by Jo Malone
Within the hour, I was sitting opposite a surgeon in his office on another floor, feeling frightened and, perhaps, a little defensive. I think it’s only natural to feel defensive when cancer’s got you cornered. This would be typical of my erratic emotions in the coming days. One minute, I’d be scared; the next, numb; the next, prickly. But not once – not on that first day or at any other time – did I ever think, ‘Why me?’ I was as undeserving as the next person. To ask ‘Why me?’ would be to wish that it was someone else, and that didn’t seem fair. Life doesn’t always deal the good fortune cards.
The surgeon pinned up the image on a light box and there it was: a sinister-looking, shadowy mass with jagged edges. Within a week, following a needle biopsy, I would receive the confirmation that it was ‘an aggressive type of breast cancer’.
On that first day, when all I had to go on was the scan, I went home, climbed upstairs and sat on the foot of our bed. Poor Gary didn’t know what to do or say but he remained stoical. Josh, who was still up, came toddling in, wearing his pyjamas. He was too young to understand but he knew enough to realise I was upset. He sat on my lap, facing me, arms slung around my neck, and, as he looked into my eyes, he kept cocking his head to the side. ‘Mummy, what’s matter?’
How do you answer that?! Mummy’s not well? Mummy’s poorly? How do you wrap cancer in cotton wool and make it sound softer? I chose not to lie, so I said nothing and gave him the tightest hug, more for my benefit than his.
‘Come on, Joshie, time for bed,’ said Gary, as he carried him out.
I started pacing the room, thinking. Okay, you have cancer – it’s a curve ball you weren’t expecting. Happens in business all the time. Think. Don’t feel sorry for yourself. Think. Josh needs you to think. What are you going to do?
In the time it took for my husband and son to share a bedtime story, I felt this energy and strength fill me up, which Gary noticed the moment he came in. I reached for the phone by our bed and started dialling. ‘I’m calling Evelyn [Lauder].’
In the three years since we had joined Lauder, she had been so kind and helpful, someone who made it clear that her door was always open. But it wasn’t only our easy rapport that prompted my call. Evelyn had founded the Breast Cancer Research Foundation in 1993 and was in the vanguard of the fight to find a cure. When it comes to the one-person-you-need-to-call-first, she was the obvious friend.
Genie, her lovely assistant in New York, answered and she knew me well enough to hear my news so I cut straight to the point. ‘Genie, I’ve been diagnosed with breast cancer. I need to speak with Evelyn.’
‘Hold on, I’ll find her,’ she said. ‘It may take a little longer than usual to connect you but bear with me. Don’t go anywhere.’
I waited about two minutes but I would have waited two hours. When I was first put through, all I heard was a fierce blowing into the mouthpiece, as if Evelyn was standing in a wind tunnel. I wasn’t far wrong. A passionate hiker, she was halfway into climbing a peak and speaking to me from the middle of some nowhere. And I’ll never forget her first wind-buffeted words.
‘Jo?! Jo! We’re going to help you, honey!’
She was the first person to whom I voiced my deepest fear, fully aware that Gary was listening. ‘It’s cancer, Evelyn. It’s cancer. I think I’m going to die. I don’t know what to do . . .’
That was what ‘cancer’ meant to me – death.
‘You’re not going to die, Jo. We’re going to get you through this. You’ve got to stay strong. Remember, you make lemonade from lemons!’
If anything summed up that woman’s spirit, there you have it.
‘I’m going to call Larry Norton,’ she added.
‘Who’s Larry Norton?’
‘The man who’s going to do everything to save your life!’
When someone whose opinion you respect says one man in particular is going to be your saviour, you go find that person, even if he lives in Timbuktu. When people ask why I didn’t use our tremendous health service in the UK, that’s the reason. I felt that I had only one shot at this, and Evelyn was emphatic in her referral when we spoke the next day – Larry was, she said, America’s most eminent breast cancer expert.
Thankfully, Dr Larry Norton wasn’t in Timbuktu. He was in Manhattan, working as the physician-in-chief for Breast Cancer Programs at the renowned Memorial Sloan Kettering Cancer Center – the clinic where Evelyn had once led a fundraising drive to establish a state-of-the-art diagnostic centre, the facility that would later bear her name. Within days of my needle biopsy and further tests in London, Gary, Josh and I flew to New York.
As my medical records winged their way to the clinic, we checked in at The Mark Hotel on the corner of 77th and Madison Avenue. I felt apprehensive about what the next few days had in store. Based on conversations with the consultant back home, undergoing a lumpectomy was inevitable, but I worried endlessly about the cancer spreading. Through the course of that evening, I drank bottled water like it was going out of fashion, downing litre after litre in the warped belief that I could flush the cancer away and cleanse my body. By now, I had already devoured books on nutrition and diet, and I came to the conclusion that the only non-acidic, non-toxic things I could eat were nuts and bananas. My appointment with the professionals couldn’t come fast enough.
The next morning, as the sun pounded down outside, I felt incredibly self-conscious. I felt unclean, almost ashamed of a body where cancer was now resident, so I picked out the largest clothes I had – a billowing shirt and baggy pants – trying to hide what couldn’t be seen.
The first doctor I met at the Sloan Kettering was Dr Alexandra Heerdt, a petite lady with shoulder-length hair and a comforting smile. She explained the procedure for, first, the lumpectomy that would remove the tumour, and, second, the biopsy of the sentinel node – the first lymph node to which cancer cells are most likely to spread. There was no prognosis or mention of treatment. Nobody was going to say anything until the results were on her desk from the joint procedure that would be carried out the following morning.
She carried out the biopsy under general anaesthetic and I remained in hospital overnight. By the time I returned to the hotel, I felt surprisingly well, apart from some soreness in my right armpit. As Josh cuddled into me on the bed and fell asleep, Gary was on the phone, dealing with some business in London – a semblance of normality. It was day two of our trip, the tumour had gone, the surgery was over and we would soon be allowed home, once the results were in.
My follow-up was scheduled for a Tuesday at 2 p.m., seven days later. On Monday, Dr Heerdt’s secretary called our room, asking if we could make it 5 p.m. instead.
‘That’s not good,’ I said to Gary.
‘Jo, she’s a busy woman. Something must have come up.’
My heart started pounding. ‘She’s moved us to the end of the day for a reason,’ I said. And as much as Gary spent the rest of the evening trying to calm my worries, every bone in my body told me otherwise.
The next day, when we walked into Dr Heerdt’s office, I wasn’t in the mood for pleasantries. ‘It’s bad news, isn’t it?’ I said as soon as she greeted us.
She didn’t say ‘Yes’ but she didn’t need to; the solemnity in her demeanour spoke volumes. ‘Let’s please sit down and I’m going to talk you through the results,’ she said. We sat around her desk on chairs with wooden armrests. Gary sat forward, on his seat’s edge, not taking his eyes off the doctor, his face etched with worry. He reached out and took my hand.
Dr Heerdt got straight to the point, explaining that the lumpectomy showed that I had ductal carcinoma in situ (DCIS), and that some of my lymph nodes were ‘positive’. And that’s when she told me that my best option was a mastectomy.
Gary slumped forward on to his knees, head in hands, and sobbed. He just crumpled. Our worst fear had just been voiced. Whereas I didn’t move, couldn’t move. Not within myself and not towards him. I felt completely numb. It took all my strength to keep my eyes on Dr Heer
dt.
‘Is there any other way?’ I asked.
She shook her head. ‘I’m sorry, Jo.’
Gary pulled himself up and sat back in the chair, shaking his head. For once, this man who had words of wisdom for any given situation had nothing to offer. Probably because there was nothing to say. All he could do was hold my hand.
‘Okay, when do we do this?’ I asked.
‘Within the week,’ said Dr Heerdt.
Cancer creeps up surreptitiously, unnoticed. Who knows how long it quietly develops and grows? But then it jumps out of nowhere and mugs you from within. Ten days after arriving in New York, I had to get used to the idea of losing a part of my body. From this point on, the whole approach took on a systematic, clinical feel, almost like a business strategy meeting. I was handed pale orange cards that further explained the surgery and the aftercare, answering every conceivable question long before my mind could think of them. It’s not only head-spinning; it’s a mental bombardment that comes at a time when you are struggling to get your bearings.
The next day, we went to see plastic surgeon Dr Joseph Disa, a charming, ridiculously good-looking man who, once my sense of humour had returned, I would later nickname ‘Dishy Disa’. He talked reconstructive surgery options but he could see I was struggling.
‘You’ll get your life back, Jo,’ he said, trying to reassure me, but I just bawled. All I seemed to have done for twenty-four hours was cry, unable to keep it together. I cried so much that it induced a headache, and I felt fed up with the sadness. So, as Dr Disa explained my options regarding reconstructive surgery, I decided that this subject matter would become my focus – something to hold on to beyond the mastectomy, beyond treatment. An action plan always helps restore my balance. He gave me a lot to think about, too: take tissue from my back for an immediate, post-op solution? Have implants inserted at a later date? If so, what type – saline or silicone? Or do nothing? But the answers to those questions would have to wait because I first had to consider my course of treatment – and that’s when I finally met Dr Larry Norton, a slightly built, bespectacled, straight-talking man whose kind face belied a warrior spirit.
As I would discover, he understands cancer like a general understands war. The New York Times once said that he offered ‘a bracing, pugnacious hope’ to his patients, and that became evident in our first meeting when he wanted to know what I was made of; probably because I had started our meeting by saying that I didn’t want chemotherapy and he’d have to find another way. I didn’t want to do it and I didn’t want to lose my hair, I insisted.
He listened, understood my reticence but, with characteristic compassion, told me that I really didn’t have a choice. ‘Look,’ he said, gently, ‘there are two kinds of people who walk in here: one that says, “Don’t hurt me,” and the other that says, “Give me back my life.” Which one are you?’
He made me face the reality there and then. ‘I want to live,’ I said.
‘Right, so from this day forward, you have got to trust me.’
And, boy, did I trust him. He had this air about him that suggested expertise, and I wanted to hold on to the tails of his white coat because that expertise told me that he was in control, not cancer. Surrendering to events outside my control has never been one of my strong points, but I happily placed my trust in Larry, in Evelyn’s opinion of him, and in God.
‘Do whatever you need to do,’ I said.
‘Good. We’ll work out a plan and I promise that we’ll fight this together,’ he said.
When it came to chemotherapy, Larry was as precise as a perfumer, measuring the dosage to exact drops. He had pioneered ‘dose-dense drug delivery’, where the treatment is administered at an optimised level specific to the patient and unique to each cancer. It felt like I was listening to a mathematician not a doctor as he explained how he would calculate and keep refining the frequency and dosage, balancing the treatment with my body’s equilibrium. This way, he said, I wouldn’t receive high doses up front.
When my tumour was removed, the sentinel node biopsy found that cancer was present in some lymph nodes, meaning cancerous cells may have migrated but they didn’t know how many – maybe one, maybe several – so the treatment was designed to mop them up. Chemotherapy that Larry described as ‘a belt and braces insurance policy’.
An insurance policy had never sounded so terrible.
It actually scared me more than the thought of a mastectomy. The first image that came to mind was Ali MacGraw in Love Story. The second thing I thought about was the wheelchair-bound young man I had seen earlier, dressed in a surgical smock, no hair, all skin and bone, with a face the colour of grey paint. I remember looking at him and thinking, ‘Please, God, don’t ever let that be me – he looks like he really has cancer.’
Months later, that would be me.
Larry warned me that my hair would fall out by the second dose ‘but not forever’. That’s what they do at Sloan Kettering – they deliver the hard truth with goals and hope attached. Yes, you’ll go through a rough time, but you’ll get your life back. Yes, you’ll be sick, but we’ve pills for that. Yes, you’ll be bald but hair grows again. ‘What ifs’ don’t exist, only positive ‘Yes buts’. That’s because the mental approach is so important; something that I would not immediately find easy.
But being around the positivity of the Sloan Kettering ethos was one reason why I decided it would be best to spend the four months of treatment in New York; plus, with a chemotherapy-weakened immune system, the risk of infection would be too great on continual flights back and forth. It proved a wise decision, because I would come to depend on Larry’s guidance to such an extent that I didn’t want to be away from him. He would become more than a doctor; he would become a dear friend, who I love and respect, and I think it’s safe to say that I won’t be his only patient to declare that.
I flew to London with Gary and Josh that evening and, in a flurry of activity over forty-eight hours, we made arrangements for our home to be looked after, for the business to be set on the correct path, and for Vicky and Lorna to oversee the day-to-day running of the shop. Leonard, Evelyn and everyone else at the company were beyond supportive, even setting up an office for Gary in the GM Building. Nothing was too much trouble.
I essentially compartmentalised my life to focus on the one job at hand. In the same way doctors sought to isolate my cancer, I sought to isolate myself. I wanted none of this episode to infect my life in London and Sloane Street, so Manhattan would be the box where I’d confine my illness. I would approach these sixteen weeks in the same way I approached everything else: fully immersed, one hundred per cent focused.
Once we returned to Manhattan, on the weekend before my Monday mastectomy, we rented a seventh-floor, two-bedroom apartment in The Sutton, a condominium on 56th Street between First and Second, about twelve blocks from Sloan Kettering. We were a mere taxi ride or a long stroll away, and, for the foreseeable future, my world wouldn’t go beyond that ten-minute radius. Manhattan was reduced to twelve blocks in length and width as far as I was concerned. My doctor, my notes, my treatment, my family were all within reach, along with a chemist, a café, and a local food emporium. I had everything I needed.
At night, from the balcony we could see the Chrysler Building lit up. The apartment itself wasn’t much to look at: grey carpets, tiny white kitchen, lemon yellow bathroom, and dark wood furniture throughout, but I wasn’t complaining. It was a base, not a home. That said, I hated the smell of the bed linen, so the first thing I did was buy new sheets, pillow cases and a blue-and-white patchwork quilt that I sprayed with Grapefruit fragrance. The apartment had to smell like home at least.
On the wall opposite the front door, there was a large, full-length mirror and, as time went on, it would offer a reflection that I refused to look at. But on the morning of the surgery, as Gary finished getting Josh ready, I stood there and stared at myself. I was wearing a red, oversized Abercrombie & Fitch zipped-up sweatshirt with blue jeans. It’
s a surreal thing to look at yourself, contemplating the imminent removal of a part of your anatomy. No matter how hard I tried, I couldn’t imagine the ‘before’ and the ‘after’ that would later confront me.
At that moment, Josh came tottering up to me, proudly showing off a piece of Lego that he had managed to construct – that was his achievement, and that was my perspective. To one very important person I wasn’t a cancer patient; I was a mum, come what may. We left him with the nanny and he carried on playing contentedly. For as long as he was happy building and dismantling Lego, oblivious to what was going on, Gary and I were okay with that.
At the bottom of the elevator, our resident porter opened the door. I would come to know this dark-suited gentleman as Paul, a gentle giant of a man who, come rain or shine, would greet us with a smile. I swear that this wonderful human being was an angel posted to the main entrance to be a constant source of assistance in the coming months.
Once outside, Gary wanted to hail a taxi. I asked if we could walk – ‘a walk will do me good’, I said. I was probably the only person in Manhattan that morning who wasn’t in any kind of rush. As we walked, a taxi driver berated another motorist, blaring his horn. I must have noticed the same thing happen a thousand times in New York and London but only now did it seem so petty. We passed a man sweeping the streets, literally whistling while he worked. I had definitely not noticed anyone doing that before in New York or London, and all I wanted to do was trade places.
As we neared the hospital, I felt like I was going to throw up. Fear, I discovered, operates in much the same way as creativity: it grips you, takes over, and consumes your every thought. But it wasn’t the fear of losing my breast; it was the fear of what lay ahead – the chemo, the treatment, the not knowing where this path led. What if it didn’t end with a mastectomy? What if this cancer proved bigger than me?