Asking why / when / how I got this tumor is dangerous ground, because it leads presently to the unproductive and unanswerable question: “Why me?”  I suppose it’s natural to try to assign some sort of meaning to traumatic events, even if it may be nothing more than bad fucking luck.  This tumor could have started from a stochastic mistake in cell division, or the chance striking of a cosmic ray while I was in a trans-Atlantic flight, or something else of that nature.  Even if it were merely bad luck, my intention is to create meaning from this awful trial by getting a move on some of the things I had always meant to do in life, like learning an instrument or writing a book.

Hypotheses:

Environmental: There are any number of environmental influences that increase the likelihood of contracting cancer.  But I have been careful about limiting my exposure to pesticides, herbicides, chemicals, etc.  I’ve worked with radioactivity and chemicals in lab, but never anything truly dangerous, and always with appropriate protective gear.  For a year, I even held my phone away from my head while it dialed, to minimize radiation from cell phones, even though no one to my knowledge has ever proven that connection with either mechanistic or epidemiological evidence.  When we were house shopping in Connecticut, one of the houses we liked happened to be a half mile away from high-voltage transmission lines, and my good friend Julie Baggs will attest that I spent a week reading papers about the connection between power lines and leukemia, and calculating expected disease risk based on the distance (1/R-cubed) and the voltage, then deciding not to buy that house.

Behavioral: I have never smoked in my life.  I do drink from time to time, but always in moderation, and never more than two days in a row, unless I’m at a scientific conference (not that we needed another piece of evidence that science is bad for your health).  I eat well, and I’ve always taken care to get something approximating normal exercise.

Stress: The Simontons have compiled some decently convincing evidence that stress predisposes patients to contracting cancer.  For example, paranoid schizophrenics are at four times greater risk of contracting cancer than catatonic schizophrenics, despite being housed in the exact same environments.  I don’t think this is an especially controversial contention to make: ulcers, heart disease, autoimmunity, mental illness, and any number of other diseases, are all influenced by stress.  Plus, we know that chronic stress suppresses the adaptive immune system via a cortisol and IL1-based mechanism.  If you concede the uncontroversial argument that the immune system has evolved to detect and eradicate atypical body cells, then it’s natural to conclude that stress can weaken the body’s defenses against cancer.  In fact, the Simontons typically see patients with a severe emotional disturbance 6-18 months preceding cancer diagnosis.  Most everyone knows a widow or widower who contracted cancer shortly after the loss of their spouse (fuck cancer, seriously).  This connection, between stress and cancer has been known for ages; an epidemiological study in 1893 in London concluded that:

“Of all the causes of the cancer-process in every shape, neurotic agencies are the most powerful.  Of the most prevalent kinds, distress of the mind is the one most commonly met with; exhausting toil and privation ranking next.  These are direct exciting causes that exert a weighty predisposing influence on the development of the rest.  Idiots and lunatics are remarkably exempt from cancer in every shape.”

This is the point where the Simontons get into some dangerous ground, implying that the patient’s state-of-mind may predispose them to getting cancer.  Certainly, there is any number of neurotic and depressives that never contract cancer.  And even implying that patients brought cancer on themselves is offensive and contemptible.  But there is a silver lining here – if you concede that one’s state of mind influences susceptibility to cancer, naturally the patient’s state of mind can also influence the progression (and clearance) of the disease.  There are opportunities to be exploited therein.

Graduate School at Harvard: Graduate school is an awful time for most people.  Harvard Neuroscience is in a class all its own.  I recall one very dark day when an older student who had graduated with much distinction pulled me aside and said: “when I was at your stage, a kind, older student told me that Harvard makes you feel this small (holding her thumb and index fingers apart by about an inch).  But, you have to remember that you’re much bigger than all that.  And, remember to pass this on to the next student you see in the program who is suffering.”  I had a bad boss who had nearly absolute power over my career, experiments were lagging, and I was competing with dozens of other students and postdocs who were cranking out Cell and Neuron papers every week.  Seriously, check out any issue of Neuron from 2002-2007, and you’ll see my classmates represented.defense1  I would give some specifics about the abuse and privation we happy few endured, but I don’t care to revisit my emails or journals from that period at the moment. Too many bad thoughts that will set back my no stress policy during this cancer fight.  Suffice to say, I typically worked 110-hour weeks, and during this time, I contracted a repetitive strain injury from over-use and stress on my wrists.  It was so bad that I had to go to the Brigham and Women’s ER and wore a wrist guard for six months thereafter.  To this day, I’m still susceptible to wrist problems during especially stressful stretches.  I also became morbidly obsessed with the series of suicides that had plagued Harvard Chemistry and made a vow that science (and Harvard) would not be the death of me, a vow I still take seriously.  The nearby picture is of me, minutes after successfully defending my dissertation. Instead of the triumph of a major life accomplishment, I see a young man worn down and worn out.  At least until I joined the Hogenesch Lab.

Hogenesch Lab: Labs take on the character of their PI, and it was refreshing to be in a lab filled with people like my friends Trey Sato, Jeanne Geskes, Julie Baggs, Kevin Hayes, Gina Hayes, Anthony Olarerin-George, and later Nick Lahens and Jason DeBruyne.  In Hogenesch Lab, hard work was appreciated, and the science was fun again.  We were publishing important papers, and as a group, we were optimistic, cheerful, ambitious, and happy to help our colleagues inside and outside the lab.  It was a huge improvement from being suspicious and hateful towards your bench mates.

Tumor origins:

Not much is known about the natural history of gliomas, but my surgeon tells me that my glioma has probably been in my head for ten years or more.  That puts its origin around 2005, which would have been the peak of the awful time at Harvard.  I can’t prove any of this, of course, but I would bet all the money in my pocket at the moment that the chronic, unrelieved stress of graduate school suppressed my normal immune function and allowed a renegade glial stem cell to start making mischief.

Why this is good news:

If you buy the argument that one’s response to stress influences the development of cancer, then naturally, stress should affect the response to and clearance of cancer.  And the good news here is that I am a completely different person with a completely different life than ten years ago.  I was rehabilitated scientifically and emotionally by the Hogenesch lab, and I now have a great job with great colleagues.  Instead of a girlfriend 300 miles away by east coast turnpikes (Boston to Philadelphia is an awful commute), I have a wife who sleeps next to me, and three little daughters that need their daddy badly.  If you believe the Simontons, a cancer diagnosis typically follows 6-18 months after a severe emotional disturbance.  I was actually very lucky (I’m tempted to say “blessed”) that I was afflicted with a tumor that has an indolent course and stays in the background for years and years.  I could have come down with something much more aggressive and much worse right around 2007 when I was just about to get married and was just starting my life properly.  As I said earlier, I made a promise that science wasn’t worth dying for, and that Harvard, etc. wouldn’t be the end of me.  I keep my promises, especially about stuff that offends me personally.

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