Cruel to be kind

21 June 2020

The worst time to get chemotherapy is the day on which you get it. The second worst is every other day. It is not pleasant. What they are doing is pumping a poisonous concoction through your veins.

When this starts, the race is on to kill the cancer before the cancer kills you. The poison attacks rapidly growing cells which are the bedrock of all cancers. The trick to treating the disease is to stop the cancer cells from multiplying out of control.

Treatment also targets other rapidly growing cells and is one reason hair often falls out under chemotherapy. The most common, and most visible, of the rapidly growing cells are in the roots of your hair. Wherever hairs grow on your body, there’s a 65 per cent chance they’ll stop during treatment. I am now 11 weeks in on mine and the hair on the top of my head is a lot thinner than it was, but it’s still there.

The prospect of going bald, even if only temporarily, is distressing for a lot of people. Nobody wants to live through a bad hair day. Think about this now that we’ve endured three months of a pandemic lock down. As businesses start up, the one thing most people want is to get a hair cut. When Guelph moved to stage 2 of the lock down and barber shops and hair salons could open here but not in Hamilton or Toronto, what do you suppose happened? The local stylists got calls from out of town people wanting a hair appointment.

I don’t have chapter and verse to back it up, but I recall surveys about the one thing people would change about themselves if they could. It was their hair. People with straight wanted curly, and those with curly wanted straight. They just weren’t happy with what they had. Sitting through three months of shuttered hair salons and barber shops has been torture for them.

For those who took scissors into their own hands, covid hair became as noticeable as chemo hair.

The theory behind chemotherapy is straightforward. It boils down to three bits of simple wisdom my grandmother picked up in the West Highlands of Scotland while training to become a nurse. The cure can be worse than the disease; you must be cruel to be kind; and my personal favourite, it could have been worse.

How else to frame a medical treatment that poisons you to cure you? Chemotherapy is a major weapon in the war on cancer. We wage chemical warfare against our own bodies.

One of the many horrors inflicted on competing armies during the first world war was the use of mustard gas. In July 1917 it was used with devastating effect against Canadian troops at Ypres in Belgium. In one night, it injured or killed 2,000 soldiers. In the moment, the military medics were so busy caring for the victims they didn’t see the upside of mustard gas.

Then, 25 years later, another world war came along. All the belligerent nations had stockpiled mustard gas and were waiting for someone else to be the first to use it. On December 02, 1943, an American cargo ship, the SS John Harvey, waited to be unloaded in the port of Bari, Italy. It carried a top secret cargo of 2,000 mustard gas bombs. A Luftwaffe bomber squadron swooped in and laid waste to the harbour. More than 1,000 people were killed, and 28 ships sunk. All the mustard gas bombs exploded at once.

In the mayhem that followed, Siddhartha Mukherjee recounts in The Emperor of All Maladies, autopsies on “the men and women who had initially survived the bombing but succumbed later to injuries, white blood cells had virtually vanished in their blood.” (p. 90)

The mustard gas specifically targeted bone marrow cells. A few more years of research and clinical trials were undertaken through the Chemical Warfare Unit of the military’s Office of Scientific Research and Development. By 1948, the fruit of their labour was chlormethine, the first chemo drug. Mustard gas became treatment for lymphoblastic leukemia.

Now, about 70 years later, it is the oldest of more than 100 other chemotherapy drugs. Chemical warfare on the battlefield progressed to chemical warfare in the body.

Or, as Mukherjee puts it:

“Every drug, the sixteenth-century physician Paracelsus once opined, is a poison in disguise. Cancer chemotherapy, consumed by its fiery obsession to obliterate the cancer cell, found its roots in the obverse logic: every poison might be a drug in disguise.”

The Emperor of All Maladies, page 89


  1. Happy Father’s Day Allen! Keep up the good fight!

  2. fascinating info….alan…

  3. Thank you Alan, for another very informative article!

  4. Thanks, Al, for this. Who could have imagined? Thanks for keeping our spirits up as you go through this.

  5. Interesting info’ about the chemicals we use in chemotherapy. Who knew? And now, thanks to you, we do know a little more about it. Keep up the good fight, Alan.

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