Alien Metamorphosis

Gregoria S. was not always an Alien.  Once she was a person much like you and me.  She loved her husband, raised her children, went to church and worked hard.  You might have called her “friend.”  Gregoria was still a human being when she got cancer; she was changed.

At first Gregoria’s prognosis seemed fine.  She received surgery and radiation, and because the cancer was so small, nothing else.  Two years later the few horrid cells hiding in bones expanded until a vertebrae fractured and collapsed and she had terrible pain and we gave radiation and then it was time to treat not just her back, but her whole.

Drugs, medicine, systemic chemotherapy.  Chemicals would reach every corner and kill the vicious tentacles of the dread disease.  Toxins to breakdown and wilt cancer.   The deviant genes which caused malignancy growth, the zombie spindle strands which delicately spread the cancerous cells, the submicroscopic metabolic fires which fed the monster, all would be distorted, disrupted, corrupted, destroyed.

Gregoria would have no 21rst century alchemy.  She refused the mystical pharma attraction and did not pour bizarre concoctions into the trembling temple of her body.  “The patient refuses chemotherapy.”

The cancer spread.  Pain flourished and grew loud, and despite all desire to remain a healthy specimen, she got worse.  Finally, trapped, desperate, Gregoria extended a vein and on a fresh, sunny, spring morning, when life is reborn, we started the poison.

Looking back over years of her serial toxic rainbow, I realize that I missed the awakening of Gregoria’s metamorphosis.  Not that I was unable, or made mistakes.  Gemcitabine, doxorubicin HCL liposome, capcitabine, paclitaxel protein-bound microparticles, vinorelbine tartrate, ixabepiline; all delivered with skill.  A modern succession of witches’ brews.  Each bruising the beast, improving pain, shrinking masses, extending survival.

No, I did a perfect job watching Gregoria’s body and supporting her mind.   Simply, the transformation did not appear on any blood test, CT or MRI, or on the most careful exams.  Thus, I missed the moment or the times or the place of the transmutation when Gregoria was no longer Gregoria.  In fact, I did not see at all that she was no longer human.

I guess it makes sense. Arms and legs waste until they are thin, weak and shake from cachexia and neuropathy.  Body unwieldy and bloated by steroids. So very difficult to even roll out of bed and gather the strength to open the bedroom door. Appetite changed as familiar tastes vanish.  The mind, assaulted by an unknown future, isolated from normalcy and from the experience of life itself, trapped in a mutant shell.

This morning Gregoria was in a particularly good mood.  Recent changes in her therapy have gone well.  Her pain is slight, appetite good, breathing fine and she has energy.  We were not having a particularly deep conversation, so I am not clear why she picked today to confess.  Maybe she sensed it might be the last chance to understand her words. Gregoria took my hand, looked into my eyes, grimaced gently and said,

“I am an Alien.”

“I don’t understand.  You feel like an Alien?”

“No. I do not just feel like an Alien.  I mean that I have always been different, my whole life. But, now I am no longer a person.  I am an Alien.”

“What makes you believe that?”

“I know its true. It know it, because only an Alien needs poison to live. A person needs food, warmth and love.  But, an Alien lives on toxin and poison.”

“Are you upset?  Are you frightened?”

“No, I’m OK.  It’s OK to be an Alien. I just want you to understand that I am not a person anymore.”

Gregoria has been changed, in her body and soul, from person to a foreign and alien creature. As the red, yellow, black and crystal fluids flowed into her body, she was transformed not just by the physiology of therapy, but by the profound emotional experience of chemicals that soak her mind’s perception of body, week after month after year.

I have extended her life, but a strange creature, suckled on complex chemical toxins has emerged. The being that survives is alien to the pure person that began the cancer battle years ago and lives as if from a place apart, another world.  Gregoria has been disconnected or perhaps so distorted that she is no more. Consumed by the thought that her body must have lethal poisons to live, figurative acid running into her blood, Gregoria finds that she is not human.

In a nightmarish distortion of healing, Gregoria is reborn Alien.  With the time that remains in her life, will she be a person again?  Can I command therapy to reverse the ablative process?  If we canceled the medicines, would she be human, even as she died?  I do not know.  Gregoria does not want to stop therapy.  Aliens need poison to survive and having accepted that distorted sick role, she wants to live.  However, I remember, will always remember, Gregoria the Alien, when she was still one of us.


  • I have always considered being in 'cancerland' a strange place, but never to that extent, even if there is an element of truth.
    • James Salwitz, MD
      It certainly took me to a new place. jcs
  • Kathleen Denny
    Well-written, and perhaps will help docs better understand patients who refuse treatment. When my aunt was diagnosed with lung cancer at 80, she refused chemotherapy. In her last 4 years she did what she liked, big and small: she traveled to places she had always wanted to see, graciously received many, many visitors, took her granddaughter on shopping expeditions, enjoyed her view of the Rockies and deer, who munched her grass. And then she went into hospice and died. Not for one minute was she anyone but Marion.
    • James Salwitz, MD
      I think too few patients are told that chemotherapy is not absolutely necessary. jcs
  • Thank you Dr. Salwitz for communicating the so often avoided harsh reality of chemotherapy treatment of cancer. It is no wonder we gloss over or avoid entirely the picture you paint with words, but they need to be said. Your despair over what chemotherapy can take from a patient is palpable. I'm hoping to read your thoughts on the more natural approach of discovering ways to promote the body's immune system response to battling cancer cells called immunotherapy which is receiving newsworthy attention of late. I understand side effects are minimal compared to chemotherapy. Hallelujah! Godspeed to those working to bring this more humane therapy to fruition.
    • James Salwitz, MD
      The future of oncology will be to focus on the genetic injury in each cancer cell and to turn those oncogenes, off. This will no doubt be accompanied, as per your comment, with increasing use of the body's own natural defenses, the immune system, to kill malignancy. At the ASCO meetings this month a number of monoclonal anticancer antibodies were discussed. They are a vital part of a gentler and healthier future. It can't come fast enough for me. jcs
      • Immunotherapies and oncogene turn-off . . . complicated to a layman like myself, to say the least. I've a sister-in-law who, over the years, has gone from two surgeries for lung cancer to radiation and chemotherapy and now back to radiation. I envision a clinical trial dream-come- true treatment that turns off those oncogenes for her. It literally can't come fast enough for her.
        • James Salwitz, MD
          Amen, jcs
  • IBS
    I have read Gregoria's story regarding being an alien. In fact, I read it more than once. I feel she was an extremely religious person; thus not letting go. She felt she couldn't stop taking the posion because that was what she learned her entire life. For some reason, one or two days before one passes, it looks as if the patient is getting well. Perhaps that was the day she was trying to explain to you her feelings. She really did explain it wonderfully. Dr. S, there was nothing you could have done, and at the end, you did take most of her pain away. May she be wrapped in her loved one's arms when she was on her journey.
    • James Salwitz, MD
      I am intrigued by your observation that her statement may have come from a religious base. One might say she was using the word "alien", rather than the word "spirit." Very interesting idea. Thanks, jcs
  • Dr. Salwitz, I save your emails until I have time to read your essays, or until I need to MAKE time to read them. Your words never fail to evoke gratitude for the simplicity of my normal daily life, and awe for the work you do. Some doctors are double-boarded; you are double-gifted. I know first-hand how powerful, educational, and inspirational your words are. Your patients must feel the same way about you as doctor. This story was especially visceral and haunting. Thank you for making time to write and share what you learn. I hope your patients realize their stories will live on...especially Gregoria. PS If you ever compile your essays in a book, I will be one of the first to purchase it.
    • James Salwitz, MD
      Thank you very much for your generous thoughts. The battle continues. jcs

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