My mind flashed to Mel Gibson and Jodi Foster in Maverick. Was that a riverboat? And how does it end? The only other riverboat I could think of was the Mark Twain Riverboat at Disneyland, and surely there was no gambling going on there. Mickey would not have it. Wait. What does this have to do with my cancer?
“Um, sure. Right. Riverboat gambling,” I answered Dr. Glaspy, but I was looking at Chris. Chris smiled and raised his eyebrows.
“My job is to walk up and down the boat looking at the cards each player is holding. I can tell you your odds based on the cards you’re holding, but I could be wrong. You could be dealt a different hand completely. All I can do is look at your hand and tell you your odds and the best way to play that particular hand.”
My worries increased. I started arbitrarily calculating my odds of survival. Fifty percent? “Okay. So, what are my odds? What have I been dealt?”
“Well, it’s not a good hand.”
Thirty percent chance of survival? Chris told me later he was thinking 20 percent. We both had our greatest moment of fear right there on the Delta Queen.
“How not good?”
“Without chemotherapy you have a 30 percent chance of recurrence. And if it recurs we’re not talking about cure then, we’re talking about treatment to extend your life.”
So, wait, that’s a 70 percent chance it won’t be back? That’s not bad. Not bad at all. I expressed my relief, much to Dr. Glaspy’s horror.
“No,” he said, “that’s not good at all. Those are not acceptable odds. You are the poster child for chemotherapy. With chemotherapy we can cut those odds in half. With chemotherapy you will reduce your odds of recurrence to 15 percent—that’s still higher than we like, but it’s better than 30 percent.”
“Oh, right. No, I get that. It’s just that the way you were talking, I was expecting a lot worse. I thought I had no face cards and not even a pair of twos.” I spent many a day playing poker with my grandfather and our next-door neighbor Art when I was a kid. I was an excellent poker player at seven years old. I knew a bad hand when I was dealt one.
“It is a bad hand. Triple-negative is a very aggressive form of cancer. When I say you’re the poster child for chemotherapy, I mean that you could go to any oncologist anywhere and they would all recommend chemotherapy. It’s all we’ve got for this. Oncologists love to debate and argue the most effective treatments for various cancers, but not with yours. Every oncologist would tell you the same thing. You need chemotherapy.”
I realized then that my response had concerned him that I wouldn’t agree to chemotherapy. But the good and great Dr. Karam had done a fine job of slowly but surely turning up the chemo heat, and Dr. Glaspy was now bringing things to the inevitable boil. It was clear what I needed to do, and I would do it. Right then, though, I was thinking about Seamus and the hand he’d been dealt—the terrible odds that he’d beaten anyway.
Dr. Glaspy continued his explanation. “If we took one hundred women with your cancer exactly and put them in a room together, we know that with no post-surgery treatment thirty of them will have a recurrence of the cancer and seventy of them won’t. We just don’t know which thirty.”
I wasn’t picturing women in a room. I pictured one hundred beagles. Thirty of them immediately ran howling to one side of the room. In Seamus’s case, it was probably thirty that would not have a recurrence. The seventy beagles on the other side of the room would have a recurrence. I figured if the doctor could be on a riverboat, I could be in a beagle rescue. Now, if those beagles were at a card table, playing poker…Stop! Listen to the oncologist! He’s talking about your cancer!
“So we give them all chemotherapy. The chemotherapy will cut that number to fifteen. That means fifteen of those women will still have a recurrence, but another fifteen will not. Again though, we don’t know which fifteen.”
Fifteen beagles ran across my mental room and joined the other thirty safe beagles. Which side of the room had Seamus been standing on after his surgery? Either way, there was, as I knew, as I had insisted to that sorority-bitch of a doctor, always the chance he would survive. There’s always a chance. Seamus had shown everyone that much.
Later when I explained to a friend why I was undergoing chemotherapy even though there were no signs of cancer in my body after surgery, when I explained what these statistics meant, what the science could and couldn’t tell us, and most particularly when I told her about the beagles racing across the room in my mind, she clearly thought I had lost my marbles in that beagle stampede.
“Teresa, the doctor is talking to you about your life, your diagnosis, and all you can think about was your dog? You’re not taking this seriously,” she said.
Not taking cancer seriously. As though that can be done. She was not the first nor the last to make this comment to me. I was taking cancer seriously. I was also taking those odds very seriously. Seamus’s experience helped me understand my odds in a very positive way, whether my friend understood that or not.
I addressed Dr. Glaspy. “So, I could have the chemo but never have needed it—I could have been one of the original seventy?” Dr. Glaspy did not strike me as the kind of doctor one discussed her beagle’s cancer diagnosis with, at least not then, so I stuck to questions geared toward understanding my own chances.
“Yes, but you could also be one of those fifteen women whose life was saved by chemotherapy.”
Like Seamus. I understood now, far better than I had then, why Seamus had to undergo chemotherapy even though the surgeon had achieved the coveted “clean margins” around his excised tumor. Chemo gave him the best chance to be the beagle that crossed the room over to the safe side and walked out the doggie door to health. And he did it. Would I be that lucky?
There was only one way to know.
Once I agreed to the chemotherapy, Dr. Glaspy and his physician’s assistant explained the protocol to me. I’d have Taxotere and Cytoxan four times each, spaced three weeks apart. I recognized Cytoxan—Seamus had been given Cytoxan. They really do give the same chemotherapy to dogs and humans. I made a mental note to check to see if Cytoxan was what caused Seamus’s white blood cell crash.
Dr. Glaspy reviewed the possible side effects with me. “You may be fatigued, and you may be nauseous. We have ways of controlling that, and it’s certainly better than it used to be, but some patients do get nauseous during or immediately after treatment. Your long drive may be an issue. Do you have someone who can drive you?”
“I’ll be with her for each appointment. Do you think we’ll be able to head home by 2:00 p.m. and miss the traffic?” Chris said.
“Hard to know. And probably not for the first treatment. You might want to consider staying in a hotel if that’s an option for you. Or I can refer you to an oncologist closer to where you live.”
I considered that option. I’d had such good care at UCLA and trusted Dr. Karam’s opinion of Dr. Glaspy so much that I did not want to go anywhere else. On the other hand, I knew I couldn’t afford a hotel room each night of chemo, not with missing work on those days as well. The thought of being nauseous in a car for sixty miles and possibly as long as three hours was also not appealing. Things would be easier for Chris, too, if I had treatment closer to home. I decided to at least get the referral and meet the other oncologist.
• • •
Hi Everybody, Chris here.
As you probably know, Teresa has cancer. I know, big-time shocker! But her surgery was successful and now she’s on to chemotherapy. Huzzah! Where, as the oncologist said, she’s GUARANTEED to lose her hair. GUARANTEED. (His emphasis, not mine.)
Expecting this even before the surgery (apparently some of her pessimism is rubbing off on me), I did what any good boyfriend would do—I offered to shave off my hair. I mean, if you’re going to have one bald person in the family, why not two, right? Three, though, wasn’t going to be an option. Se
amus is far too reluctant to go the shaving route with us. He gets freaked out at the sight of a Mach 3. Plus, apparently he’s vain.
Teresa, though, was just as reluctant as Seamus to go through with my whole head-shaving scheme. She’s always loved my thick, full head of hair (“Democrat hair,” she calls it— think Kennedy, Kerry, Clinton....yeah, you got it), and the last thing she wanted was for me to get rid of it when she lost hers. Why have two bald people in the family when you only need one, she said? And who am I to argue? I mean, she has CANCER, for crying out loud! (And don’t think she ever lets you forget it.)
So, I decided to go another way with it instead: instead of shaving my head in solidarity, I would grow out my hair during her chemo and radiation sessions. I get to look like Clinton, she gets to look like Jimmy Carville.
Long story short, I had what may be my final haircut of 2009 (gulp! or at least until August—gulp!) Saturday.
But here’s the thing: (1) My hair grows really, really fast. Like Usain Bolt speed-of-sound fast, (2) I think the longest I’ve ever gone without cutting my hair is three months—all told, this is going to be at least six months of growth, possibly seven or eight or even longer (if I keep it up post-treatment while Teresa is still, well, shiny. We’ll see. That will be a game time and psoriasis-related decision). I’ve never grown my hair out that long. I have no idea what’s going to happen, and (3) unlike most normal people whose hair grows down as it gets longer, mine doesn’t. It grows up. And big. Like pompadour big. Like Del Shannon in 1957 big. Like Roman centurion helmet big. As my hair grows, it develops into a White Irish Afro (or Whi-fro).
Anyway, that’s what I’m doing to support Teresa in her fight against cancer.
See you all later. Longer, shaggier, and substantially more democratier than before.
• • •
A week after our visit with Dr. Glaspy, Chris and I met with Dr. Blaine, the oncologist closer to home. I was immediately discouraged by the sight of her office. Valentine’s Day was coming up, and thus there were pink and red streamers, Cupid cutouts, and hearts adorning every spare inch of wall and ceiling space. As though chemo wasn’t going to be nauseating enough, I was going to have to put up with a cuteness overdose? I quickly calculated my three months of chemotherapy and realized I’d have to suffer through St. Patrick’s Day and Easter décor as well. My hopes that the treatment rooms were not likewise vandalized were dashed when, thirty minutes after my scheduled appointment time, I was led back to the exam room, past plates of heart-shaped cookies on heart-shaped doilies, more streamers, and Mylar balloons shouting, “Happy Valentine’s Day!!”
I waited in my paper dress uniform for another twenty minutes before the doctor made her appearance. Where Dr. Glaspy had seemed reserved and somewhat humorless compared to Dr. Karam, he seemed endearing, warm, and fuzzy compared to the icicle that was Dr. Blaine.
She quickly introduced herself and then commanded I lay down for an exam. I did.
Her cold hands poked and prodded.
“You can sit up now.”
I did.
“So you’re a lawyer,” she said as she reached for a file. “What kind of law?”
“I do estate planning, mostly for family business owners.”
“Estate planning? Don’t a lot of lawyers do that? Isn’t that just wills and trusts?”
Nice move. It’s always endearing to add “just” in front of someone’s occupation. Aren’t you just a priest? Just a schoolteacher? Just an oncologist?
“No. It’s not ‘just’ that at all.”
“Oh. Well, I’ve had lots of lawyers as patients. Do you know John Allen? He’s not a patient, but we’ve done lots of work together.”
I knew of John Allen. He was a well-known, well-respected attorney who sued insurance companies for breach of good faith and abuses of their insureds. I wasn’t sure how I felt about her working with him so much or how I felt about discussing legal matters. She had a motive for this discussion though.
“Well, my staff tells me you’ve declined to sign our waiver,” she said.
“I did. For two reasons—first, I’m only here for a consultation so I shouldn’t need to waive anything, and second, that waiver reads as though you could completely screw up everything and I’d have no redress whatsoever.”
“John Allen drafted it.” She smiled in a manner clearly meant to convey “Checkmate, bitch.” And she continued, “If you don’t sign it, I won’t treat you.”
I wanted to ask what had caused her to be so defensive about lawsuits, but I didn’t. I was too floored by her response and demeanor.
With my surgical scar still healing, I was not able to discuss my choice of oncologists with Chris in the hot tub. Perhaps that is why our decision was not a good one. I wish I had more vividly recalled my encounter with Seamus’s Dr. Sorority Chick and been able to recognize when I’d walked into yet another alpha-female battle that I could not win, especially not when dressed in a paper towel, stitches in my right breast, and the nightmare of chemotherapy on the horizon. If I had recognized what was happening with Dr. B, I would have spared myself much frustration and pain over the next several months. But once we learned that Dr. B was also the oncologist who had treated the mother of Chris’s friend Ashley (who’d been at dinner with us the day we first met Dr. Karam), and Ashley gave her glowing reviews, it seemed she was an obvious choice. Dr. B came highly recommended by Dr. Glaspy as well.
I was there for health care, not to find a new friend, I told myself. Maybe she’d just had one bad day and I happened in on that day.
Maybe.
• • •
I’ve learned many surprising things, but way up on the list was this fact: by the time a breast cancer mass (fancy word for “lump”; unless you are trying to apply it to your spouse—it doesn’t work the same) can actually be felt, those dastardly cancer cells have been hard at work in the breast for six to eight years. Years! I’ve had cancer for years! (I’m totally expecting phone calls, cards, and flowers from some of you....the way you’ve treated me....and I had cancer then!!!) Modern technology can’t detect the cancer in the beginning years of growth (nope, not the mammogram, not an MRI, and you can’t feel it either....these are just little tiny bad-guy cells), so it’s only after they’ve divided and multiplied and turned into a gang that they get discovered.
Basically, a fertile little cancer cell reproduces to be two cells in about one hundred days, then four cells at two hundred days, eight at three hundred, sixteen at four hundred, up until at about five years the cancer party is now about 1 mm in size. Millimeter....not centimeter. Only at eight years have they divided in number to get to the 1 cm size, which is generally considered the smallest “palpable” tumor (meaning you can feel it—if you were trying; the machines might pick it up before this....if you were getting regular mammograms). At ten years that could be 2 or 3 cm or larger, depending on the rate of growth.
Let’s just think about my rude little invading tumor bastard (just a little pet name I have for it). I have had a mammogram every year since I turned forty. So that would be five mammograms that didn’t pick up on the party going on. The last of these was July. Then in November I could actually feel something. By December it was clearly “a lump.” And it turned out to be a 1.7 cm lump. It had maybe been growing there for eight years??
Quite a party of evil. Which explains the change from July to December. It also, in part, explains the chemotherapy as necessity. We don’t know if there are other cells starting a party o’ bad somewhere else in my body that just hasn’t been picked up yet—some of the gangbanger party attendees could have flowed out into the street and down to a neighbor’s where they are hiding out (cowards, really) until there’s enough of them to make their presence known. We need to flush those out and banish them.
Chapter 18
A COVER-UP
I
sat at my desk with the prescription in front of me and read “Cranium Prosthesis.” I flattened out the blue slip of paper, picked it up, put it back down, read the fine print, and ultimately stared blankly.
I needed hair.
I had no idea how to go about getting a wig, yet I would be bald in a few weeks’ time. Dr. Glaspy had guaranteed it.
“And you will lose your hair. Guaranteed. One hundred percent. No question. But it will grow back. It will take”—and here he looked at my hair, a few inches below my shoulder, blond, and relatively healthy—“a couple of years to get back to that, but you’ll get it back.”
Dr. B was equally direct, although she threw in a gratuitous eye roll when I asked if I really would lose all my hair and she answered, “Of course you will.”
Chemotherapy is almost as frightening as cancer. Every chemo patient must hang on to the idea that maybe they won’t lose their hair; maybe they will be one of the lucky ones. These oncologists had obviously had the discussion too many times.
At UCLA, in my initial meeting with Dr. Glaspy, he gave me several prescriptions to begin preparing for chemotherapy (several very serious prescriptions, just to be clear)—antinausea, pain relief of varying degrees of strength, and a cranium prosthesis. The latter cannot be filled at your neighborhood pharmacy—which is why I was sitting in my office, twirling a blue piece of paper, and contemplating synthetic hair.
I’d been stumped for a few days. My “cancer to-do” list was long, and I was busy taking care of most of it with the help of my family and Chris. My mom sent me sweatsuits with zip jackets to wear during the infusions. My dad sent antioxidants, vitamins, and books. Chris stocked our pantry with the foods I liked most or that had been recommended (much as I had done for Seamus, I couldn’t help but note). I read as much as I could on the Internet, and I made an appointment for Chris and me to attend chemo “boot camp” training at Dr. B’s office.
Dog Lived (and So Will I) Page 22