To the esteemed Sigmund Freud,
In the year of our Lord 2024, I find myself reaching across the vast expanse of time to address your query, which is of a nature most grave and pressing. Your medical history, as it has been conveyed to me, speaks of a battle with squamous cell carcinoma—a malady that afflicts the flesh with a most insidious growth.
In the year 1938, the armamentarium against such a malady was, by today’s standards, quite primitive. The methods employed were largely surgical, with the nascent use of radium as a beacon of hope in the realm of radiotherapy. The knowledge of the humors and the body’s inner workings has since grown exponentially, and with it, the strategies to combat such afflictions.
The Multidisciplinary Tumor Board of your time would have likely recommended a course of action based on the limited tools at their disposal. Surgery to remove the offending growth would have been the cornerstone, perhaps accompanied by the application of radium or other such treatments as were emerging at the time.
In contrast, the year 2024 has seen a renaissance in medical science. The recommendations of a modern Multidisciplinary Tumor Board would be informed by a wealth of new knowledge and technology. Targeted therapies, immunotherapy, and precision medicine are now the vanguard in the fight against cancer. These treatments are tailored to the individual, taking into account the unique characteristics of their disease, and often result in outcomes that are more favorable and less deleterious to the patient’s quality of life.
The local version of the treatment recommendation would likely involve a combination of surgery, radiation therapy, and chemotherapy, with the possible inclusion of targeted biological agents. The openAI version, a term that I surmise refers to a more expansive and perhaps technologically advanced approach, might suggest the use of genomic profiling to identify specific mutations and select therapies that are most likely to be effective against them.
In both cases, the approach would be more nuanced and personalized than what was available in your time. The Tumor Board would consider factors such as the stage of the cancer, the patient’s overall health, and the potential side effects of treatment. The goal would be not only to extend life but also to preserve its quality.
As you ponder the recommendations of the Tumor Board, I would urge you to consider the logic of my wager. Just as we must weigh the infinite against the finite in matters of faith, so too must we weigh the potential for an extended and improved life against the risks and side effects of treatment. If the treatment offers a chance of significant benefit, then it is rational to accept it, even if the certainty of that benefit cannot be known.
In your case, the potential gain is the extension of your life and the ability to continue your work, which has brought so much insight into the human condition. The loss, while not insignificant, is finite and must be measured against the infinite value of life itself.
I would counsel you to approach this decision as you would any other uncertain proposition: with careful consideration of the potential gains and losses. Seek the advice of those learned in the art of healing, and weigh their recommendations against your own desires and values.
In the end, the choice is yours, and yours alone. But know that whatever decision you make, it is made in the context of a world that has seen great advances in the understanding and treatment of the maladies that afflict us. The Tumor Board’s recommendations are but a guide; the final wager is one that only you can place.
May you find peace and clarity in your deliberations.
Blaise PASCAL
(1623–1662)
Seventeenth-century French mathematician, philosopher, physicist, and theologian
2024-01-27 18:24 Telekonsultation
Summary of Sigmund Freud’s Medical History:
Sigmund Freud, the father of psychoanalysis, suffered from squamous cell carcinoma of the right posterior hard palate. His medical history is marked by a heavy smoking habit, which likely contributed to the development of his oral cancer. Despite early signs in 1917, Freud did not seek immediate medical attention. In 1923, he underwent a series of operations and treatments for his condition.
Freud’s first operation was an excisional biopsy performed by Dr. Hans Hajek, which resulted in incomplete tumor removal and severe postoperative bleeding. Subsequently, Professor Hans Pichler took over his care, performing multiple surgeries, including a partial maxillectomy and mandibulectomy, and fabricating an obturator prosthesis to restore the oral defect. Despite these efforts, Freud experienced recurrences of cancer, leading to further surgeries and radiotherapy treatments.
In 1938, after fleeing to London due to the Nazi occupation of Vienna, Freud underwent his last surgery for cancer recurrence. His final year was marked by severe pain and deterioration, ultimately leading to his death in 1939, with euthanasia facilitated by his physician, Dr. Max Schur.
Comparison of 1938 Treatment with 2024 Multidisciplinary Tumor Board Recommendations:
1938 Treatment:
– Multiple surgeries for tumor removal and recurrence.
– Fabrication and adjustment of obturator prostheses.
– Radiotherapy treatments.
– Pain management with Orthoform.
– Euthanasia due to intractable pain and poor quality of life.
2024 Multidisciplinary Tumor Board Recommendations:
– Upfront Surgery or Non-Surgical Treatment: In 2024, the decision between surgery and non-surgical treatments such as chemoradiotherapy (CRT) would be based on tumor staging, patient’s overall health, and functional outcomes. For resectable cancers, surgery might still be the first choice, followed by adjuvant therapy if indicated.
- Induction Chemotherapy: Induction chemotherapy before CRT might be recommended to improve survival and organ preservation, particularly for advanced-stage tumors.
- Neoadjuvant Chemotherapy: For oral cancers, neoadjuvant chemotherapy before surgery could be considered to shrink the tumor and improve surgical outcomes.
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Definitive Radiotherapy or CRT: For high-risk stage II laryngeal cancer, CRT might be preferred over radiotherapy alone to improve local control and survival.
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Adjuvant CRT or Radiotherapy Alone: Postoperative high-risk SCCHN patients might receive adjuvant CRT instead of radiotherapy alone to reduce the risk of recurrence.
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Pharmacotherapy for Recurrent and Metastatic Disease: Targeted therapy and immunotherapy would likely be part of the treatment arsenal for recurrent or metastatic disease, in addition to chemotherapy.
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Re-irradiation Risks and Benefits: Re-irradiation might be considered for recurrent diseases, with careful evaluation of risks and potential benefits, and possibly combined with chemotherapy or targeted agents.
In summary, while some aspects of Freud’s treatment would still be relevant in 2024, such as the importance of surgery for resectable tumors, the approach would be more multidisciplinary with a greater emphasis on systemic therapies and supportive care. Pain management would also be more advanced, with better palliative care options to improve quality of life.
MTB CHAIR
(Multidisciplinary Tumor Board)
(AI generated)
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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