Promise Me

by Nancy G. Brinker

  “Please tell me I’m not being a spoiled Jewish American Princess.”

  “You’re not,” I assured her. “I always thought he was a little … well … ‘not like other guys’ is one way to put it.”

  “He kicked Louie down the stairs,” said Suzy. “How was I going to spend my life with a man who’d do something like that?”

  “You couldn’t,” I said. “Of course, you couldn’t, Suz.” (Even now I find it remarkable that she was more concerned for that little dog than she was for herself.)

  “I don’t know how I would have gotten through this without you and Mom and Dad,” said Suzy. “You’ve all been aces.”

  In proper little Peoria—or any midwestern town during the reign of Father Knows Best—being rashly married and hastily divorced would have spelled social disaster for a lot of girls, but Suzy’s unstoppable charm coupled with Mom’s get-on-with-it disposition simply didn’t allow that. There was no energy wasted on chagrin, no time budgeted for wallowing. With her head held high, Suzy greeted people on the street and continued her charity work and good-neighborliness, being her fabulous self, going out on dates, winning friends and influencing people. We couldn’t walk into the grocery store without meeting a dozen people who loved her. An elderly neighbor she’d taken time to sit with. A grieving widow to whom she’d brought flowers. A Girl Scout from whom she’d bought cookies. A teenager she’d cared for at the Florence Crittenton Home for unwed mothers.

  There was a small space available in a shopping center Dad was developing, and Suzy opened a little art gallery that showcased and sold the work of local artists. She hosted parties that were packed to the rafters with smart, witty people and earned extra money modeling for department stores and catalogs. She played with Louie and toyed with learning guitar. To me at nineteen, it seemed like my big sister had it all together, but in retrospect I see she was flailing a bit in her search for herself.

  We’d always taken an interest in politics and got involved early, stuffing envelopes and knocking on doors for Illinois’ own Adlai Stevenson in the 1956 presidential primaries. We were both entranced with JFK in 1960, and I was insanely jealous that Suzy got to vote in 1964, squeaking under the wire and turning twenty-one a matter of days before the presidential election. I was still too young, but I was determined to make up for that by rabble-rousing to the best of my ability. We got a great education in political discourse during election years. Daddy was an old-school, fiscally conservative Republican, which—back in the day—meant pro-business and anti-nonsense. Mommy was a pragmatically moderate Roosevelt Democrat, which meant social consciousness with a firm nod to personal responsibility.

  Growing up at that diverse dinner table, Suzy and I never equated a difference of opinion with hatred or disrespect, and to this day, I’m disappointed whenever I see it come down to that. We saw between our parents—in action and in rhetoric—the perfect model for a democracy; both sides of a debate are needed, and even the extremist views are valuable because they remind us where the middle is. Because I’ve witnessed the fundamental principles of both parties at their truest and best, I have respect and affection for people on both sides of the aisle, and I cherish the aisle itself as a welcoming middle ground, free of obstacles and hostilities.

  I went off to college that fall and was up to my neck in activity within minutes. I knew I’d learn far more out of the classroom than in it, so I dove into student government and media. I was an eager volunteer when it came to organizing anything from a sorority dance to Trick or Treat for UNICEF. Even at eighteen, I knew my most lamentable weakness and my most marketable asset were one and the same: I simply had a different way of seeing things. Most people saw letters and numbers as clear and finite and viewed the boundaries and railroad tracks that separated class and culture with the same unbreachable clarity. My inverted vision turned a field of obstacles into an expanse of opportunities the same way it transposed W to M. Constantly circumventing this learning disability trained me to question what I was seeing, to ferret out the devilish details and look for an open window when confronted with a closed door.

  I’d seldom been stranded without a date for homecoming and other high school functions, and the same held true in college, but I was way too busy to be swept off my feet by anyone in particular. First the pool was narrowed to men who were tall enough to dance with me at my full five-ten-plus-heels. Winnow from those the few who were smart and well informed enough to carry on a conversation. And among those, look for the one who didn’t mind playing second fiddle to a crusade against the arming of campus security guards or fundraising for Radio Free Europe.

  In January 1965, LBJ spoke of the “Great Society” in his State of the Union address.

  For today the state of the Union depends, in large measure, upon the state of the world. Our concern and interest, compassion and vigilance, extend to every corner of a dwindling planet.… We know that history is ours to make. And if there is great danger, there is now also the excitement of great expectations.

  Looking back through the telescope of three decades in politics, I see the well-crafted wording, the agenda, the angles. But as I watched that speech on a grainy black-and-white TV in the dorm lounge, the vision of a society without poverty or racial prejudice formed a hard lump in my throat. I felt in my chest a whirlpool of possibility and yearning, youthful energy, a huge sense of future. I felt the excitement of great expectations.

  The Great Society asks not how much, but how good; not only how to create wealth but how to use it; not only how fast we are going, but where we are headed. It proposes as the first test for a nation: the quality of its people.

  Our good friends, David and Michael, had evolved from little boys who engaged Suzy and me in water balloon wars to solid young men ready to see the world. When they told us they were going to Europe, Suzy’s eyes came alive.

  “Nanny, we have to go too,” she said. “It’ll be spectacular.”

  I was immediately on board. Mom and Dad took a little convincing. Suzy and I prepared an elaborate sales pitch and were prepared to pay for everything with money we’d saved.

  “The boys are true-blue trustworthy escorts,” said Suzy. “There won’t be any shenanigans.”

  “We’ll call you every week,” I chimed in, “and send postcards and look out for each other.”

  “Think of the history and art. Very educational.”

  And so the lobbying went until Mom and Dad relented. Sitting at the kitchen table, poring over guidebooks and travel brochures, we felt terribly grown up. Real women of the world. We planned to fly to Spain, then go to Paris, where we’d buy a Volkswagen for cheap and spend the next three months driving an amorphous loop through France, Italy, Germany, Denmark, and England.

  “Then we’ll ship the car home from England, sell it here for twice what we paid, and split the money,” I told Daddy, our oracle for all business advice. “What do you think?”

  “You’d better have something on reserve,” he said. “In case you shop beyond your budget.”

  “I just want to take in every speck of art my eyes can see,” Suzy assured him. “I don’t even care about buying anything. Other than gloves for Mom and Aunt Sylvia. Maybe a chic little suit if I see one that’s inexpensive. Plus knitwear, of course. But that’s it. Well—shoes. And if we end up going out a lot, we might need another evening dress or two. But other than that, I don’t see us shopping much at all.”

  We judiciously packed summery, wrinkle-resistant Arnel shifts and sensible walking shoes for daytime, killer heels and Mad Men chic dresses for nightlife, and plenty of extra hosiery, because Suzy wouldn’t be caught dead in Paris with a run in her hose.

  The first week of June 1965, Mom and Dad threw a lovely bon voyage party for Suzy and me and drove us to O’Hare airport in Chicago. As we climbed the stairs to board the TWA flight bound for Madrid, I breathed in the heat radiating from the tarmac and said, with all the hope and hubris of a nineteen-year-old, “Ah, the intoxicating s
cent of freedom!”

  “What a great life,” Suzy smiled up at me. “We’re so lucky, Nan. The luckiest.”

  We spent the first few hours engrossed in our phrase books, but out over the Atlantic, the air got choppy. With each dip and swell, unsettled gasps and murmurs rippled through the cabin. Mike and Dave were full of bravado, cracking jokes from across the aisle, but Suzy quickly became miserable.

  Resting her cheek on my shoulder, she moaned, “I need Dramamine. And vodka.”

  When the food cart rolled past, I shook my head even though I was starving.

  “You’ll be okay,” I said, stroking Suzy’s hand. “Just think about Spain … Paris … Italy.”

  “Italy.” She smiled wanly. “It’s too wonderful to imagine.”

  Little Pearl Harbor

  THE THRIVING port at Bari, Italy, was fully lit and hustling with activity the night of December 2, 1943. The Luftwaffe had no trouble finding it. During an hour-long raid, fuel gushed from a severed pipeline and flames bled across the bay, enveloping thirty cargo and transport vessels from America, England, Poland, and Norway, including a U.S. Liberty ship, which harbored a deadly secret. Hidden in the bowels of the foundering John Harvey were 2,000 hundred-pound mustard gas bombs.

  In response to the hideous effects of World War I mustard gas attacks, an international pact forbade the use of chemical warfare, but nations quietly stockpiled supplies, fearing others might not be as good as their word. The Allied High Command knew Hitler had his own cache and suspected he’d use it without hesitation if the true nature of the John Harvey’s cargo were discovered. In the days following the attack known as “Little Pearl Harbor,” Eisenhower and Churchill scrambled to deny the existence of the mustard gas, which left medical personnel on the ground in Bari scrambling to determine what was happening to their patients.

  Less than twenty-four hours after the attack, sailors who’d been plucked from the water relatively unharmed were in searing agony, blind, coughing blood, covered with chemical burn blisters that oozed a garlicky yellow substance. Blood tests revealed a dramatic change in body chemistry: lymphocytes—white blood cells that power the immune system—had been virtually wiped out. Autopsies showed severe damage to lymph node tissue. Soon, people from the nearby village where the smoke plume had settled were stumbling into the already burdened medical facilities, presenting the same symptoms. Within weeks, eighty-three sailors and uncounted civilians were dead, and hundreds more lay grievously debilitated.

  On Churchill’s order, the incident was stricken from the records, the casualties attributed to burns from the fuel spill, but U.S. documents regarding the incident at Bari were declassified in the late 1950s, confirming what physicians had suspected all along. Had the truth been known from the beginning, it’s possible they would have missed a pivotal discovery in the history of chemotherapy. Now the Third Reich had fallen; researchers were contemplating the use of chemical warfare on a different kind of enemy. If the deadly alkylating agents in mustard gas killed lymphocytes, they theorized, mustard gas could kill lymphoma. And if it killed lymphoma, it could kill breast cancer that had metastasized to the lymph nodes.

  If only there was a way to deliver the mustard gas without killing the patient.

  Dr. Paul Ehrlich, a German Nobel Laureate known as “the Father of Chemotherapy,” pioneered techniques for standardizing toxic chemical cocktails and delivering them intravenously prior to World War I. He was an immunologist and did significant work in cancer research, but the practical application that won over the most enthusiastic funding was Ehrlich’s success in using arsenic-based drugs for the treatment of syphilis. Some say Ehrlich was the first to hypothesize about the “magic bullet” of cell-specific drugs. He accomplished a great deal before his death in 1915, but because he was a Jew, his work was discredited and the street signs bearing his name were torn down until after World War II.

  Breast cancer treatment in postwar America hadn’t advanced much since the time of Frankenstein. By the turn of the twentieth century, physicians and medical students from far and wide were packing into the observatory above an operating room at Johns Hopkins Hospital to watch and learn as Dr. William Stewart Halsted (usually braced by a pinch of cocaine) whisked away the breasts, chest wall, and lymph nodes, along with surrounding fatty tissue and skin, in one symphonic stroke. He was the undisputed Elvis of the super-radical mastectomy, hailed as the most brilliant surgeon who’d ever practiced, and the Halsted mastectomy remained the gold standard for breast cancer treatment for almost a hundred years. In Dorothy Parker’s New York in the enlightened age of A-bombs and torpedo bras, offering anything less than the Halsted radical would have been deemed “a mistaken kindness” to my Aunt Rose.

  Standard practice was to put a woman under general anesthesia and keep her under while pathologists did the biopsy. If the tumor was benign, she woke up with a small incision. If it was malignant, she woke up to an entirely different life, having had a radical mastectomy—or the new and improved super-radical mastectomy that went inside the rib cage, as technology advanced the limits of survivable surgery. If that didn’t do it, hope was offered in the form of an oophorectomy, removing the ovaries. If the cancer recurred, sometimes removing the adrenal glands from the kidneys had some effect. Beyond that, there was brain surgery to remove the pituitary gland.

  In the late 1950s, as a research fellow at the Postgraduate Medical School of London and subsequently as a professor of surgery at the University of Pittsburgh, Dr. Bernard Fisher was no longer buying into a mindset that looked at the frequent recurrence of breast cancer and said, “We’re not cutting enough.” Fisher, a scientist first and surgeon second, looked at the data and said, “We’re cutting too much.”

  If breast cancer cells broke off and drifted through the lymphatic system long before the tumor was large enough to detect, Fisher said, it was therefore a systemic disease and surgery was far from the “perfect cure.” At the time, of course, this view was heresy—a return to the bad old days of humoral medicine. With quiet confidence, Fisher conducted laboratory and clinical research that proved the efficacy of lumpectomy and radiation and eventually upended a century of conventional wisdom based on the Halsted approach. A new day was dawning. By the time Dr. Strangelove hit the movie theaters in the mid-1960s, radiation was improving survival rates, and clinical trials spearheaded by Fisher showed promising results for cyclophosphamide, the drug derived from mustard gas.

  Statistics indicated there was no lifesaving advantage to the biopsy-mastectomy combo platter. Fisher argued that women should be given the opportunity to open their eyes, consider the unique circumstances of their individual situation, and make an informed decision about how they wanted to proceed. Essentially, the only argument against this humane, respectful approach was that because it required more than just one surgery, it caused a woman “inconvenience”—a word that makes me cringe when I hear it tossed up as a reason to abolish routine mammograms and breast self-exams.

  For the record: Courtesy boarding, free Wi-Fi, a little plastic spoon attached to an ice cream cup—that’s a “convenience.” A canceled flight, a lost BlackBerry, a stain on your blouse—that’s an “inconvenience.” If the powers that be really want to help a gal out, they should offer to do our laundry, not relieve us of our power to make decisions about our own bodies.

  Through the 1980s and 1990s, Fisher conducted clinical trials (funded in part by Susan G. Komen for the Cure) pioneering adjuvant and neo-adjuvant therapies, orchestrated campaigns that included chemo, radiation, and surgery. Preoperative chemo permitted less invasive surgery and killed off free-floating cancer cells in the lymphatic system before they could set up shop; postoperative radiation then zapped the vulnerable tissue where the tumor first presented. Given the improved chance of long-term survival, women were quick to sign on, despite the devastating side effects of chemotherapy.

  And devastating they are: Cyclophosphamide (Cytoxin) and other alkylating agents strip away the immu
ne system’s ability to fight infection. Doxorubicin (Adriamycin) is essentially a toxic-caliber antibiotic that binds to fast-growing cells and destroys them, whether they’re cancer cells or cells you’d prefer to hang on to—like hair follicles and the lining of your stomach. Fluorouracil (appropriately nicknamed “FU”) and other antimetabolites disrupt the DNA that cells need to repair themselves.

  All this translates to a firestorm of temporary side effects and sometimes lasting damage to every aspect of the body: total hair loss, debilitating fatigue, piercing headaches, vomiting, nosebleeds, raw sores in the mouth and throat, heart and lung damage, organ failure—a thousand strange anomalies, aches, and aftertastes that seem to (and often do) emanate from your very bone marrow. The early onset of menopause is common; loss of olfactory senses, a disjointed loss of memory referred to as “chemo brain,” and even changes in eye color have been documented.

  Every woman who’s experienced this Little Pearl Harbor inside her own body knows exactly what I’m talking about, but I think those of us who survived to see our children grow up would agree: it was worth the “inconvenience.”

  In 1999, the first Susan G. Komen Race for the Cure in Rome—our first such event in Europe—drew a few thousand committed volunteers and advocates. Ten years later, my son, Eric, addressed a crowd of over fifty thousand runners and walkers gathered at the starting point in Terme di Caracalla Stadium. Led by Dr. Riccardo Masetti, a renowned breast surgeon and founding member of Komen Italia, dedicated volunteers extended outreach with a traveling Early Detection Village, a mobile facility offering free breast cancer screening to women across the country. In 2007, Komen Italia brought the Race for the Cure to Bologna and Bari.

  On a bright spring morning, sixty-odd years after the deadly chemical plume stained the sky over the Bari harbor, the salt air was filled with pink balloons. And hope.