Monday, June 02, 2008

Slayer of Atwater and Kennedy

Death from Glioblastoma Multiforme is certainly not sudden, but it is inexorable. It shuts down the central nervous system as it grows, so one enters a progressively sleepy state punctuated by seizures. Along this downward course, other brain functions start to shut down: paralyzed limbs, a loss of speech. Eventually one enters the deep sleep of coma, and then death.

I'm sure Allan Friedman MD, Guy L. Odom Professor of Neurological Surgery, in the School of Medicine, Chief, Division of Neurosurgery in the Department of Surgery, Co-Director, Neuro-Oncology Program at Duke University ... I'm sure he's a capable guy, but I'm just as sure he knows he made only a gesture today. Nobody has the delusion that they can divert the juggernaut deathgrip Glioblastoma; not even, it is notable, any neurosurgeon. He must have been aware that he was participating in Kennedy myth-building. The patriarch must be seen as fighting to the last. All of the reports I'm seeing on Cablenews about "successful" surgery just indicate the patient survived surgery perhaps without new neurological deficits.

Unlike more well-behaved tumors, Glioblastoma has no definable plane between itself and normal brain tissue. Even with image-guidance, even with large margins taken around any obviously necrotic mass, macro- or microscopic tumor infiltrates and evades. After surgery, after radiation and chemotherapy, these little islands of viable tumor show up bad as ever as malignant little deathblossoms that are sadly never going to go away.