NOVEMBER 16, 2022 – Today, after many weeks of embracing the delights of life—yes, LIFE in all its beauty and brilliance—following my autologous stem cell transplant in August, I had to spend two hours on the phone with a coordinator of a clinical study. The call reminded me that though I’m out of “cancer jail,” I’m on parole.
The study is designed to assess a medication combination for the long-term treatment of multiple myeloma. The coordinator’s job was to walk me through 31 pages of mind-boggling parameters germane to the study. Smart and thorough, the coordinator suffered politely through my judiciously persistent brand of humor.
But on page 19, the laughter stopped. As I read, listened, and jump-started actual cognition, I developed a serious question: Would participation in the study compromise my immune system so as to delay emergence from my “isolation bubble”? This is an even bigger issue for my spouse, who, understandably, wonders when she’ll get to leave our bubble. When can we have house guests? When can we visit friends indoors, dine indoors at a restaurant—travel by air, go to a theatre, attend a play or concert, visit a museum, et cetera infinitum?
What tripped me up among the risks: reduced neutrophils and lymphocytes—front-line defenses against bacterial and viral infection.
Humor yielded to focused analysis behind a furrowed brow. I outlined a diagram of possibilities, each with questions to reach a well-informed decision. As I later (today) advised a client in a sticky situation, “There are no simple solutions, just intelligent choices.” (Quoting the slogan of an old ad campaign for Caterpillar heavy equipment.) Judging by the coordinator’s responses, I don’t believe she was rolling her eyes. She answered questions within her sphere of expertise and deferred to my oncologist, those that weren’t.
Several hours later, with darkness falling, my good doctor called. I was on my way to . . . Little Switzerland for x-c skiing and stress relief. I pulled over to talk. I first told him my destination. He had the good sense not to question my sanity. I then stated the problem (the isolation bubble), the corresponding question (would my participation in the study materially reduce my immunity?) and my analysis.
To my relief, the good doctor said, “I know exactly what you’re asking, and I understand completely your analysis. The way you’ve described it is accurate.” It helps to have a well-established rapport with your doctor.
The bottom line: “There are no simple solutions, just intelligent choices,” and in a context in which no guaranties exist, “the risk needle” associated with the study isn’t in the unreasonable zone. Moreover, I can always opt out of the study. Thus, if on the neutrophil or lymphocyte dial (measured regularly) the “risk needle” shifts materially, I can mitigate the risk by exiting the study.
At the end of the call, Dr. Kolla asked me where he should buy x-c ski equipment. I gave him my recommendation, then expressed my delight that he was “embracing the concept of winter.”
With restored confidence, I continued to Little Switzerland for a half hour of skiing. I won’t tell Dr. Kolla that I . . . crashed . . . about 5 minutes into the workout, thanks to a ski hitting “raw grass” under the new, wet snow. Before any non-existent spectators on the “Aletsch Glacier” could wound my pride, however, I righted myself and without further mishap, skied into the night.
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© 2022 by Eric Nilsson
