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Glioblastoma’s spectre in the Senate

With his right arm extended – pausing for just a moment – Senator John McCain flashed a thumbs-down and jarred the Senate floor. Audible gasps and commotion followed. At 1:29 am on 28 July, Senator McCain had just supplied the decisive “Nay” vote to derail the fourth and final bill voted on that night. With that, a seven-year pursuit to undo the Affordable Care Act had collapsed.

The weight of that moment was magnified by the circumstances under which Senator McCain had arrived in D.C. days earlier. After undergoing a supraorbital keyhole craniotomy to remove a five centimeter blood clot from above his left eye, McCain was diagnosed with glioblastoma multiforme – the most aggressive primary cancer of the brain. Just two weeks later, McCain returned to Washington and made waves throughout the Senate chamber and the national health policy debate. Curiously, he may have been subtly drawing strength from the eerie history of American senators before him who — in the face of glioblastoma — lit up the Capitol in gripping, historical moments.

Senator Edward “Ted” Kennedy, made his courageous return in 2008, enduring the physical effects of glioblastoma to cast a deciding vote to advance a critical Medicare bill. McCain was there cheering on his old friend Kennedy when the entire Senate chamber engaged in a thunderous standing ovation upon his return. Kennedy, in turn, was on that same Senate floor in 1964, to witness the very first account of an active US Senator’s mettle when confronted with glioblastoma. For that remarkable story, we turn to Senator Clair Engle (1911-1964), whose poignant moment came during the most crucial moment in the passage of the landmark Civil Rights Act, described by historian Dennis W. Johnson:

Promptly at 11:00 a.m., the clerk began calling the roll. “Mr. Aiken.” “Aye.” “Mr. Allot” “Aye.” When the clerk got down to “E”, the Senate reached a moment of high drama, rarely seen in its history. Senator Clair Engle, fifty-two, once a handsome and rugged liberal who had earned the sobriquet “Congressman Fireball,” was now a mere shadow of his once robust self. His fragile, wracked body slumped in a wheelchair, gently guided onto the Senate floor by an aide. Ten months earlier, Engle had undergone an operation to remove a malignant brain tumor; since then his condition had deteriorated to the point where he could not walk, could barely move his arms, and was unable to utter a word. Gallery spectators watched in respectful silence as several times Engle weakly lifted his crippled arm, pointed to his eye, and tried to mouth the word “Aye.” There were tears in the eyes of many of his distinguished colleagues. Senate procedure did not require that a vote be uttered out loud, and Engle’s vote was recorded in the “Aye” column.

GBM in the frontal right lobe as seen on CT scan by James Heilman, MD. CC BY-SA 4.0 via Wikimedia Commons.

With Engle’s vote, cloture was invoked, and a fierce 60-day filibuster by Southern segregationists was cut off – producing one of the 20th century’s towering legislative achievements, the Civil Rights Act of 1964.

Glioblastoma multiforme, or glioblastoma for short, is the most common malignant brain tumor in adults. Originally named in part by Harvey Cushing, the “father of neurosurgery,” the tumor originates from primitive precursors of glial cells (glioblasts), and frequently takes on a highly variable appearance from the presence of necrosis, hemorrhage, and cysts (multiform). Glia (derived from the Greek word for “glue”) refers to cells that support neurons through various functions. These tumors have drawn significant attention due to their poor prognosis, yet patient outcomes have changed little as these aggressive tumors have evaded increasingly clever and sophisticated attempts at therapy over the last half-century. Researchers continue to work to gain new insights that may improve survival.

Glioblastoma is a devastating neurological disease. Most patients die within one year. Thus, a diagnosis of glioblastoma confers to the patient an ineffable load. In these moments, it is the duty of dedicated, compassionate clinicians to embrace a patient and family whose lives have disintegrated, and work until they can get back up and make sense of their existence. The decision and determination to find meaning in the precious time that remains requires great strength and the support of loved ones.

Engle, Kennedy, and McCain, whether through a moving gesture or an expression of vitality, offer powerful examples of that strength. Though tragic, there is a poetic thread to how these men are connected over time and through service – each producing moments of inspiration, demonstrating what is possible even when facing terminal neurological illness.

Featured image credit: United States Capitol by denishiza. CC0 public domain via Pixabay.

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