Metamorphosis by Dr. Vladimir Zelenko: Chapters 21 and 22

In 2018, Dr. Vladimir Zelenko published an autobiographical book Metamorphosis, in which he talks about how he, being a completely non-religious young man, came to faith, and how he overcame a serious illness. The book has multiple positive reviews online and was well received by the readers all around the world.

Today, we are publishing the twenty-firsth and the twenty-second chapters of the book. chapters of the book.

§21

CHEMOTHERAPY

The study compared the use of an old drug called doxorubicin together with a new drug called olaratumab, versus using just doxorubicin alone. The study was specific to very sick patients with metastatic disease, who were also not candidates for surgery or radiation. The results showed that the group of patients that received both drugs lived twenty-six months whereas the group that only got the old drug alone lived twelve months. There was a significant survival benefit with the use of the old and new drug together. The FDA fast-tracked olaratumab and approved it for use in patients with metastatic sarcoma.

Fortunately, my situation was different. I had sarcoma that was surgically removed and my cat scan after surgery was clean of cancer. Clean of cancer does not mean free of any cancer. It takes a hundred million cancer cells to form a mass that can be seen on a CAT scan. The question was: Do I have any cancer cells left within me? No one could answer this question. My options were to do nothing and hope that the cancer never returns, or to take chemotherapy and hope that it kills any remaining cancer cells. This was a question I would have to discuss with my oncologist. Another question was, if olaratumab had such benefit in patients with metastatic disease, would it perhaps play a role in prevention of the recurrence of sarcoma? This idea had not been tested yet and there was no data available.

I called Mrs. Landau from Refuah Helpline and asked her to help me get appointments with the best sarcoma experts in the area. She made me three appointments for me: 1) Dr. Gary Schwartz at Columbia Presbyterian hospital, 2) Dr. William Tap at Memorial Sloan Kettering, and 3) Dr. Robert Maki at Lenox Hill hospital.

Three weeks after surgery I went to see the oncologist. I was very anxious, and it reminded me of the time that I had gone with my mother to her first oncologist appointment. I went to see Dr. Gary Schwartz in Columbia. He was considered the leading expert on sarcoma in the New York area. Rinat and Mrs. Landau from Refuah Helpline also came with me and I was glad to not be alone.

After waiting patiently, Dr. Schwartz came into the exam room. He was a man in his early sixties and he made a positive first impression on me. He asked me questions in a very empathetic and sincere way. I could tell he was a caring human being. After examining me, he spoke about my treatment options. He recommended preventive chemotherapy.

Dr. Schwartz told me that he felt I had a ninety percent chance of recurrence without treatment, G-d forbid. With treatment, he felt that the risk could be lowered. He then recommended the standard treatment with doxorubicin and ifosfamide. This very difficult regimen has many side effects.

I then asked Dr. Schwartz if he was aware of olaratumab study. He answered me that he had “DESIGNED and INVENTED the drug,” and that it was his lab that had published the study. He was THE man on planet earth whom I needed to talk to and get an answer to my question. I asked Dr. Schwartz if olaratumab could be used for prevention of recurrence. He told me that in approximately a year he would be running a study to test this very idea, but the results would not be ready for three years. I told Dr. Schwartz that I want to be alive in three years. I did not want to wait until the study started. Even if I did wait, there was no guarantee that I would get the drug. It was possible that I would be placed in the group of patients who got the standard treatment. That is how medical studies are run.

I asked Dr. Schwartz if I could be treated with olaratumab and doxorubicin off study. He agreed and told me that I would be the first patient in the world to take this regimen as preventive treatment. He had not recommended this treatment initially because it is not considered standard of care^[1] He had only considered this protocol once I had asked my question.I then went to see Dr. Maki and Dr. Tap for second and third opinions. They both recommended the standard treatment. I asked them what they thought about using olaratumab in my situation. They both said that it was an interesting idea, but it was not considered the standard of care at this time. Once I told them that Dr. Schwartz had agreed to administer this regimen to me, they both smiled and then concurred. They had both been taught by and worked for Dr. Schwartz earlier in their careers. It was obvious from their reactions that they both respected and admired their former boss.

I believe and feel that the abovementioned sequence of events was Divine providence. It made my choice to take this chemotherapy regimen clear. Just to clarify: my faith is in G-d and not in Dr. Schwartz, olaratumab, or Columbia University Medical Center. I do believe that G-d appoints his emissaries to help heal people. I pray that Dr. Schwartz will be the right shliach from G-d to help me stay healthy.

Six weeks after my surgery, I started taking chemotherapy. The process was complex and emotionally challenging. After registering in the infusion center, I had to wait to get blood work. I then had to wait to see Dr. Schwartz. I then had to wait for the blood work results. I then had to wait for the nurse to review the blood work and clear me to start the treatment. I then had to wait for a room to become available. I then had to wait for the medicine to be sent up from the pharmacy. Only then could the treatment begin. It took around two hours for the medicine to be administered intravenously. There was a lot of waiting.

While sitting at the infusion center, I observed the other patients also waiting for their treatments. The patients were all at different stages of their disease process. Some looked healthy, and others looked close to death. Sitting in a cancer infusion center makes people very aware of their own mortality.

Many of the other patients were observant Jews. One patient who left an impression on me was a Chassidic woman in her late fifties. She was a mother of ten children and was always there with her husband. She looked very sick and appeared to be in a lot of pain. I was impressed and emotionally moved to see how her husband cared for her. Then one day she stopped coming.

I was speaking to Rabbi Schonbuch about my feelings regarding everything that I had recently been through. He sent me a book by Dr. Bernie Siegel called Love, Medicine, and Miracles^[2] Dr. Siegel was a retired cancer surgeon from Yale University with over fifty years’ experience. His book really helped me with the last stage of the grieving process, acceptance.

Dr. Siegel explained that he had witnessed many patients overcome the statistics of their diagnosis. He noted that most of these patients had positive attitudes and used their illness as an impetus for spiritual and emotional growth. As Viktor Frankl would say, they found meaning in their suffering^[3]

Dr. Siegel’s book helped me change my attitude toward my illness and treatment. It also reminded me of important life lessons that I had learned in the past but forgotten over the years. For example, after the incident I mentioned earlier, of witnessing a young child die from being crushed by a truck, I became obsessed with the well-being and safety of my own kids. What helped me overcome this pathological worry was the realization that G-d loves my children more than I love them. My worry had been rooted in lack of faith and a delusion that I can control everything. The first step in healing was to let go of worrying about things that I cannot control.

Happy birthday to you, my reader. You may be thinking that I have just lost my mind, but I am trying to illustrate a point. Every nanosecond of existence and life is an act of recreation by G-d. In other words, in addition to being born some number of years ago, you are being RE-created all the time. Your continued existence is evidence and proof that G-d wills that you exist. So, happy birthday.

No one knows how long he or she is going to live. The length of my life is out of my control. To worry about dying is a sign of a lack of faith and is foolish. Everyone dies eventually. What I should worry about is how I choose to live and use the pre- cious time that G-d grants me out of His love for me. Instead of worrying about what will happen to my children after I die, I should worry about the amount and quality of time that I spend with them WHILE I am alive. G-d loves my children more than I love my children. What He decides for me will be the best for them as well.

Letting go of worry and accepting G-d’s will for me has had profound ramifications in my attitude toward chemotherapy, my illness, and my life in general. Instead of viewing the medicine as a poison that kills the bad and the good, I view it as life-sustaining Divine energy that provides hope for continued health. Instead of viewing my hair and beard loss as a negative side effect, I perceive it as proof that chemotherapy is working. In other words, a positive and hopeful attitude is a worthy goal to strive for when faced with adversity. As the holy Tzemach Tzedek^[1]teaches, “Think good and it will be good.”

§22

INNER PEACE

I thank G-d for giving me cancer. To explain this state- ment, I want to mention what Rabbi Yosef Yitzchok Schneersohn said after being in prison, “I would never want to go to prison, but the fruits of being there I would never give up.” I would never want to have cancer, open-heart surgery, lose a lung, experience a ridiculous amount of pain, or take chemotherapy. However, I would never give up the life lessons, emotional growth, and spiritual growth that I have gotten from having cancer. I am happier now than I have ever been in my life. I enjoy the moment and thank G-d for every breath.

Inner peace has been elusive my whole life. I have made many wrong detours and mistakes in trying to find inner happiness. Surprisingly, my illness has led me to a certain soulful tranquility that I have been searching for, for as long as I can remember. I have chosen to let go of anger, forgive, and ask for forgiveness.

A successful life is defined by the degree of positive emotional and spiritual growth. Everyone is tested and challenged during their life. All new stages and experiences in life are initially faced with apprehension. How we navigate these turbulent waters determines and defines us as people.

The universal solution to happiness is surprisingly simple when you finally find it. Let go of what you cannot control, place your faith in G-d for everything, and use your time and energy efficiently. “Efficiently” means to make sure that your thoughts, speech, and action are in line with G-d’s will. Look honestly inward into your soul, identify your own personality flaws, and fix them. It is more difficult to fix an internal demon than it is to win an external war.

My life up to this point has been very colorful and filled with many difficult challenges and dramatic events. In retrospect, this turbulence has been a priceless gift from G-d. My challenges have led me on a path of Wisdom, Knowledge, and Understanding. I have grown and hope to continue to grow emotionally and spiritually. He has been patient for me to discover Him. I have come to have an intimate and deep relationship with G-d. He was always with me, He is with me now, and He will always be with me. Where my life will take me from this point is unknown. What is known is that wherever I do go, it will be an opportunity to get closer to G-d. This is the evolving story of my metamorphosis.