The Cancer Club

Office Tow­er

My interof­fice phone line rang. “Hey, Ken. It’s Paul. Can you come up to my office?”

“Sure.”

I climbed the inside fire stair­well from floor 43 to 46 and walked around the tow­er to Paul’s office. Tall and lean with dark brown hair, he sat at his desk, smok­ing a cig­a­rette. “Close the door,” he said.

I closed it and sat in a chair across from him, my back to the bank of win­dows that looked out over LA.

He stubbed out his Marl­boro and looked me direct­ly in the eye. “I have cancer.”

I couldn’t process most of what Paul said after that. About all I remem­ber are the words “aggres­sive” and “late stage.”

I cried.

In 1990, Paul and I were in our ear­ly 40’s, and we were attor­neys with the law firm, Lath­am and Watkins. If I had ranked my friends back then, he would have placed in the top ten.

I pulled myself togeth­er. “Is there any­thing I can do?”

“Don’t give up on me.” He told me about surgery to remove tumors and scrape the lin­ing of his lungs to stim­u­late his immune sys­tem. It sound­ed hor­rif­ic. He did his best to appear hope­ful, but I could tell he knew the score.

We talked for a long while about fun times we’d shared. Then he said he had to call the next friend on his list. We hugged. I went back to my office, closed the door, and cried some more.

He was gone in three months. An emo­tion­al wreck at the funer­al, I got it togeth­er long enough to give my con­do­lences to his wife. She told me Paul had trea­sured our friend­ship, and the way she said it, I knew it was true. I’ve car­ried that with me ever since.

Loca­tion of My Mole

Thir­ty-three years lat­er, I noticed a small mole on my shoul­der near my neck.

Because Cindy is fair-skinned and sus­cep­ti­ble to melanoma, we fol­low a reg­i­men of six-month check­ups with a der­ma­tol­o­gist. At the next exam, I asked him to look at the mole. “It’s noth­ing to wor­ry about,” he said. His ver­dict remained the same for two years.

Last spring the mole grew larg­er and dark­er. One after­noon in June, my daugh­ter and I were in the pool watch­ing my grand­kids. “What’s that on your shoul­der?” Chelsea said.

“Just a mole. The doc­tor says it’s nothing.”

“I don’t know, Dad. It looks bad.”

That night I awoke from a sound sleep at 3 am. My first con­scious thought came to me in a clear qui­et voice: “Get that mole off your shoul­der, or it will kill you.”

It scared me bad. I went to the der­ma­tol­o­gist. He again said the mole was harmless.

Dermatologist’s Prep for Removal

“I want to take it off,” I said.

He agreed to remove it, gave me a shot, and sliced it off. “There’s dark tis­sue under the mole,” he said, sound­ing con­cerned. He cut into it.

“I only gave you a local. Are you in pain?”

It was killing me. “No pain,” I said.

He cut deep­er. “You must be in pain.”

My shoul­der was on fire. “I’m fine. Make sure you get all of it.”

A few days lat­er, he called with the biopsy’s results. The mole was benign; the dark tis­sue beneath it was can­cer­ous. “I excised what I could see,” he said, “but this is an aggres­sive type of melanoma. You’ll need surgery to remove all the can­cer cells.” He’d already called the City of Hope (COH), the top can­cer treat­ment cen­ter in the region, and jammed me into the crowd­ed cal­en­dar of its lead melanoma surgeon.

The dermatologist’s sense of urgency alarmed me. “How bad is this?” I asked.

“Hope­ful­ly, we caught it ear­ly. If it hasn’t metas­ta­sized, you should be all right.”

I hung up the phone and stared at it. The mole had appeared two years ago, but the can­cer­ous tis­sue under it may not have been there as long. The sur­geon will remove it, and I’ll be okay, I thought. I decid­ed not to tell any­one until I knew more.

Sur­geon

A few days lat­er I met with the sur­geon. In his fifties with a full head of gray hair, he told me my form of can­cer, melanoma beneath the skin, was rare. It could have tak­en root in anoth­er part of my body and spread to that spot, or if it orig­i­nat­ed in my shoul­der and had been there awhile, it could have spread to oth­er loca­tions. “I need to know if the can­cer has metas­ta­sized before I oper­ate on your shoul­der,” he said. He sched­uled a bat­tery of tests over the next six weeks, fol­lowed imme­di­ate­ly by the shoul­der operation.

The surgeon’s diag­no­sis fright­ened me. “Could this be fatal?” I asked him.

“Try not to wor­ry,” he said. “We’re very good at what we do.”

Stunned, I walked from the hos­pi­tal to my truck. Mem­o­ries of Paul, Papaw, Thom, Stephanie, and oth­er friends, who lost bat­tles with can­cer, flood­ed my mind.

I got lost dri­ving home. I pulled to the curb, cut the igni­tion, and took deep breaths.

A cou­ple years ear­li­er, a nice gray-haired lady dri­ving a black Escalade hit me and my gro­cery cart as I walked from a Ralph’s store through a cross­walk. I wasn’t hurt, but she fell apart, sob­bing hys­ter­i­cal­ly. It took her a long time to calm down enough to tell me she’d just been diag­nosed with pan­cre­at­ic can­cer. I helped her park her Escalade and called her husband.

The Grim Reaper blind­ed the nice lady that day. Now he squat­ted on the hood of my truck. I punched my home address into Google Maps and fol­lowed the voice com­mands, crawl­ing along at a tur­tle-pace in the slow lane.

When I got home, I told Cindy. Pos­i­tive and sup­port­ive as always, she didn’t flinch. “You’re strong! If they find some­thing, you’ll beat it!” My son and daugh­ters said the same. So did my good friend and horse­back-rid­ing instruc­tor, Janet. And my rid­ing bud­dy, Alecia.

Every­one was con­fi­dent except me. That night in bed in the dark trapped inside my head with the boogey­man, I was cer­tain the can­cer had metas­ta­sized. I cat­a­logued all the recent symp­toms I’d ignored that might be can­cer relat­ed. Those hard cramps last week, stom­ach can­cer; my aching joints, bone can­cer; occa­sion­al headaches, brain can­cer; severe chest con­ges­tion, lung can­cer. I imag­ined var­i­ous scenes with the sur­geon deliv­er­ing dif­fer­ent dead­ly diagnoses.

Show some courage, I told myself. You’re 77. You’ve lived a long full life. Can­cer cut Paul down in his prime, but he faced death brave­ly. Go out proud and brave, like he did.

I don’t want to go out! I love my life. I want to stay with Cindy, my kids and grand­kids, the hors­es, P.D., my friends. I don’t want to die!

Get a grip. You’re not going to die. You don’t know any­thing yet. You don’t even know if the can­cer has spread.

Yeah, well, I know some­thing is grow­ing inside me right now that could kill me.

And so it went. On and on. All night long.

Lily’s Soul­ful Eyes

At dawn, I drove to the barn and went to Lily’s stall. An Azteca gray mare, she has equine melanoma. There is no cure, but it isn’t always fatal. She may live out her life with the can­cer or it may kill her, and there’s noth­ing I can do to influ­ence the out­come. (See Lily’s Song for more about her.)

I groomed her, then stood beside her, look­ing into her soul­ful eyes. I placed my fore­head against her neck and put my arm over her back. Even if they love you, most hors­es pull away when you hold them close for too long. That morn­ing, Lily stood still for me. I don’t know if she knew, but it felt like she did.

Lat­er, back at home, I reached out to my phys­i­cal fit­ness train­er, a can­cer sur­vivor. She gave me under­stand­ing and encour­age­ment and told me about an “affir­ma­tions” web­site. It seemed hokey to me at first, but over time, I found reas­sur­ance in its sooth­ing mantras: I am strong; I will let go of neg­a­tiv­i­ty; I choose well­ness and peace; I choose faith over fear.

In the 1970’s, I taught Eng­lish Lit­er­a­ture to high school seniors. One of them lat­er became the top intel­lec­tu­al prop­er­ty attor­ney in the nation. Now in retire­ment, he’d been diag­nosed with can­cer and was under­go­ing treat­ment. “I’m scared crazy,” I wrote to him.

“This ‘not know­ing’ stage that you are in might well be the hard­est part of the process,” he wrote back. “I hope and pray the can­cer has not spread. That is the hope and prayer of all in our club. But if it has spread, to a small or large degree, you are smart and capa­ble and sur­round­ed by a great med­ical team and fam­i­ly, and you will deal with it as best as you can. That’s all we can do.” His steady guid­ance through the com­ing weeks calmed me down and gave me hope.

Mean­while, my can­cer tests went for­ward. Most of them were famil­iar to me from pre­vi­ous ail­ments and some seemed designed only to deter­mine if I was healthy enough to sur­vive surgery, but I ago­nized over each one, con­vinced it would dis­cov­er more can­cer. Thank­ful­ly, my anx­i­eties went unre­al­ized. One by one, the results came in negative.

The Donut

The last test, the big moth­er of them all, the one I feared most, the PET CT Whole Body scan, came at the end of the six weeks. My daugh­ter, Devon, drove me to COH’s radi­ol­o­gy depart­ment. They inject­ed me with radioac­tive flu­id, placed me on a gur­ney, and slow­ly slid me through a giant donut, cap­tur­ing inter­nal images of my entire body, start­ing at my feet and mov­ing up to the top of my head. If there were can­cer­ous tumors inside me, the donut would find them. The tech­ni­cian said the results would come back in three days, just before the shoul­der operation.

That night I dreamed I rode Lily on a moon­lit trail. We entered a dark for­est with branch­es arch­ing over us. Deep into the tree tun­nel, Lily stopped sud­den­ly; her body tensed; and her ears pricked for­ward. Peer­ing into the night-shad­ows ahead, I could bare­ly make out the form of a big roan and a black-robed rid­er. Lily screamed, whipped around, and sprint­ed back the way we had come. Grab­bing her mane to hold on, I heard the thun­der­ing hoof­beats of the roan behind us, gain­ing ground. I awoke just as we broke out of the trees into the moonlight.

I was still fright­ened by my dream when I got to the barn at dawn. Lily was skit­tish and flighty, but she calmed down when I stroked her neck and rubbed her ears. I did, too. I stayed with her a long time that morning.

On the day of my oper­a­tion, they stretched me out on a bed in the nuclear med­i­cine room and inject­ed radioac­tive flu­id into my shoul­der to track blood flow to the near­est lymph nodes. For the can­cer to spread from my shoul­der it would first infect “sen­tinel” nodes that would car­ry the can­cer else­where. The pro­ce­dure would iden­ti­fy any bad ones the sur­geon would need to remove. The tech­ni­cians worked on me for two hours, then wheeled me down to pre-op.

Track­ing Radioac­tive Fluid

The sur­geon came in. “The Whole Body scan was good,” he said. “It found no can­cer any­where oth­er than in your shoulder.”

Sit­ting by my bed, my son, Josh, pumped his fist. “Yes!”

If I hadn’t been exhaust­ed, I would have jumped up and cheered.

Now, it all came down to the shoul­der surgery and the poten­tial­ly infect­ed lymph nodes. They rolled me into the oper­at­ing room, and the anes­the­si­ol­o­gist knocked me out.

I awoke in the recov­ery room with a ban­dage on my shoul­der cov­er­ing an inci­sion three inch­es long. I was telling the nurse about Lily when the sur­geon came in, smil­ing. “I got all the can­cer. We didn’t take any lymph nodes. They all looked good.”

Enlarged Lymph Nodes

That was the night of Sep­tem­ber 9. I’d got­ten the best pos­si­ble results on all the tests; the surgery was suc­cess­ful; and my lymph nodes appeared to be clear. I was elated.

I thought can­cer was done with me, but in the post-op meet­ing, I learned that mem­ber­ship in the can­cer club is like the Eagles’ Hotel Cal­i­for­nia. You can check out, but you can nev­er leave.

Can­cer is resilient. It might be hid­ing in clus­ters of cells too small for the tests to detect, wait­ing to blos­som into new tumors, or it might sprout inex­plic­a­bly again in a new loca­tion, like it did in my shoul­der. “We will observe you,” the sur­geon said. He ordered a round of tests for next Feb­ru­ary, includ­ing anoth­er PET CT Whole Body scan. After that, he plans to slide me through the big donut every six months. If the can­cer comes back, the sur­geon will find it ear­ly to give us the best chance of beat­ing it.

Can­cer’s Hotel

Cancer’s Hotel Cal­i­for­nia is a big place with many rooms. Can­cer vic­tims pay a dear price for most of them: chemother­a­py, radi­a­tion, abla­tion, immunother­a­py, stem cell trans­plants, hor­mone ther­a­py, bone mar­row trans­plants. Not me. I got off easy, at least for now. I got the best room in the build­ing, and it cost me almost noth­ing. No real pain. No sig­nif­i­cant sac­ri­fice. Just six weeks of wor­ry and the prospect of peri­od­ic tests going forward.

Although my lit­tle skir­mish didn’t require the colos­sal strength, bound­less sta­mi­na, and lion-heart­ed courage so many can­cer patients bring to their gru­el­ing bat­tles against the dis­ease, it scared me enough to change me for­ev­er. It gave me a price­less gift: The real­iza­tion that each day of my life is pre­cious. Of course, I knew that all along. We all know it. But I know it in a dif­fer­ent way now. I know it deep down inside, and I nev­er for­get, even for a moment.

So, it looks like Lily and I will out­run that big roan and the angel of death for a while longer. Each day, I’ll feed the hors­es at dawn, walk P.D., ride Lily and my hors­es over the trails of Hid­den Hills, love Cindy, hug my chil­dren and grand­chil­dren, keep my friends close, and give thanks from that new place deep down inside for that day and every day yet to come.