I Need Science
SITTING IN the radiation oncology clinic exam room with me was Mr. N, sixty-three years old, who until the previous month had worked full-time as a county judge. Dressed in wrinkled khaki pants, sneakers, and a faded blue T-shirt, he presented a contrast to his wife, who sat next to him—smaller, younger, sporty and elegant, in boat shoes, pale pants, a tennis shirt. I turned to the computer to pull up the work-up scans he’d completed. “My understanding is you know the diagnosis,” I said. “Let’s go over how you got here, starting weeks ago, when you came to the emergency room.”
In the middle of the night, he’d rushed to the hospital, wild with fright that tightness in the middle of his chest meant he was having a heart attack. Within a few hours, blood tests and EKGs ruled that possibility out. He told the ER doctors that in addition to chest pain, for several months he’d had problems swallowing, with a sensation that bread or meat felt like it got stuck. Upper endoscopy was recommended, with the flexible video camera to be inserted through the mouth so as to directly inspect the esophagus and stomach. The procedure was done the following week, with Mr. N lightly sedated, the gastro-intestinal doctors watching a video screen and tracking the scope down his esophagus. In its lower segment, the usually smooth and slick inner lining appeared distorted by a bulbous, cauliflower-like tuft growing from the periphery, extending in an uneven blob down to the junction where the esophagus emptied into the stomach. A biopsy was taken. Several days later, the results returned: esophageal adenocarcinoma, the cancer cell subtype characteristic of the lower esophagus. More tests were obtained—a chest CT scan, a PET scan, another endoscopy exam, this time with an ultrasound probe to assess the thickness of the tumor—before Mr. N was sent to the thoracic surgeon, to consider an operation. But since the cancer infiltrated the great vessels of the chest, with the tumor wrapped around the aorta and the left main pulmonary artery, the surgeon had told him an operation would not be possible.
Now, meeting with Mr. N and his wife in one of the exam rooms in the radiation oncology clinic, with its white linoleum floor, fluorescent lights, steel sink, vinyl pastel colored chairs, I described
