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The Truth About Cancer
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Chapter 11: When Is the Fight Over? [9:52]

Vinay gets his marrow transplant. Jamie leaves the clinical trial. How doctors help families when the end is inevitable.

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Transcript: Chapter 11 - When Is the Fight Over?

ROBERT HURCKETT: Uh, donor 068842004.

NICOLE YOUNG: Mmm hmm. Okay.

ROBERT HURCKETT: Recipient... oh.

NICOLE YOUNG: Yup, go ahead.

ROBERT HURCKETT: You want that, too?

NICOLE YOUNG: Yup. The recipient...

ROBERT HURCKETT: 65...6546991.

NICOLE YOUNG: Okay.

CAITLIN DONAGNY: Do you want to hold 'em?

RASHMI RAO: Ooh, I want a picture of this. 'Scuze me. [laughs]

VINAY CHAKRAVARTHY: Wow.

RASHMI RAO: Look over here, I want to get a picture of you.

VINAY CHAKRAVARTHY: This is what's going inside of me, wild.

CAITLIN DONAGNY: You can, you can, alright, you can hold it until we're ready.

VINAY CHAKRAVARTHY: Okay... Twenty minutes or so?

CAITLIN DONAGNY: Mmhmm.

RASHMI RAO: Let me call you back, okay? Bye.

CAITLIN DONAGNY: There they go.

RASHMI RAO AND FAMILY: Yay!

VINAY CHAKRAVARTHY: This thing looks crazy; it goes through this IV, into my heart, and then the heart pumps it. And somehow it, I mean, I know we have talked about this before, but somehow it finds its way into my bone marrow.

CAITLIN DONAGNY: It's almost done. It's got...done? That's it.

RASHMI RAO: Yaay!

VINAY CHAKRAVARTHY: We're done. Yeah! Officially done.

FAMILY: Finally.

RASHMI RAO: One hour.

VINAY CHAKRAVARTHY: This is to donor ID 068842004. Don't know who you are, but you've just done something great for myself and for humanity by giving a life back, and I really, really, really am grateful to you and indebted to you forever.

NARRATOR: It was 9:15 pm when the last drop of bone marrow hit Vinay's veins. Soon, he would no longer have his old blood type; he would no longer have his old immune system. Vinay Chakravarthy would be born again.

*

LINDA GARMON: Larry's brother has kindly offered to take his clothes to the Pine Street Inn. Oh, these are cute. So, it's incredibly hard because I want to give him a lot of the clothes, and most of the clothes, but I now can see this is not the right time for me because it's sort of actually kind of hard to par... to part with this stuff. Oh man. Maybe I shouldn't start with the shoes.

NARRATOR: When I was packing Larry's clothes six weeks after he died, I also removed a poster he liked from above our bed, and as I headed out one evening, I put it on the sidewalk.

LINDA GARMON: I would never want to see him to wear this tie, except for right now; I would want him to wear this tie.

NARRATOR: Fifteen minutes later, I realized with startling clarity that I didn't want to part with it, and I ran back home...

LINDA GARMON: These are too... too "Larry" to sort of part with right now. So...

NARRATOR: ...but the poster was already gone. I eventually learned that the experimental drug Larry tried was approved by the FDA. It was not one of the new "smart drugs," and the median survival for patients with Larry's form of cancer increased by only four months. At the time, it hardly seemed a victory to me. For the leading causes of cancer deaths, the best that medicine can offer patients with metastasized cancer is often 1 to 2 years with one drug, and 1 to 4 months with another. Still, I must confess, I'd give anything for four more months with Larry, and for that poster that I should never have let go of.

BOYD ESTUS: Are you okay?

LINDA GARMON: [crying] Can I go read that e-mail?

BOYD ESTUS: Sure.

LINDA GARMON: "August 23rd. Dear Linda, it's hard for me to express my emotions about Larry's demise. This is probably the reason for replying to you so late. It was an absolute privilege to know Larry and you, and to be involved in Larry's care. We doctors get inspired and energized by our very unique patients like Larry. Since I had the chance to care for him and watch closely what Larry and you were going through because of this dreadful disease, I have developed more of an interest in mesothelioma, and have already designed an investigational protocol for treating this disease, and will continue to work on this in the future. I am sure the person he was, he has inspired hundreds of other people around him in various fields, and will also survive in their existences. I apologize again for replying so late, thank you for your kindness, and look after yourself. My best regards, Dr. Forouzesh." Wow. [laughs] That's so Larry. [laughs]

*

DAVID RYAN: In colon cancer, when I first started ten years ago, um, the median survival without chemo was about six to eight months; with chemo, it added three to four months, you got about a year. Then, all of a sudden, we had one drug and it added three more months. And then we had another drug, and added it three more months. Then we had another drug and it added a couple more months. And now we have another drug and it adds a couple more months. So the median survival with colon cancer, in ten years, has gone from a year, with the one drug that you had, to about two years now. Now, if you look at each one of those individual steps alone, you can always say, "Well, that's - that's awful. What's a two to three month improvement in survival?" What I'm hoping is, ten years from now, I'm sitting down with someone with pancreatic cancer and I can say to them, "Well, you know, the median survival now is close to three years." So, you have to take the long view.

DAVID RYAN: Make sure when you make the decision to send somebody home and you have a pretty good idea that they might not come back, even though you scheduled a three week ah, visit, and you know in your heart of hearts that there's a pretty good chance that they're gonna die in the next three weeks, absolutely, positively make sure you tell the patient and their family that if you're feeling overwhelmed for whatever reason, come back in.

DEBORAH COUTU: Hospice is actually a different benefit program within the insurance companies, and what they have done is put together a list of resources available towards someone who is going to remain in their homes with a terminal illness. The first requirement is that it is a terminal diagnosis, and the doctor expects that there is a possibility that in the next six months that you would pass away from the disease; that there is no cure and, at this point, anyway, there is no cure, and so what we look at providing is palliative, or comfort, care.

JAMIE KLAYMAN: Right.

DAVID RYAN: The worst thing you can do is not realize that if - when you have that conversation, there's a certain finality to it, and the patient feels like they're getting abandoned and left to these hospice providers that they don't know...

Vicki Jackson: Right.

DAVID RYAN: You may have taken care of the patient for the last three years, and then all of a sudden they're left to the hospice providers.

Vicki Jackson: Right.

CHANA BOGSTED: Let me see, what else I wanted to ask. Uh, the hardest question: have you thought about funeral arrangements at all?

JAMIE KLAYMAN: Somewhat, yeah, I have.

CHANA BOGSTED: Okay, that's something that I can help you with, if you'd like.

JAMIE KLAYMAN: Okay.

CHANA BOGSTED: It's not the most fun part...

JAMIE KLAYMAN: Right

CHANA BOGSTED: ...of the job but, uh, it's, it's something - I'd be glad to go to the funeral home with you if you want, or just to give you information or resources.

JAMIE KLAYMAN: Okay, yeah. Right.

CHANA BOGSTED: Okay, um, what are your main concerns, now, Abbye?

ABBYE WARREN: [pause]

DEBORAH COUTU: You don't want her to suffer.

CHANA BOGSTED: [laughs] Yeah, okay.

DEBORAH COUTU: That's going to be number one; make sure we can keep her comfortable.

ABBYE WARREN: Yeah.

CHANA BOGSTED: Okay. Alright, we'll be here every step of the way, okay?

JAMIE KLAYMAN: Yeah.

ABBYE WARREN: I want her to get better. [laughs]

DEBORAH COUTU: Exactly.

CHANA BOGSTED: Do you know something? I always care plan to pray for a miracle but to prepare, just in case we don't get it.

DEBORAH COUTU: Prepare for the worst, and work toward the best.

DAVID RYAN: This is what the family remembers. After the patient dies, you get this incredibly warm letter back and it's about this particular conversation that you had, or this particular week that you took the family through. They don't remember the fact that you made these great calls about their chemotherapy, you know, two years earlier. Um, it's very - uh, it's, it's - you have to manage this pe-- this pe--this period of their illness, um, very well, um...and, because nothing else to the family at that particular time matters.

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