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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.
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