Life, on the Line by Grant Achatz (book club reads .txt) 📕

meant, are you feeling different or unusually unwell compared to how you were feeling, say, a week ago?”

“No. I just didn’t really see the point of coming.”

“Well, let us be the judge of that. I think you might be surprised. So, then. Open your mouth as wide as possible. This will not feel great but I will take care.”

Dr. Vokes gently pulled the tip of my tongue out and over to get a good look. The pain was excruciating, but he acted slowly and methodically. In a minute he was done.

“Well, it is as they said. You have a late-stage cancer in your tongue and probably in the lymph nodes on the side of your neck. I will have to see the scans to know more, but I can tell you a little bit about what we do here.”

Dr. Vokes went on to explain that while the standard of treatment over the last twenty years put surgery first, the clinical trial under their guidance had reversed the process, putting chemotherapy first.

“We intend to shrink the tumor with a series of chemotherapies, including the use of cetuximab followed by aggressive targeted radiation. Our goal is not just the eradication of the tumor, but limiting the occurrence of metastasizing after eradication of the localized area and overall preservation of the organ whenever possible.”

“That sounds like you’re saying that you don’t want to cut off my tongue,” I said.

“Indeed. I most definitely do not wish to cut out your tongue. We try to balance quality of life with preservation of life. The two should go hand in hand. But if the treatment is not working then certainly we will look to surgery as an option to save your life. We do not sacrifice one for the other. But I also believe that we do not have to. Our method works better and saves more lives while saving organs.”

This was unbelievable to hear. No other doctor had even considered this, and yet it made so much sense to me. I looked over at Nick.

“My father-in-law is a patent lawyer who does a lot of pharma work and he steered me towards Erbitux,” Nick said. “In his words, ‘when it works, it really works’ and . . .ʺ

Dr. Vokes interrupted Nick, “Yes, that’s right. When it is effective in an individual, for whatever reason, it significantly reduces the size and scope of the tumors.”

“So, in reading everything,” Nick skipped ahead, “the argument against doing this type of protocol is that it turns the tissue to mush, not the technical term, and if the tumor remains the necessary surgery becomes difficult or, well, really difficult.”

“Yes, that is true. But we have a great team here and we do a very targeted radiation to try to preserve as much of the surrounding tissue as possible. It could very well be that Grant is not responsive to the treatment, in which case we revert to a standard treatment. But a majority of people are responsive and the resulting surgery, if any, is less than it would have been, which preserves the organ.”

“And your survival rates?” Nick asked.

“Unpublished at this point, but we are nearly inverting the previous rates.”

Nick was beaming.

“So why is it that everyone everywhere else we’ve been has told us the opposite? Why is it that you’re the only ones embracing this?”

Clearly this made Dr. Vokes a bit uncomfortable, like he knew the answer but didn’t want to be so blunt. Thankfully, two other members of his team—the surgeon, Dr. Elizabeth Blair, and the radiation oncologist, Dr. Daniel Haraf—had entered the room.

“Someone needs to be the smartest guy in the room, I guess,” said Dr. Haraf.

We all laughed at that.

Dr. Blair explained that unlike many surgeons, she believed that the ideal situation was one where she never had to operate on a patient. Sure, she wouldn’t publish new techniques, but her patients would be alive. Dr. Haraf had a morbid sense of humor as he described the radiation protocol. “Basically, we target it exactly to the spot of the tumor using a computer model of your head in 3D. That said, I’m the guy that makes you so sick that you’ll want to die. But ideally you won’t.”

I instantly liked the team. It’s hard to describe. It’s not just that they were saying what I wanted to hear—that I had a chance of living and that if I lived I would keep my tongue—but that they embraced the idea of doing something new, something different, something better.

“You know, I’ve been waiting to hear this, and now I’m a bit wary. We named our restaurant ‘Alinea,’ which means a ‘new train of thought.’ We strive for new and better and different. And still, I’m thinking that you guys are either really smart or really crazy.”

“Let’s hope smart,” Haraf said. “But there is nothing wrong with a little crazy, too.”

The doctors left for a few minutes so we could talk it over and see if we had any questions. The most amazing part was that because it was a clinical trial, the university paid for any nonstandard treatment. The only toss-up was the double-blind study regarding the amount of radiation and whether or not it was inpatient with a three-week stay in the hospital, or outpatient and five days per week.

“What do you think?” I asked Nick. “I can’t see a reason not to do this. What choice do I have?”

“I think we’re home, Grant. These are good people.”

CHAPTER 24

Chef Keller reached out to me and asked if it was a good idea to throw a party for Grant and a few close friends. “A blowout dinner somewhere.”

Of course, his heart was in the right place. He had called Grant several times, and I knew that Grant was downplaying the gravity of the situation. I wrestled with what to do. Should I e-mail chef Keller and tell him the whole story? Or would that be betraying a trust I had with Grant? Ultimately I decided to