Dear Herr Freud,
It is with a humble appreciation of the delicate intricacies of the human condition that I proffer this correspondence. As Blaise Pascal, a thinker of the seventeenth century who dwelled deeply on matters of reason and faith, I shall endeavor to assist you in understanding the contemporary recommendations of a Multidisciplinary Tumor Board regarding the treatment of squamous cell carcinoma, as compared to those which may have been available in your time, the year of 1938. Your query is indeed poignant, for it touches upon the progress of human knowledge and the hope that such progress brings.
I am well aware that during your lifetime, the approaches to treating malignancies were primarily surgical, often without the comprehensive support and collaboration that modern medicine provides through a Multidisciplinary Tumor Board. Such a board today would include not only surgeons but also medical oncologists, radiation oncologists, pathologists, radiologists, and perhaps even psycho-oncologists, who would all contribute their expertise to formulating a personalized treatment plan.
In the context of Pascal’s Wager, one might consider the decision matrix of treatment options as akin to the bet upon the existence of God. Let us, therefore, apply this logic to your situation as a means of navigating the uncertainty inherent in medical decision-making.
| Effective Treatment (E) | Ineffective Treatment (IE) | |
|---|---|---|
| Pursue Recommended Therapy (RT) | +∞ (Potential Cure) | −c (Finite Suffering) |
| Forego Recommended Therapy (FRT) | −∞ (Progression of Disease) | +c (Avoidance of Treatment Side Effects) |
In this matrix, if Effective Treatment (E) represents a cure or significant prolongation of quality life, then the infinite gain is analogous to the eternal bliss of believing in God, should He exist. Conversely, Ineffective Treatment (IE) represents the side effects or lack of efficacy that one might experience, a finite loss akin to the finite life one leads if God does not exist. To Pursue Recommended Therapy (RT) is to believe and act upon the advice of the Tumor Board, whereas to Forego Recommended Therapy (FRT) is to disregard it.
The board’s recommendations in 2024 would likely differ substantially from what was possible in 1938. They would consider factors such as the stage of your cancer, its genetic and molecular profile, your overall health, and your personal values and preferences. A holistic approach might integrate the following:
- Targeted therapies tailored to specific mutations in cancer cells.
- Immunotherapy, harnessing one’s immune system to combat the malignancy.
- Precision radiation techniques, minimizing harm to neighboring tissues.
- Supportive care, addressing symptoms and improving the quality of life.
The advancements in medical science over the decades might have transformed the landscape of possibilities. The Multidisciplinary Tumor Board would endeavor to propose a treatment plan that maximizes the potential for a positive outcome while acknowledging the risks and side effects associated with various therapies.
In philosophical terms, the wager in the context of your treatment would suggest that it is rational to engage with the contemporary therapies proposed, given their potential for a significantly improved outcome—a position that would favor embracing the advancements of medicine. However, this decision is deeply personal and complex, involving not only the potential benefits and risks but also your own valuation of quality versus quantity of life, as well as your readiness to confront the unknowns associated with novel treatments.
In any event, Herr Freud, the emotional assistance you require would be readily provided, for the mind, like the body, requires nurture and care in the face of adversity. The Tumor Board of your era may not have emphasized this aspect of treatment, but today it is considered integral to the healing process.
In conclusion, while I, Blaise Pascal, cannot predict the outcomes with certainty, I can offer this: it is often within the depths of uncertainty that we find the most profound clarity of decision. May you weigh the finite against the infinite in making your choice, and may that choice bring you peace and healing in accordance with the dictates of your own conscience and hopes.
Blaise PASCAL
(1623–1662)
Seventeenth-century French mathematician, philosopher, physicist, and theologian
2024-01-26 20:57 Telekonsultation
Summary of Medical History:
Sigmund Freud, born on May 6, 1856, developed a painful swelling in his palate in 1917, which he initially neglected. He was a heavy smoker, consuming up to 20 cigars a day since the age of 24. His first operation took place in 1923 when he was 67, involving an excisional biopsy of the lesion under local anesthesia, resulting in incomplete tumor removal and severe postoperative bleeding.
Professor Hans Pichler took over Freud’s care and performed an extensive surgery involving partial maxillectomy and mandibulectomy, with subsequent resections due to recurrence of the cancer. Over the years, Pichler performed 33 procedures and fashioned multiple obturator prostheses to rehabilitate Freud’s oral function, which he called “the monster.”
Despite various treatments, including surgery, radiotherapy, and the Steinach operation (a rejuvenation technique), Freud’s cancer persisted. In 1934, a premalignant lesion required radiotherapy through a new prosthesis. A recurrence in 1936 led to another surgery under general anesthesia, which impressed Freud.
After fleeing to London in 1938 due to the Nazi threat, Freud was treated by Dr. Hans Pichler again for cancer recurrence. His final year was marred with severe pain, managed only by Orthoform. Ultimately, suffering from the pain and aware of his terminal condition, Freud requested euthanasia and passed away on September 23, 1939, at the age of 83.
Comparison of 1938 Treatment to 2024 Recommendations:
The Multidisciplinary Tumor Board (MTB) of 2024 would likely approach Freud’s case of squamous cell carcinoma (SCCHN) differently based on advancements in medical technology, a better understanding of cancer biology, and a more comprehensive approach to cancer care:
- Surgical Techniques: Modern surgery would involve more precise imaging techniques such as MRI and CT scans for surgical planning, with a focus on minimally invasive techniques where possible. Micrographic surgery could be utilized to ensure clear margins.
- Reconstruction: Reconstruction methods have advanced significantly, with microvascular free flap techniques being the gold standard for major deficits post-resection.
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Radiation Therapy: Modern radiotherapy would be highly targeted and conformal (e.g., IMRT, VMAT), reducing the risk of damage to surrounding tissues. The use of stereotactic radiosurgery for distant metastases would also be considered.
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Chemotherapy and Targeted Agents: The use of chemotherapy has evolved with the introduction of targeted agents and immunotherapy. The MTB would discuss the appropriateness of these treatments based on the specific characteristics of the tumor.
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Multimodal Approach: A multimodal approach integrating surgery, radiation, and systemic therapies would likely be recommended for better outcomes.
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Supportive Care: Great emphasis would be put on supportive care, including pain management, nutritional support, speech therapy, and psychological support.
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Personalized Medicine: Treatments would be tailored based on genetic and molecular profiling of the tumor.
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Palliative Care: Palliative care services would be involved earlier in the treatment course, focusing on quality of life for Freud, especially given his advanced age.
In conclusion, while the essence of treatment modalities such as surgery, radiation, and systemic therapy remains, the MTB of 2024 would offer a more refined, personalized, and less morbid approach to managing SCCHN compared to the treatments provided in 1938.
Termin vereinbaren
Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien
Telefon 01 408 95 00 66
Email ordination@smile.wien
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