OPINION: Are Justice Ginsburg’s Supreme Court Days Numbered?

Brian Joondeph | Physician

Supreme Court Justice Ruth Bader Ginsburg is in the news again. Not for a controversial judicial opinion, but for her ongoing health issues. Last week, Ginsburg had surgery to remove a lobe of her lung as two suspicious lung nodules were found following her recent fall.

Last month, she fell, fracturing three ribs. Presumably, the lung nodules were found by x-ray after her fall. Further imaging likely caused her doctors to recommend removing the nodules.

Interestingly, a week ago, she told a group of admirers, “My health is fine.” Perhaps the Clinton appointed justice is borrowing a page from Bill Clinton, parsing the meaning of “health” and “fine”.

Her surgeon last week removed two malignant nodules. Were they primary lung cancer or metastases from one of her previous cancers?

She had colon cancer in 1999 and pancreatic cancer in 2009, both of which are known to spread to the lungs. The lungs are a common site for metastatic cancer as the entire blood supply flows through the lungs, carrying cancer cells from distant parts of the body.

If these nodules were not metastatic, then she would have primary lung cancer. While possible, having three different types of cancer is unusual. Ginsburg was not a smoker, which makes lung cancer less likely. Occam’s Razor suggests metastatic cancer.

Her lung nodules will be examined microscopically to determine the type of and origin of the malignancy. Until that news is announced, we can only speculate.

If her cancer is indeed metastatic, it is considered to be stage IV, with the worst prognosis. For stage IV colon cancer, the five-year survival is 15 percent. For pancreatic cancer, the five-year survival for stage IV disease is much worse at only 3 percent.

Justice Ginsburg’s fall was fortuitous in that her lung nodules were diagnosed early. While they would eventually be found, they may have grown to the point where surgery was no longer possible.

Why did she fall? Falls are common in the elderly and are a leading cause of injury and death in that age group. Cancer occasionally spreads to the brain, affecting balance, but presumably, her doctors checked for this after her fall. Cardiac issues also cause lightheadedness and falls. Ginsburg had a cardiac stent placed in 2014.

As an 85-year-old, she has had her share of health issues and I wish her and her family well in her recovery. She exercises regularly and her dedication to fitness is commendable and contributory to her ability to bounce back after a succession of major medical issues.

The RBG Workout has been published as a book, another fitness fad. A young Politico writer tried the workout and said, “It nearly broke me.” That’s the unfortunate state of fitness in America when a millennial male can’t keep up with a frail 85-year-old woman in the gym.

What’s next for Justice Ginsburg? She first has to recover from her thoracic surgery and partial lung removal. That alone is no small feat in someone her age. She is at risk for bleeding, infection, respiratory issues, all on top of three broken ribs.

Based on the cancer found in her lungs, further chemotherapy and/or radiation may be needed. As her medical challenges mount, her ability to serve on the nation’s highest court comes into question. Reportedly, she is already back up and working from her hospital bed.

As Justice Ginsburg’s retirement may be sooner rather than later based on her health, President Trump may soon have another court nominee. This time it won’t be a replacement for moderate swing-vote Justice Anthony Kennedy but instead for one of the court’s quintessential liberals.

Expect fireworks far beyond what we saw in the Kavanaugh confirmation hearings. People are already stepping up to donate their lungs to Ginsburg, sacrificing their lives in the pursuit of liberal judicial activism.

In the meantime, let’s wish Justice Ginsburg a speedy recovery but be sure to get a good seat for the circus when she eventually retires.

Brian C. Joondeph (@RetinalDoctor), MD, MPS, is a Denver-based physician.


The views and opinions expressed in this commentary are those of the author and do not reflect the official position of The Daily Caller.

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