It’s a trope in vaudeville routines and farces: two people have an ambiguous conversation, one of them making an incorrect assumption so they’re actually talking about different things, leading to belly laughs from the audience. “Who’s on First?” is a classic example. As I found this week, it’s not so amusing when the topic is serious and it happens to me.
To catch up those who haven’t been following my personal story, my SL partner Jakob showed signs of illness a little over a month ago. This first appeared as problems using language when we were chatting online (detailed in this post). He was diagnosed as having a brain tumor.
That’s where ambiguous cross-talk bit me in the ass. Jakob could not write after surgery to remove the tumor and I got updates from his sister. Her Facebook messages, even when translated carefully, were very upbeat and reassuring. They removed it and he will be fine again! They checked his lungs but they’re clear! They’ll move him to a more comfortable room! Such good news.
But it wasn’t. Re-reading her messages after I got more news yesterday, I can see the clear problem: she must have thought I already knew that his tumor was cancerous. Without that information, she seems to be saying that it was benign and he will have a full recovery. With that information, her notes still seem overly optimistic, but they’re not worthy of the gif dance party of relief that I posted.
The vast majority of malignant brain tumors are metastasized cancer from another part of the body, usually the lungs. That explains why the doctors checked for a problem there. They kept looking and yesterday there was confirmation: there is cancer in Jakob’s stomach. There are more test results expected later this week, but he has stage IV cancer, and at this point it appears to be gastric cancer. (There is still a possibility that it started somewhere else, spread to his stomach, then spread to his brain — but that’s not better news.) Gastric cancer metastasizes to the brain in fewer than 1% of cases and the prognosis is extremely poor. Median survival time is measured in weeks and there is no 5 year survival rate.
I find comfort in data, so I read some studies I found on PubMed, like Gastrointestinal cancer and brain metastasis: a rare and ominous sign, published in 2011 in the journal Cancer. Here is a quote from the paper. SR is surgical resection, WBRT is whole brain radiation therapy.
Response to treatment is poor among patients with brain metastasis arising from gastric cancer. York et al noted neurologic improvement in only 4 of 24 (16.7%) patients treated with either SR+WBRT (n = 3) or WBRT alone (n = 1). Median survival among the WBRT group did not differ from patients who received steroid monotherapy (9.0 weeks with WBRT vs 7.0 weeks with steroids, P > .05). Kaskura et al reported a median survival of 24.0 weeks in the surgical group (SR, n = 2; SR+WBRT, n = 1) compared with 10.8 weeks in the WBRT group (n = 3) (P < .05). The longest median survival was observed in patients treated with both surgery and WBRT (54 weeks; range, 22-83 weeks). In general, the prognosis of gastric cancer patients who present with brain metastasis is dismal, and treatment is palliative. Younger patients and patients with less extensive systemic disease may benefit most (if at all) from surgical palliation.
Jakob is younger than the typical patient with this disease. He had surgery quickly after his neurological symptoms appeared. He has his first radiation treatment in early January and he’s at an excellent hospital where they have a strong focus on quality of life. Optimistically, he may push the upper limits of the survival range for treatment with surgery and WBRT, which is about a year and a half, and feel comfortable most of the time.
Looking at the numbers through tear-blurred eyes yesterday and seeing some median survival rates as low as 9 weeks (9 fucking weeks!), I immediately started looking at options to get to Germany as soon as possible. His sister asked me to wait until they know more, after his first radiation treatment. I’m not sure that she understands that the treatments are to extend Jakob’s life a small amount, not to cure him, and it’s not my place to hammer that point home. I already have plane tickets to see Jakob in May. That’s 22 weeks from now. I think I’ll be scraping together some cash and going much sooner. With luck, we can have a second visit in May.