Read more: http://imgur.com/gallery/XK4DV
Read more: http://imgur.com/gallery/XK4DV
Macmillan Cancer Support says one in two people will get a cancer diagnosis. Yet our treatment still focuses on the disease, not the persons specific needs, says Dr Ranjana Srivastava, oncologist and author
I need you to see this patient now, a nurse whispers, her quiet tone masking a mountain of concern.
I am an oncologist, I introduce myself to the stricken stranger. We havent met before, but you dont look so well so I am going to help.
For weeks, he has been in the grip of nausea, pain and insomnia. His six-hour wait in A&E culminated in being sent home. He has been bed-bound since, too weak to move, eat or drink.
I am so sorry, I offer, wondering for the umpteenth time how patients deteriorate like this before our very eyes.
Tears form and he shrugs.
Dad just wants to feel better, he knows things are bad.
My heart melts at the plea of his daughter, barely out of her teens.
Weve got this, I reassure her. Hell feel better soon.
The nurse, ever attentive, flicks the chair to recliner mode and catches his wrist. You are safe, she says simply.
At this, he dissolves into sobs that rack his whole body.
As I take in the heartrending sight of a grown, burly man reduced to the helplessness of a child, I try to imagine the affronts that have led him here. The patients differ but the underlying themes dont months of chemotherapy, failed drugs, countless appointments, perpetual uncertainty, endless waiting, lost income, tired relatives, disappearing friends and on top, the existential questions, Why me? Why my family? Why anybody?
I chart fluids and drugs and arrange for a hospital bed, feeling discomfited that the family is so dramatically relieved at such a basic intervention.
Later, in clinic, I see patients ranging from a stoical university student to a devastated father to the frail octogenarian who cant remember the day, let alone that he has cancer each patient an illustration of a recent Macmillan Cancer Support UK finding that it is more common for an individual to be diagnosed with cancer than to get married or have a first child. One in two people will encounter a cancer diagnosis in their lifetime, which is why the report says that, alongside marriage, parenthood, retirement and the death of a parent, cancer is now a common life milestone.
I bear witness to this milestone every day, yet I confess the report is a wake-up call because it has prompted reflection on the chasm between what medicine delivers and what patients desire.
Even a cursory search will reveal the leaps of imagination and discovery that have made cancer medicine fascinating, and indeed life-changing, for so many patients. In the short time that I have been an oncologist, I have gone from ruing that no effective therapy exists, to deciding how best to sequence an array of choices. Sure, not all therapies have delivered stunning results, unacceptable toxicity looms large, costs are prohibitive and our successes are largely confined to the rich world. These are problems to ponder but they dont diminish the genuine, incremental gains in cancer care. Every day, I see the human face of these gains and whisper thanks to the researchers who empower clinicians like me.
But as nearly every cancer patient observes, what cancer medicine has failed to keep up with is the needs of the person behind the patient. Though there are many diseases with no good treatments and far worse outcomes, the very mention of cancer invites terror like no other. A common rejoinder to the statement, You have cancer is, Am I going to die? to which a common, and unhelpful, response is: We cant say. For what patients are really asking is not for oncologists to be fortune tellers but for reassurance that we will be there to see them through the whole cancer experience, of which chemotherapy is just a part. They want doctors who are not only proficient but also humane, as capable of consoling as treating. Most oncologists aspire to this, but two things get in our way.
The first is medical training, which has an outsized focus on defeating disease at any cost and struggles to take into account patient choice. For all the rhetoric around patient-centred care, it has not been easy to put into practice. Cancer is a heterogeneous disease and the people who get cancer are a diverse lot too. A champion athlete, a vulnerable refugee, a youthful retiree and a frail elderly person all need care but each merits special consideration. The athlete wants to avoid nerve damage and the executive begs to keep her hair so her colleagues wont know.
The refugee doesnt own a car and cant travel to have intravenous infusions and the elderly man trembles at the thought of his inability to care for his disabled wife. He values quality of life over extent; he values staying together over being forced into care, but finds this a nearly impossible conversation to interest anyone in. Faced with an ageing population for whom a cancer diagnosis is but one of several serious challenges, this particular problem will test us all. Studies show that the frail elderly are willing to forego aggressive treatments in favour of preserving their quality of life, provided they are offered the choice. We will need to be realistic about what defines successful cancer treatment. It will mean looking beyond the tumour at the whole person.
Now let me be the first to admit how difficult it can be to do this, even for the most well-intentioned oncologist. Given patients myriad needs from rehabilitation and nutrition to financial, social and emotional welfare it is obvious that one doctor cannot come close to fulfilling them all. Cancer patients need team support but on any given day, it is far easier to prescribe a 50,000 drug with dubious benefit than find a physiotherapist or social worker. It takes months to access aged-care services in the community until the same patient falls and fractures a hip, after which services swing into place. There is no reason to bunch together cognitively impaired, mentally ill and non-English speaking patients except that they consistently receive inadequate care across all parts of the healthcare system.
Palliative care has value for patients and oncologists, yet the nexus between oncology and palliative care remains weak in many places due to a lack of education, collaboration and resources. If the emphasis, and hence funding, stays determinedly on finding a cure for cancer (which, as we are now realising, is not one disease) the manifold supportive care needs of patients will continue to go unaddressed. We will keep identifying the gaps without filling them. Oncologists need to appreciate the broader needs of their patients but they also need access to help. When people reach this sobering milestone, the science and art of medicine must coexist.
My next patient is late because there is no parking and the scarce wheelchairs are all in use. While waiting, I duck out to see my patient in the chemotherapy chair but stop at a distance. Saline courses through his veins and a crisp white blanket protects his stretched body. His nausea is gone, his pain has settled, and finally he is asleep, his agitated tears replaced by rare calm. Amid the low-level hum, he is fast asleep, his son dozes, and my heart cant help but skip a beat at how far a measure of kindness goes.
The nurse comes over to join me and we look on, feeling like proud parents who have averted a crisis.
What did you give him? I ask quietly, although I know the drugs that I charted.
Nothing more. He just needed to know he was safe.
Dr Ranjana Srivastava is an oncologist and an award-winning author
You probably already know about Otis, the dog who was spotted gallivanting around Sinton, Texas, with a bag of dog food in his mouth, ready to take on the world despite the constant downpour. He’s a good dog.
But had you heard about this cat, snapped by Getty Image photographer Scott Olson, as the animal swam through floodwaters to presumably try to find a dry spot? The cat is resilient, and there’s little doubt that it’s a feline badass and a meme in its own right. But man, do not even think about going near it.
A cat swims for dry ground after an apartment was inundated with water following Hurricane Harvey. pic.twitter.com/kVj0B3Waow
— Los Angeles Times (@latimes) September 2, 2017
That right there is the anti-Otis. That cat is furious with Harvey, with the water, and, perhaps most dangerously, with you. Because you’re looking at it and taking a photo. It looks like it wants to bat your head around like it’s a ball of yarn and then use your body as its own personal litter box. As the internet was quick to note, the cat looks beyond pissed.
Coming soon as the illustration to the "Adapt or Die" slide in 400 Tedx PowerPoints. https://t.co/HmRI4bYKyV
— Lindsay Robertson (@lindsayism) September 3, 2017
Badass Harvey Cat had "one f— to give, and that f— is gone."
Whoever wrote this deserves a Nobel Prize pic.twitter.com/h9pUfcLx0d
— Marc Caputo (@MarcACaputo) September 3, 2017
— Johnny♡ (@Mr_Johnny_E) September 4, 2017
"Anybody seent a dude name Harvey? Tell him I got sumptin for him." -this cat pic.twitter.com/eMBmwToKqS
— G O L D I E. (@goldietaylor) September 3, 2017
Beyond the obvious explanation—that the cat is having to swim for its survival—there is another reason the cat might look so ornery. Where’s the help when the cat needs it most?
He's probably pissed at the photographer for taking his photo instead of helping him out of the filthy water. 😾 https://t.co/Kcf0XZYVEI
— Melissa Rentería (@Daily_Dos) September 2, 2017
As for the photographer who took the picture, it sounds like he knew better than to approach that cat. Thus, we don’t know what happened to it.
Most of the people had been evacuated and the cat was in no mood to be messed with so he is probably still on his own.
— scott olson (@olsongetty) September 1, 2017
You may not like Hurricane Harvey cat. You may straight-up hate it. But goddamn it, you have to respect it.
Earlier this year, a Texas assistant principal named Eric Hauser wrote and published a right-wing children’s book called “The Adventures of Pepe and Pede.” The story follows the two characters, a frog named Pepe and a centipede named Pede as they celebrate the end an oppressive farmer’s eight years of rule and work to make their farm great again in his absence.
There’s more to the plot, which has been criticized as being Islamophobic, but it’s essentially a send-up of our current political climate told from the point of view of some of Trump’s most dedicated supporters. If Pepe the Frog sounds familiar, that’s because he’s become a meme popular on right-wing blogs.
And he wasn’t about to let someone profit from his work while spreading a hateful message to children.
While there’s nothing illegal about publishing a book with a racist and xenophobic plot, Hauser made one huge mistake in his process: He stole someone else’s character, running afoul of a number of copyright laws. Pepe, as it so happens, is the intellectual property of Furie, who first published the character in his 2005 comic “Boy’s Club.” Not exactly pleased to learn that someone was using Pepe for personal gain and to teach a hurtful message, Furie sued Hauser.
The frog was supposed to just be a “blissfully stoned frog” who liked snacks and soda, not some unofficial “alt-right” mascot.
Around 2010, Pepe began to take on a life of his own as fans began drawing the character into their own stories and internet memes. In the lead-up to the 2016 presidential election, the frog became increasingly associated with white supremacists, neo-Nazis, and internet trolls. Images of Furie’s super-chill creation began popping up in Nazi regalia and KKK robes, earning a spot on the Anti-Defamation League’s list of hate symbols.
It wasn’t until Hillary Clinton delivered a speech excoriating the “alt-right” and white supremacists that Pepe truly went mainstream. In the speech’s aftermath, the Clinton campaign published an article explaining the significance of Pepe in the context of an image posted to Donald Trump Jr.’s Instagram that depicted a Pepe-fied version of the future president.
As the campaign raged on and Furie saw his creation slip further out of his control, he published a few fresh Pepe cartoons over at The Nib, including one that illustrates his “alt-right election nightmare.”
In May, Furie officially killed off Pepe in one final comic.
As reported by Motherboard in August 2017, Furie and Hauser reached a settlement in which the book would no longer be available for sale and all past proceeds would be donated to the Council on American-Islamic Relations. Given the book’s Islamophobic themes and Pepe’s popularity with white nationalists, the decision to donate the money to CAIR was a pretty fantastic bit of trolling on Furie’s part.
Furie also tried preserving Pepe’s more peaceful legacy in an October 2016 #SavePepe campaign with seemingly little success, which led him to draw the character one last time at his own funeral. It appeared that Furie had given up on rehabilitating Pepe’s image when, in June, he launched a Kickstarter campaign geared towards resurrecting the little green frog in hopes of “reclaiming his status as a universal symbol for peace, love, and acceptance.”
He wasn’t alone in wanting a return to the comic’s roots either. By the time the campaign wrapped up, Furie had raised nearly $35,000.
Between his decision to donate the money made in the copyright infringement suit to a great cause and refusing to give up on his own creation, Furie is himself a testament to the bizarre and sometimes wonderful possibilities of the internet.