An Adventurous Woman's Fight Against Cancer

When cancer interrupts a lifelong friendship, two women find solace in the sea—and the strength to accept the unexpected.

Best of Friends

My dive buddy, Carol, is floating 50 feet under the surface of the sea. We glance at each other every few minutes, keeping track. We have been diving off a little island called Southwest Caye, 35 miles from the coast of southern Belize, for several days. She and I swim quietly through the warm water, over sandy plains and coral boulders. We see sharks and garden eels and blue parrot fish motoring madly against the current.

Like astronauts, good scuba divers are weightless and can take any posture. Carol likes to stand as she might in a museum, hands folded, gazing into the crevices of the coral reef. Right now, I'm hanging upside down, peeking under a ledge.

After several minutes, I look up and see that Carol is making one of her favorite faces: pursed lips, hands on hips in pretend exasperation. She catches my eye and shakes her finger.

I get the message: "Pay attention." She does not mean the fish.

Carol and I have been diving together for six years. She's a natural, as she is with most physical activities, and a few times a year, we take off for distant shores. But three years ago, in the same week she was elected to be the first woman judge in her rural western Oregon county, Carol was diagnosed with stage IV breast cancer.

We've made four dive trips since then, and on each outing, Carol has more bluntly asked me to watch out for her. For the first time in our long friendship, we are both saying out loud that we need to attend to each other—something we've always done but never really acknowledged.

Before the trip to Southwest Caye, with her fatigue worsening, Carol said, "I can't imagine getting on an airplane right now." She was in the middle of a chemotherapy cycle. I reminded her that I was starting to come down with a cold. An old shoulder injury and a strained ligament in one of my knees were also bothering me. "We'll just adjust as we go," I said. "But I'm getting too old for these red-eye flights, that's for sure."

"Enough with that talk of age already," she answered.

Carol is 53; I am 51. We met in college when she was 18 and I was 16 and dealing with sudden independence. A self-possessed woman with a head of thick, curly hair and a wry sense of humor, she intimidated me. That she felt shy and unsure of herself, she says now, makes me laugh out loud. Neither of us recalls clearly how we became friends. While I was rearing children, Carol worked on fishing boats. While I was writing books, she went to law school and started a solo practice in criminal defense. But even when we were living in different states and saw little of each other, Carol felt inevitably a part of my life.

She has always had the endurance of a sled dog, a comparison she would find flattering. (Carol considers dogs to be better creatures than most humans.) As long as I've known her, she's seemed durable, a person of stamina. She's hiked and camped and kayaked, often alone. Once, when we were camping together in Oregon's Strawberry Mountain Wilderness, she told me she had never been afraid; she wasn't sure what that felt like.

Continuing the Fight

When my mother was 52, she was diagnosed with stage IV breast cancer; she died two years later. I was 30 at the time and felt much too young to lose her. I called Carol and asked her to bake Christmas cookies with me in her honor, using my mother's old recipes. Then Carol lost her mother to cancer, as did two more college friends, Kathy and Rebecca. Carol and I invited them to join the Cookie Orphans. Now the four of us bake every Christmas season. While we bake, we like to talk about being old women someday—really old, eccentric women—sitting in rocking chairs and saying quirky, quotable things.

When Carol was diagnosed, I was working as an oncology nurse. Her cancer had been stealthy; it had spread to her abdomen and bones before it was caught. I knew the disease didn't play favorites and, given my family history, wouldn't have been surprised to be told it was my turn. But Carol, who rarely ever caught a cold—this was different.

We calmly talked about what to expect. I reviewed options for treatment with her husband and printed out new research on late-stage breast cancer. But in private, I cried and struggled. I was juggling roles. When my mother became sick, several relatives expected me to nurse her, which I found impossible; I needed to be her daughter and nothing more. Over time with Carol, I've found the dual roles—being both a friend and a cancer nurse—easier to manage but still tricky. Every cancer, and patient, is different, but it is hard to let go of statistics. The prognosis for stage IV breast cancer is bleak; only half the patients are alive two years after diagnosis. I knew this too well.

Carol began treatment with Arimidex, a new oral chemotherapy. She felt almost normal and went right back to work. The drug took. The tumors didn't disappear—they won't, because metastatic cancer is chronic—but they didn't grow either.

Carol hated it when Elizabeth Edwards, in discussing her cancer, said, "I pretty much know what I'm going to die of now." She hated the idea of being seen as a "sick" person, a "patient," the idea of her crowded life—with her new role as a judge, her mob of five dogs, her huge vegetable garden, her many friends—becoming just about cancer. She hasn't felt the urge to start checking off wishes on a life list. She likes her life as it is, and most important, she likes herself in it.

Her powerful engine of health has paid off. After several months of treatment, we went on a dive trip to Turneffe Atoll off northern Belize. We planned a little more carefully than usual for emergencies. We both got travel insurance in case we had to cancel. She carried pill bottles, something she'd never done. Carol was raised a Christian Scientist. This in part has made it hard for her to accept the pharmacopoeia of cancer; she resists taking the support drugs that help with nausea and fatigue.

She told me, "I don't want any doom and gloom." We did what we always do on our trips: dove two or three times a day, and then I loafed in the hammock in the afternoons, while she dragged a banana-yellow kayak into the water and glided up and down the lagoon.

Back home last winter, Carol suddenly found it difficult to swallow. Tests revealed a tumor wrapped around her esophagus. Her throat had to be dilated mechanically. The dilation led to an infection. Carol spent days in the hospital and needed radiation to shrink the tumor.

The new tumor made it clear that the Arimidex had quit working. We went diving off Bonaire, and then Carol started intravenous chemotherapy. She and her husband, David, began planning an African safari, a trip she had dreamed of for years. As they worked out the details, her hair fell out, she vomited, and she learned what fatigue really meant. She became neutropenic, meaning that her bone marrow didn't make enough white blood cells to fight infection, and the night before she and David were scheduled to depart for Johannesburg, she spiked a fever of 102. Many patients would be hospitalized at this point. Carol is not like many patients.

"It is not safe for you to be on an airplane," I told her. I was scared for her; I knew the risks. I wanted her to be safe, but how could I suggest that she stay home? How could I not? She left four days later with a bag full of scarves and antibiotics.

After Africa, Carol's hair grew in, but the fatigue persisted. She began to experience the first stirrings of peripheral neuropathy—damage to the tiny nerves in the toes and fingers caused by the chemotherapy drugs.

An Inspiring Anniversary

On Southwest Caye, we make small accommodations. Carol has less tolerance for the heat; she sleeps a lot and is slow to wake in the morning. There is persistent pressure in her chest, and now and then I see her touching her sternum, looking thoughtful. With cancer, every sensation is a symptom. But, as always, we take off our shoes and never put them on again. Carol makes friends with Ninja, a little terrier mix, and he comes to our cabin at daybreak to talk dog talk with her. I read trashy mysteries; Carol takes her Margaret Atwood novel to lie negligently in the sun. She finds a machete one day and tries to harvest coconuts. We notice the palm trees around our cabin are filled with grackles; in the mangrove, we spy a small green heron. The big sky changes constantly: heaped clouds and rainbows, rainsqualls and stars.

Sitting in the overheated shade one day, she tells me, "Today is the third anniversary of my diagnosis." We are quiet for a moment. "I thought I might never leave the hospital," she continues. "I just wanted to enjoy the little things—what was out the window. When no one was around, I would putter around the room. I actually felt peaceful." We have never spoken of this before; usually we are more glancing, touching the difficult areas as delicately as you would a sore tooth.

Morning and afternoon, we walk to the dock and climb into the dive boat for a quick, bouncy ride through wind-driven swells. We get into our gear and roll into the clear water, sinking down like peas in honey. I can forget a surprising number of worries underwater. We take our time, pointing out a cowfish and two huge crabs shuffling back and forth in front of a crevice like gunfighters at high noon. The diving goes mostly as usual, but one day Carol feels something off in her regulator and signals me. I ask if she wants to surface, but she says no. We swim close together for the rest of the dive. I have needed her help underwater before; I am glad to be able to return it. There is new vulnerability in her, to match mine. She now knows what fear feels like.

In the evenings, we spend time at the tiny bar on the pier, watching the sun set and telling fish stories. One of the young couples on the island wonders if we are sisters. We laugh and say no, old friends. "Friends for 34 years," I say. I can see by their faces that they don't really understand that kind of time. We have been friends longer than they have been alive.

Carol walks along the sand each morning. "The morning light," she says, and doesn't need to say more. Her appetite for the sky, the edge of the sea, for the world, is constant and steady; she walks along the wrack with solid grace, looking down, looking up, back and forth.

One afternoon, Carol and I kayak out to the shallow reef. I'm pathetic in a kayak, clumsy and slow. Carol patiently rudders in the back. We tie up to a buoy and snorkel for a while. I find two Caribbean reef squid hanging in the sun-dappled shallows like mottled bread loaves with big silver eyes. She finds the biggest scorpion fish we have ever seen.

As we head back, we talk about summer camp. She was in Camp Fire Girls, I was in the Girl Scouts, and we both cherish those years. We talk about the special friends we made and how they eventually slid away. The sky is hot and blue, and ahead of us, the tiny island lies flat on the sea. I feel buoyant, almost weightless on the waves.

"Were you ever homesick?" she asks. "I never understood what that was about."

Between dives, we talk about where to go next. I make lists while she dozes. Our plans are more theoretical now, and the big trip to the South Pacific we hoped to one day take seems a long way off. Cancer has become part of our friendship. Some things have changed, but the biggest difference is common to every long-lasting friendship—the visceral reminder that our bodies are temporary gifts. Not knowing what comes next, having no idea at all what comes next, means anything is possible. Perhaps I will be hit by a truck, or my heart will stop, or there will be a shadow on my next mammogram. Life is dangerous.

We take our last dive of the trip. We glide slowly over the grand architecture of the reef. When we reach the wall and the deep blue water, we swim away. I try to turn a cartwheel, then a somersault. Carol lies on her side, an odalisque in a wet suit. Then, at the same time, we spread our arms out, like wings, and pretend to fly.