Melanoma vaccine in the works

The ABC‘s AM program reported trials for a melanoma vaccine today. This is very good news. The research was published in the Journal for Immunotherapy of Cancer – read it here. The vaccine was effective even in cases of metastatic melanoma. Patients with stage 3 or 4 melanomas responded well. 

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They don’t muck around

Melanomas are the gallopers of the skin cancer family.

I have a skin check every six months. Last Christmas, I was all good. By June this year, I had a stage 3 melanoma. Early stage 3 – but still, that’s fast.

A melanoma might start as a mole, which then goes rogue.

MedlinePlus‘s melanoma page says a good way to spot them is to use the A-B-C-D-E checklist:

  • Asymmetry – the shape of one half does not match the other
  • Border – the edges are ragged, blurred or irregular
  • Color – the color is uneven and may include shades of black, brown and tan
  • Diameter – there is a change in size, usually an increase
  • Evolving – the mole has changed over the past few weeks or months

I would add a ‘T’ to that – Thickness. Any thickening of a skin mark should be taken as a warning sign. Get it checked. It might be fine, but it might not.

But not all melanomas start out as moles. Mine didn’t. It was a small pink mark – pretty harmless looking, really. But just because it’s pink, don’t assume it isn’t deadly. A pink melanoma can kill you just as fast as a black or brown one will.

So be vigilant.

We all worry about bothering doctors for nothing. But with melanoma, being alarmist could save your life.

A sense of urgency

Not long ago, I made my will.

The next day, I was diagnosed with melanoma.

A superstitious person would probably link the two, but of course it was just a coincidence.

What was odd was why I was making my will in the first place. I felt driven to do it – literally driven – by a not-to-be-denied push to get things sorted.

It  had started on a weekend a few weeks earlier. I got out of bed, full of energy, fuelled by a determination to get things straight. I went through my desk. I started hauling stuff out of cupboards. I threw out clothes and papers. Two full bin bags later, I felt relieved. The clean up had begun.

And it went on like that, weekend after weekend. I just moved through the house, room by room, emptying drawers, filling bins, throwing things away.

After that it was other things I was determined to check off, things that can so easily be put off because of busy-ness, or the pressure of work. Little things like … having a skin check.

I went for the skin check, and here I am – still alive. The melanoma was spotted before it got to my lymph nodes.

I have no idea where that mad urge to put things straight came from.

But I know it probably saved my life.

If you get a similar urge, please pay attention to it. It doesn’t matter where it comes from, or why.

But acting on it could save your life.

The final countdown

When I was told I was dying, I did not cry. I did shed a few tears on the walk to my car, as I tried to adjust to a completely altered reality. And later – telling people, saying the words – I cried then.

But a tremendous calm seems to settle as well. Small anxieties just drop away. Problems at work – well, they are not yours to worry about any more. Hideous traffic – not something to stress about for too much longer either. All the little niggles of everyday life, and all the bigger problems – climate change, war, the appallingness of Australian political life – just melt away. They don’t seem to matter.

Of course there is the horrible, ever-present issue of impending death, but I never feared death half so much as I dreaded incapacity, invasive testing, and loss of autonomy. I also dreaded the clinical trial drugs with their  inevitable side effects and dubious efficacy.

And I dreaded the pain of people I would leave behind.

But I never saw myself as someone who would ‘rage, rage against the dying of the light‘. Perhaps I might have, had my ordeal gone on much longer, had I had to contend with drugs and pain and illness. Sickness can make cowards of us all.

But when I stumbled across them by accident two years ago, I was very touched, to the point of weeping, by the thoughts of Charles Brooks, a man long dead. His words seem to embody some of the eerie calm I felt in coming to grips with my death sentence. They also express the seemingly paradoxical gratitude I felt in knowing how long I had left to prepare for the end.

On 9 October, 1689, Charles Brooks was tried and convicted  at the Old Bailey for stealing silver. Only two short weeks separated his conviction from his execution. It was his last words, at Tyburn, his place of execution, on 23 October, 1689 that resonated for me. He said:

However, I abundantly thank my Maker, That he has let me know the number of my days, even to the hour of my Departure: For Death, many times, comes like a Thief, when Man least expects it … 

Not everyone gets the chance – the luxury – of preparing for death.

Some lives go out like a match.

Still beating

Being ill is really a full-time job.

Since being diagnosed with melanoma, I have been busy day in, day out, just keeping on top of doctors’ visits, wound re-dressings, scans, tests, tests and more tests. The constant schedule checking forced me to buy my first paper diary in years.

I am not a Luddite. I use an electronic scheduler for work, and rely on it totally. But when you are at home trying to organise test times over the phone (I have heard lots of ‘on hold’ music lately; it’s uniformly awful) you need a physical diary. You need to see the empty slots.

Into one of those vacant spaces I pencilled in time for a cleaner. With my injured arm hors de combat, and likely to be so for at least three more weeks, I have been told not to pick up so much as a frypan. So it was time to call in a professional. Nothing makes being out of action worse than seeing dirt and mess spread like a fungus.  A clean, tidy house really lifts your mood. So thank you Houseproud in Fairfield. You made my day.

I had a cardiac echo today to check for pulmonary hypertension. I heard my heart beat strongly, which is good, but I am not sure the news will be good. I have been short of breath quite often lately, and I do have a dodgy valve on my pulmonary artery. Still, I might not have got it checked without all the relentless testing I have undergone post-melanoma, so maybe that is one good outcome of what has been a trip into  hell.

I have days of tests ahead as I try to rebuild my health but I got back to work yesterday – something I thought I would never have to do. It felt good.

Every day above ground is a good day.

Long term investments

Just before I got my melanoma, I planted some asparagus seedlings. From planting seedlings to harvesting the first spears generally takes around four years. So it was an investment in the future, in my garden, in my life in this house. When I thought I was dying, I felt incredibly cheated that I might not get to eat the first spears. A small thing to worry about in the face of death, perhaps, but all the same, I minded.

When you make a long-time commitment, you want to be around for the pay-off.

And it can be amazingly rewarding when you do get a return on something, even if it takes years and years and years.

When I was 17, I began a double degree in French. Not what would be considered a really useful degree in these relentlessly vocational days, but I enjoyed studying it, mastering the language, and learning about the culture. I learned that you can express things in French that can’t be expressed in English, at least not exactly. I started reading Proust in French, and found it as tedious and long-winded as I eventually found it in the English translation. But it was wonderful to read other writers like Camus and Simone de Beauvoir in French – to read the words as they wrote them, not filtered through the mind of a translator, however gifted.

I used my French very little over the years, except for brief forays to Paris when I lived across the water in London.

But in 2006 I went to Paris for a longer stay. Having already done all the tourist stuff, I just walked and wandered and finally all that study kicked in. Streets would be named for authors I’d read, or for public figures whose lives I had studied. I knew the history of the place. Paintings of obscure, mainly forgotten celebrities of their day spoke to me. Probably the high point was in the Musee Carnavelet where I walked through the rooms where Madame de Sevigne (who lived in the time of the Sun King, Louis XIV) had lived and written some of her letters. I had read all her letters, some many times, and I began to speak to one of the museum guards (in French). We had the room to ourselves and I think she was surprised to meet such an enthusiast. We talked for quite a while, and then she opened a cabinet and took out some of the original letters, written in the Marquise’s own hand. She let me see them. What a gift.

It made me realise it is important to do what you love. I loved French. I still do. I like speaking it, hearing it, deciphering it. It took 30 years for my degree to really reward me, but it did reward me, in quite unexpected ways, like seeing and touching those centuries old letters.

Who we are sorry for

When I thought I was dying, huge waves of sympathy and sorrow (humbling amounts; did I really deserve it?) came my way from friends and co-workers and family. Had I died, I am sure there would have been a lot more.

But it got me thinking – is it the dead we should pity? Or the living?

For the dead, the race is run. Whatever pain, illness, or suffering they endure on the way to death will be erased – completely – once they draw their last breaths.

We came from nothingness. We go to nothingness.

But the living have to go on, even as they grieve, and mourn, and try to accept what they have lost.

As John Donne said in No Man is an Island: ‘Any man’s death diminishes me.’

When we lose someone we love, we lose part of ourselves. Their memory of us, of who we are, and were, vanishes from the earth. Anyone who has ever moved to a new town, a new country, knows how diminishing it is to lose the reflection of ourselves we enjoy in the eyes of the people who care for us.

When my children were small, I sometimes read a picture book to them – Badger’s Parting Gifts, by Susan Varley. I never got through it without weeping; finally I had to stop reading it altogether. I always seemed to break down at the same spot – not at the death of Badger, sad as that was, but at the part where spring has come around again and Badger’s animal friends are finally able to remember him without pain. There is a picture of a fox on a hill, sad but brave, and what touched me most is the tentative, tremulous nature of the hope in the fox’s eyes – hope leavened by grief, pain and loss, but hope all the same.

The living are like that fox – stitching their broken selves back together after the battering of loss and grief, facing an uncertain future with fragile but genuine courage.

They deserve our pity and our support.