"You must get on with your life. Dying will take care of itself."
In an episode of television's "St. Elsewhere," Dr. Auschlander, the kindly old doctor who has incurable cancer and occasionally feels deeply depressed, is given that tart advice by his wife.
Dr. Fred Lee of Ann Arbor, Mich., is a real doctor who is getting on with his life.
He tells you, "I'm sitting on a time bomb," an inoperable prostate cancer, and he gives himself only one chance in 10 of surviving as long as 10 years.
This has been true since June 1984. How does he handle it?
"I sometimes go into depression," he admits. "You can't help it."
But his far greater solution to the problem faced by every cancer patient -- How do I go on living now? -- has been hard, fervent work. For almost two years he has been working on a possibly revolutionary way to detect prostate cancer early by ultrasound and, it is hoped, cure many more cases of this long silent killer that trails only lung cancer in causing cancer deaths in men over 55.
Like a number of other cancer patients, Lee also reports what they rather amazingly call a "gift" or "reward" that their cancer, as unwelcome as it is and as limited as the gift may be, has bestowed. In Lee's words -- stated with medical objectivity, as though he were speaking of Patient X or Patient John Jones -- it is "a realization that life is finite, and a sudden appreciation of the things that are really important to you. All of a sudden you realize that many of your old values don't mean a thing. Human values become much more important.
"And your life becomes so precious you don't waste one day."
Such are what one might call this 55-year-old man's survival philosophies, as, he says, "I'm just running and running. I'm not sure where I am regarding the spread of my own disease, so I'm running like mad. I'm really in a race for my life. But it has been one of the most exciting times in my life, because what I am doing has the potential to help people."
The "what I am doing" had its origin in September 1983, when Lee -- a radiologist at Ann Arbor's St. Joseph Mercy Hospital -- attended a University of Michigan ultrasound conference. Some doctors had been trying to use ultrasound waves to detect early prostate cancer, with uncertain results. Still, Lee put his name on a list of people asking for a demonstration.
In June '84, saleswoman Cathy Warner finally brought an ultrasound machine to St. Joseph, and Lee had his own prostate examined. "I don't know what you've got," she told him, "but it looks different from what I normally see."
What she saw turned out to be prostate cancer, incurable because, with no pain or other warning signs, it already had spread well beyond the prostate gland.
This is common. The prostate, a plum-sized gland that men literally sit on, is an organ that produces semen and helps trigger orgasm. Standard methods of examination, mainly a doctor's touch, too often detect any cancer too late.
Lee's prostate cancer was first treated by implanting radioactive seeds in the organ, "the wrong choice," he says. He knows now that he should have had radical surgery, because tests soon showed that the cancer had spread and his long-term chances were poor.
He underwent further radiation treatment. He and his family were for a time devastated. Then, after two months, he went back to work. He quickly persuaded his hospital to invest $60,000 in an ultrasound machine as a "gamble."
Different doctors have different views about the problems of identifying and precisely locating and treating prostate cancers. As Lee describes it, "a major problem was that nobody knew just what cancer looked like on an ultrasound image." He and associates -- including his son Fred Jr., a Boston University medical student on loan to help his father -- photographed thousands of ultrasound views.
Lee now believes he has learned some important new things about where and how a prostate cancer first appears. He believes he has learned to work with a urologist to locate cancers half the width of a fingertip, by a bit of teamwork in which he uses ultrasound to monitor the movement of a biopsy needle that the urologist manipulates.
He believes this will lead not only to accurate location of early cancers but "potentially" to far more accurate staging or diagnosis of their nature, all of which should lead to far better choice of treatment.
"We still have to say 'potentially,' " he says. "We are now adding a large number of cases to our study, but we will have to wait 10 years to see if they live longer as a result of these methods."
But potentially, he says again, "this could be a major advance" and one that could lead to establishment of prostate screening clinics all over the country.
He is personally convinced. "We're going to see a lot of lives saved. It's so important. There's so much cancer out there."
He says these things with a degree of excitement now going beyond classical medical objectivity. He may be forgiven. "I'm racing to develop this," he says. "I'm just one step from being taken over" by the disease.
Is all this more than a scientific quest? Is it his way of coping with his illness?
"Yeah! The main problem when you get cancer is that you lose hope. If you just keep thinking about nothing else, you get depressed.
"I substitute an activity that offers a lot of hope to people. Just seeing what we can do with it in my everyday medical practice gives me a sort of inner high. It's a good feeling to know there may be hope for other people, and because of that you assume there may be hope for you too."
He says he now has recurrent cancer in his prostate gland. He is being treated with two drugs, one a hormone. One complication is thrombophlebitis, inflammed veins in his legs, so he often works with his legs propped up and a heating pad across his thighs.
A former marathoner, he no longer can jog. Instead he goes on long early morning walks with his wife, Ethel. "About five miles," he says. Cancer or none, he does this too with intensity.
He sometimes credits his intensity to his Chinese heritage. His immigrant father walked off a farm in Canton and became an indentured servant to pay his way to San Francisco and the "Golden Land." He later went back to China for a bride, then returned to America and both slaved -- he in restaurants, she in their hand laundry -- to send seven children to college. Three became physicians. "It's that Oriental philosophy," Lee says.
Cancer patients of many heritages tell similar stories of continuing quests of one sort or another -- and a personal reward.
Dr. Robert Mack, a Seattle surgeon who developed terminal lung cancer, wrote that following a time of devastation, "I could . . . look at my life and ask, 'What are my priorities? How do I want to spend the time that is left?' These are truly among the best days of my life," he concluded.
Massachusetts' Paul Tsongas, who quit the Senate when he found he had cancer so he could spend time with his family, and himself, wrote: "My illness has forced me to understand that I have true spiritual needs whether I am healthy or unhealthy . . . These changes, or more accurately reinforcements, are a precious gift."
Such experiences are "not the norm," it is true, yet are "not rare" -- "I have repeatedly encountered that same affirming joyfulness," writes E.A. Vastyan, Episcopalian minister, theologian and professor of humanities at Pennsylvania State University's Hershey Medical Center.
A kind of whistling in the dark?
No, says Fred Lee. "I think that once you arrive at the realization that your time is limited -- and it takes a real big jar to make you realize that -- real growth then occurs. That's when you learn that things like money and power and control of others are worth nothing, and other parts of life that have passed many of us by -- love, kindness, nature, beautiful things, music, literature, poetry -- are so much more important.
"When you're finite, when you may be dead and gone in two years, you don't worry about, 'Do I look good enough? Am I dressed properly?' It's only you as the bare bones person, and nothing else matters.
"It's only at this time that we come to realize this. Why can't we make that realization when our bodies are whole?"
Next Week: Looking at medicine for profit.