The Green Mile, Stephen King has taught us, is the last hallway the condemned must walk, from Death Row to the electric chair. For some, it is a place of despair, of anger, of desperate bargaining, and of failing hope. For some it is an opportunity for quiet reflection. For a very few, it is the anteroom of reprieve.
This is the Yellow Mile. It connects the Cancer Center, where doctors and patients huddle and scrum, with the Infusion Room, where toxic fluids are administered to the hopeful and the hopeless alike, while they wait for their pardons to come through. The end is dark with doubt, and green with promise. Though surrounded by family and friends, down this hallway patients walk alone.
The artwork, donated by well-meaning artists and meant to brighten it, is mercifully awful. It provides no distraction to slow one’s passage, is seldom noticed, and it will not be missed. Yet those who walk here must traverse the bustle of the lobby, pass the gift shop filled with colorful plush toys and shiny Mylar balloons, and skirt the lusty, fragrant florist. At the little bistro where lattes are served with sweet pastries, loved ones and caretakers lean in across glass tables, sharing ironies and intimacies too terrible to contemplate. Along with the pools of warm sunshine that punctuate this dark hallway, these islands of vitality are cruel reminders to the stricken of what they may soon leave behind.
When I began my medical journey in the ‘70s, most who trod such hallways did not survive for long. We often told them, trying to keep hope alive, that though our treatments were imperfect then, if they could just stay alive, much better ones would follow soon from research hospitals around the world. Sometimes they believed us. Sometimes they saw through our subterfuge, but were grateful that we offered them our faith in science as a source of hope. Some railed at our solicitude, and died in a paroxysm of spiritual agony. A few found inner peace. In any case, fewer than 15% survived for long.
Today, so much has changed. That promise that once rang hollow is coming true. Almost three quarters of those diagnosed with invasive cancers today continue their fruitful lives, their cancers subdued or vanquished. There are few of us whom cancer has not touched in one way or another. The cancer survivor is no longer a rarity.
A better understanding of our bodies’ own tumor defenses have given rise to immunotherapies, like the checkpoint blockade techniques, that have brought many back from the brink. Vaccines are under development that will enable the immune system to recognize proteins occurring only in the tumor, allowing it to attack the cancer preferentially, while leaving healthy cells alone.
The rapid advances in genetic chemistry, from gene knockout techniques to CRISPR, have opened the possibilities of treatments that attack specific tumor cells directly, minimizing collateral damage to healthy cells. Some of these, like the remarkable CAR-T techniques, may leave clones of immune cells behind that seek out and destroy recurrent tumor for years, even a lifetime.
Each year now brings surprising revelations, just as we hoped it would. Discoveries break faster than the ways of traditional medicine can accommodate them. Who can guess what the future will bring?
The gloom at the end of the Yellow Mile is beginning to dissipate. There is light at the end of the tunnel.