Multimedia: A Season in Hell

Marilyn French Virago Press, £15.99, pp 288 ISBN 1 86049 447 1 ——————— Rating: ★★ This is a remarkable true story. In 1992 Marilyn French, best selling author of The Women’s Room, was found to have inoperable squamous carcinoma of the intrathoracic oesophagus, presenting with metastatic supraclavicular nodes. She was told that even with localised disease and intensive treatment the chance of surviving five years was less than 1 in 5 and that metastatic disease meant terminal illness. Although espousing truth and assertiveness in her everyday life, she chose to disregard these figures and decided that she would invent a personal chance of 1 in 4. Five years on and in complete remission, she gives her account of treatment with fluorouracil, cisplatin, and radical radiotherapy and its consequences. I found this a gripping read and enjoyed trying to piece together what really happened and why, and to anticipate the side effects of treatment as the patient began to notice symptoms. There was a “full house” of acute complications—nausea, mouth ulcers, diarrhoea, neutropenic sepsis, paraesthesia—although when they occurred they seemed to take her medical attendants by surprise. Some mysteries I could not solve: why for instance was she in the intensive care unit for two weeks in a coma? The fragmented nature of transatlantic care is well illustrated: no one provided overall direction and support, each problem was offered to the appropriate specialist and, when she finally reached the end of her tether in clinic and became impatient and angry, the psychiatrist. The patient herself organised her referrals to over 50 doctors for treatment and second opinion, as well as to alternative practitioners for acupuncture and visualisation, and to nurses and physiotherapists. Holistic care depended on advice from her family and friends rather than from the establishment. Although they generally did the right thing, most of the medical staff emerge from this account as dogmatic, abrupt, and apparently uncaring. They remained aloof and impersonal, and, because they wished to avoid raising false hopes, were generally gloomy and unwilling even to share her pleasure at the good response to treatment. Was it all worth it? At present she is a chronic invalid with painful osteoporotic fractures, oesophageal stricture, cerebellar degeneration, diabetes, and kidney stones, spending $1500 a month on drugs and physical treatments, and is by no means an advocate of life at any cost. The final chapter places her experience in context—she feels that response to treatment is a matter of luck and shrugs off the “miracle patient” label. She is eloquent in her description of living for the moment rather than for a delusional and unattainable future ideal. It is a pleasure to read her description of the “plateau of serenity” she has reached, and I hope that this continues.