TRUE LOVE

Recently, I have been thinking a lot about love. No, this does not have anything to do with Valentine's Day last month. Rather, I recently saw the movie Amour and read the book Me Before You. Each of these works made me think about life and the lengths to which we are willing to go for the ones we love.

Amour won the Best Foreign Film this year and tells the story of an octogenarian French couple. Their lives are irrevocably altered when the wife suffers a devastating and progressive stroke. The husband assumes the role of caregiver while still somehow maintaining an intense love of his wife that far exceeds anything I have ever felt.  This comment is not meant to disparage my marriage. Rather, it speaks to the depth of this particular husband's devotion.  He is willing to do anything for his wife, and one cannot help but hope for him to succeed. Depending on one's perspective, he does.

Last night I finished reading another incredibly moving work about love despite illness - this time a debilitating spinal cord injury. That book was called Me Before You. The main character Louisa Clark, is a young woman, who has been hired to care for a quadriplegic man named William Traynor. Before Will met Louisa, he was a playboy, a world traveler, a successful business - i.e. someone who lived big! All of that ended when he was hit by a motorcycle and rendered immobile and wholly dependent on others.

Before Louisa met Will, she was a waitress in a small town in the English countryside - Will's hometown. Louisa had never left England, was in an unfulfilling long-term relationship, and lived in a crowded house with her parents, sister, and her sister's illegitimate son.  However, her world view changes dramatically once she accepts a position as Will's caretaker.  In fact, one could draw a line marking Louisa's awakening, and that line was drawn by Will.

I will not give away the endings to these two exceptional works of art, but I will encourage you to see and read them for yourself. After experiencing these stories, you will come away affected. You will have a greater sense of how life and our loved ones are gifts to be treasured. You will think about your life in pre-Amour and pre-Me Before You terms. If we are lucky, the lessons we learn from these works will not be fleeting. I hope these lessons remain for a long while....

BIOGRAPHY BALL

Last week, we attended the Biography Ball at Nicholas' school. What is the Biography Ball, you ask? Every two years, members of the Junior Class (second and third graders) get to chose a historical figure to be for the day.  The students read books on their person of choice, write a brief report about the person without revealing his/her identity, and dress up as their person on the day of the Biography Ball. On that day, the parents come in to class and try to guess the identity of the other 19 or so characters. Nicholas chose Benjamin Banneker for his character.

I had never heard of Mr. Banneker until the Biography Ball, but I will share a few facts about him courtesy of Nicholas. Mr. Banneker was a free black man born in the 18th Century near Baltimore.  He was a tinkerer and is called by many the "first African-American scientist."

Reportedly, Mr. Banneker once took apart a watch. After studying the inner workings, he is said to have designed his own watch. He also wrote an almanac on an annual basis that contained a variety of unique and important facts and observations.

Finally, Mr. Banneker was also known for his principled opposition to slavery. He once wrote a letter to then Secretary of State Thomas Jefferson. In that letter, Banneker asked Jefferson how he rectified writing "all men are created equal" in the Declaration of Independence with the fact that many people in America, Jefferson included, owned slaves. Jefferson did not have a good answer in his reply to Banneker. Nicholas astutely wrote in his report of Jefferson's hypocrisy - "when you say one thing but then do the opposite."

At the Ball, I managed to guess the identity of the figures for all but one child - the composer Edvard Grieg. Like "Edvard," Nicholas stumped everyone.

Until that day none of the parents had heard of Benjamin Banneker. However, I have a feeling that all of us will remember this man after Nicholas brought him to life in writing and in pottery in the Design Study Class.

Here's to Nicholas and here's to Benjamin Banneker!

MISSION ACCOMPLISHED

Today, Barcelona accomplished what no other European team has ever achieved - a comeback after losing the first leg of a Champions' League series 2-0.

Words are not sufficient to describe what these players - especially Messi - accomplished today. I will let these videos of their 4 magisterial goals speak for themselves.

Enjoy! I know I did!

LA REMONTADA

The title translates to the recovery or the comeback. This is the term the Barca press, team, and fans have given to their next match - the return leg of the quarterfinals of Europe's top club soccer competition, the Champions' League.  And a recovery is what Barca needs if they are to stay alive in this competition.

We will not dwell on how Barca got into this mess (see the last few posts for that). Rather, we will hope that the last two weeks of stinging defeats will somehow awaken the slumbering giant that is Barca.

The team must give their all (and then some) tomorrow if they are to get past a determined and capable AC Milan side.  We, the fans, can believe, and we can hope, but it is time for these players to weave another tapestry, orchestrate another symphony, paint another masterpiece. Feel free to add your own metaphor.

I have no doubt that Barca will rise to this occasion. Win or lose, the team must come out fighting. Barca must remember what they are capable of and who they are. To quote a famous Catalan slogan: Som i serem (We are, and we will be)!

The defender Gerard Piqué also had a message for the fans planning to attend the game tomorrow in Barca's home stadium - the Camp Nou- "We need 90,000 people who believe that we can get through this. Anyone who thinks that we can’t do it, please give your ticket to your children or friends.”

Barca's former coach Pep Guardiola said it best at his first press conference when he was announced as coach. I am paraphrasing here, but he said, "We do not promise to win football titles. We do promise to play football that will make you proud of us."

Well said maestros. La remontada es posible (the comeback is possible)! Ara, ens enorgulleix (now, make us proud)!

THE LAST GOODBYE

Today, I met with one of my dearest patients - Mr. D we will call him - for the last time.  His cancer was out of control, and I had run out of treatment options to slow it down or relieve his discomfort. Mr. D's visit and this news made both of us reflect on our four year journey together to combat his metastatic prostate cancer and how we had arrived to this spot.

In 2009, Mr. D first noticed back pain. He attributed this to moving some appliances and thought nothing of it. However, when the pain quickly escalated, he went to the emergency room. He expected to find a slipped disk or a pulled muscle. Instead, x-rays showed that his spine was riddled with lesions concerning for a cancer. His PSA blood test was sky high, and a biopsy confirmed prostate cancer.

I met him after he received surgery to his spine to prevent damage to the spinal cord, and I began to manage his prostate cancer with therapies that lower levels of male hormones.  We got two years out of that initial treatment, but then his cancer began to grow. We next tried additional hormonal therapies and then chemotherapy, which led to a remission. Unfortunately, that remission was short-lived and we moved on to a newer, more potent hormonal therapy. All the while, the patient was able to spend time with his friends and live a "near-normal" life.

He loved to fish on the Columbia River, and he often brought a cooler to clinic for me full of salmon or sturgeon. It was the best fish I have ever eaten, and I am not just saying that out of sentimentality; it was really that good.

In the past year, we went back to chemotherapy - this time at a reduced dose - and then a new hormonal agent. The benefits were limited, and the patient presented to the ER last month with new and severe back pain. The cancer was back and was threatening his spinal cord. If left unchecked, paralysis and loss of bowel/bladder control were certain. Although his cancer was advanced, I felt that the benefits of aggressive surgical intervention were worth the small risk of death during the procedure. His spine was stabilized, and his back symptoms did not worsen. He was released to a skilled nursing facility and recently made his way home to the Coast.

Today, I spoke to Mr. D about the crossroads we were at. Another form of chemotherapy could be tried. However, I expressed my concern that treatment might make him sick and feeling worse than he already felt. I explained that we had reached a point where medicine and treatments could not make his cancer go away but that I did not want to give up on making his symptoms go away. I told him that hospice was the best chance to help him feel as well as possible for as long as possible and that hospice would allow his family members to go back to being his family members rather than medical care providers. In essence, I told him that he was going to die and that there was nothing I could do to stop it.

I paused. He reflected. The silence was deafening. I waited for him to speak. He said that he got four great years with treatment, and he thanked me for everything that I had done for him. He said that he knew this day would come but that that knowledge did not make today any easier.

I told him that it was a privilege to be his doctor, that he and men like him are the reason why I come to work everyday, and that I would be with him for the entirety of his journey. We hugged and fought back the tears. I helped wheel him out of the room. It was clear what each of us had meant to the other. Then, we said our last goodbye.

MES QUE UN CLUB

Today, Sandro Rosell, the President of Barca, held a press conference and affirmed his loyalty to the current manager. That man Tito Villanova is pictured above, and Tito is currently on leave receiving cancer treatment. Since Tito's absence, the team has experienced a significant drop in form.

To put this drop in form in perspective, one must consider the team’s record prior to Tito’s medical leave to treat an aggressive form of recurrent salivary cancer and the team's record after Tito’s leave. In the first five months of the season, Barca had only lost two matches; they were on pace to set the record for all-time wins in a season in the Spanish League. In the past month, and more specifically in the past four games, Barca has lost three matches. They have been eliminated from the Spanish domestic cup competition, and they face elimination from Europe’s most coveted club trophy – the Champions’ League.

There have been many reasons for this drop in form, which I reviewed last time. Chief among them is the lack of a leader and the inadequacy of Villanova’s stand-in, his assistant coach Jordi Roura.

Many of us had hoped that the club would name an interim, more well-qualified manager until Tito returns. Indeed, there are a host of former Barca players or coaches who would have gladly and ably stepped into the breach. However, at today’s press conference Rosell made it clear that this was Villanova’s team and that no temporary or permanent replacement would be made unless it were clear that Tito could not return. Rosell went on to state that if Tito recovered but Barca lost every trophy, then this season would be considered a success. This was coming from the head of a club that has won 75% of the trophies they have been eligible to win in the past 4 years.

Any other club would have taken a different route and either replaced their manager or temporarily relieved him of his duties. Football is a business, and those clubs would have been within their rights to make such a move. However, for Barca, football is more than a business, and Barca has always been mes que un club – roughly translated from the Catalan into more than a club.

Barca represents not only the city of Barcelona and the province (or to some country) of Catalonia. Barca’s play on the field and the club’s conduct off the field represents fair play, decency, beauty, excellence, and above all justice. To usurp the authority of a man fighting cancer who led them to the greatest start in the club’s history would have been an insult to the man and to the club’s creed.

I cannot say I agree with this discussion as a Barca fan since the team has been utterly rudderless in the past month. I told myself that if the club were to regain its form under a new interim manager, surely Tito would be pleased. However, as an oncologist and as a human being, I stand by the President’s decision. Life is about more than winning and losing matches. Life is about leaving the world better than you found it. Life is about putting people ahead of profits and plaudits. Life is about leaving a legacy of which your children can be proud.

Mes que un club. What an understatement.

THE END OF AN ERA?

In the span of one week Barcelona's season seems to have unraveled.  During those seven days, the team lost two huge matches. The first loss was to AC Milan in the Champions' League, and the second was to Real Madrid, their arch-rival. The latter match eliminated Barca from the Spanish Cup competition.

To put things in perspective Barca had only lost three matches all year long until last week.This slip in form and the severity of the defeats have led many to wonder whether this is the end of Barca's reign as invincible.

It may be too soon to pass that judgement, but I do believe that the current style of play- 10 men in attack with only the goalkeeper to defend has passed its prime. The previous incarnations of Barca were attacking teams as well, but those teams' success started and ended with defense and an affection for the ball that bordered on patronly.

If your opponent does not have the ball, they cannot score. If you give the ball away and immediately retrieve it, your opponent cannot score. Those principles have deserted Barca this season. Even though Barca continues to dominate possession, they too easily surrender the ball and do not have the same urgency in taking it away from their opponents.There are several possible explanations for this slip in form.

First, their coach Tito Villanova has been away from the team for over one month undergoing treatment at Memorial-Sloan Kettering in New York City for a recurrent salivary tumor. The emotional toll of the loss of their leader who is battling such a serious and life-threatening condition should not be underestimated.  This Barca team more than any other club is like a family.

Second, the fill in coach, Villanova's assistant Jordi Roura, has been present in body only.  He lacks the skill or experience to manage the best club in the world against some of the best opponents in the world. The line-ups have not been chosen wisely. Substitutions have been poorly chosen or not made at all. There have been no tactical adjustments mid-match. As a result, the team's play has suffered. 

Finally, the team must be physically spent. They have played one match every three days for the past six months. I play one game per week, and often have discomfort for two to three days afterwords. I cannot imagine how taxing Barca's schedule must be - especially since Barca's competition is among the best in the world and since many of Barca's opponents commonly kick and abuse the Barca players.  None of these reasons are excuses for Barca's poor form, but they are explanations.

This brings me to the key question at hand:  is the Barca era - that has run for nearly four years - now over? It may be too soon to say, and it is almost comical that we are having this discussion since Barca sits 12 points above its nearest rival in the Spanish League and 16 points above its arch-rival Madrid. The League title seems like a forgone conclusion, but Barca has never been satisfied with one trophy per season. Anything less than winning all possible competitions - and winning with an attacking flourish - is viewed by players and fans alike as a disappointment.

I think we will know the answer to whether Barca's era of invincibility has come in the next two weeks.  If they can defeat Real Madrid this weekend with a convincing victory, then the jury will still be out. Moreover, if they can come back in the second game of their two game series against AC Milan and win by the necessary 3-0 scoreline, hope will be restored.

These victories will only be possible if Barca returns to its supernatural style of play- greedy possession of the ball, precision passing, and lethal exploitation of their rivals' mistakes. It will take focus, coaching, and shifting lineups to achieve this goal. Without these three elements - particularly without coaching - "success" for this club will not be possible. The Barca team is made up of many of the best players at their positions in the world, but these players are human. Despite what the pundits would have us believe, these players do not coach themselves, and these players break down. If one needs proof, one need look no further than the past seven days.

I am hoping and praying for a turnaround. Visca Barca, and we await your speedy recovery and return Tito!