Pam — you ask if you are alone when you ask this question?

Yes Pam, you are alone. Very, very alone!

Sent by S.R. from Australia | 9:39 AM ET | 01-12-2007

I didn't think Pam's e-mail deserved my comment but I definitely think yours does. My mother has Stage IV breast cancer and your daily posts have helped me so much. I thank you for your blog and please continue with it. I pray for all people with cancer to get better and the rest of us to never experience it.

Sent by John Pappas | 9:41 AM ET | 01-12-2007

Dear Mr. Sievers,

I have written before to thank you for your courage in sharing your experiences. "Let he who is without sin cast the first stone" was what came to mind when reading this mornings blog. Pam has no experience with cancer and admits it, so it must be difficult to understand the worth and expense, fears and decisions behind your journey. I learn from your words and it has been a tremendous help in better understanding what my mother and my mother-in-law must have been thinking as they battled cancer. Your willingness to share is enlightening, personal and worth so much more than time or money. Perhaps the best response to Pam is compassion for her ignorance, and hope she never has to face her words. With grateful and humble thanks.

Sent by R. L. Janus | 9:44 AM ET | 01-12-2007

When cancer came to us we were grateful for the blessings we had, like living in a one floor three room flat with an elevator in the building, like the most loving family doctor whose office was across the street and he would make house calls and did — sometimes daily, like having health insurance where the customer service personnel were literate and handled our bills competently so we could handle other things, like the Family Leave Act that allowed me to spend the last three months caring for my husband with leave time that I previously earned. Also we had saved for a rainy day, and guess what — it was raining.

After my husband died from cancer in 2006 a woman colleague was visiting my home. Her opinion was that we all had to worry about health care costs and that perhaps my husband's life ought to have ended sooner. I wanted to slap the crap out of her and throw her out of my home. Any attempts to change her thinking would have been a great waste of time. I do think escalating health care costs are a concern, but not providing care is not the way to fix it.

I would be willing to bet that this woman who wrote to you, just like my colleague, has spent no time around people with cancer as some of their compassion would surely have rubbed off on her.

My husband and I often did things for those less fortunate. When you pray tonight and ask God to help the poor people he might just tell you I already did, so take it from your pocket and do the right thing.

Sent by Irene | 9:49 AM ET | 01-12-2007

Seems to me that if we question who deserves what quantity of treatment, we'd need to question just every other aspect of wealth, all of the time, as there is no objectively fair and equitable distribution of personal wealth, safety, education etc. Does Donald Trump (to use a hackneyed proxy) deserve all of his wealth? Does a middle class family in a suburb of Iowa deserve their safety and security from threats that families in Rwanda experience? Does Pam deserve to sit comfortably at her computer each morning, sipping coffee and reviewing world news?

As with you, Leroy, and at 52 I realize that not much is fair in the world of wealth and suffering. We do not each get what we "deserve" as a direct product of our personal inputs. So, yeah, Pam's question is heartless and especially ignorant. And naive. I'm glad for her if life is working out so far, and I hope it continues to do so. But blaming the victim for the care they require and are getting is pretty low and pretty smug.

When do we start redistributing her wealth?

Sent by Teri | 9:51 AM ET | 01-12-2007

I hope Pam is alone in her ignorant thinking. Sitting there with her first cup, deciding whether or not you deserve treatment, I think is really sick. I could go on and use other choice words, but she's not worth it. Rock on, Leroy, I love that your sharing your experiences with us, it gives us a view of what friends and family have gone through when we were otherwise unable to find out. Thanks again.

Sent by Sharon Mathieu | 9:53 AM ET | 01-12-2007

I've had a similar encounter with a colleague. He asked me how I was doing. I gave him a brief account thinking that was what he was asking. Then he told me he had no sympathy for me — it was the kids being killed in Iraq he had sympathy for. And that money should be spent on stopping the war instead of on research for cancer. It still leaves me cold when I pass him in the hall. On the other hand, when I ran out of sick days, 15 teachers anonymously donated personal leave days to me. Most people I just pass in the hall with a brief hello — their responses to my thank you note put me in tears with the depth of their compassion.

Sent by Cheryl M. | 9:55 AM ET | 01-12-2007

Leroy,

You always speak from the heart. And we appreciate it. You can NOT put a price on a life, no matter what age/color/race. I have seen our own medical bills. The medical field accepts 10% of what is billed to insurance companies. That is sad for people without insurance, and just shows how too high a price is put on treatment. Ex. monthly bill is $100,000 and they settle for $10,000 payment. Crazy. Keep on bloggin'.

Sent by Jane | 9:57 AM ET | 01-12-2007

Leroy, you responded to Pam's heartless question way better than I could have. It made me angry, too. I know that it's only easy to ask a question such as that if neither you, nor anyone that you love has struggled with cancer. It can't be an academic question if you're the one taking hundreds of dollars worth of medicine monthly, and hoping that you never loose your drug coverage, because then what will you do?

The question also struck me as the kind that may have been asked, and still may be by dictators, or those who feel more worthy than others. Our own government asked it in the Reagan administration when choosing to ignore the AIDS epidemic because of who was getting it at the time — mostly gay men and IV drug abusers. I could go on and on, but Leroy, you did a masterful job of responding.

Sent by Nancy K. Clark | 9:59 AM ET | 01-12-2007

That comment jumped out at me the other day too, and frankly, I didn't think it deserved a response. 1) As you're aware, I have lung cancer, too. The amounts expended are not unknown, or else they would be uninsurable. I pay $13,000/year for my health insurance, and I'll be g*da**ed if I'm going to apologize for using it. 2) Same with Social Security Disability. I paid in far more than I will ever get out. 3) We all pay taxes and lots of them go to things we don't agree with. It's called living in a democracy. Our country has an obligation to take care of its own citizens.

You were wrong to call her ignorant, Leroy. Ignorance can be cured; "stupid is forever."

— Wash. Post May 15, 1969

Sent by Thomas J. Clarke Jr. | 10:33 AM ET | 01-12-2007

Even though I have not written in a while, I have been keeping up with your blog and your progress every day. My husband seems to be almost on the same schedule in the sense he finished his chemo treatments in Dec. and now has moved on to radiation. The chemo shrunk the tumor a lot but not in the right place to make him "respectable surgically" (he has non-metastized pancreatic cancer) so now they are trying radiation to shrink it some more. He has had issues with blood counts and infections so things are not running all that smoothly, as you know. We don't know what is going to happen, but he certainly is still in the fight and intends to stay there as long as there is something that can be tried. Yes, it is very expensive, but I would sell all my worldly possessions and move heaven and earth if it meant keeping my husband alive. Yes, it consumes all our time and effort, but he is worth it. He wants to live and I want him to live.

That being said... I have thought many times over the last couple of months... does Leroy ever get angry? I mean really angry at having cancer. Does he ever strike out at the people he loves and love him? I know we do. Sometimes we say things to each other that neither one of us mean out of frustration and fear and anger. We love each other very much and are very frightened by what is happening. I am relived to hear anger in your blog.

I guess it never ceases to amaze me how ignorant people can be. I only hope Pam or someone she loves never gets cancer. Who is she to judge whose life is worth something and whose isn't. How can you put a dollar value on human life?

We have not experience anything in our lives like you have. We were two normal happy people enjoying our "mundane" lives, traveling a bit, dining out with friends, enjoying our family. Then cancer invaded our lives and changed everything.

If I sound angry... I am. But we will never give up and when we can we enjoy each other as best we can. But your life and my husbands life and every other person on this earth whether they have cancer or not is precious and nobody, including a heartless ignoramous like Pam is going to convince me otherwise. Keep fighting!!!!!

Sent by Amy Wile | 11:12 AM ET | 01-12-2007

Better questions for Pam to ask are why are such resources so expensive and why have we cut the research dollars looking into a cure for cancer? If we could lower the costs and find a cure I wonder if her question would then move to another arena such as education. I am sorry for Pam — it must be a sad way to live always wondering about such questions and judging.

Sent by L.J. | 11:17 AM ET | 01-12-2007

Leroy,

Well said in truth and honor. I would not have objected to you letting yourself go and rebuking Pam with all your might. But what would that have accomplished?

You are someone that has seen up close the horrors of this world and are living with a terrible disease that takes away so much. Thankfully, you know, as do most it seems who battle cancer, that life is precious. It does us no good to repay each others evil with evil, and although Pam's note was not "evil", it was born of an uneducated perspective. Through your composed response, hopefully she can see from your perspective why hers was hurting others.

I'm continually amazed at us as humans. We are capable of unfathomable cruelty, yet also limitless compassion.

Sent by Phil Dreger | 11:20 AM ET | 01-12-2007

THANK YOU, THANK YOU, THANK YOU... for responding to Pam's note.

I, too, read all that you post and I was also disturbed by her thoughts. Maybe Pam ought to read Left to Tell, by a Rwanda survivor. Compelling story and beautifully written. It is from that story that I have gather my strength to battle my cancer.

There are so many more people out there who have much more tragic stories than myself and are mostly likely much sicker than myself. I never lose sight of that. I remind myself daily how blessed I am to have worked so hard for what I have. Should I be denied the latest and greatest drugs for my cancer? It may not matter to Pam what becomes of me, but it matters greatly to all the people in my life what happens to me in the future. It is for that reason that I will continue on this white-knuckled roller coaster ride called cancer.

Sent by Marianne Dalton | 11:23 AM ET | 01-12-2007

Ironically, this comes up on your blog a couple of days after the publication in the Journal of the National Cancer Institute of a study entitled "Patient Time Costs Substantially Increase Burden of Cancer Care."

That study, just like Pam's comment, makes me, a cancer patient with stage IV kidney cancer with bone metastasis, uncomfortable. Why? Because it sees me as a cost factor rather than as a human being, as a cog in a productivity-based system rather than as a person.

At first glance, I appreciated the fact it put a value on my time: time spent in waiting rooms, time spent waiting for appointments, time spent undergoing exams and so on. But then, that is in turn looked at as time where I am not productive. My social value is seen as my ability to work, earn money, allow an employee to earn money for an employer. The moment I can't do that, or can only do it less, my value diminishes. I become a cost factor.

What about the human factor, purely and simply the human factor? Is a life something that should be valued only in terms of monetary value? Is an American worth more than, say, a Canadian or a Mexican? Is an Israeli worth more than a Palestinian? Is a Christian worth more than a Muslim?

Should we start putting a price tag and a productivity tag on every living thing on this planet? OK, we can let this species of plants, of animals go extinct, they don't bring in any cash, and besides, they're not human and not generating any revenue for anyone. Never mind that they are living beings, as entitled to life on this planet as we are.

Let's set a line beyond which we don't bother taking care of seniors. After all, they are beyond their money generating years, therefore they are liabilities in the accounting books.

Let's deny care for the homeless and the unemployed. They are already unproductive; let's not turn them into an additional financial liability.

Saving a life, or attempting to save a life, isn't a matter of dollars and cents. All living beings are worth the same, and they all deserve the best we, as human beings, can muster to preserve that life.

We would do well, as a species, to remember that.

Sent by Benoit Bisson | 11:33 AM ET | 01-12-2007

Good comeback on today's blog. But, I must admit I'm glad she got a rise out of you. I bet you haven't been that angry about anything (except cancer) for some time. Your anger had nothing to do with cancer and that just goes to show that cancer hasn't gotten your spirit. You're still Leroy!!

B.T.W. — I read you every day for insight. I, fortunately, do not have the disease yet, but since everyone in my family had died from it I read you to help me cope when it may be my time.

Sent by Mary Lynne Carlisle | 11:34 AM ET | 01-12-2007

Leroy,

I just wanted to send you a quick note about your post today and the question that a writer named Pam posed to you about whether we where spending too many resources on one person's survival and your comments. I have been reading your blog for some time now and I have written to you before. You wrote in your blog today that you sound angry. I disagree.

I thought your response to Pam was most dignified and you struck me again as you often do as a sensible, thoughtful man, I only hope to follow in your example.

Sent by Jerry R. Steuewald | 11:36 AM ET | 01-12-2007

Leroy,

I read this blog every morning and have for several months now. My mother has cancer and this blog has been a great source of solace for me, knowing that there are many others like me out there, not only victims, but also family members who have to deal with the prospect of an impending major loss.

I also read a lot of other blogs — mostly political. One of the great things about blogs, and the Internet in general, is the free form dialogue and the ability for everyone to have a voice. Usually, on the political sights I haunt, for those of you who don't know, there are what are referred to as trolls. People that will leave outrageous, sometimes inflammatory comments to rile others up. The term "trolls" is derogatory and commenters will either ignore them or jump down their throats. But I posit that trolls are an essential part of transforming a blog from an echo chamber, where commenters will consistently applaud the blogger for his/her ability to write effectively, to a real community resource where many different subjects are brought up and many opinions and points of view are on display. It is here that true discourse is accomplished. The term devil's advocate comes to mind.

I completely understand the offense you took to Pam's comments, but the post you make here which ties together all of human suffering with the suffering endured by patients of cancer, and the metaphysical questions posed concerning the expenditure of precious resources on the sick and needy, would never have been made were it not for someone like Pam to make a comment that no one really wants to hear.

Blogs are the answer to the lonely & vacuous opinion/commentary pages in our newspapers. No longer do we have to listen without recourse to someone else's opinion — we now have the ability to achieve true discourse and further the obligation to consider everyone's point of view. And that, I think, is a great accomplishment.

Sent by Ben Turkel | 11:46 AM ET | 01-12-2007

I admire your restraint in responding to Pam's smug missive. Talk about "privileged"! She sounds like the embodiment of the luck that has, so far, kept some of us from cancer and a host of other ways to suffer. I don't actually wish any of those on her, but I wouldn't mind if she got close enough to get a whiff and maybe even try to understand.

Sent by Vicki Lambert | 11:47 AM ET | 01-12-2007

Amen. Right on, Leroy! It is obvious Pam is on the other side of "that line." There is another view I've often taken regarding two other camps the world is divided into... the Clueless and then everyone else. Our local paper did a story on it years ago, and somewhere I still have it. Fabulous article! A little bit like the "Sixth Sense", it said that the clueless don't know they are clueless. They will never cross over the line and become clueful.

Sent by Carol | 11:50 AM ET | 01-12-2007

Rock on, Leroy! After I read Pam's note yesterday, I was incensed. I agonized over how to respond to such a heartless (yes, heartless) sentiment as was expressed in her writing. Then I read your blog this morning, and raised both fists in the air and shouted, "YES!" There are many appropriate forums to discuss the allocation of health care resources and whether we spend too much on treating disease rather than on prevention. On this forum, our concerns are different. Instead of peacefully enjoying our "first cup of the day," some of us wake to face another day of nausea, pain and that awful stab of existential terror. Pam states that she has "never been the victim of cancer," and for that I am thankful. Perhaps her cold-hearted perspective would change if she was diagnosed with the disease and had to endure the slash, burn and poison which is the standard treatment. Someone in this blog aptly called chemo and radiation "weapons of mass destruction."

This blog has explored humanity struggling with some of the worst things the universe can inflict on a sentient being. People contributing to the discussion are facing things most of us would rather look away from than even consider. Yet they maintain their civility, sensitivity and even their sense of humor. I would love to see the insights of Leroy and the other people sharing their experiences organized into a book which could go on to help others in their struggles with cancer. I continue to suffer the ravages brought on by colon cancer treatment, and this resource is invaluable to me. It is a tragic failure of modern medicine when a person has to ask that one big question: quality of life versus quantity of life. But the greater moral failure would be to deprive the individual of the right to ask the question.

Sent by Mike B. | 11:52 AM ET | 01-12-2007

I read Pam's note and it puzzled and angered me as well. In one sense she's simply raising the public policy debate of cost/benefit analysis of end of life care — and that's ok as a medical economics exercise looking at broad statistics. What angers me is that those statistics are real people struggling against illness that can rob them of all the normal experiences the non-victims take for granted. Ten years ago when my wife was in the final stages of breast cancer and holding on by a thread she and I would have done anything for more time. Even when she began to slip in and out of consciousness I wanted to do everything I could just to my three daughters could see her smile at them one more time. Did that make her or me social parasites for using precious and costly medical resources. No, it was just evidence we were human. Leroy, hang in there and grab all the life you can!

Sent by Roland Woodward | 11:55 AM ET | 01-12-2007

Pam should ask my children and fiance if I am worth it. All I can say is THANK GOD Pam is not my caregiver. Heartless? Oh Yes!

Sent by Debbie | 11:57 AM ET | 01-12-2007

I am stunned by Pam's logic. Would the victims of war, genocide, hunger and poverty be better served if we spent less dollars extending the lives of the "privileged" ill in this country? Does it seem more just to her that if some can't be saved none should be? I don't see her point. Surely we could work harder as a nation to fight world hunger. Look at the funds that were instantly available to fight the war on terrror. Pam's suggestion that the life of an ill "privileged adult" is cheap is disturbing to say the least. I lost my husband to cancer in 1999. We fought it for 4 years before he died. They were the best years of our lives because the cancer taught us much... like how precious each and every day really is.

Sent by Susan Rook | 11:59 AM ET | 01-12-2007

It sure makes one wonder just how Pam will change her tune when she is faced with a life threatening illness, be it cancer or perhaps a serious accident that involves multiple surgeries, etc. Not that I would wish that on Pam or anyone, but it happens. I, too, believe Pam has a very shallow perspective on life. Perhaps she hasn't known what it is to love or be loved. At any rate, perhaps one day she will know one day what love is or loss is.

Sent by Karen | 12:05 PM ET | 01-12-2007

And even if I bought into Pam's premise, which I don't, who would determine where and how those extra resources would be spent? Somehow I doubt they would be being used to stop the death, destruction and sadness in those wrong places in the world. We each are placed where we are placed and must fight the battles presented us as best we can. Yes, we all need to do what we can to promote justice wherever we can in the world, but does my refusing a chemo treatment really help the orphan in the Sudan?

Sent by Stephanie | 12:07 PM ET | 01-12-2007

I am appalled by Pam's comment, and hope that she is speaking from ignorance, not a version of enlightenment. As an oncology protocol/research RN, I am employed through the University of Pittsburgh Medical Center, and located at one of our community sites. McKeesport, Penn. is an area that was hard hit by the demise of the steel industry. To say that the population is at risk is to put it quite mildly. As a protocol RN, I am in a position to further enhance the cancer care of the local population via enrollment in cancer protocols that are open to them in their own community hospital, with the support of the UPMC Cancer network. There is in place a Patient Navigator Program to afford support in all aspects of patient care from transportation to MD visits. We are all working together to advocate for our patients — to give them choices — to give them opportunities to live as full, productive, and symptom-free a life as possible. Thank you for your incredible sharing of your experience, and I will keep you in my prayers.

Sent by Patty Hartman | 12:09 PM ET | 01-12-2007

Dear Mr. Sievers,

I've been reading your blog daily since you first started writing. It is the one column that I read every single day. I am completely moved by your experience and the grace in which you live your life on a daily basis. I find strength and wisdom in the things that you write and also peace and comfort in your words. Once in a while I am drawn to someone because of the things that they are able to teach me. I have read quietly each day... never commenting, but always keeping you in my thoughts and prayers.

Today is a little different — after reading the comments that Pam submitted, I wanted to make my support of you known. I don't believe you can put a value on human life as I don't believe that one life is worth more than another. I don't believe that we have a right to choose who will live and who will die, but I do believe that we can and should do everything in our power to serve and help and heal whenever possible. That is why we are here: to help one another. I realize that there is great destruction and devastation throughout this world, in no way do I think that diminishes the value of someone that has had the fortune of living a full life in this wonderful country; on the flip side of that, I don't think our lives are worth more than theirs either.

It does sadden me a great deal to know there are so many that suffer so much on a daily basis, however, this does not mean that we should not provide and have a great desire to provide any type of help/assistance that we can to anyone else in need. I believe that we are here to help one another - not choose who should or should not receive that help. I don't want to ramble as there are so many thoughts floating through my head, but I agree with you, I don't feel that we have the right to make the decision of who should receive care, rather we should care in any way we can and give that care (whatever it might be) as freely as possible. Honestly, if the tables were reversed and Pam were in your shoes maybe she'd look at this differently, maybe not? But whatever her thoughts or feelings I would like to believe that our society is one that would choose to care for anyone in need and not place boundaries on that care for any reason. We aren't going to be able to help/save/fix everyone, but we have a responsibility to try our hardest without passing judgment.

I'd hate to think we live in a world that has Pam's mindset — that would scare me — rather, I'd like to believe that there is more compassion, more of a desire to care for one another for the mere fact that we are all human beings! I think horrible things would happen if we were to start to try and choose who does and doesn't have a right to live based upon their "status" in life. That just isn't our place!! Instead I am grateful each day for the medical Doctors that are available and for their knowledge/insight/compassion and desire to help and for the support of others that are willing to stand beside us during difficult times and give their support. You have my complete support and as I said earlier I have learned a great deal from you, for which I am very grateful!!!

You are in my thoughts each day!! Keep fighting the good fight!! And thanks so much for sharing your incredible journey with us!

Sent by Cris | 12:38 PM ET | 01-12-2007

Pam's question was not ignorant. I would probably be angry, too, but I hope you will give the question a more thoughtful response when your anger subsides. I have read all of your posts and, like others, I have found all of them to be deeply intelligent and compassionate and insightful and generous. Your post today was a glaring exception.

Sent by John D. | 12:39 PM ET | 01-12-2007

While Leroy has said it well, I also feel honor-bound to put in my 2-cents worth.

We are starting a biotech company, whose lead product candidate is in oncology. The odds are difficult, but try, we must.

I lay awake nights thinking about Leroy and my friend, T, who has cancer. I think about my grandmother who survived breast cancer in 1950! By a new "hail-Mary" treatment called radiation.

It is an indelible part of the culture we grew up in, that we try to leave no one behind. This drives and compels us to try our best, under the circumstances given to us. We look ahead, where the horizons are absolutely unlimited.

My old boss used to say that "fairness is not a principle of life." It sure hasn't been fair to T or to Leroy, or the rest of you out there. But legions of us in the pipeline are risking most of what we have, to help make a difference. To do any less would be to dishonor generations of lives cut short, that perhaps we can ameliorate within the next generation.

Sent by Emile Bellott | 12:42 PM ET | 01-12-2007

When I read the blog last night I came across Pam's comment/opinion and I thought "Wow, these comments are really clueless." I thought I should just let this go and not get wrapped up in Pam's ideas, but I can't let go them just without commenting.

I would like to take that myopic telescope that she views the world (don't worry Pam, I wont smack you with it) and turn it around. Here on this blog you will find people, often facing impending death, that know how precious life is. Not in an abstract way but it a real tangible, gut-felt way. We "victims" of cancer have had to look real hard at the possibility of losing our lives. We know in an un-abstract way how precious life is.

I have faced death and would have slipped down that drain if it wasn't for the doctors who grabbed my hand and leg and pulled me out. They kept me alive. Should they have just let me go since the odds are that I wont make it more than 2 or 3 years? Should they have let me die because it will cost quite a bit of money and resources to keep me going? By that same logic I suppose we needn't care that a child is dying of typhoid, after all if she is living in a country in the midst of war she might die. Or she just might die in childbirth?

Perhaps if those additional $6 billion that are proposed to be spent to accelerate a war could be redirected to funding health care in Africa or in the United States our world would be better. Such a change would likely bring more peace to and security to the world.

Today I go for treatment of metastatic cancer. I know I'll be with others who are struggling to stay alive. I am so fortunate really to be with people who know what a treasure life is.

Have a great day Pam.

Leroy, thank you for tackling this straight on.

Sent by Susan M. | 2:25 PM ET | 01-12-2007

Dear Leroy,

I respect your response to "Pam" (I would have responded much harsher). Actually, I will respond much harsher. I personally think she is extremely HEARTLESS and does NOT know what she if talking about!

What you write every day is so very important, you are helping so many people cope with their illness and treatment. You inspire us all. I consider you to be a strong and courageous man. Until I started reading this blog I had a hard time opening up to the people in my life about my illness. Which is unfair to them as they want to know how I am feeling and what can they do to help. I now ask for help when I need it.

As for having led a privileged life, from all accounts you are a hard worker and have put your life in danger many times, all to help people understand what is happening in this world. If we don't know what's going on how can we help to fix the problems?

Maybe Pam would like to talk to my 13-year-old son, who just this morning was talking to me about my death and also my 16-year-old daughter who won't talk about it at all? Explain to them that I should also quit "expending unknown amounts of resources extending the life of one adult victim who, it appears, has lived a privileged life up to this point". Like you Leroy, I've also had a great and happy life. You know what Pam? Call me greedy, I want more!

Leroy, keep up the good work!!!!!!!!

Sent by Sherri | 3:03 PM ET | 01-12-2007

Hi Leroy:

Your tact and diplomacy is as inspiring as your sensitivity and candor. The next time Pam sits down for her "first cup of the day," I think she ought to switch to DE-CAF!

Sent by Nancy | 3:05 PM ET | 01-12-2007

Dear Mr. Sievers,

I have yet to have cancer, but since my parents have each had a bout (or two), I expect it is in my future. Were I to be in your position, I would be fighting just as vigorously. That said, I don't think that Pams question is "ignorant" or unfair.

It is legitimate to question the distribution of health resources, even while you are benefiting from an unequal share. Of course, for those of us who rely on insurance, this is largely an academic exercise we have little power to redistribute the time and money spent on our care to immunizing children in lesser-developed countries. Nonetheless, questioning the systems and institutions that distribute opportunities so unfairly throughout the world is the responsibility of an ethical person. What you view as a personal attack is really an indictment of all of us.

I will keep you, and all who suffer from cancer, in my prayers.

Sent by Travis | 3:07 PM ET | 01-12-2007

OK NPR, you may need to edit my message. We will see... I have been reading Leroy's messages, I don't have cancer, but a lot of my friends do. I love all the postings and how people are helping people and talking about what needs to come out of the darkness and fear so we can learn and help one another. On that note, I'll get on with my comments about and to Pam. Pam, please remember that what these folks are going through is a scary painful experience and on top of physical pain there is also psychological pain and words can hurt. The cool thing about words though is they can also build and teach. Pam, you "question the morality of expending unknown amounts of resources extending the life of one victim." Wow! Pam, you're using some fairly large words and you've put them together in an argumentative statement so I'm not sure using the old Saturday Night Live phrase of "Pam, you're an ignorant..." is accurate, but I digress.

Pam, have you ever considered that the work being done to help extend the lives of cancer patients is helping to come up with stronger, safer, and more successful cures? The treatments that Leroy is going through now will help with a breakthrough that ultimately will help save you or one of your family members in the future, if God forbid cancer comes into your life.

Pam, in the future please be careful in what direction you fire your words.

Sent by Tom | 3:25 PM ET | 01-12-2007

Leroy,

Pam's lack of compassion is very sad. Your response was gentle, considering her comment.

While I'm sad for your circumstances, I'm glad you write about it. You're smart and brave to research the disease and various treatments and not just sit back and "wait." Keep on! And, may God bless you and give you strength for the journey.

Sent by Judy F. | 3:39 PM ET | 01-12-2007

Leroy,

I have never posted on your blog before, and to be totally honest, I don't read it everyday. However, on the days I do read it, it changes me. I think about things differently... I think about how lucky I am. I don't have cancer, nor do I have anything life-threatening and in the moments it takes to read your blog, I realize that I'm blessed.

Unlike Pam, I know a few people who have had cancer — some have survived and others, unfortunately, have not, and the thing that Pam doesn't understand (lucky for her) is that one person's cancer or sickness affects hundreds of people. Although you may not be the person who has cancer, I can't help but wonder how many family members, friends, and other loved ones wake up in the morning and read your blog for support and some insight into how their loved one is feeling.

The last thing I want to touch on is Pam's life? I can't help but think... Pam, do you have a family and more importantly do you have children? Because if the answer to either of these questions is yes, what happens when you need the support of strangers?

Sent by Melissa | 3:42 PM ET | 01-12-2007

What is mystifying about this Pam issue is this: Is it possible she has had no contact with cancer?? Is there a person alive who has does NOT: have cancer, be related to someone with cancer, work with someone who has cancer, have a friend with cancer, or any combination of those things!!?? I work my behind off to enjoy the insurance coverage I have, and pay monthly for the extra (cancer) coverage I started three yrs ago. And thank God for that, as I have been treating breast cancer now since April 2006. How would my not-treating or my death help anyone else? I don't understand Pam's argument from an economic/financial standpoint either. And who among us would refuse treatment because there are sad and unfortunate global tragedies that are always there (somewhere in the world)? If Pam or her husband, child, mother needed cancer treatment, would she consider them too privileged to get it and let them die?

Sent by Sherri Eggleston | 3:45 PM ET | 01-12-2007

Your courage in the face of a very, very difficult situation is commendable. The life of a privileged person is just as valuable as the life of one who is not so privileged. You and I did not choose to be born to our parents and neither did we choose our country of birth. I happen to have been born in the U.S. of American parents in the early '50s, but raised elsewhere. I have lived out of the U.S. most of my life and have an abundance of world neighbors and friends from many countries, some privileged, many not. I would not wish cancer on any of them. I am a wife, mother, and caretaker of an elderly parent with dementia. I work full-time and have good insurance. If my melanoma returns, I will not wish it on anyone. Life IS unfair. I'll deal with it. May you continue to have valor and strength in your battle, and you certainly have my understanding.

Sent by Linda Catano | 3:56 PM ET | 01-12-2007

I thank my lucky stars for insurance every day. (At a price tag of over $200K in the past two yrs.) No one should make the decision as to the value of a person but a (much) higher power then anyone on earth. I was 49 on my diagnosis with an 11-year-old and a 20-year-old. Is it ok to spend lots of money on my cure because I have a young child? What if I have no kids? What about the brilliant surgeon that gets cancer? Should he get more/better care then my neighbor who is 91 and "lived a full life" because he can contribute more? I just don't think people can make these judgments until they are faced with their own diagnosis, not even those who are very close to someone with cancer. Ya gotta be living it to really see it. Thank you for your blog. Reading it has been a real pleasure and I look forward to it every day. Best to you.

Sent by Jenene K. | 3:59 PM ET | 01-12-2007

Leroy — Just as in other times in life, as soon as Pam (or someone she loved dearly) received a diagnosis of metastatic cancer, she would eat her words. It seems to be human nature for individuals to not truly understand the difficulties of someone else's life journey until they are experiencing it themselves.

Your blog keeps me going day in and day out. And you can't put a price on that. Thank you.

Sent by Elena Widder | 4:25 PM ET | 01-12-2007

Let's see how Pam feels about her naive response, should she be in a similar position in the future. Unfortunately, ignorant people are everywhere.

Best wishes to you, Leroy.

Sent by Peter Hoberg | 4:27 PM ET | 01-12-2007

Wow! Pams statment was thought-provoking if nothing else. I have the Ashkenazi Jew gene mutation, which gave me an 84% risk for the cancer I have. (Gilda Radner also had this.) This mutation was unknown a decade ago, so I unwittingly have passed it to both of my children who are now in their 30s. I suppose by Pam's account, we should all be tested at birth and us "mutants" be disposed of before were a bother to her.

Sent by Patricia | 4:29 PM ET | 01-12-2007

Dear Pam,

Get a life.

Sent by Marisa Niemczyk | 4:30 PM ET | 01-12-2007

Leroy,

As a bleeding-heart-liberal type I have had moments of conflict about the money being spent on my care. One morning, someone was on NPR questioning the validity of spending $5000 on a PET scan for one patient when so many need basic health care. As I had a PET scan scheduled for that day, I felt my face grow red from shame at such selfishness. Should I cancel the appointment? In the end, I went. Who would it really have benefited by not going? My insurance paid 10% of the $5000 bill and I learned that the cancerous lymph node in my chest was gone. Health care in this country is surely a mess, especially for the uninsured, but after both open-heart surgery and breast cancer, I'm very grateful I live here.

More importantly, will you continue chemo? I have a strong feeling that you will, and that you should. When faced with the choice of doing radiation or not, I finally had to realize that I didn't want any regrets, that I did what I could and my family knows that also.

As for side effects, we are human and can't help being a little vain. Shave your hair before it starts falling out, and a lint roller works great at getting rid of the little nubbins that are left! You're right that chemo is work, but there are good and bad days, and you live for the good days. Maybe the best job title is to be "surviving cancer."

Sent by Marcia | 4:32 PM ET | 01-12-2007

I hope Pam is not in the medical field, caring for patients or in the medical insurance business deciding insurers' coverage in this country. That would be scary. She should probably also refrain from having children, if by some odd chance she does already. I doubt anyone who has raised a family, or has been raised by a decent family with morals, would place such little value on a human life just because they happened to have been stricken by cancer.

I wonder if she got into a horrific car wreck one day and lost her right leg, and her other leg got infected by some fungus, so surgery was needed to save the other leg and prevent the fungus from growing more, if she would be singing the same tune along the lines of, "Well I would like a new leg and would like to have the surgery, but I have lived a privileged life up to this point and I really feel I am not worth surgery. Besides, walking and living are so overrated."

Sent by Lisa V. | 4:34 PM ET | 01-12-2007

I wish that words could be as precise as mathematics. Perhaps we would then better understand Pam's comments.

From her worldview, I think we would all agree that the extent and magnitude of suffering is horrible. Among the people dying of war, malnutrition, and disease, we are losing potential world leaders, doctors, etc.

But from an individual view things are the same. I also feel badly about friends dying of cancer. If Lance Armstrong had not used the medical help available to him we would not have his Lance Armstrong Foundation.

If Leroy did not avail himself of help we would not have his healing words. And, who knows what Leroy (and many others) will do in the future, for us individually, and for mankind, in general.

Sent by Don Winslow | 4:37 PM ET | 01-12-2007

I think that Jane touched on the fallacy that is part of Pam's premise — cost of care being a true measure of the value of care — and that the costs printed on our medical bills are an accurate accounting of the cost to deliver care. I've come to believe that the costs printed on our medical bills are often the result of the providers chosen accounting practices — whether for surgery, chemo, drugs or hospitalization. We're all familiar with the $50 Tylenol tablet that appears on a hospital bill. More recently, the cost of medications for senior citizens varies enormously by country, even when the medication is manufactured in the same facility! In my own cancer treatment therapies I've seen prices vary significantly (by several thousand dollars) for prescriptions, depending on whether they were provided by my clinic or my HMOs pharmacy. It's hit so close to home that even my staunchly conservative husband believes in nationalizing all pharmaceutical research, production, and distribution! So one grain of truth in Pam's argument may be that every dollar spent in other countries can indeed purchase much more treatment. And, the shame is that with inflated "costs" in the U.S. we use money that could otherwise be spent on humanitarian aid.

In the meanwhile, my husband and I are truly grateful for our excellent health and long term disability insurance care, subsidized by a generous employee benefit policy. And we are grateful to be living in Eastern Massachusetts, where the availability of care for most cancers is unparalleled.

Sent by Sheara | 4:40 PM ET | 01-12-2007

Maybe we can forgive Pam for not understanding. Every person fights a great battle. Who knows, maybe her family is dealing with a great battle, but isn't getting enough attention, causing her to feel resentment.

Sent by Kevin Hillstrom | 4:56 PM ET | 01-12-2007

This is why conservatives often can build a good case against liberals... we sometimes are too liberal and make statements like this, dumb statements, in an attempt to maintain some ideological continuity... it doesn't work that way.

Sent by Brit | 4:59 PM ET | 01-12-2007

Pam, supposed someone you really loved was affected by cancer or some other disease, could you really say, um, you have spent enough, let them die.

Sent by Phil | 5:01 PM ET | 01-12-2007

There is nothing more I can say that you haven't said and said it well. God forbid that she or a loved one does not have to deal with this disease. I am sure she would think differently.

Sent by Roger | 5:05 PM ET | 01-12-2007

Go, Leroy! You tell it like it is.

Yesterday I got very angry with a friend who had said something I found mean/ignorant/unjust... and I really laid into him and told him what I thought! Later, we both realized that was the first time since before my diagnosis a little over a year ago that I'd disagreed with anyone so openly. I think it's hard to express anger (especially to people you care about) when you are numb with fear and fighting for your life. So — it felt good to be back, feeling and showing all the "normal" emotions. And I'm glad to see your fighting spirit aroused, too!

Sent by Doris | 5:21 PM ET | 01-12-2007

Pam, This is for you.

Your comments do not make you a heartless person, but they do open a window into who you are, or more to the point, your experiences in life.

From where I sit, and believe me, I'm sitting in a front row seat of an E-ticket ride I'd rather not be on... NEVER have I thought of Leroy as someone who is living a privileged life. He was lucky enough to be born with a brain and capable of maturing into a smart guy. He used that brain to get a good education and he turned that into becoming a solid journalist and a mentor to young people in this business, who still seek out his advice.

In short, I guess I'm saying he's damn good at what he does BUT he worked very hard to get there. Inside those 26 years of traveling to the uneasy regions of this world, where the ugliness of war, famine and death go to hide, it was Leroy, from behind the camera, bringing you the stories that you consider more important than this life saving mission he is on now.

This is the part you don't get: Leroy is fighting with everything he's got to live. He's doing that with the help of great doctors, a ton of support and an inner strength that blows me away! He is also trying to help others who are in the fight of their lives... NOT just for themselves, but for those of us who love and need and want all of these folks in our world...to share in this life.

It's not about expending resources... it's not about the research, it's ABOUT what life is all about! You ask if you are alone when asking this question... the answer is, you are alone. Period.

Sent by Laurie (Leroy's other half) | 5:26 PM ET | 01-12-2007

Leroy,

It takes great strength to acknowledge when someone poses a question that is just plain hurtful. However, none of us who know you personally or through your blog are surprised that you did just that. It's what you have done for your entire career, and we are the blessed recipients. You give words to unthinkable situations. You give hope to many in a world that sometimes just doesn't make any sense. You give it generously. It's courageous and it's changing lives. Know that.

Thank you for your strength. Thank you for sharing something so personal. Whether or not you know this — you have made this world a better place, simply by being you.

Pam, on the other hand, sounds like someone very sad and misguided. She could use a little hope. My only advice to her is to continue to read your blog because your words often cut to the heart of all sorts of suffering.

Sent by Joan | 5:34 PM ET | 01-12-2007

Hopefully, Pam will never hear those fateful words "It's positive." I wish no one would ever hear them again. Would she look at her life in dollars and cents? Would she think she contributed enough to society to be worth the cost of her treatment, even when its outcome was unknown? Would she count her contributions into health care premiums and stop once she reached that amount? I doubt it. I'm sure she would just want to live like all of us do. We're all going for the golden ring.

I've had guilty feelings about the cost of health care I received. What made me so fortunate? I don't know. I do know how grateful I am for the treatment and technology that was used on me.

Sent by Chris | 5:36 PM ET | 01-12-2007

Like many others, I, too, was taken aback by Pam's comments yesterday. At first I was angry, but now I just feel like Pam needs a little enlightenment, which, after all, is what this blog is all about. How can we judge the value of a terminal cancer patient's life? Here's how! For example, Leroy's life! How wonderful is his blog? How many of us have found solace and wisdom in his words? Many, and not just cancer patients and their families. Sometimes even people like Pam.

Another point, how many of us are in clinical and experimental drug trials, the results of which may eventually lead to a cure for cancer and other deadly diseases, one of which may effect Pam someday. Even if we are not in a trial, we are in our personal oncologists trial! What he or she learns from our experience, what helped, what didn't, gets passed on to other patients.

At the very least, or perhaps the very most, we patients are always helping the patient in the treatment chair next to us...what foods actually help with nausea, where the best wig shop in town is, how to help a child in our lives cope with having a parent with cancer. These things, no matter how small, are important to someone, and that gives our lives value like nothing else!

So please Leroy, not another minute wasted in anger. I have a feeling that because of you, Pam will come around, and you will have just one more person on your long list of people whose lives you have touched beyond measure.

Sent by Karen King | 5:38 PM ET | 01-12-2007

Dear Mr. Sievers,

I am not a cancer victim or survivor, nor do I have a personal story to share. What I do have is an opinion about Pam's note, and a strong one at that. Every morning before work I sit down to read your blog. I do this for a variety of reasons, but mainly to remind myself that life and health are precious and should never be taken for granted. I am amazed (but not surprised) that there are people out there that have the audacity to think, let alone post a comment that devalues individual life. Regardless of what Pam and others like her may think, I believe that your individual contribution to this world is priceless! Thank you for sharing your experiences and please know that what you bring to the many readers of your blog is highly valued, awe inspiring, and greatly appreciated.

Sent by Gail S. | 5:40 PM ET | 01-12-2007

Hi Leroy — I have noticed that your comments in 2007 have taken on a bit of an "edge" and I admire you so much for putting your life out there for all of us to see. I actually went back yesterday and read all your columns from the beginning and am once again reminded about the amazing ups and downs of this incredible experience. I am glad that you responded to Pam's comments in such an eloquent but up front way. I really don't separate my world (stage 3 inflammatory breast cancer but doing well now)from the "non-cancer" world because I have had nothing but positive experiences from friends & strangers alike which makes Pam's comments more stunning.

Your circumstances have certainly evolved over the course of your blog... keep writing from your heart as many of us are out here waiting to hear from you every day!

Sent by Ellen Macaulay | 5:42 PM ET | 01-12-2007

Pam's folly was her insensitivity, not her central idea. It IS legitimate to question the distribution of health resources. I am thankful for the care my parents have received in fighting their cancers, and I can assure you that if/when I get cancer, I will fight it with every resource I can muster. I also recognize that those of us who have insurance have little power to redirect the resources spent on our care to immunizing children in lesser-developed countries or other high-impact uses. Nonetheless, we cannot be blinded by our circumstances from seeing that the world's health resources are distributed unfairly. Trying to bring about change in the systems and institutions that distribute these resources is the responsibility of an ethical person. What Pam injudiciously phrased as a personal attack is really an indictment of all of us.

Sent by Travis H. | 5:45 PM ET | 01-12-2007

I am a daily reader, and I am thankful for Leroy, this blog and how he has provided me with insight on a subject I knew almost nothing about prior.

I won't take sides about what Pam said, although I think it was insensitive.

A twist on the point she may have been trying to make could be explored if you ponder this: If Leroy was given $10,000 and a choice between using it to continue his treatment, or to be used to continue the treatment of the boy he saw being wheeled out of the radiation therapy room, or to be used for research to cure cancer, what would he do. This question is unfair, and I don't want it answered.

The point is that we live in a world of limited resources, and the only common denominator we can tie things to is money. Some people can't even get a sandwich, let alone $15,000 worth of cancer treatment. Like it has been said above, it's all just luck, we don't choose these situations, but for a lot of us we are in a position to be assisted with these challenging situations.

Does the machine just roll on, even in the face of unsustainable resource allocation? Would/will our society make the choice to balance the equation between the "haves" and "have nots"? Because, if we want to, there will be a seriously harsh quality of life correction for the lot of us, when we finally act on our beliefs that every life has infinite worth.

Sent by Thom | 5:55 PM ET | 01-12-2007

I have two problems with Pam's comments.

One: she implies some lives are worth more than others. I just don't believe this.

Two: the time, money and effort being spent to save Leroy is not just saving Leroy. All cancer patients benefit from the knowledge gained by what works and what doesn't work. Cancer is still a medical mystery to some extent. Well, to a great extent. The work in colon cancer has benefited other cancers. Avastin is a great example.

It is my heartfelt wish that Pam remains ignorant and never knows the terror of cancer, nor the insult of being thought of as a life not worth saving.

Sent by Karen | 6:01 PM ET | 01-12-2007

I just wonder that if Pam had been in your shoes, would she have decided that her life wasn't worth expending resources? And chosen no intervention? Or if her child or spouse or favorite parent were seriously ill or injured?

And I wonder what she is doing to alleviate all of those terrible conditions that she lists?

Sent by Maggie | 6:04 PM ET | 01-12-2007

I certainly HOPE Pam is alone! What a horrible note. A single life is a precious gift to be cherished. That some of us are more privileged than others in terms of money and resources is certainly not YOUR fault, Leroy.

Sent by Diana Kitch | 6:05 PM ET | 01-12-2007

Ironic title. Pam judged us and we are returning the favor. If we were truly non-judgmental, I suppose we would accept that she has the right to her misinformed opinion. I do feel sad for her, if and when cancer touches her life.

Sent by Stephanie | 6:06 PM ET | 01-12-2007

Now, now, everyone, please calm down. When I first read her comment, I, too, was appalled. After reading Mr. Sievers' response, I felt much better! It was satisfying — as if wits were justifiably counter matched. As the day grows old, I have simply come to enjoy the term "our" Pam has referred to us - "privileged". "Cancer People" are indeed a privileged group. It is amazing how clear and precise life is viewed after diagnoses. Please do not be offended by Pam. Perhaps she has seen a little difference in us, but cannot quite grasp the meaning and is only angry about that.

I have been reading Mr. Sievers' blog for about a month now. I have been searching for someone who could express what I am really experiencing (for just over 2 years now). Diagnosed LUNG CA Stage IV 10/2004 mets to chest wall and liver. I am glad to say that I have found him! Job well done, Mr. Sievers. Thank You.

Sent by Sharron Polozola | 6:09 PM ET | 01-12-2007

Dear Leroy, I have been reading your blog since early summer. I was diagnosed with Stage 1V follicular thyroid cancer three years ago. Your comments help me articulate to others exactly how I am feeling. To address Pam and her insensitive comments. She sits with a cup of coffee, and first reads the headlines etc, then she checks your blog. Checking your blog is a conscience decision. If she does not like what she reads, don't click on your site. Sort of like watching TV... if you don't like the show, don't watch. Perhaps, Pam's mother forgot to teach her "that if you have nothing constructive to say, it is better to say nothing at all." My blood is boiling over her insensitive comment — guess that makes me more alive than ever. Keep up your good work, Leroy.

Sent by Elizabeth | 6:11 PM ET | 01-12-2007

I'm sure Pam is not alone in asking her questions. I have rarely left a doctor's office not wondering what I just got for my $30 co-pay and $200 insurance bill. However the cost of healthcare should not be tied to the person getting it. Everyone deserves to live a long, healthy life — regardless of where they came from. You cant tie the cost of the treatment to the worth of the individual — it is the wrong concern (at least not in any moral fashion, as she was referring to). My life was not more or less worthy of being saved (dx in my 20s) than Leroy's at his age or child of 5. We are all human, we all have things left to do in the world, and we all mourn the loss of the life lost. Its been said before, if you're not part of the solution, you're part of the problem. I am not a victim of cancer, I am a survivor of it, and I use my (hard earned, tyvm) knowledge to try to better the system by advocating for reasonable health care for all, better allocation of resources, and funding that could make cancer a memory. My question to Pam would be: What are you doing to change the system?

Sent by Chris | 6:14 PM ET | 01-12-2007

Has Pam ever stopped to pondered that maybe one of those privileged lives saved today by those unknown amount of resources devoted to cancer research may just be someone who helps prevent the suffering of the faceless masses injured by war, genocide and countless other social injustices?

Lead on Leroy.

Sent by Jessie | 6:16 PM ET | 01-12-2007

Nicely said. I'm not a "victim" - my husband is. I'm grateful she's not his care giver.

Sent by Joan Kelly | 7:05 PM ET | 01-12-2007

Leroy:

Your blog got stronger today. In a strange way you can feel the power emanating from this page. Pretty fascinating, if you ask me.

Sent by Ben Turkel | 10:53 PM ET | 01-12-2007

I'm sure today's posting with Pam's comment will bring a record number of responses. I will add mine. I agree that Pam is both thoughtless and ignorant — not what I typically expect of my fellow NPR addicts. I was not in Rwanda, but I have been in the feeding camps of the Ethiopian famine. I wonder whether Pam has ever actually had to make a judgment on what one life is worth? I hope not. It's a horrible decision to face. Horrible. When the value of a life comes down to the dollars and cents it takes to save it... or prolong it... or enrich it... we have reached a landmark low in the human journey.

In the same situation, faced with the choice between have resources devoted to prolonging her life, or being set aside as having received "enough" out of life and declared not worthy of having another day — what decision would Pam make? It's easy to pontificate when the subject at hand hasn't touched you (although I disagree with the premise of her pontification), but when it's you and the face in the mirror, none of us knows beforehand what we will think, know, or believe.

God bless you, Larry. Yours is the only blog I read daily — thank you for all that you touch and give to all of us.

Sent by Martha Wharton | 11:55 PM ET | 01-12-2007

Dear Leroy,

I started reading your blog some time ago when my cousin Johnny was battling cancer and it helped me to better understand what he was going through. Thank you so much for that! Johnny passed away on November 11, 2006. Since that time, I have continued to read your blog because you are so open and honest and have become so real. Now, I feel I know you and I care for you. That is the reason why I am writing to you.

There is a stark difference when I compare you to Johnny, who was diagnosed with pancreatic cancer in December 2005 at age 65. That is that very early on Johnny accepted God's will and was at peace with whatever God had planned for him. I recall his telling me he began each day with The Lord's Prayer and it kept him close to God as he prayed "They will be done?" It was so heart-lifting and inspiring for everyone who came in contact with him during the past year to witness the power of trusting in God. Seeing how Johnny's deep faith supported and guided him through the challenges he faced, I wish that you too could find peace and comfort.

Today at Mass the priest talked about "faith", which is a gift we wish for everyone. When he compared "faith" to "love", I thought of you. He said that just as we decide to"love" so to we can decide to have "faith". My prayer is that you will find "faith" in God and that it will serve as a source of strength and courage for you.

May God keep you in his care.

With love.

Sent by Ann | 2:28 PM ET | 01-14-2007

Mate, I didn't count them all, but I think there were at least 80 responses to Pam's letter, and I couldn't find one in her favor. And I imagine each letter would represent at least 100 people. So that's at least 8000 to 1. Consider yourself alone, Pam. And Leroy, keep hanging in there. Cheers.

Sent by Tom K. | 9:05 AM ET | 01-16-2007

Pam speaks with the arrogance of youth. Evidently she has little familiarity with cancer, perhaps because she has not lived long enough to know it intimately. She sips her morning coffee and disapproves of the efforts of cancer victims to live another day. Death is but an abstraction to her.

Pam, I hope you live a long, good life, one full of adventure and laughter and friendship and generosity, as Leroy has lived. I hope that you grow in wisdom and compassion with the years. And when the time comes for you to face your death, as you surely will one day, I hope that some callous and naive person will question whether anyone so privileged, as you deserve the resources to live longer. Perhaps then you will appreciate just how appallingly cold and small-minded your comments to Leroy are. You might even use that opportunity to respond with the same thoughtful reflection that Leroy displayed in considering your question to him, but that seems unlikely.

Sent by Ross Barker | 10:58 AM ET | 01-16-2007

Pam, please do not pretend you are concerned with lives of millions if you are not caring about single life. Please do not pretend an idealist and moralist. Sorry, but to me you are simply self-righteous.

Sent by Nella Rokicki | 11:07 AM ET | 01-16-2007

Pam — I feel sorry for you and sad that you would treat another human being the way you have treated/spoken to Leroy. You are sadly lacking compassion. I don't have cancer either and I hope I never do. But, if I am ever diagnosed, or heaven forbid, if someone I know and love is, I would pray they (or I) get the best cancer treatments possible, whether you like it or not. Leroy, thank you for your honesty and courage.

Sent by Carol | 11:11 AM ET | 01-16-2007

I have not read all the comments so I hope I'm not repeating. I'm a 40-year-old cancer survivor, diagnosed at age 31 who has benefited from the very care Pam derides. I am a physician who has treated thousands in my career and saved many lives — maybe someone Pam cares about.

Sent by K.A. | 11:15 AM ET | 01-16-2007

When I read Pam's "heartless" note, and Leroy's reasoned, honest and very human response, I was reminded of my grandfather's statement that such a person is "more to be pitied than to be censored." Fight on, Leroy. Legions are praying/pulling for you.

Sent by Gail Krejci | 11:17 AM ET | 01-16-2007

You guys are funny! I'll come back to that comment later.

Leroy, thanks again for what you accomplish in this blog. I lost my spouse five years ago and I know that if I am at peace with her death today, it is because she was extremely up-front with her disease. She was well educated about her cancer, especially helpful to the medical field trying experimental drugs when there is no more "known best next line of treatment."

Cancer patients are, in my eyes, admirable troopers, fighting for their life and teaching us all.

Her knowledge ("privilege") made her matter of fact about hope and possibilities, and most importantly, her skills to communicate helped all her loved ones to be as aware as they wished, ultimately we felt in control with her.

She educated us about dignity and generosity, in a word, about life.

Pam! She struck a nerve.

Why being affected by her comment? She obviously feels guilty about her own state of privilege, so she tries to spoil it for others.

Why did it work? Why did it bring so many justifications?

I saw a few Pams before. They are usually draining all your energy with their insecurities. At the time I was busy making sure that my spouse had every once of my strength, I decided to ignore the Pams.

Was I selfish? Who cares! In the big picture, we are all helping ourselves and each other but we cannot always take the time to be each others therapists!

Enjoy your day, Leroy.

Sent by Fra. | 11:19 AM ET | 01-16-2007

First, I want to thank you and all your friends for all their comments, questions and general supportive statements. As a nurse, they have given me a great many things to think about and to consider in my life both as a medical professional and a patient myself. While I do not have cancer my life has been touched, as many have by, someone we love living with the disease.

I myself was diagnosed a few years ago with acute heart failure a virus "attacked" my left ventricle and my life at 49 was suddenly and totally changed forever. I was told I had two choices: I could go home and "put my affairs in order" or I could opt for an experimental cardiac device that would "hopefully" retrain my heart to beat in a rhythm that would decrease the heart failure and increase my life expectancy. I am now the proud owner of a $68,000+ device and all the medical experts in my area are my guardians. I was in a clinical research study up until last week (3 ? years after surgery). The device has now gone to market! Now others will be able to lead a longer healthier life because of this study. In the mean time I have reunited with my daughter, I have lived to see my son start high school and show interest in girls, driving and looking for a job! I have seen my first grandchild born.

Would Pam put a price on my children still having their Mom (their Dad passed away 15 years ago)? Would Pam like to put a price on my grandsons smile when I walk into the room?

Was I privileged? Was my life "worth" this cost? I certainly have not lived a privileged life (I have a 1993 Ford Escort in my driveway as we speak). My life is not worth more or less than Leroy's, or Pam's for that matter. But when I was in trouble I'm glad Pam was not there tossing the coin in the air.

Leroy, God's blessings to you. You have given support to more people than you know. I hope that by giving strength you have felt it returned to you ten-fold.

Sent by Karen | 11:25 AM ET | 01-16-2007

Leroy — God Bless you! Your answer to Pam was, indeed, eloquent. My husband has small cell lung cancer and your blog and helped me so much to understand the cancer world we were tossed into. I am grateful to you for NOT GIVING UP and for my husband NOT giving up. We were ALL given LIFE and we are to fight the GOOD Fight. I cannot conceive Pam sitting there on her computer, drinking her coffee, deciding who should live and die — some people never fail to amaze me with their short sidedness. Pam should consider herself truly blessed that cancer has not darkened her doorstep — yet. Thank you for your strength, you'll never know the extent of which you life has touched so many and helped us all. God Bless you — Never GIVE UP!!!!

Sent by Joan Weaver | 11:29 AM ET | 01-16-2007

I was really shocked by the comment Pam made, and I suppose I'm trying to think about what it means to make such a comment, especially in light of what Leroy wrote. There are three features that strike me as particularly noteworthy.

The first involves empathy. I can just about understand someone posing such a question, or asking such a question, in a debate about ethics, which was theoretical in its nature. What is harder to understand is posting such a comment in the kind of space opened up by "my cancer." This space is, to me, an intimate one, where someone makes his experience available in an unusually open way. Hypothetical questions sort of don't belong here, and it seems to me that you would have to lack a very basic sense of empathy not to know that.

The second feature is its ignorance. As Pam settles down with her coffee and her computer, she has already benefited in countless ways from the privilege to which she was born and which operates explicitly at the expense of those who are not born to it. So have I, so have all of us, I'd guess. To isolate cancer treatment as if it alone — as opposed to your cup of joe or your laptop — represented the unequal distribution of assests is crass, simplistic, deluded. I'd rather money be "wasted" on cancer treatments than the wanton squandering of resources that is part and parcel of our privileged lifestyles.

The third noteworthy feature is that a writer, name of Swift, anticipated her post in his piece "A Modest Proposal." I recommend Pam read it to see just how diligently the worth of a human life can be appraised.

Sent by Melissa | 11:33 AM ET | 01-16-2007

Leroy, what a horrible message to send to someone struggling for his life. I suspect Pam has never suffered from a life-threatening illness. My God, what a horrific thing to say to a cancer patient. Can't one say that about any type of medical intervention whatsoever? I would ask Pam if she forgoes any kind of medical treatment in her life... either preventative or that which helps her recover from an illness. If she were to answer no, she doesn't ... then I would ask her why, after all those resources should be used for those "less privileged." Yes, she is entitled to her opinion, and yes, we are allowed to express our thoughts on her opinion.

I am so sorry you got attacked that way Leroy. Stay the course, we are all rooting for you.

Sent by Sher | 11:35 AM ET | 01-16-2007

Leroy,

I have a feeling that Pam's comment was not meant to offend you. She did take some amount of care to phrase it, and admitted that it may sound heartless. I do not think she is an unfeeling person, although others were quick to characterize her this way.

Had she been unfeeling, I doubt shed be reading each morning with her coffee, about the tragedies that befall the world.

Lets face it, we all see things through our own eyes, and it takes effort to look through another's.

Let's look through mine for a moment. I am a long-time nurse who has been with countless numbers of people at the end of their lives, those who were strangers to me and also close family members.

I have seen them struggle with treatment decisions, either for themselves or for others, and I have made decisions for my own dear mother. Just how much treatment do we opt for? For how long? How many different types of chemo do we try? When do we say, "Enough!" When do we acknowledge that the end of life is coming, and rather than prolong it, when do we begin to accept it, and live for the moment?

I have seen people I would love to have counseled to put their lives in order, take a trip somewhere where they've always wanted to go, rather than make daily trips to the hospital for treatment, treatment that will extend life for 4 or 5 months.

Unbelievably tough decisions, admittedly.

I encourage you to read "A Year to Live," by Stephen Levine. Great book to help learn to live each day to its fullest.

Warm regards.

Sent by Hillary | 11:37 AM ET | 01-16-2007

As someone who's come across this blog for the first time just today I feel compelled to comment.

Clinically, this is much ado about nothing. Pam's comments were clumsy, rather than hurtful.

Leroy's consumption of medical resources is from the pool of resources to which we all contractually contribute, to be used in the event of someone's affliction.

Rwanda and Somalia didn't contribute to this pool, Pam, which is why they're not benefiting from it.

Really, it's not much different than any other form of insurance. We don't judge the claimants. A loss is a loss regardless of size of the claim or the wealth of the claimant or whether they're smart or stupid, handsome or ugly.

So Leroy, this isn't about your personal value or worth and you need not take offense at Pam's comments.

Extend that privileged life of yours as long as possible.

However, on a different level most of us might agree with Pam. Why would anyone spend a billion dollars on a new football stadium when the same amount would purchase incredible relief for a million disadvantaged people in the third world? Why spend $100,000 on a sports car and not a dime on the homeless?

I won't even pretend to know those answers.

Sent by Michael | 11:40 AM ET | 01-16-2007

I do think Pam has a good point. What was cruel was misdirecting it to an individual fighting a battle with cancer. In this country, where supposedly all have equal opportunity, with more resources than any other country for health care, we do ration care. There are 44 million people in this country without health insurance and many more with terribly inadequate insurance, and they are looked in the eye and denied treatment for their cancer, simply due to the bad luck of working at a job without coverage.

However, this is not Leroy's decision to make or battle to fight. He is doing what any other human being, including myself, would do in this situation — he is fighting for as long and as good of a life as he can with all the resources at his disposal. But there are people who are making decisions that affect the availability of health care to Americans and to people around the world. And those of us who are not focusing our energies on a battle with cancer can tell decision makers that we want answers. Why do these drugs cost so much, with so much $$ going to profit and pharma CEO salaries? Why doesn't Medicare negotiate for drug prices instead of using our govt health care dollars for pharma profit? How could we shift more money from insurance company overhead into direct health care if insurance was regulated or Medicare expanded? How would world health and peace be served by shifting our government money from war to global health care?

I agree that Leroy can't affect these problems by getting or not getting a PET scan. And further more, no one with cancer should be expending their energy thinking about these issues — they are appropriately focusing on health, life, and family. But the rest of us shouldn't just throw up our hands and say that nothing can be done, it's just the system. We should ask why, in the richest country on earth, that spends more per capita on health care than any other country, but is the only developed country without universal health coverage, why every American cant have the same good care that Leroy has.

Sent by A.M. | 11:44 AM ET | 01-16-2007

I read your column everyday. It gives me strength. I have just completed treatment and have run up a lot of insurance bills. It costs way more than one can ever imagine. As I head back to work this week after six months of medical leave I feel grateful. I am heading back to a job I love, teaching. I feel ready to touch the lives of many students. I feel that my expensive treatment has allowed me to do this. I hope it is worth it. To Pam, I hope you never have to face such an illness. You just sit back and enjoy your cup of coffee. To everyone else be strong and continue to fight!

Sent by Geri | 11:46 AM ET | 01-16-2007

My only experience with cancer has been my husband's prostate cancer. One of the most easily curable and treatable. We are very lucky. Our only difficulty was with sexual function. Our insurance pays for shots and pills so that we can have a fairly normal married life. He is 72 and I am 64.

Apparently Pam would say that the money paid for his surgery and medication was a waste and should have been used to help someone she considers more unfortunate than us.

But how many cancer survivors are still alive because of money spent on treatment, and therefore are able to be healthcare workers, volunteers for Red Cross or some other charitable organization or any other myriad of opportunities to help those less fortunate than themselves in this country or elsewhere.

Why isn't Pam sending the money she spends on computers and all that enables her to read your blog, to Doctors without Borders, the UN relief fund, Darfur, or any number of other places.

My experience in life tells me that she might be a very judgmental person who does not herself, contribute much to the very problems she says would be better served by using money now used for cancer treatment and research.

It would be very interesting to know just how she does contribute to the "the growing numbers of innocent victims of genocide, war, hunger, disease, poverty."

An important question that I haven't seen asked in the comments is "Why is she even reading the blog if she can't relate to it on any level?"

Sent by Susan S. | 11:48 AM ET | 01-16-2007

Wow! I almost fell out of my chair when I read her comment. I am a 34-year-old woman and I was diagnosed with Stage 2 (T3N0) rectal cancer on 12/22. I found your blog while searching for information about Folfox - which I am starting week after next. Along with radiation. Then I am having surgery to remove my entire rectum — which means Ill have a colostomy bag for the rest of my life. And then after surgery I am looking at 4-6 more months of chemo. So, I guess you could say that many resources will be expended to guarantee that I live to see my 50s or 60s. I had what would be considered a privileged upbringing and live a nice life now. I work hard for what I have, but have always had the cushion of generous parents — if something happened to me. And now something has. My whole world has been turned upside down. I will not be able to have children because of this. I am going to have a colostomy bag at 34. Not fun things to think about when you're 34 and single! But I absolutely believe that mountains should be moved to make sure I live. I volunteer and have been involved in the fight against breast cancer since my Mom had it for the first time in 1985. (She got it again in 2005). I truly believe that the good we do for others comes back around and now it's my turn to reap the benefits of it. And I am going to take all I can get. And I think you should, too. This woman Pam is a fool and clearly does not "get it." Thanks for your blog and I'm going to keep reading!

Sent by Carrie | 11:51 AM ET | 01-16-2007

I have one more thought.

My mother died from colon cancer. The doctors gave up on her and didn't treat her. According to Pam's theory, there are underprivleged people somewhere that benefited.

Of course, this is ridiculous. No one chooses whether to treat illness or give an underprivileged person a better life.

The reason there is funding for any cause is a direct result of advocacy.

So, Pam feels passionately about the plight of the underprivileged. Her choice is to sit on her butt sipping coffee and sling guilt at someone for seeking treatment and announce their life is somehow not worth saving.

Heartless?? That is a complete understatement.

Sent by Karen | 11:54 AM ET | 01-16-2007

This is the first I have posted although I have been reading your blog for sometime.

My first thought after reading Pam's post was that she has never had a loved one with a serious disease. My mother died of lung cancer this past May at the age of 73. Before her illness I never realized how desperate one could be to see someone live. I am certainly much more empathetic with anyone going through this journey than I was before. I read your blog with the hope that you will be around a long time.

Also, I am a medical librarian, so everyday I see the value of medical research. Physicians do not practice in a vacuum. They learn from each other, from the medical literature and from their patients. Your physicians are not wasting money trying to keep you alive. They are also learning how to keep other patients alive. This is the process that has resulted in cures for cancers that once were death sentences. This is why we tried to get my mom into a clinical trial?because it not only offered hope but also the chance to help future cancer patients. Your struggle is not pointless. Hang in there.

Sent by Doreen Roberts | 12:08 PM ET | 01-16-2007

I may be in the minority here, but I understand the origin of Pam's question. I can understand her reasoning — how and why she drew that conclusion.

Further, I may be in an even smaller minority when I state I disagree with Leroy on the issue of "luck of the draw." It is unknown if our souls (or any other power) decides when, where, and what conditions/circumstances will await us when were born.

Once we are born, however, decisions and judgments are made every minute of every day regarding who lives and who perishes. We choose to call it things like, "distribution of wealth", "supply and demand", "market forces", and my favorite, "capitalized and free economies".

These aren't ethereal forces that coincidently decide people's fate. PEOPLE make these decisions. As human beings, we are ALL responsible for one another and the privilege and/or deprivation that befall us. We decide which causes warrant the resources that will provide salvation. Western civilization decided long ago that countries in Africa, the Middle East, Caribbean, Asia, etc. weren't worthy of the same treatments. This has existed for centuries and humanity has allowed it to be explained away by calling it happenstance.

Leroy, the answer to your question of "Who decides?" is all of us. Part of being a "lucky" U.S. citizen (or European) is being able to have the money and resources at the expense of others.

Sent by Michael McGalin | 12:12 PM ET | 01-16-2007

I found Pam's comment to be very interesting. I, too, am concerned about the few who waste resources while the many suffer. However, I don't think I would have ever applied that thinking to healthcare.

Firstly, if she really is concerned about the cost of treating cancer, Pam may wish, for example, to look at the profits drug companies make in the U.S. versus in other industrialized nations. I don't think the solution to that issue should be to let more people die so that we can save healthcare dollars.

Secondly, there are so many other areas of waste that are much larger, and have much less benefit to society than healthcare. Look at the cost of the Iraq war, for example, with lots of no-bid contracts that are not audited or checked in any way for fraud or the tons of dollars ear-marked by congress every year for pork barrel projects. Resources that could be used to better purposes without costing others lives.

If it were your child or spouse or parent who were ill, you might find it difficult to deny them expensive treatment and we are all someone's children, if not spouses or parents.

Sent by Jane | 12:14 PM ET | 01-16-2007

I am a cancer patient and I find Pam's comments offensive.

Its so easy to sit back and make comments about things you haven't experienced. I wonder if Pam traded places with us if her opinions might change.

Sent by Mary Scruggs | 12:15 PM ET | 01-16-2007

Has Pam ever stopped to pondered that maybe one of those privileged lives saved today by those unknown amount of resources devoted to cancer research may just be someone who helps prevent the suffering of the faceless masses injured by war, genocide and countless other social injustices?

Lead on Leroy.

Sent by Jessie | 12:17 PM ET | 01-16-2007

It seems as though these kinds of thoughts come to us when we see all the truly awful things that happen to people in other parts of the world — and here too! Leroy, you've seen it. Sometimes I feel a bit guilty for my "daily bread" plus so much more.

But all that is gone when my thoughts about "too many people" in the world and not enough money to fix the problems (never mind that money will not fix many of the problems!) when I think about: hmm, just which people would I eliminate? Not my family, not my friends, not my friends' friends. Considering that were all connected at some level, that pretty much eliminates the elimination.

Pam's thoughts perhaps provoke contemplation — but only in the abstract. Just as soon as medicine, housing, food affects people I know or even can imagine, compassion kicks in. As a previous commenter noted, Pam must not have anyone close to her who has faced such dire adversity.

Leroy, I hope the radiation and chemo haven't — and don't — diminish your hug-ability. I wish I could reach out and give you a hug of comfort and appreciation.

Sent by Gail | 12:19 PM ET | 01-16-2007

Leroy,

You have dignity and poise I can only aspire to have in my lifetime. Keep up with what you do every day. You inspire us all.

Sent by Rhonda | 1:44 PM ET | 01-16-2007

Message for Leroy...I, too, read your posts every morning and doing that reminds me to pray for you and for all those in need, struggling to survive every day.

Included in my prayers is my friend Jennifer who has cancer. She is only 29. Your blog helps me to understand better what she does just to get through every day. She is expecting her baby in April. During this time of pregnancy, she has not had chemo and the prospect of her resuming, let alone the time the cancer has had to evolve, is scary for all of us who love her. Like you, and many, many others, she exhibits courage beyond imagination.

I am sorry for the post from Pam. I am sorry for your cancer and for all those who suffer in this world. I use almost nothing of my health insurance and if the money I don't need goes to helping you, Jennifer, and others, Hurray! It is the least I can do... keep on, Leroy! More courage and strength and hopeful miracles to you! None of us can put a price on the life of another... in God's domain, He loves us all. Nobody is worth more or less.

Sent by Imani | 1:47 PM ET | 01-16-2007

I think many people would react as you did to Pam's questioning the cost of care for sick privileged people. With all good intentions for the overwhelming masses of grossly underprivileged humanity, it is a natural response on an impersonal level to think that spreading out resources evenly would be more just. Theoretically it seems so. In practice, the needs or the world are so great possibly no one would benefit.

It is a great starting point for several discussions. One is that by spending large amounts of resources on sick people in this country we have effectively used each patient in an experimental fashion. Patients try a variety new drugs and therapies, advancing the knowledge of the medical community and the treatment for all future sick people.

Another discussion is the allocation of resources to treat patients and the rising cost of medical care. One of my own views is that abortions to prevent unwanted pregnancies or the births of severely ill babies is positive on many levels, including the cost issue. And that the resources spent on extremely aged or ill individuals who would prefer to opt out is a waste. I would never advocate anyone be required to have an abortion or be euthanized because they have Alzheimer's or Lou Gerhig's disease, but I strongly feel the right to these choices. It is a belief in quality of life over quantity of life and my concern that resources not be forced on adults that don't want them.

My last of many other discussions I could prompt is the idea of who is a victim. Pain and sadness and suffering is just that no matter what age you are, where you live, the number of people you are suffering with or how lucky you have been up to that point in life. Why Pam would choose to put the word victim in quote marks is the biggest mystery to me of all.

Pam probably isn't heartless. I would question her logic and the depth of thought she has put into the matter. But there is a wide range of values in your audience and it's great you bring them into a forum that might prompt some thought.

Best of luck and thank you.

Sent by Lynn | 1:48 PM ET | 01-16-2007

It's appalling that people can be so "heartless" or "ignorant." I can't decide which best characterizes Pam. But I do appreciate your struggles and I appreciate your willingness to share the details of your treatment. I hope Pam never gets the dreaded diagnosis but odds are not in her favor. I had surgery for colon cancer last January & this week had the follow-up colonoscopy. I'm cancer free! A close friend has just been diagnosed with melanoma but in its earliest stage so she should be fine. One of my husband's co-workers just received a diagnosis of prostate cancer. So I hope someone out there isn't making decisions about whether any of us deserve to have resources expended on us! Actually, we need a national health care system to provide better treatment to more people. Take care!

Sent by Ann Donley | 1:52 PM ET | 01-16-2007

Pam appears to have triggered an enormous outpouring of support for you, Leroy. She poses the challenge we all face daily in dealing with cost versus value. The fact is every life is priceless