Renal Cell Live!

Wednesday, June 27, 2007

Skylla and Charybdis

In Homer's Odyssey, upon reaching the cliffs of the two rocks called the Rovers, Odysseus faced the difficult choice of losing 6 men to the howling terror, Skylla, or his entire company to the fierce whirlpool, Charybdis. Given these choices and following the counsel of the goddess Circe, Odysseus sailed close to Skylla. Six of his company were thus sacrificed in the interest of the whole group.

I think this is the perfect description of the balance we face between dosages and side effects on the one hand, and disease progression on the other. Do I pursue the maximum dosage for maximum benefits, only to succumb to side effects? Do I achieve the level of side effects I'm comfortable with, only to lose the medication's effectiveness? I'm once again living in anticipation of my scans 3 weeks hence, to see if the lower dose we've settled on to avoid side effects can in fact maintain the stability I've enjoyed for the last 18 months. For the past month I've been able to travel and enjoy something close to life pre-1997, and it's pretty darned pleasant. But in the back of my mind is always the fear that this quarter dose isn't enough, and that my period of stability will end. If I do see disease progression, what do we do next - increase the dosage and suffer the side effects, or move to a different drug?

Odysseus questioned Circe's wisdom, seeking in some fashion to avoid Charybdis yet deny Skylla her prey. Circe's response began, "Hardy man, your mind is full forever of fighting and battle work. Will you not give way even to the immortals?"*

There is an inevitability to all our doings here. Life is one long progression of choices to be made, balancing the negatives against the positives. In all cases, I think, better Skylla than Charybdis; but only after making an informed choice.

*Odyssey of Homer, trans. Richmond Lattimore, Harper & Row (1977 repr)



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