Andy Kessler - The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor

W e were on our third pitcher when the conversation started getting interesting. I used to ski just about every year with Brad Miller. Id known the guy forever, but then again, you never really know someone until the third pitcher. He was an equity salesman at Morgan Stanley out of San Francisco, back when I was an analyst following companies like Intel. I used to meet him and a few others on the ski slopes at Snowbird and Alta in Utah to, uh, discuss tech trends, at least thats what I put on my expense reports.

As the Red Hook slid down easy, Brad started babbling about a ski trip to Sun Valley, Idaho.

It was one of those beautiful dayssun shiningits getting warmer as the day goes onmy legs are feeling great, he started. I pretend to enjoy other peoples skiing adventures but usually just think about myself in the deep stuff.

Uh, you somehow forgot to invite me on this trip? I joked.

Must have been an oversight. Anyway, this is the first day of the trip. Were hitting the bumps just before lunch. You know that feeling, you hit the trough of the mogul, the snow kicks up behind youyou feel like a fucking rock star.

Doesnt happen to me that much. I sighed.

Then I catch my skis on some soft snow. Instead of the usual ass-over-teakettle fall, I get twisted in some weird half turn, my upper body goes 180 degrees and I end up looking uphill, my ass hits the top of the mogul and a shock wave rips up my spinemy glasses go flying, the whole damn thing.

Jeez. Okay, now Im paying attention.

So Im seeing starsIm dizzy, woozy, nauseous, sweating. It took me 15 to 20 minutes to get a grip. I side-track out and get on some green run and meet my buddies for lunch.

They didnt wait for you? I asked.

Nah. So I immediately went for a beer, figured that should help, Ill be fine. After two sips, my neck is stiffening, seizing up, so I say, Guys, Im fucked. I gotta get out of here. And they started laughing, You wanna ride in the toboggan behind the ski patrol guy? Yeah. Really funny. No fucking way.

That would have been a sight! I said.

Yeah, maybe. So I rode the ski lift down, got to the bottom, and drove myself to the Wood River Memorial Clinic.

And they patched you up?

I was third in line. Two people ahead of me had hit trees that day. Just my luck. I end up waiting four hours and then finally get an X ray, then a CAT scan, then another X ray. This very nice female doctor tells me the little wing piece on one of my vertebrae looks like it may have broken off. If its floating around, it can cut your spinal cord and kill you. I needed an MRI, which they have in Boise. So I get strapped to this plastic backboard, head immobilized, and they put me in an ambulance for a three-hour ride to Boisethe long way, which had less bumps.

Ouch.

Just as the ambulance is about to leave, she says to me, Oh, yeah, theres this other thing. You have this tumorwe dont know what to think. But thats not your immediate problem, we have to deal with your neck first. The next three hours were not the most pleasant, as you can imagine.

What was it?

Well, I get wheeled into the emergency room in Boise, still strapped to this board. I waited another three hoursthere were only these curtainsa little girl next to me had drunk too much Jack Daniels and was detoxing and some old guy on the other side was puking in a bucket.

I started laughing. Sorry, thats not really funny. I put my beer down.

It is now. So around three in the morning, I finally get an MRI. This really cool doctor comes out and tells me, You didnt break your neck. Nothing to worry about there. I felt relieved. But then he says, However, you do have this tumor the size of a martini olive sitting on the top of your spine. He knew a doctor at Stanford he would put me in touch with, and then he discharged me. Brad sighed. Then the nightmare started.

Oh, jeez.

Yeah, you dont want go through the rest of this. The good news is that I kicked it.

Kicked what? I asked.

Well, I had this tumor on my clivus, at the base of my skull. Its inoperable, too much in the way. It turns out that I had multiple myelomabone marrow cancer. Its one of those autoimmune things, your body generates lots of white blood cells, which basically eat your bones away from the inside. In the 1800s, people would sneeze and break ribs, that kind of stuff. Its rareand misdiagnosed all the timebecause other things can kick up your white blood cell count.

So you had to almost break your neck skiing to find it? I asked.

Yeah, its just a fluke, but luckily, it happened early enough.

Chemo, I assume?

First thing, I had to find a doctor. Stanford led to USF, which did some focus radiation on the tumor to try to stop its growth. But bone marrow is messy stuff. Dana Farber at Harvard is the leading clinician in multiple myeloma. But they pointed me to M. D. Anderson in Houston, Fred Hutchinson in Seattle, which was full, and ACRC, the Arkansas Cancer Research Center in Little Rock. So off to Little Rock, every four to six weeks, 15 months start to finish.

For what? I asked.

Four rounds of VAD cocktail, two rounds of DT-PACE, which has thalidomide

No plans on getting pregnant any time soon? I kidded.

and then two rounds of stem cell transplants. They basically pump your blood through a machine, which pulls out all of your stem cells, like 50 million of them. Then they give you this high dose of melphan, which is like battery acid. It kills all your bone marrow and then they bring you back by reintroducing your own stem cells, which regrows the bone marrow.

I had no idea, I said in wonderment.

Its gone. I get tested every month. $900 in blood testshow thats paid for is another nightmare, a kegs worth of discussion. It workedIm sitting here drinking beers today.

Thank God.

There was a long pause. I wasnt sure what to say. Sorry? How inspiring? Youre a model of strength? I hope to hell that doesnt happen to me?

So what youre telling me is that skiing saved your life? I asked.

You could put it that way, Brad replied.

Im going to use that line with my wife. I laughed.

Brad laughed, too. I stared at him and just shook my head. The whole thing was unbelievable. I felt a twinge in my neck. I unconsciously rubbed my right hand on the top of my spine and thought I felt something mushy. Brad started looking at me funny and I moved my hand and scratched my head and chugged the rest of my beer. Shit. I think I am going to schedule a visit to my doctordo I even have a doctor?tomorrow goddamn morning.

H ow long has it been since your last physical?

Uh, hmm, well, I dont know, probably ten years or so. How long has it been since 1989?

More like 15 years.

Thats about right. I had one of those mandatory physicals when I started at Morgan Stanley back then. No, check that, I thought about it, but I think I skipped it.

Pretty healthy, then?

As far as I know.

What I meant to say was that Id been sitting in just my white BVD u-trow on a raised bench covered with a flimsy piece of paper for, lets see, 45 minutes, waiting for Dr. Welby or Kildare or whatever his name was. Id probably caught a cold or virus or infection or something from the last patient.

Then why are you here?

40-year physical. Couldnt quite say my wife made me.