The day after Daniela's surgery, her second and final day at the hospital, I managed to find a wi-fi oasis at the Georgetown University student center. While I checked my email and replied to many well-wishers, I overheard a conversation a few couches away. The main theme of the exchange between the two students was philosophy. The particular context was a debate on free will vs. determinism. If a man is in a room...and the door is locked...but he is not aware that it is locked....does he have free will? I scanned my email. Inbox, 22 new messages. Spam folder, 14 messages. The hypothesis of the causation of actions states that..... After thirty minutes or so, I had replied to most of the emails. The serenade of philosophical postulates continued, and I recall rolling my eyes thinking about the pleasures of the particular, the concrete, and the immediate: negative lymph nodes, validating my parking ticket, Daniela will be home tonight. The argument of abstractions between the apprentices felt so distant, until last night.
Last night, Daniela was scanning her own email's inbox. One message stood out, an email from Dr. Paul Carbone, an oncologist and friend of the family, and the son of her former oncologist who treated her Hodgkin's Lymphoma. This email message had its own menacing ganglial spurs...four attachments...articles from medical journals discussing breast cancer risk for Hodgkin's patients treated with radiation. (At that moment, I had not yet read the articles.) Daniela glanced up from her laptop, and calmly offered, "I may not live much longer...." She went on to quote statistics from the one article she was reading, frustrated that no one had told her, or no one knew about the risks inherent in her previous radiation treatment.
Statistics. Dr. Cocilovo mentioned a few days ago that Daniela's cancer, classified as Stage I, had a 95-96% survival rate at 10 years. A good friend mentioned in an email that Stage I breast cancer has a 100% survival rate at 5 years. The articles attached to Daniela's email offered other analyses...a risk factor of developing breast cancer as high as 29%, depending on age, for Hodgkin's survivors...a radiation dose of 4 Gy or more delivered to the breast has a 3.2 fold greater risk of developing breast cancer, for Hodgkin's survivors...hormonal stimulation (pregnancy) is a significant risk factor for developing breast cancer among Hodgkin's survivors treated with ABVD Chemotherapy (a chemo cocktail that does not appear to cause ovarian damage).
I recall a quote by Mark Twain (quoting Benjamin Disraeli): Figures often beguile me, particularly when I have the arranging of them myself; in which case the remark attributed to Disraeli would often apply with justice and force: "There are three kinds of lies: lies, damned lies and statistics." - Autobiography of Mark Twain
Daniela and I both mulled over the sour forecasts...her Hodgkin's treatment plus pregnancies probably gave her a 1 in 3, or greater chance of developing breast cancer.... She is now a survivor's survivor, and she wonders about the consequences of her upcoming treatments...about mortality, about the unknown and unforeseen side-effects of her upcoming chemotherapy. She reluctantly surrenders to the idea of another oncological alchemy. She sighs. I sense her attempts at divination, her faith in the words of the medical journals' actuarial augury visibly shaken. Twelve years ago, her physician also mentioned that leukemia was a possible side-effect of her Hodgkin's treatment. Leukemia, another possibility, another set of worries distracting her. What do the oncology odds makers forecast for this risk?
I remind her that statistics and probability are just that. She is an individual. She shouldn't dissolve herself in the data pools and acquiesce to the communal fate of chi-square tests, P values, and regression models. Adrift in the sense of the abstract, I try to bring her ashore with images of the concrete by listing some of her attributes: athleticism, a healthy diet, a resilient Mediterranean physiology....
I think back to the student center days ago and wonder if those two Georgetown students, emerging philosophical sufists, have considered other logic puzzles in their study sessions, examples drawn from an interplay of the metabolic and the molecular, an ontology informed by oncology, molecular determinism vs. cancer-free will. I (re)imagine their conversation. If a young woman has Hodgkin's disease...and is treated with high dose mantle radiation...but is unaware of her severely increased risk of developing breast cancer and leukemia....is she free to consider herself a survivor? I scan my email. Inbox, 14 new messages. Spam folder, 3 messages. The hypothesis of causation of actions states that.... My impatient curiosity wonders how they would have answered. How would you answer?
I think back to the student center days ago and wonder if those two Georgetown students, emerging philosophical sufists, have considered other logic puzzles in their study sessions, examples drawn from an interplay of the metabolic and the molecular, an ontology informed by oncology, molecular determinism vs. cancer-free will. I (re)imagine their conversation. If a young woman has Hodgkin's disease...and is treated with high dose mantle radiation...but is unaware of her severely increased risk of developing breast cancer and leukemia....is she free to consider herself a survivor? I scan my email. Inbox, 14 new messages. Spam folder, 3 messages. The hypothesis of causation of actions states that.... My impatient curiosity wonders how they would have answered. How would you answer?
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