The Coming Battle (11/19/24)

 

“You are about to embark upon the Great Crusade…The eyes of the world are upon you. The hopes and prayers of liberty-loving people everywhere march with you...Your task will not be an easy one. Your enemy is well trained, well equipped, and battle-hardened. He will fight savagely…But this is the year 1944! The tide has turned! The free men of the world are marching together to Victory! I have full confidence in your courage, devotion to duty and skill in battle. We will accept nothing less than full Victory! Good Luck! And let us all beseech the blessing of Almighty God upon this great and noble undertaking.”

--General Dwight D. Eisenhower’s Order of the Day

It may seem like hyperbole to compare the initiation of chemotherapy on 11/22/24 to the events of 6/6/44, but I think there are more similarities than differences. Certainly, the domain expertise and strategic approach with which our treatment regimen was crafted eclipse anything that existed in the Pentagon during the lead up to the Normandy invasion. Whereas Operation Overlord brought the largest naval, air, and land operation in the history of warfare, the pharmacologic agents that will be injected on Friday represent a multi-faceted attack in which the native immune system is weaponized against the cancer simultaneous to the sabotage efforts of an antimetabolite which slips undetected into the DNA of replicating cells, halting their already limited ability to spread due to the actions of a third agent which can facilitate programmed cell death. I’m not sure how they refer to this three-pronged approach in the medical literature, but General George S. Patton described it fairly precisely in the Army vernacular: “We’re going to hold onto him by the nose, and we’re going to kick him in the ass. We’re going to kick the hell out of him all the time, and we’re going to go through him like crap through a goose.” I should point out that while there are undoubtedly more benign combinations of drugs that we could have considered, “Shock and Awe” is kind of a family motto. Joyce has shown tremendous courage in choosing to move forward down this path, and she has done so without any delusions about the heavy casualties that are expected. You can’t unsee the first 24 minutes of “Saving Private Ryan,” which was Hollywood’s best attempt at portraying the tragic fate of 10,250 servicemen who were killed, wounded, or found missing during the D-Day invasion, and we’re not expecting anything to be easy in this first offensive. Nausea, hair loss, nephrotoxicity, pancytopenia with opportunistic infection, line complications, thyroid dysfunction, pneumonitis, myocarditis, hepatitis, and encephalitis are just a few of the risks that we will have to prepare for in the coming months. On the bright side, I haven’t come across any reports of this stuff causing cystic acne. Depressingly, all this collateral damage can only weaken an enemy that can’t be completely destroyed with the weapons currently at our disposal. As we pray for a miracle, we are reminded of what a critical role the efforts of scientists like Alan Turing played in cracking the Enigma code through the very first application of computer technology. We are so thankful to be fighting this battle at the very dawn of Artificial Intelligence. Just this past week, the Wall Street Journal described the efforts of a company called EvolutionaryScale: “The company’s eventual goal is to enable all sorts of companies—from pharmaceutical makers producing new drugs to synthetic chemistry companies working on new enzymes—to come up with substances that would be impossible without their technology. That could include bacteria equipped with novel enzymes that could digest plastic, or new drugs tailored to individuals’ particular cancers.” One of the stories my mother read to me as a child described a boy named Joseph Meister who had been bitten by a dog and contracted rabies—a lethal condition in 1885 when the story took place. But in this story, he became the very first patient to receive an injection of a vaccine over several weeks. The boy would go on to survive and become the caretaker of a tomb in Paris that marked the resting place of the vaccine’s inventor, Louis Pasteur. I think often of that story, reminding myself that there will eventually be a first time for curing Stage IV breast cancer. It is with fear, uncertainty, and hope that we prepare to take the first steps onto our own Omaha Beach in just a few days. We do so standing on the solid foundation of Hebrews 11:1-3. “Faith is the confidence that what we hope for will actually happen; it gives us assurance about things we cannot see. Through their faith, the people in days of old earned a good reputation. By faith we understand that the entire universe was formed at God’s command, that what we now see did not come from anything that can be seen.”