The Cancer Chronicles

The Ticking Man
So you get cancer, but you don't believe you have cancer. You endure radiation and chemotherapy; months pass, and you still have cancer, so you undergo surgery and more months pass. You feel the cancer cells ticking, ticking like some internal IED. You have a PET scan scheduled and four months pass in an instant. You're clear, but another PET scan looms 6 months away. You relax until the ticking begins again in your head--you have plans to die, but not to live (Stage 4 is Stage 4). Then one month, three weeks, one week, three days. The flight that carries you to NY is cancelled. You're stuck in Washington for a night, and then on to Manhattan. You cram everything in: daughter, friends, food (you still can't taste), Central Park. Then it's the morning of the scan--no cabs around and it's freezing. Winter don't care about cancer. The Scan, then hours waiting to meet the surgeon, surrounded by very brave, disfigured folk, and you remember you're one of them. Of course the surgeon is running late, late, late.
It all comes down to the little exam room and the ticking is thunderous. Finally, you notice feet, lots of feet, in the tiny crack under the door: Surgeon, interns, residents, nurses. The door swings open. You're clear! You laugh, thank the lost friends and family members you've appealed to for intercession. In the background the ticking has already begun.



What You Have Is All You Have


Cancer is this old, cracked, hardcover book, with a prologue--your existence before--and lots of chapters and sections--diagnosis, denial, anger, acceptance, self-pity (confirmed by outrageously debilitating and humiliating treatments), recovery and rekindled hope; then stay-awake nights where you ponder alone every single happenstance and event and choice in your life, the odds, the statistics, the research, the loved ones, family and friends orbiting around you; and the immortal treacherous, little bastard cells determined to kill you no matter how high tech the treatment, or what you promise God or how hard you fight.
You have this urge, this incredibly powerful urge to just take the side of your hand and push the pages forward--fifty, a hundred at a time until you get to that last page. But you don't because you can't let go.
And you look at your children, and Suzanne who has walked with me this whole course, and you look at the sunrise streaming through the window and, for the first time, you are forced to ponder a life with no future. What you have is all you have.
And it's a good thing--live or die--because you get moving, and do good work, and tell all the people you love that you do love them, and make the most of every single moment. And it's hard, but really, the pages are turning for all of us.



From The Big Casino (Vincent Coppola, Editor)


CONTROL




By John S. Macdonald M.D.


How individuals and families deal with the diagnosis of a serious cancer cannot be predicted with certainty. Many Type A personalities deal with problems by controlling all aspects of the problem. Sometimes this works. Sometimes it works for a while. Sometimes it doesn't work at all. The healthcare system, hospitals, clinics, doctor’s offices also have policies (specific office hours and strict appointment times) based on controlling the interactions between doctors and patients. When a controlling patient meets a controlling medical care system the results are not always what one may have anticipated.





I first met Sonya shortly after I became the principal investigator for a clinical study of Oxaliplatin in advanced colon cancer. My assistant, Denise, told me that she had gotten multiple calls, she called it, `serial calling,’ from a woman in the New York suburbs who said that she had `found out’ that I `had’ Oxaliplatin. She told Denise that she had liver metastases from colon cancer and she `must’ have the drug. She added that she was coming into the city tomorrow to talk to me. Notably, she didn't ask for an appointment. She was coming.





It required an administrative tour de force to put Sonya off for 10 days while records, films and pathology were gathered. She thought that much of this information gathering was not necessary since, `I know all Dr. Macdonald needs to know about my case.’ Sonya also said that she would come to the consultation ready to receive chemotherapy immediately since she knew that Dr Macdonald `would want me to have Oxaliplatin right away.’





The day of Sonja’s consultation arrived. Denise felt that Sonja might be `a handful’ to deal with quickly. She was given the last appointment of the day at 4:00 P.M so plenty of time could be spent with her. When Sonja arrived at 2:00 P.M., a full two hours before her appointment, one of the nursing assistants called to tell me that a `Mrs. G’ (Sonja) had arrived and told her to contact me because she was sure that `Dr. Macdonald will want to see me as soon as possible.’





I was ready to see Sonja a little before 4:00 P.M. Denise told me that they had placed Sonja in our largest exam room because she came for the consult with her husband and three adult children (two daughters and a son). It’s been my experience that patients coming for an initial oncology consult with multiple family members may be withdrawn and depressed. Frequently, the family will be `doing the talking’ for the patient. Also frequently, family members feel the need to ‘protect’ the patient from the full impact of the diagnosis and particularly from hearing a realistic prognosis. In both models of behavior, the bottom line is that the family is in charge.





With Sonja the family was not in charge. When I entered room and said, `Hello Mrs. G, I’m Dr. Macdonald. How can I help you?’ The first thing Sonja was, `Call me Sonja. We are going to become very good friends and beat this cancer together.’ She then pointed to one of her daughters sitting in a chair by the exam table and said `Madeleine, get up so the doctor may sit down.’ I sat down and said I’d gotten a chance to review her medical records, radiology studies and pathology slides. I commented that she had been receiving excellent treatment.





Sonja said that she was glad that I `liked’ her medical history, but she didn’t care about the past. She was most interested in what I was going to do now for her. I said that I wanted to examine her so I could decide what the best options for treating her would be. I told her husband, Mort, that he could stay in the room while I examined Sonja if he wished. Before Mort could answer, Sonja said `Mort, go out with the girls and Howard. I don’t want the doctor distracted. I want him concentrating on me.’





The nursing assistant was in the room helping Sonja get into a hospital gown and I was looking at one of her CT scans when she said, ‘You know, Doctor, it would have been much better if this whole thing had happened to someone else.’





`Well that’s a generous thought, Sonja,’ I said.





`You know what I mean. I have lots of things I need to do.’





As I examined Sonja, it was pretty clear that she had advanced colon cancer. There was a very hard left supraclavicular (Virchow’s) lymph node and her liver was enlarged and very firm consistent with metastatic cancer. Sonja was watching my face as I examined her abdomen and said `I don’t like it when my oncologists frown. It worries me if you look worried. I am sure you will not let this cancer get any worse and that you are thinking right now about getting rid of all my cancer. You know it would be a real feather in your cap if you cured me.’





After the exam was completed, I was telling the nursing assistant to have Sonja’s family come back into the room, Sonja said, `Hold on! Let’s get our story straight. I am going to start on Oxaliplatin and my cancer should shrink down with this treatment. Meanwhile, Dr. Macdonald and I will be looking for new and innovative treatments for me.’





I said something like, `We’ll do what we can.’ Sonja quickly modified my admittedly tentative comment by saying, `You mean that we’ll do absolutely everything that may possibly help.’





The family came in and I said that Sonja’s blood work, radiology, and physical exam made her a candidate for Oxaliplatin and we could start that therapy within the week. Both Sonja and her family were pleased that there was a plan.





About this time, Mort noticed a picture on the exam room desk of me standing by a small airplane. He asked me if I flew I said that I did. Sonja looked at me and said, `You’re not still flying, right?’ I said that I was flying. She said, `Oh my God! What if you have an accident and get killed in that little thing? You’re my oncologist! What’ll happen to me? You’re supposed to be looking out for a breakthrough treatment for me.’ I told Sonja, jokingly, that her concern for my well-being was touching and that I would only fly in good weather. This was not the answer she wanted and, as she left the room with her family, she said to me. `I can’t believe your wife lets you fly that little thing.’





Sonja started on an Oxaliplatin regimen. She was doing reasonably well and her cancer was at least stable. She continued to look for evidence of that breakthrough treatment for her cancer. Whenever I saw her in follow-up, she asked me in how I was coming along looking for a new treatment for her. She would always ask me about what was `new.’ I told her that scientists were interested in starving tumors of blood supply by using what were being called antiangiogenesis strategies. These approaches were aimed at altering the blood flow that tumors depend upon to grow.





Sonja had been on her Oxaliplatin-based therapy for about 5 months when she read that a new clinical trial of an antiangiogenesis agent called Angiostatin was being started in Philadelphia. Sonja called the institution doing the clinical trial and was told her oncologist (me) would have to order some blood tests and radiology studies and if they were acceptable for inclusion in the study, a patient could be referred to Philadelphia. Sonja called immediately and I ordered the appropriate tests. All the study results were acceptable for inclusion in the Angiostatin trial except for the bilirubin level. The upper limit of normal was 1.5mg/dl and Sonja’s bilirubin was 3.1mg/dl. I repeated the test and it remained above 3.0.





Sonja came in with her husband to talk about what to do next. I emphasized with Sonja and Mort that she was not eligible for the Angiostatin trial because of the elevated bilirubin. Sonja said she had called Philadelphia and told the nurse coordinating the study that she was eligible and that I was `very anxious’ that she start the trial ASAP. I told Sonja, again, that she was not eligible and would be rejected when the Philadelphia docs saw the elevated bilirubin. Sonja looked at me and then turned to Mort and told him that she and her doctor needed to talk very seriously and that he should wait for her outside. As always, probably as a result of years of training, Mort did exactly what he was told and left.





Sonja turned to me and said that the new study was clearly the next best treatment for her and that she didn’t see why a `little’ bilirubin abnormality would prevent her from receiving Angiostatin. I reminded her again of the importance of eligibility criteria for clinical trials and that they could not be flaunted. She looked directly at me and said, `Dr. Macdonald 3.0 is just a number amidst lots of other numbers in my medical record. This bilirubin number can’t be the be all and end all. A little whiteout and 3.0 disappears and 1.5 reappears as my bilirubin. No one is the wiser. I get on the Angiostatin trial and get a treatment I clearly need and a little elevation in my bilirubin level becomes no problem at all. This’ll be our little secret!’





I looked at Sonja and shaking my head, I said, `This is something that will never work. You cannot control your liver function tests. They will be repeated in Philadelphia and you’ll be declared ineligible for the study. Aside from the fact that what you propose is highly unethical, it just won’t work!’ She looked at me and said that she understood what I was saying but she was going to call Philadelphia and would `plead my case.’





Sonja did call Philadelphia. The oncologist leading the Angiostatin study, a friend of mine, said that Sonja was very persistent and her bilirubin was repeated several times but never went below3.0. She didn’t get Angiostatin.





Eight weeks after the start of what my assistant Denise started calling `the great Angiostatin caper,’ Sonja was bought to our emergency room confused, febrile and having clinical evidence of liver failure. She was admitted and a work-up showed marked increase in her liver metastases and the development of new lung metastases. In speaking with her family I made it clear that there were no good options to treat her cancer and that palliative care aimed at keeping Sonja comfortable was the best strategy at this point, and the family agreed.





As Sonja continued in deepening hepatic coma, completely unresponsive but clearly in no obvious discomfort, her husband and family underwent a striking change in behavior. During all of my interactions with Sonja while she was being treated, her husband and children were pleasant but very reserved. They did what Sonja asked them to do. It was clear she was in charge. Now with Sonja in irreversible coma and clearly dying, the family was much more spontaneous and seemed very comfortable sharing memories of living with Sonja. Her son who was 33-years-old at the time his mother was dying said there was no doubt that his mom was controlling. He said she would call him when he was in his twenties and thirties on weekend nights and if he was not home at midnight she would get in the car and go looking for him. Another family story: one of her daughters who in her 20s had been seriously involved with a man whom her mom didn’t like. Sonja started referring to this young man as TWM (The Wrong Man). The relationship did not last.





Finally Mort told me that he was always fascinated with flying and becoming a private pilot. He took flying lessons until Sonja decided there would be no pilots in the family and his flying stopped. Mort allowed that in his 35 years of marriage, the only thing that Sonja could not control was cancer, `though God knows she tried!’






John S. Macdonald, M.D. is Senior Consultant, The Academic GI Cancer Consultant Consortium (AGICC) & The Academic Myeloma Consortium (AMyC).





The Big Casino

"I Have Only One Doctor"
By James Harvey, M.D.

I was two months into my first year fellowship at Georgetown’s Lombardi Cancer Center. I owned a copy of DaVita (DeVita, Hellman, and Rosenberg, Cancer: Principles and Practice of Oncology),had read Cancer Treatment Reports weekly since arriving. I knew I was an oncologist and knew all I needed to know about taking care of cancer patients. This was predicated on my having been in clinic with patients and their families maybe 20 times in my first two months. (I’d rounded on oncology patients on a daily basis.) What I thought I needed to learn was to understand trial design and recognize what protocols and new drugs would be effective. And, of course, on whom to use them and when.




One Saturday evening I was on call for the oncology service I felt confident enough to accept an invitation to a black tie dinner given by a patient’s husband at a diplomat’s home on nearby Embassy Row. Around 7:00 P.M., I was paged to the ER at Georgetown Hospital. A patient I’d met a few weeks before was in the emergency room complaining of severe shortness of breath. The patient, a 60-year-old, Eastern European gentleman, had recently been diagnosed with lung cancer. He’d had one treatment with the well-known “FAM” chemotherapy regimen (5-fluorouracil, doxorubicin, and mitomycin).





I could not fathom why this patient would choose to go to the ER on a Saturday evening. I’d seen how excitable he was and in clinic. I knew he was overly somatic (sensitive to his body) and his entire review of symptoms was positive. I was not the least bit happy as I walked down the street to the ER to see him. I knew I would be late for the dinner and my tardiness would be conspicuous.





I walked into the ER in my tuxedo and inquired where the patient’s room was and asked if he’d had an X-ray. The X-ray was in his room and I proceeded there, hoping to find a stable x-ray and a nervous. but essentially well patient. I walked into the room to find both the patient and his wife terrified. He was sitting bolt upright and was breathing at least 30 times per minute. I didn’t need to look at the X-ray because I knew he had a large pleural effusion. (I was too naïve to think he might have had a pulmonary embolism with a normal chest X-ray except for the cancer.)





I knew my plans for the formal dinner were down the drain. Looking back I am sure that the patient and his wife read me like a book because they both complimented me on my tuxedo and apologized profusely in halting accented English. It took a while to get set up for a thoracentesis (a procedure to remove fluid from the space between the lungs and the chest wall), so I had a chance to sit and talk to the patient and his wife. They told me about their life in Eastern Europe, their struggles living under a harsh Communist regime and the joy of finding political asylum in the United States. He’d brought his wife and five children with him; they’d been in the U.S less than two years. An accountant in his former country, he was reduced to working as a doorman for an apartment building.





In less than half an hour I had learned so much about this man and his family, far more than I had learned in our consultation a few weeks earlier. Now, I understood his anxiety. It was from having a frightening, debilitating disease, being in a strange country, and facing a very uncertain future. His greatest anxiety was for the welfare of his family.





After the thoracentesis, he felt much better. I really believe he thought a medical intervention like this would make his cancer disappear every time it reared its head. We talked a few more minutes. When I got up to leave, he asked me if I’d still go my important dinner. It was 9:15, so with a sigh I said, ‘No, but it’s not a problem.’ Again, he read me like a book and said, `I am sorry that I caused you such an inconvenience, but I really needed you.’ He then asked me, `Doctor, how many patients do you have to take care of in your practice?’ As I put my cufflinks on, I answered, greatly exaggerating my position, `around 400 patients.’ This was likely a 10 fold exaggeration, but it inflated my sense of self-worth.





His reply changed my life and my approach to the practice of oncology: `Doctor, you have 400 patients,’ he said.` Very good. I have only one doctor.’





Every time I get an after-hours phone call, or have a patient or a family member say, `Can I ask you one more question?’ I remember that lesson given to me by a frightened patient nearly 30 years ago. I may be busy; I may have other things to do, but that person or family member, facing the most horrible thing in his or her life, only have me.





We live in an era when every day seems to bring a breakthrough in oncology. I’ve known many great oncologists and had many great mentors but my greatest lesson was given to me that Saturday night in 1982. My patient died later that fall. In one evening, he shaped me into a type of oncologist that I likely would not have been without him. I am thankful to this day for his wisdom.






The Big Casino




Unstoppable







By Elias Jabbour, M.D.



War taught me many things.



As a boy in war-ravaged Lebanon, I grew up without access to many things normal kids have, but I was also blessed with invaluable life lessons. My godfather, Joseph Jabbour, was a doctor. Following him on his daily rounds in Zahlé, a small town in the Bekaa Valley, I was inspired to follow in his footsteps, treating and healing suffering people. When I saw a neighbor die in front of my eyes—a random shooting typical of civil war—I realized how fragile life is and that we are granted nothing is in this life.

Many years later, working as an oncologist at the University of Texas M.D. Anderson Cancer Center in Houston, I’m reminded of the truth of that realization every day. My own journey, as you can imagine, has had its ups and downs, joys and heartaches. One of my areas of specialization is acute myloid leukemia (AML), a relentless and devastating malignancy of the blood. AML is often fatal, particularly in adults. When AML patients come to see me, they’ve already been told more or less in so many words, “You’ve have cancer. The cure rate is only 5 percent. You are going to die.”



We are all going to die. I inform patients that AML has several subtypes. Five-year survival rates vary from 15 to 70 percent and relapse rates range from 35 to 80 percent depending on subtype. Statistics are derived from a great mass of people, some who do great and some who do not so great. I advise my patients, “Don’t make yourself a number. Take the statistic, build on it and make it longer. Be one of the people who make it.”

George is one of those rare people. He arrived at M.D. Anderson in 2010 presenting with fever, fatigue, anemia and some internal bleeding. In simple terms, his blood studies revealed that rapidly proliferating, abnormal white cells (leukocytes) in his bone marrow were “crowding out” oxygen-bearing red blood cells (erythrocytes) and blood-clotting platelets (thrombocytes). AML is not hard to diagnose. What’s harder to discern are the prognostic factors, i.e., how the disease is going to behave. George had all the bad factors: abnormal karyotype (the number and appearance of chromosomes within the cellular nuclei) and bad molecular markers.

I was under the weather when I first met George. I wore a mask and avoided close contact, startling him and his wife until I explained I was trying to protect him from catching an infection from me. After he was stabilized and discharged from the hospital, we began to get to know each other. He insisted on knowing everything about his illness, and asked me to speak to him “not like a doctor.”

AML demands immediate, aggressive intervention. We began treatment with rounds of high-dose chemotherapy (cytarabine and idarubicin). When that failed to bring him into remission, we moved on to investigational agents. George did not respond. We found a matched donor and recommended him for an allogenic (donor) bone marrow transplantation. Because he was young (late 30's), a transplant was George’s best alternative for a cure. Unfortunately, he relapsed post-transplant. As every known leukemia expert knows, this suggests a very poor prognosis.

George never lost faith. When I talked him, he’d already decided another treatment would work.

“Let’s find a way to do it!” he said.

What impressed me is that in his heart and head, George was always smiling…always unstoppable. “O.K., Dr. Jabbour,” he’d say, “I’m grateful for all your efforts, but we can do more to get this under control.” Every time I had an idea or became aware of some form of new treatment, I’d call him. We’d meet and I’d discuss it with him and his wife.

“This is what we need to do!” he’d say.

We fought as a team in an unstoppable way.

What set George apart is that most people—and cancer patients in particular—project into the future to forget what is happening today: “When I’m cured, I’m going to go on a trip with my wife to Hawaii…When my son graduates from high school, I’m moving to Florida…When I retire, I want to go to Europe.” What we’re doing is looking ahead to forget what’s happening today. Maybe it’s a way to ignore the disease. By contrast, George would say, “Let’s have a great day today and have faith that we’ll find something tomorrow. There’s no reason to be upset. Tomorrow will come. Let’s focus on how we can make this day, a better today.”

We were able, for example, to adjust the treatment and the palliation we were prescribing to let George attend his son’s high school graduation. “Please make sure I’ll be in good shape to be there,” George insisted. It was a big deal for him because there might not be a next year. He made it, and the family went on a cruise for a week. The “happiest days of my life,” he told me. For two years, he was able to overcome every single obstacle and bad result with joy despite the disease and the catastrophe he was going through. Our team continued to fight. Eventually, we reached a point beyond which we could not push.

“There’s nothing else,” I told George.

I remember it was a Friday. I was about to travel to Croatia for a medical meeting. George was very sick, back in the hospital. I wasn’t his attending physician, but I showed up just to visit with him and his wife. I remember sitting on the side of his bed. He was drifting in and out of consciousness. When George saw me, he came back—I swear--I’ve never seen anything like this…He smiled for a whole minute!

When somebody comes to see you, and you both know that you are going to die in the coming days, it is horrible. We sat next to each other and I held his hand. He was telling me, “… the kids are so and so… the graduation was fun…we had a Fourth of July barbecue!” George was going over the events of the last years, telling me how much he’d learned from his disease, how much his wife learned in this fight…how you can fight with courage. He expressed his appreciation for all our team had done.

Finally, for the first time ever, George cried. I cried with him. I had my tears too. We had each other.

“Doctor, we’re going to meet again one way or another,” he said.

I was trying to explain that I was traveling. I wouldn’t be back until Tuesday. “I’ll see you then,” I managed.

“Not here,” he said. “I’m very certain we’ll see each other someway, somehow.”

I left. George passed away Monday evening. He faced the end of his life with dignity, respect, with decency and with a smile.

The story for me and for all my patients is simple: “Have faith. You will make it one way or another. We don’t know when our life is going to end, but we can all be unstoppable and achieve whatever we want. Enjoy life and love it.”












The Big Casino









Denial




By Vincent Coppola





When cancer came calling like a grim and fearsome wolf, I didn’t hide behind the straw and wood constructs of supplication or outrage; for me it was the brick and mortar of impenetrable and boundless denial. Denial is not an emotion, but literally a state of being, odd and off-putting. In weeks, my doctors—the gentle internist I’d known and respected for 25 years, the ENT to whom I’d been referred, the radiologists performing the FNA biopsy and CT scans of the mass that had mysteriously appeared on my left neck, were no longer wise and experienced medical professionals, but stubborn and misguided antagonists determined to tear me from the complacent world of the healthy to some dark and uncertain place I wanted no part of.





More than most, I wallowed in denial. The eldest son in a blue-collar family, I’d always been the caretaker. To be untimely ripped from my dysfunctional “comfort zone” was unthinkable. I was highly educated and skeptical of authority. I’d spent my professional career as a reporter, probing other people’s lives and problems. Worse, I was Internet-savvy, convinced all the data I wanted was to be had at a key stroke. It was, though it ran counter to the facts as they began piling up.





I was familiar with the epidemiologists at the Centers for Disease Control and Prevention and had taken their dictum, “If you hear hoof beats, look for horses, not zebras!” to heart. I was 64-years old, “never been sick a day in my life,” never smoked a cigarette or drank very much either. I didn’t “feel” sick. For some reason, the fact that my mother, a non-smoker, had died of throat cancer at 65, one of the great tragedies of my life, retreated into the past.





So I began to marshal facts, information my doctors (too shortsighted, or busy with other patients?) wouldn’t recognize. A month before the lump appeared, I’d undergone a dental implant procedure involving a bone graft. Obvious (to me), the mass was a swollen lymph node, an outsized immune response to alien (cadaver) tissue introduced into my body. This was clearly horses, not zebras. My dentist, a most prudent and careful man, insisted he’d never observed such a response. I countered by going into the medical journals and company records and finding precisely such a response. To me, he was more worried about a malpractice suit than he was about my wellbeing.





When a first round of antibiotics didn’t work—(no fever and my blood counts were normal throughout), I demanded a second round. The mass remained unchanged. Then I decided a Fine Needle Aspiration (FNA) biopsy—literally jabbing the lump and analyzing its contents—would settle things. During the biopsy, the radiologist wouldn’t comment—rightly so—but I put my stock in a talkative technician who told me I had a cyst, not a malignancy. Two days later, having educated myself on the nuances of branchial cleft cysts, I raced across Atlanta to pick up the pathology report:





“The core biopsy shows fragments of benign salivary gland…The fine needle aspiration biopsy material demonstrates abundant degenerated dyskeratotic squamous cells consistent with cyst contents (italics mine).”





I skipped right over the red flag, “However….” at the bottom of the page. Once again, I was furious when not one of my doctors accepted this biopsy as definitive. What is denial after all but displaced fury and fear? Two months later, a CT scan conclusively identified the lump as a necrotic lymph node (“20-25 mm in size”)—raising the specter of squamous cell carcinoma—but was otherwise inconclusive.



Never do I question my own judgment. Rather than trusting my doctors’ advice and expertise, I find other doctors, and distrust them.





In December, I accept a friend’s advice—he’s a retired oncologist—and travel to New York City to meet with Dr. Jay Boyle, Director of the Fellowship Training Program in Head and Neck Surgery at Memorial Sloan-Kettering Cancer Center, pretty much the top of the food chain as far as throat cancer goes. At Sloan-Kettering, a heartbreaking and yet hopeful place, I finally begin to see other cancer patients as kindred spirits to be embraced, not losers in some monstrous lottery. All the protective layers I’d wrapped myself in for the past 25 years begin to peel way.





When Doctor Boyle examines the slides from the FNA biopsy done in Atlanta, then thrusts his face four inches from my face and tells me bluntly, “You have Stage IV squamous cell carcinoma,” I’m no longer in denial. And I’m no longer afraid. In fact, I take heart from the quotation posted above the hospital’s entryway, “God Loves A Courageous Spirit,” and decide that, whatever happens, I will be courageous.





In Atlanta, I choose Dr. Charles Henderson as my oncologist because of his great compassion, his long and excellent history in the field, and the fact that he is a throat cancer survivor. And once, he too, was in denial.







The Cancer Chronicles




Il Purgatorio and Il Paradiso






I begin chemo and radiation therapy the day after Christmas. It’s as simple as this: clean up discarded Christmas wrap, wave goodbye to Dan and Jane, Suzanne’s parents visiting from Savannah, report to a dim basement room with walls three feet thick where radiology technicians snap my unwilling head into a form-fitting white mesh mask out of Friday the 13th, where it takes all my will to keep from gagging in a massive panic attack, and later, to keep from crying out in despair. How did this happen?




Six months earlier, I’d presumed the lump under my left jaw was an unfortunate immune response to a dental procedure; now I know it’s at least two lymph nodes packed with necrotic tissue and metastasizing cancer. I also know—thanks to a throat biopsy that made swallowing difficult for a week—that the primary tumor—a squamous cell carcinoma, lurks at the base of my tongue where there are no nerve endings that might have alerted me to its presence.

Checkmate.
I leave Il Purgatorio with Suzanne and Gabrielle, my daughter—who lives in Brazil and had looked forward to joyous Christmas visit with the family, clinging to my arms and ascend to an upper floor infusion center, which I’ll call, Il Paradiso. Here it seems all sweetness and light: panoramic windows overlooking Atlanta’s greensward, outsized beige leather Barcaloungers, perky nutritionist, massage therapist, every kind of psychological support, a hair salon, even a Martha Stewart-sized kitchen to demonstrate the oh-so-healthy foods I won’t be able to taste or eat without puking for the three months. I’m on a movie set carefully designed and cast to hide the horror of the Emperor of all Maladies. I sit there shivering for six hours wrapped in a blanket while Cisplatin, a powerful cytotoxin, drips, drips, drips into the port on my right chest a surgeon slipped in the week before Christmas.
On December 26th 2012, I stand 6’ and weigh 208 lbs. Fighting debilitating anxiety—my son Thomas was deployed to Iraq and later seriously injured in a training incident—I’d spent the last years walking endless miles alone on the Silver Comet trail…exhausting myself pumping iron at the local gym. In total, I’d lost 7 lbs. On February 20th 2013, I barely weigh 185, thanks to the almost constant nausea, the deep burn from the radiation at the back of my throat, and a reduction of my saliva into foot-long gagging strands that recall nothing so much as the slow-motion dripping mandibles of the creature in Alien.
Overnight, my sense of taste totally vanishes. I love food. I love preparing my family’s southern Italian dishes—ravioli, meatballs, veal parmigiana, and the simple pastas I’ve sampled in Umbria. I love to grill steak and sausage and Hebrew National hot dogs. I love hot wings and brick oven pizza. Ribs and hummus and baba ganoush. I spend hours preparing antipasti on the holidays.( I’ll happily drive 25 miles for De Lusso salami, Suzanne’s favorite olives and fresh mozzarella.) I entreat Ernie and Sal in New York City to ship me dry sausage and soppressata from Faicco’s Pork Store on Bleecker Street which I hide liker a miser. (I do send my latest discovery, Olli Calabrese salami, to Thomas in Iraq.). I’ve spent half my life sussing-out hole-in-the-wall ethnic restaurants—the latest Gu’s Bistro on Buford Highway—one of the blessings I suspect of being determined rather than rich.
And now, because of the chemo everything tastes like dishwater, mucilage and cardboard. A metal utensil makes me vomit like it’s New Year’s Eve and I’m 17-years-old and drunk. Biting into a fresh orange--it tastes grey--takes all my willpower. (I’m supposed to fight dehydration which will kill me and keep the inevitable weight loss under control or else put in a feeding tube, yet another invasive procedure.) When my own dishes fail me, I go on a quest. Something must taste like its Platonic self? For five days, it’s Waffle House hash browns and raisin bread toast, Vittles' (don't ask) pancakes soaked in butter and syrup and wrapped around enormous links of country sausage, Popeye’s chicken and red beans and rice, carne asada tacos, spicy chicken, cha gio, pizza, matzo ball soup, brisket, Ben & Jerry’s pistachio ice cream. Suzanne scours the markets for smoothie ingredients; I make two pounds of rice pudding and eat two bites. My buddy, Bobby Ezor, ever faithful, delivers me a box of bread pudding and toffee sauce.
It all makes me sick. I have to stop, afraid of developing an aversion to what I love the most… which I suspect ultimately may be my life. I remind myself not to be surprised at what is happening. I foreshadowed it on the Prologue to my Gowanus Crossing blog:




A pestilent and stinking Nile, the Gowanus flows through the neighborhood, defiles it with stench and disease and dark secrets. In the decades ahead, many of those who’d grown-up near the stream would be dead or dying of an epidemic of cancers and birth defects long after they’d escaped to the ranch houses and stick-tree suburbs of Long Island and New Jersey; an epidemic veiled by other plagues—violence, AIDS abandonment and addiction—visited on South Brooklyn.


In the 1960s, the canal is poisoned womb … grave … open sewer. These things and more: it is a barrier that keeps the surrounding neighborhoods isolated from the rest of New York City, keeps them insular, with a fierce identity and demarcated borders.


The Gowanus has a history—unknown in the neighborhood--that in other places would be noteworthy. George Washington’s army clashed with the British along its banks. Its tides, rhythmic and regular, impose order on the chaotic lives that cling precariously to its banks. At flood, it carries the faraway scent of ocean; moonlit, a glimmer of primordial beauty.


After my mother’s throat cancer metastasized—like me Gloria was a nonsmoker—in the late 1980s (see “Losing Mom” ( http://tinyurl.com/a8b3oqy on this blog) I pondered the “….enormous chasm that stretches between the living and the dying, a gap love cannot bridge…” Now, it is I who begins to feel this distance despite my own upbeat nature, the care and love Suzanne showers on me, the overwhelming kindness of friends and strangers—some on Facebook whom I never met or seen in decades--who send prayers and kind words, get-well cards, Ron Scharbo’s poster declaring “Go Vince!” and Kate Nerone’s box full of hearty Italian soup.


I doubt I will have my mother’s courage and selflessness in facing what lies ahead—the lump, dead or alive, persists in my neck—but I remember promising that I would keep what was best in Gloria alive in me. A promise I do intend to keep.


























The Big Casino




Losing Mom


Looking back, it seems I'd waited my whole life for the call. It came late in the night, the Friday after Thanksgiving, my brother Greg telling me our mother had been rushed by ambulance to Brooklyn's Methodist Hospital in terrible pain. The "backache" she'd barely mentioned when the kids and I had called on Thanksgiving Day would turn out to be an enormous tumor mass--squamous cell carcinoma--that had invaded her lungs and swollen her liver three times it normal size.



The call came three days after my 43rd birthday. Like so many other babyboomers, I was living a life vastly different from my parents; living it far from the blue collar enclave in Brooklyn where I'd grown up. Twelve years earlier, my job had carried me to Atlanta, a way station I'd imagined, on the way to the top; like so many others I stayed and stayed. My children, years of friendship and struggle were here. My brothers, my childhood friends, the house I'd grown up in, the streets I'd roamed, were 1000 miles away and fading, becoming stratified under layers of more recent experience. Recently, I'd noticed my memories had begun to outnumber my real-life interactions "back home."

Gloria had turned 66 a few weeks earlier. Since adolescence, I'd been telling myself how lucky I was to have young parents, how I wouldn't have to worry about losing them until my own mortality had begun to weigh upon me, until the needs of my children forced me to relinquish any enduring claim to childhood.

Those illusions were shattered in my mid-30s when emphysema debilitated my father, quickly transforming a man whose life had been marked by stubborn self-reliance into a frightened and helpless child. My father's illness set into motion that cycle of dread and responsibility we must all pass through when our parents become too old, too poor, or to sick to care for themselves. In my case, the struggle, though searing, would end early. For tens of millions of my generation with careers and families of their own, it is fully underway--an enduring burden that will affect every aspect of their lives.

There is much irony in the Me Generation having to slow down. Much irony and so little time for introspection and self-examination. The years draw quickly upon us; the oldest among us are already gray, with children grown. The parents many of us rebelled so fiercely against have become our dependents, threats to our vaunted freedom only in the demands they make. If they loved and cherished us, we are about to learn that requiting their love, no matter how deep our devotion, can be painful and demanding; a task that can stretch a childhood's length in fact. If our childhood memories are unhappy and escape-driven, we may again find ourselves trapped and bitter. Too many of our parents have nowhere else to turn; the responsibility is ours.

We live in a culture where youth is exalted. It has proved an idiot king. The elderly have been banished from the public arena, their appearance deemed unsightly, aging itself unseemly. Their needs, save for the failing machinery of Social Security and its concomitant programs, removed from the public agenda.

We've held Death at arms's length; dying, for must of us, is real the way a DVD is "real." We imagine a sterile process occurring in white rooms behind closed doors to other people. Now that it has begun to stalk our parents, we will become intimate with death and dying. And well we should. Death has edged one generation closer to us.

As if awakening from childhood's untroubled sleep, we hear the whispers of our friends and peers--whispers only until we are affected--the coworker's father with Alzheimer's disease...another whose father developed and died of cancer in the span of a few weeks...yet another raising the issue old folks so often dread, institutionalization...the realization that strikes a neighbor after her regular commute back home to Virginia, that roles have somehow been reversed: her parents need more and more support; they are losing their ability to play Mama and Daddy for her. "It's the hardest thing in the world," she says, "and it happened so quickly."

I was the eldest son in what had been a poor family. I was well-educated. Through my 30s, like millions of other babyboomers, I'd steadilly climbed the career ladder, started a family of my own, bought into the notion that my generation was unique and special in history. Then divorce, and a series of reversals had abruptly knocked away 15 years of stability. In what is now a familiar pattern, I found myself at least spiritually returning to the nest...turning to Mom and Dad for comfort and support. In varying degrees, my three brothers did the same. Yet, I'd always considered myself responsible for my parents' well-being, still bound by traditions that that in one generation seemed to have gone from being the right thing, the expected thing, the American way if you will, to some impractical folkway practiced only by recently arrived immigrants.

Looking back, I realize I'd taken absolutely no concrete steps to support these notions. Like so many of my generation, I had avoided talking with them about any possibility of planning for their aging. My parents were still young, and I was full of myself. I imagined my life full of drama and tempestuousness. Living it was a full-time job. My parents accepted that. They were of a generation that lived through their children. They'd had four sons to keep them busy. They'd never left the street they were born on and never cared to. The likelihood of either or both of them moving to Atlanta in a crisis was nil. In neither of my unhappy marriages would there have been a place for my folks. Among many Italian-Americans, extended families are viable; a nursing home would have been out of the question.

When things began to to wrong--for example, my father, in taking early retirement, had neglected to check off a clause that would continue pension payments to my mother in the event of his death--I could offer little more than concern and guilt. My feelings were real, but they wouldn't have put food on the table.

Death had come early in our extended family. Aunt Dolly, my mother's elder sister, died of breast cancer in her early forties. Aunt Marguerite, a younger sister, succumbed to cancer in her 50s. "Not three," I'd told myself "Three sisters couldn't get cancer." I was younger then. Later, shadowed by the ironies and disappointments that seem more than anything to mark our passage into adulthood. I knew the clock was ticking for Gloria.



Death came closer in 1982. My 28-year-old brother, Thomas, a struggling actor living in Greenwich Village, developed Kaposi's sarcoma, a skin cancer that signaled the onset of a disease that would become all too common, AIDS. Thomas returned home to die with his family. Gloria tried to save him with home cooking, prayer and a mother's love. Every day for a year, my father, Joseph, bucked Manhattan traffic in his old Cadillac, a raging bull on a mercy mission: getting his son to Sloan Kettering Memorial Hospital for treatment. They barely spoke, the issues were way too complicated, but one morning I found my father in the backyard shaking his fists at the heavens. "Why him? he demanded. Why him!"

Thomas died in the spring of 1985. I remember cherry blossoms and dogwood petals floating in the bright sunlight as we passed into Brooklyn's Green-Wood cemetary. I was forced to purchase his grave while he still lived.

That year, my father's chronic shortness of breath--the result of his smoking unfiltered cigarettes for 40 years--developed into full-blown emphysema. He grew afraid, a man who had seemed to thrive on shouting and turmoil, who as a foreman "down the piers" had terrorized deckhands and longshoremen with his furious temper and work ethic. At his funeral, half-a-dozen, gruff, gnarled men, old beyond their years, came up to me and said, "Your father worked like an animal!" It was the highest compliment they knew.

My father died over the telephone. My part played out in a series of long distance calls. It took five years and as many hospitalizations. I was in Atlanta those years, trying to put Thomas's death, the ruins of my first marriage, and a financially devastating career change behind me. I called often, trying to get him to let go of the oxygen bottles, the cigarettes and the sofa that defined his world.

At the time, I was married with two children, a demanding job, mounting bills. I lived far away. He had two other sons nearby. I constantly reminded myself of these things; it kept the guilt for the nightmare I knew was unfolding in Brooklyn at bay.

At age 64, my father couldn't walk 10 feet to the bathroom. He'd urinate into a milk carton. Gasping for air, he kept the windows wide open on January nights while my mother and Gregory shivered upstairs. At the same age, his father, my grandfather, had sat proudly at the head of a long table, surrounded by doting children and grandchildren. My great grandfather had lived at home well into his 90s.

Too many nights I knew my father had only the white noise of the television for company. Too many nights, his needs left my mother and brothers angry and exhausted. When I called, he would whimper, "I'm scared." He was a wonderful cook; sometimes, to distract him, I'd ask for one of his recipes, always endlessly complicated and detailed. He'd hand the phone to my mother. Once when I'd gone to far, he moaned a desperate, "Please!" After that, it became easier when he didn't feel like talking.

March 6 was a special day. My wife, an actress, had landed a television commercial. She seemed happy. (A month later, she would pack up and leave, our marriage over.) We picked up the kids and headed home to make dinner. The answering machine's red light was flashing angrily, five...six messages.

"Vincent, this is your brother Joseph. Daddy just died."

Again and again, each time the voice choked with panic.

"Vincent, Daddy just died. Please call! Vincent, please! Vincent, Daddy's dead. He's lying on the floor!"



Thanksgiving marked the third time my mother's cancer had recurred in three years, despite all assurances that the massive neck surgeries and larynx reconstruction she'd endured had been successful. "No evidence of tumor," the lab reports had read, but each time renegade clusters of epithelial cells had escaped detection. The four months she'd spent recuperating in the crowded wards of Mount Sinai Hospital and her permanent inability to drink liquids or swallow most solid foods (we'd sit silent and helpless at the dinner table watching her gasp and choke as fluid flowed into her lungs) were a terrible price, but--we told ourselves--she could speak and she would live.

Twice before, my response had been optimistic and aggressive--read the literature, roust the experts, get second and third opinions, find the best hospital, the latest treatment, listen to the anecdotes of miraculous turnabouts everyone seems to volunteer. This time, the machinery of hope shut down. I could neither think nor act. I made one call, to Dr. Sanford Matthews, my kids' pediatrician. I wanted medical advice; Sandy tried to comfort me. Then came a telephone conversation with my mother.

"I can't understand what's happening," her voice in a morphine haze. "I went shopping last Wednesday. I was fine. I walked all over the Avenue."

"I love you mom. I love you so much."

I spent Thanksgiving weekend lost on familiar streets, alone though surrounded by friends who cared for me, beyond of the reach of arms that would comfort me. "We all have to go through this," someone whispered. "It's part of life." Even so, in my car, I howled the injustice, the unfairness of it into the night. I raged. I cried and hated myself for crying; each tear was an acknowledgement that she was dying.

By Monday, I'd come to a decision. I was going to New York and I would stay however long it took...two weeks, a month...a year. This was my personal choice and I attach no moral certitude to it. Everyone makes his own. This woman had given me life; she made my well being her life's work. She'd sung to me as a child. In our toughest times, seeing me shamed by cardboard stuffed inside my worn-out sneakers, she'd risked my father's wrath to buy me new ones. She still cooked my favorite dishes, still pressed money on me when I was broke. She loved her sons and grandchildren more than herself.

The bond between us was fierce. I'd never, as I'd promised, taken her to Florida, Los Angeles or the Vatican. Never become rich or famous... never danced with her at my wedding. She never cared. Last autumn, swept by some strange prescience, I'd taken six weeks off from work and traveled to New York to write, sleep in my old room, be her son again.

This would be my time to comfort her and stand with her at the fading of the light. If pain and tragedy were my mother's lot, I wanted my share. Something else was at work. The dying can give precious gifts to the living clarity... perspective... priority. This would be my last opportunity to give back something; the last time in this life I would ever be a son, the child of a living person.

In some ways, my position was special. Given the circumstances, easier than it would be for most people. My children were young, and, after the breakup of my second marriage, they were living most of the time with their mothers; my expenses modest. A support system of family and friends was in place in Brooklyn. I was not bound by corporate dicta that typically make no provision for extended leave or other support in times of family crisis...that make it simpler for employees who are substance abusers to get help than for caregivers to provide it. Journalism for all its prickly edge is a sympathetic business. My boss told me to do what I had to do. We'd worry about it later. I was a reporter; experience, no matter how painful or personal, was the raw material of my craft.

"If God wants me, then I'm not afraid," Gloria always told us. Whatever God wants..." was a phrase I grew up with. I'd never seen her without her rosary beads. She supported an endless stream of church-related charities with $5 donations, yet could curse a blue streak, held grudges and always wanted the latest gossip. She attended services three times a week at Our Lady of Peace Church, one of the last devoted churchgoers in what had once been a thriving parish. As a child, it had been my job to stir the tomato sauce on Sunday mornings during the hour she was at mass. She always sat in the same pew, "Gloria's row," her friends called it. Over the last few years, I'd begun attending mass with her whenever I was in town.

She always wore high heels to church. Young women had always marveled at my mother's figure. In the three years, since her first operation, she'd lost 40 pounds, suffered disfiguring scars and complained she "looked like a skeleton." Greg, always loyal, still called her "Tubsy."She still wore those high heels. Awash in memories in the nearly empty old old church I'd look at her and tears would flow.

She pretended not to notice.

Returning to New York had always been a joy for me. This time it was a rite of passage. I had come as a son seeking his mother; instead, I found myself in an empty, memory-haunted house, the head of a family heading for disaster.

Once again, I found myself emotionally, but not practically prepared for crisis. Gregory, who had been supporting Mom since my father's death, was unemployed. Joseph was in a rehab program. Bills were piled up; the mortgage and property taxes hadn't been paid. My parents had managed family finances out of an old shoe box in which they kept payment books, canceled checks, etc. Mom's hospital costs were already in the tens of thousands of dollars and surging daily. Though well-insured, she still owed thousands from her previous surgeries. Our resources essentially consisted of her small savings account, a $2,000 life insurance policy and the modest row house we'd grown up in. Determined to keep the house and our family intact, I found myself worrying about losing both every day.

At the hospital, Mom was being maintained on heavy doses of morphine and little else. We asked that the dosage be cut back and discovered the pain had diminished. Other problems had developed: her feet and ankles had begun to swell with fluid; she couldn't swallow without choking. Her only sustenance was the intravenous solution that dripped slowly into her arms. Every day, untouched containers of soup, pasta, fruit, toast, eggs, Jell-O, tea, lined her window sill.

After ten days, she was finally transfered to Methodist Hospital's third floor cancer ward for chemotherapy. Each day, I'd imagine the runaway cells inexorably growing, approaching some critical mass.

"Do you think this can really help me?" she asked.

"Please, Mom I said, "there's nothing else we can do."

I'd half-convinced myself the harmless-looking liquids in the clear plastic bags above her bed could work some miracle. They were powerful cytotoxins that would kill any fast-growing cells in her body: she would lose her hair, develop sores in her mouth and the lining of her stomach, experience nausea or worse. On Friday night, she was given a cocktail of painkillers and anti-nausea drugs to prepare her for her first treatment.

I arrived early Saturday morning carrying coffee and a newspaper, eager for some hopeful sign. A nurse stopped me outside the room to ask whether Mrs. Coppola should be revived if she went into cardiac arrest. I rushed past her to find Mom semi-conscious, gasping for breath. A nurse was suctioning her throat with a vacuum device. The anti-nausea drugs had supressed the gag reflex that allowed her to clear phlegm: she was drowning in front of my eyes. We stared silently at each other. Half-a-dozen other patients were in distress; the nurse passed the vacuum tube and saline solution to me and left.

Mom revived, survived the first round of treatment. By then, she'd seen herself in a mirror and asked for Father Louis DeTommaso, her pastor. We all took communion together around her bed. Another lifelong image was seared into my consciousness. My relatives had begun placing religious pictures by her bed, alongside those of her grandchildren, Justin, Gabrielle Pia, and Thomas. Her brother Sonny and his wife Madeleine, postponed their annual winter trip to Florida.

In the cancer ward, some patients slept constantly; others never. One woman, suffering from both lymphoma and Alzheimer's disease shrieked through the night. Many of the patients smoked constantly. One of Mom's roomates, a woman apparently without family or friends to support her, endured three days of chemotherapy and then was preparing to make her way home alone. Gloria ordered me to drive her home. She had Greg give $10 to another, indigent patient.

Despite the high tech medicines and the decency of the caregivers, the ward was not a place to inspire hope. Half-a-block away on Seventh Avenue, the shops were ablaze with lights and Christmas decorations; men hawked Christmas trees on the sidewalks while carols played over tinny speakers. Our house, always bright and filled with people at Christmas time, was dark and empty.

Greg and I stayed in shifts. Our relatives visited regularly but we kept the haunted hours. Other families kept similar vigils; many of the "children" were my age. Two brothers, both in their 40s, had flown in from Florida at Thanksgiving to care for their mother. A month later, they were still there "trying to get Mom home for Christmas." At the other end of the scale was the daughter who publicly berated her dying mother for all the "trouble and expense" she was causing. The woman's last months would be spoent shuttling between cancer ward and nursing home.

Three days before Christmas, I asked Mom's permission to return to Atlanta to spend time with my children. She insisted I go.

"I'm okay, I've got plenty of company."

Holidays were important in our family, heralded by huge dinners my parents would spend days preparing. I sensed she was passing on the tradition to me. As I was leaving for the airport, torn between my responsibilites as both father and son, she handed me money for gifts and Christmas cards for Gaby and Thomas. Inside, she'd written,

"Grandma will love you always."

A patient died Christmas Eve. Three days after Christmas, a surgeon had cut into my mother's abdomen attempting to install a feeding tube directly into her stomach. He failed. He told us her liver was so enlarged with tumor, he couldn't find her stomach. A tiny tube he attached to her small intestine pulled free and Mom refused to have it reinstalled.

On New Year's Day, a 43-year-old woman whose husband and daughters had kept a lonely vigil in the room across from us died of brain cancer. Their wails echoed through the ward.

At noon on Saturday Jan. 5th, Gloria was discharged from Methodist Hospital. The plan was to get her out of the grim ward environment for a week, after which she'd return for three days of chemotherapy. Visiting nurses and home healthcare workers would help us manage.

I spent that morning at home scrubbing the floors and putting everything in order. Over the last year, Gregory had renovated the ground flooer of our dilapidated, 100-year-old row house, ripped out walls, exposed brick, installed new appliances, windows, even parquet floors.

While Mom was hospitalized, he had her dingy bedroom redone all sunshine and bright colors. I'd dumped the worn-out bedroom and living room suites, bouth new sofas and a bed--charged it all--framed and hung pictures of my brother Thomas and the grandchildren alongside her photograph of Pope Paul VI. My mother had spent her entire adult life living in that rundown house. The renovation was Greg's final gift to her.

On the sidewalk outside the hospital, she couldn't walk four steps to the car without gasping. The painful swelling that had begun in her feet by now had bloated her legs. When I'd massaged them, imprints of my fingers remained in her flesh. She couldn't have weighed more than 80 lbs. Her face was grey, her lips pulling back from ther teeth.

"It's so beautiful," she whispered as Greg carried her into the house. "So beautiful."

A neighbor had prepared lentil soup and run it through a blender for her. She couldn't eat. (At the hospital, she'd ordered her cousin Millie to eat the food I'd leave "...so Vincent wouldn't worry." ) She spent the day exhausted on a BarcaLounger we'd borrowed from a neighbor. On Sunday, a visiting nurse noted Mom's systolic blood pressure had dropped below 90; she looked at me oddly when I announced I had gotten Gloria to eat two full tablespoons of oatmeal. A medical reporter, I refused to acknowledge any medical information. It had come down to "...what God wants."

Sunday night, Greg carried Mom upstairs to her bedroom, the stairway as insurmountable to her as Mount Everest. It took six pillows to put her at ease and still she couldn't sleep. She called to me in the middle of the night. I lay awake next door in the narrow room that had been mine as a teenager.

"Vincent, my back...I can't get comfortable any more."

I adjusted her pillows for the 10th time.,

"I'm sorry," she said. "I'm not letting you sleep. I'm sorry I made you come up here so far from the kids."

I clung to the iron rail of her new bed. An enormous chasm stretches between the living and the dying, a gap love cannot bridge. I wanted to hurl myself across it. "Mom," I said, "There's nowhere else in the world I want to be." I realize now that I had been granted a precious moment. A chance to say those special things we feel for those we love but so rarely do A chance to say goodbye.

"Mom, I want you to know that you've been the best mother any son could have. I want you to know that whatever is good and special in me has come from you."

She lay there staring.

I was blinded by tears. "Mom, You know that I can't change this. I can't change what's happening to you. You know if would if I could."

"I know that," she whispered. "I know."

Monday morning, her blood pressure continued to drop.

"Vincent," she said, "I don't feel good Maybe I should go back to the hospital."

I didn't want her to die surrounded by gaping strangers in a crowded emergency room or wind up lifeless on an respirator. "Okay, Mom. Let's wait a little bit." I knew what choice I was making. The hospital had an arrangement for bypassing admitting procedures on the cancer ward. After a while, it became too much Greg drove to the hospital to find the head nurse. I was upstairs when Angela, a family friend, shrieked, "Vinny, come down! Something's happening!"

Mom had pitched forward in the chair. She'd grabbed Angela's hand She wasn't breathing. I pinched her nostrils and began breathing into her mouth. It was the first time I'd ever kissed my mother on the lips.

"Breathe Mom. Please, Mom breathe! Don't die!"

Somehow she heard me and delayed her passing. She came back, but only for a moment. Her last breath passed into my mouth. Later, Josie Stuto, our octogenarian Italian neighbor across the street would tell me this was a special gift.

I was aware of Greg kneeling beside me sobbing. I won't cry," he'd said, "until there's no hope." There were no open beds at the hospital. Angela dialed 911. Half-a-dozen police officers and EMTs piled thorugh our front door, pushing us aside. Mom lay on her back, her pajama top open as a team worked to defibrilate her. Her ribs and collar bones protruded It was the only time I'd ever seen her undressed.

At that moment, our brother Joseph walked in. He never got his chance to say a last goodbye, make amends, and tell her he loved her. Of course, Gloria knew that. Her last thoughts were of him.

As I write this, the tulips and irises I'd planted in the yard that last fall are beginning to blossom. I was going to surprise Gloria with them. Her favorite outfits and a few pieces of jewelry were given to family and friends, the rest donated to the poor. I would have kept everything exactly as it was. But life goes on. Her passing left a hole in my life into which I hoped would flow all the kindness she represented...

Sometimes, I wonder what might have happened if Alzheimer's had been the diagnosis instead of cancer...if those intense and devastating 10 weeks had stretched into 10 years. And I wonder about the road ahead for me.



Remember how I'd assured myself that the cancer that killed Gloria's sisters had somehow inoculated my mother against the disease. In fact, my Aunt Mary, another of her sisters, and two of her brothers, Sonny and Tony, would all die of cancer. They grew up in a house on the corner of Carroll and Nevins streets, since demolished, a few hundred feet from the canal. As a boy, I remember the poisonous green tides flooding the cellar, my uncles wading into the noisome water to clear the drains.

Ours is just one story of a hundred families in a forgotten neighborhood. My hope is that neighborhood and its people will live again on these pages.

I remember wise guys dumping medical and other wastes into the canal. It was cheaper for their corporate customers than loading the toxic material on a barge and ferrying it out to sea. The deals no doubt done in Monte's Venetian Room, a restaurant across from our house. I couldn't afford to eat there until I was in my thirties.

As a boy, I played pirate on half-sunken barges, climbed a mountain of metal barrels filled with industrial chemicals. A king, I held "magic" turquoise crystals and golden powders in my hands when the containers spilled open. I remember raw sewage from our toilets passing straight into the water through a stone conduit alongside the Carroll Street Bridge.

Last month, the EPA declared the canal--now eagerly eyed by a new generation of developers and self-styled urban pioneers--a Superfund site.




In December 2012, it was my turn: I was diagnosed with Stage 4 throat cancer at New York's Memorial Sloan-Kettering Hospital and have begun treatment.