Mooting in Baltimore, Snow-Pocalypse 2010, and Scientific Subjectivity

This weekend we went to Baltimore, MD; ground zero for both the North American-Atlantic Regional Round of the Stetson University, International Environmental Moot Court Competition (for which we signed up and prepped last semester) and apparently, the snowstorm of the century.

Thankfully both were fun, relatively disaster-free, and we actually ended up winning the dang moot court thing (though we're still slightly unsure how, why, or what just happened).

The Team's Effort:

To be honest, I think that our victory was a combination of things. My teammates, Erika Fisher and Greg Katz, and myself listened well to one another, our judges' feedback, and internalized the suggestions and constructive criticisms of most everyone involved. But while these elements really came together and helped us synthesize our baseline knowledge/strategy with new information, we really were the only team (of 8) in Baltimore who attended simply to "work out our jitters;" jitters that we individually endeavored to work out for various and personal reasons. The win was simply icing that we didn't expect, and I think this fact lent a certain flexibility to our team's demeanor and argumentation that none of us really expected. Anyway we did well, had a wonderful time hanging out getting much closer, and then we braved the treacherous roads of I-95 to arrive back in Philly a day later than originally expected. Oh yeah, we also spent $150 on a victory dinner (plus lots more later on really expensive Scotch/Martinis [don't worry, I didn't order any]) to celebrate-but hey, we deserved it, right? Meanwhile, our competitor teams all performed very very well, and it surprised us that we were able to pull out this big win from such minimal expectations. The next step is to head down to Florida from March 11-14 to compete against several other two team-contingents from both the North American-Pacific Rounds, as well as from around the world (I think there will be about twenty teams total competing in Florida). It'll be a great time, though it's certainly possible that my radiation therapy might interfere and not allow me to go. However if that's the case, I really am okay with it. Either way, constantly popping my pills with a ten-inch scar running across my head, while Erika laughed constantly and Greg told strange stories about...um, riding bears in front of the other teams was sure to have them convinced that Penn Law only lets in the most drugged up of law students. That's not always the case though...

My Personal Performance:

I performed adequately; even exceeding my expectations to a large degree. Before my seizure and surgery, I felt perfectly comfortable speaking in front of judges, professors, and others in a legal reasoning context. In short, I really had no problems with public speaking. But as one might guess, this whole process has shaken my confidence somewhat and left me a bit more than worried about whether or not I can continue as a future trial lawyer-preferably in a US Attorney's Office. Furthermore, "word finding" has been a persistant and somewhat bothersome problem for me at times lately. While public speaking might do this to most people every now and then, for me it seems to be more of a cognitive problem with actually finding the correct word stored somewhere in my brain. It's a very similar feeling to just knowing THAT word that one might try and find in conversation, only to then go completely blank when attempting to recall it. Thankfully this is improving rapidly, which is something for which I went to this moot court competition to test. Now while there certainly WERE a few moments this weekend that forced me to pause and "find words" that I might have easily found before (in front of the judges!), I emerged with my self-esteem and composure substantially rebuilt. This weekend, while also a whole lot of fun, was a wonderful confidence builder that I am very sure helped my healing. Of course, it can definitely be said that I "played third fiddle" to Greg and Erika (who were also, admittedly, much better prepared than me). But I did argue two out of six "moot" rounds (for which there were two mooters/team/round), including a "rebuttal" that apparently went well.
(To better describe the process, moot court competitions basically go like this: the whole thing is an hour of oral argument, supported by facts and legal reasoning, which is broken up into two half-hour sections per team. The "applicant" goes first, dividing their half-hour in whatever way they prefer and reserving time for rebuttal at the end of argument if they like. The "respondent" goes second, dividing their half-hour time in the same way but without any left over for rebuttal which, while the luxury of the applicant, helps to balance the burden the applicant faces in court for bringing the suit in the first place).

Snow-Pocalypse 2010

The snowstorm itself WAS actually somewhat apocalyptic. We stayed at the Lord Baltimore Hotel, right smack dab in downtown Baltimore, a stately old building built in 1928 (en.wikipedia.org/wiki/Lord_Baltimore_Hotel) and placed on the National Register of Historic Places in 1982. It's an amazing place absolutely soaked in history, though its interior sort of reminded me of the Overlook Hotel (or rather, The Stanley Hotel if you're considering the TV show) of "The Shining" notoriety. The overall effect was one of a once-industrial-but-now-kinda-dystopian city (of "The Wire" fame, nonetheless), an old but beautiful hotel, and a massive snowstorm that dumped more than two feet of snow on the entire region in about 24 hours-leaving only the city's streets "cleared" for walking ("cleared" as in, pressed down from snowplow tire tracks). Strange and beautiful, just like I imagine the end of the world will be...with a definite emphasis on "strange." I know that Philadelphia was walloped even worse than us in Baltimore though (by two inches), and the word is that more snow is coming tomorrow night. What an odd winter; I think we're even likely to break a seasonal snow record this year, which is crazy since it was so beautiful outside today and somewhat hard to imagine. Anyway, get ready because the next wave is on its way-up to two feet apparently.

Scientific Subjectivity:
So everything else aside, during the competition I learned a bit more about scientific subjectivity and the general idea that pathologists' assessments don't always agree. Apparently, MD Anderson in Texas has one of the best tumor pathology departments in the country, just as does Penn Medical. However, MD Anderson's pathology department determined that my tumor is actually what is called a "glioneuroma," which is basically a much more benign tumor than an anaplastic oligoastrocytoma. The problem is that these types of brain tumors are rather rare. However, their prognosis for long-term survival is quite good-something like 90% (depending on the source) of patients with this type of tumor end up living greater than 10 years, which is usually the maximum time frame for when statistics like these are kept. While the prognosis/lifespan for a patient with an anaplastic oligoastrocytoma can vary quite dramatically, it generally seems like the glioneuroma is the better way to go.

So now we have two very prestigious pathology departments saying two very different things-and with Johns Hopkins on the way with our third opinion (probably to come back within a week or so). The sorta bad news in all of this gray speculation is that my 1p/19q came back undeleted, which means radiation therapy is guaranteed. At least that's not really a decision anymore, and it does feel good to have locked myself into that option. However, if my tumor is a glioneuroma as opposed to an anaplastic oligoastrocytoma, then it would seem that I may not need chemotherapy after all-which while systemically non-toxic, is not something to which I necessarily wish to subject myself (because of the possibility of systemic toxicity down the line).

As for the quality of Johns Hopkins' pathology department; while I have been assured that their pathology department is "very thorough" and definitely also "one of the best five in the nation," I can imagine that whichever way their pathology report comes out, the gray area of scientific subjectivity will not be eliminated one way or another by whatever they conclude. Similar to legal reasoning on a right-wrong/yes-no spectrum, a good argument can be made for either diagnosis. That possibility is what makes me think that simply taking the additional chemotherapy might not actually be so bad of an idea after all, something which may actually be precluded by the legal obligation a physician has to not contravene "best practices" in light of overwhelming (or at least "more likely," evidence). 2 against 1 is apparently pretty important even in an extra-legal context, and at least in part because of lawyers no less. It's amazing how much influence lawyers have on decisions that are not always obviously (but still are) related to matters of legal analysis, but for which they (we?) might sue if there are any resulant debits down the road. My preference at this point would be for the tumor itself to be a glialneuroma, but for Johns Hopkins to determine it as an anaplastic oligoastrocytoma, which would kick me back into chemotherapy-land. Like my neural-oncologist told me, "this isn't your grandma's chemotherapy." I guess that's good, though my grandma still beat the heck out of their life-span prognosis.

So, What Now?
We wait for Johns Hopkins pathology department to get back to us and let the doctors decide from there. Because to be honest, at this point that is really all we can do.

The Erie Grave of Edgar Allan Poe