M. D. Anderson Cancer Center has a mission statement, and everyone who works there, from the president to the cleaning crews, can state it like a catechism: to "eliminate cancer in Texas, the nation and the world."
For the nearly 90,000 patients who will go to the center in Houston this year, that mission cannot be fulfilled soon enough. They and their families arrive at the world's largest freestanding cancer hospital from around the world, often leaving behind jobs and stashing children with relatives for months. Some rent apartments or stay in mobile home parks near the hospital.
They enter through a soaring lobby, with cheery aquariums and exuberant volunteer greeters eager to help in any way. They come looking for hope.
But there is no mistaking what this place is: the front line of the frustrating war on a still largely incurable disease.
Doctors are encouraged to try everything, and when insurers balk, they pick up the phone, repeatedly, hoping to persuade them to pay for what may be unconventional treatments.
The federal government gives more cancer research money to this hospital than to any other, and the hospital has an abundance of specialists in many forms of cancer, including rare ones. Medicare offers more generous reimbursement, and the hospital offers treatments that often go far beyond what can be offered at most other places.
"I tell young physicians who are starting out here that the big limitation is imagination," said Dr. Martin Raber, an oncologist — and a cancer patient himself — at Anderson. "If you are good at what you do and you have great ideas, we will help you find the resources you need to make them happen."
But like a modern version of the tuberculosis sanatorium in Thomas Mann's "Magic Mountain," Anderson is a world where the best that medicine has to offer is often far from enough. The odds are still grim, and while there are exhilarating recoveries, the exhausting, dispiriting road traveled by many patients comes into sharp relief.
They are patients like 35-year-old Mindy Lanoux of San Antonio, who has melanoma that has spread to her liver and lungs, her odds of surviving in the single digits. She has been to the hospital 16 times in nine months, spending a week there each time for treatments so debilitating she wanted to give up. But she keeps returning, smearing peppermint oil under her nose when she walks in the medical center's door to hide the odor.
"The smell gets to me," Ms. Lanoux said. "It smells like cleaning products and the sickness and the medicines. It takes your brave edge off."
Then she and her father go to her room and start putting her things away. "We don't talk," Ms. Lanoux said. "There is no polite conversation. It is like an army setting up to do battle."
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