiness. But fortunately for us, we have many doctor friends in our congregation, one of whom was a dermatologist and another a plastic surgeon. Over the years they told him that sores that don’t heal are not a good sign, even if you keep bumping your head and injuring the same place. Finally, after much hemming and hawing, and denial, our friend the plastic surgeon performed a biopsy. After two months we got the results and it turned out he had BCC. Of course, we laughed about it, it was the good cancer wasn’t it? But the doctors thought he had it for a long time and needed an operation with general anesthesia. Through protexia, we were able to go the hospital and have an operation. Ramag joked about it for years, saying “I needed this operation like a hole in the head”, something which he did have.  During the six-hour operation (it seemed like a lifetime) the surgeons took a slice of his skin to create a flap to cover the hole in his head. The place where the graft was did not heal quickly. Our close friend the nurse, came in regularly to help out and we thought it was all over with. The sores remained, and we continued to treat them, until finally they went away and life went back to normal. I was left with a whole bunch of bandages that I no longer needed.

Then a few years later (around the time that Covid began), the sores started to get worse and again did not heal. We were not interested during this time in checking it out, because we were afraid to go to hospitals and clinics. But our plastic surgeon friend persisted and after the results of a new biopsy, he put us in touch with his colleague, a prominent oncologist, who agreed to take Ramag on as a patient.

So in December 2020 we went to the Cancer Center in Soroka Hospital. He was proscribed Odomzo—pills to be taken every day. It took time for our health plan to agree to this treatment, but they did. All of this was during the Covid period. In fact, the first day he started treatment, was the same day we went in for our first vaccinations. The Oncologist assured us that there was no problem and okayed the vaccinations. But he kept a close eye on Ramag and we went in for checkups every 2 or 3 months. At the oncology clinic, Mike hesitated before signing, and asked what would happen if he did not accept the treatment. Dr. Y told him that without treatment, in a year or two the BCC might penetrate his brain. He described it as advanced BCC, although the plastic surgeon re-assured us and said that’s just the official description to get the expensive medicine approved by our health plan.  We were very impressed with the cancer wing at Soroka. This was one of the few times we left Omer for Beersheva and were thrilled to be out, despite the fact that our “outing” was cancer related.

After almost two years of treatment, we thought it was all over. Except that it turned out that the BCC was back. He was told to stop taking the pills. It looked like he was having a reaction to the pills which caused the BCC to reoccur.

The oncologist gave us all the options: 1) Surgery; 2) Radiation treatment; 3) Immunotherapy; 4) do nothing.  Ramag chose option four. The whole family agreed, why should he suffer.  But then the sores got worse and six months later, the oncologist suggested that we go for a consult with the plastic surgery department. It happened that my daughter and her partner were filming in Beersheva that day and they got permission to document the consult. After all the options were laid out again, he again refused treatment. He spoke beautifully: I’ve lived a wonderful life and am willing to take my chances was the gist of what he said. We also asked what could happen if the BCC remained untreated: it could penetrate the bones and brain, could cause deafness and blindness etc. All this was documented on film. When our immediate family viewed the video, we felt that by forgoing treatment, Ramag was choosing a possible painful death over life.  I also began thinking of how to deal with all of this; the long and short of it is that I convinced him to start treatment.

Yesterday, was the first treatment of an intravenous drug, called immunotherapy. I had been feeling guilty about pushing him for treatment, with its possible side effects, but am convinced it’s for the best and I have tremendous support from friends and family for the decision to undergo treatment. But what’s most interesting was Ramag’s switch in attitude. After all of his reluctance to get treated, he now “owns” it. He read an article by the oncologist about the treatment and he quotes from it and tells everyone how lucky he is that Dr. Y is his doctor and brags how good the treatment is.

We are now officially part of the cancer family. The Cancer building at Soroka has five floors. There are five elevators and they all work. The attitude of the nurses and administrators is positive. There is no yelling. It was very confusing to be in a new ward. We know the building well. There is free parking for cancer patients. There are volunteers all over the place. There is a kitchen with tables and chairs and food. There is one nurse for six patients, all of whom have private cubicles. Our nurse told us that she is studying to be a health administrator. And a young social worker came and told us what our rights were as part of the cancer family. She spent more than a half hour talking to us. I even asked her, if she didn’t have to be someplace else.

In previous generations, cancer was called the big C, or the curse. It was not mentioned by name. Today, this is no longer the case. As more and more cures and targeted medicines become available, the curse, may not quite turn into a blessing, but will certainly offer different opportunities and allow people to get on with their lives. As I wrote to friends on WhatsApp: “We are in oncology ishpuz yom. Starting on a six-month journey. Hopefully will be cured in February if there are no obstacles on the way”. To which one of my friends wrote: “wishing you a safe journey”; “looking forward to celebrating together in February”; refuah shelemah (may you have a complete recovery)”.

Mind over matter; blessings over curses; positivity over negativity. That is my new mantra (at least for this week). Our sages in Pirkei Avot wrote:  איזהו עשיר השמח בחלקו (The rich man is the one who is content with his lot). I took the picture of Ramag as he was getting ready for treatment; he radiates contentment!