请不要耍花招

What does it mean to treat a disease? The simplest sense is to restore normal health, “修复”错误的东西, to make the disease go away and not come back, as if it had never been present at all. Sometimes medicine can do that; applying effective antibiotics against an uncomplicated infection produces eradication, and if the antibiotic has exerted no side effect, 我和以前差不多, save poorer for the cost of the prescription. I am certainly healthier after treatment than I was while the infection raged. 我已经痊愈了. I am better.

What we mean by “better” can vary, though. We are usually satisfied if treatment takes care of the immediate problem even if it leaves some residual, even permanent, change. I go to the emergency department with severe lower abdominal pain, vomiting, and a fever. My appendix has nearly burst, but I have come in time. A skilled surgeon removes my sick appendix, relieving me not only of the discomfort but the threat of serious, 甚至危及生命, complications. After healing, I am left with a small scar defacing my once-pristine abdomen. I willingly embrace the trade-off, though, sacrificing my vanity for my health. I shouldn’t be wearing Speedos to the beach, anyway. 我又被治愈了. I am better, even if no longer quite the same.

Perhaps during my brief hospital stay the nurses find that my blood pressure has remained abnormally high even after all the stress of the acute appendicitis has resolved. The condition has not improved when I go to my outpatient health care provider. 调查后, she determines that I have primary hypertension and that I should begin taking medication to lower my blood pressure. I don’t smoke, 我保持着理想的体重, 我经常锻炼, so I lack a fixable cause that will return my blood pressure to normal when resolved. However, the medication works and I tolerate it well. Treatment lowers my related risks of heart attack, stroke, and kidney damage. I am better, but the hypertension will recur if I stubbornly refuse to take my medicine. I am not cured. 高血压并没有消失, 一切尽在掌握之中, in a similar way that a caged lion poses no immediate threat to those outside. Again, I am changed, but I prefer this change to leaving dangerous hypertension uncontrolled.

在之后的跟进中, however, testing discloses that the blood pressure medicine, still working well for its intended purpose, has produced an elevation in my triglycerides, a kind of fat. Either I must take a different drug, or I must now adjust my diet and perhaps take another medicine to combat the unwanted side effect of the first drug. My health care provider works diligently to reestablish an equilibrium, and the result is one more return to near-normal, but at a price—now I’m taking two medicines. Still, my health condition is treatable even if not curable.

这和癌症有什么关系? In oncology, we also deal with varying attainable goals. The best of all possible outcomes following a cancer diagnosis is cure, although with uncommon exception we will not know this for several years after treatment, and often must maintain vigilance against a later recurrence. Sometimes we can apply additional treatment to reduce the risk of cancer recurrence and stave off that recurrence for a long time. Sometimes we cannot get rid of the cancer, but available treatment can keep the disease under control for weeks or even years. Sometimes we cannot control the cancer at all, but we can apply various treatments to make its manifestations easier to bear, 至少在一段时间内是这样. All of these circumstances are “better.” Some, however, are better than others.

There is always something we can do. Even if the disease itself is past control, we can always treat the person afflicted by it. We can find a path to “better” by easing pain and other discomfort during the dying process. No tricks involved, just good medicine.