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A Good Fight

by Sarah Brady and Merrill McLoughlin

CHAPTER NINETEEN (Sarah discusses her battle with Lung Cancer)

“This Is It, Then? My Life is Over?”

Early in 2000, I realized that Jim and I needed to get established with some local doctors, and I made appointments for complete physicals for both of us. We chose Dr. Charles Stanislav, a wonderful young physician who had taken over a practice from a woman who had treated Jim on one of our summer visits. His reputation was spectacular, and we loved his personality.

The physicals, of course, included loads of tests—blood tests, for instance, and for me, a mammogram—and Dr. Stanislav also said he thought I should have a chest X-ray. A year before, one of Jim’s doctors who knew I was a heavy smoker had advised me to skip X-rays and get a lung scan, which could catch lung cancer very early, so I told Charlie that’s what I wanted to do. I pointed out that I’d been smoking for a long time and that my father had died of lung cancer. If I did have anything, I said, let’s catch it early. So he set up a lung scan for me at the Beebe Medical Center in Lewes, Delaware—about seven miles from our house—on Monday, March 6, at 4 in the afternoon.

As it happened, Jim left for Colorado, accompanied by our wonderful companion, Emmy Bania, the day before my appointment. This was shortly after the school shootings in Columbine, and Jim had been asked to help rally public opinion behind legislation to close the legal loophole that permits people at gun shows to buy and take possession of guns without any waiting period. So they had flown out on Sunday, and I was home alone when I went in for the scan.

It was my first of those things, and it was quite uneventful. First they hooked me up to an IV and had me drink a barium solution. Then I went for a CT scan. They scanned me once, then injected an iodine dye, which helps enhance certain images, and scanned me a second time. The scanning took only about twenty minutes. When it was over, I went home and thought nothing of it for the rest of the day.

About 8 the next morning, the hospital called. They asked me to come back in as soon as possible because they needed to do another scan. I said sure—how about 11 o’clock? They suggested 10 o’clock instead.

I wasn’t all that nervous on the way in, because I knew very well that X-rays and scans often don’t come out clearly. That was probably the reason I’d been called back. However, as I was getting ready for the scan, I did notice a difference in attitude on the part of the woman who helped me—the same one who’d helped me the day before. She seemed much more solicitous and kind, and I had my first little chill of fear. When the scan was over, I asked why they had needed to repeat it. The fellow in charge said that two radiologists had a difference of opinion on whether or not there was anything there, and they thought they should take another look.

Once again, I went home. It must have been 11 or 11:30 by the time I got there, and by now, I was quite nervous. Maybe there was something there. I called Charlie Stanislav and explained what had happened. They must have looked at the new scan by now, I said; could he possibly call Beebe fairly soon and check to find out what it showed?

Bless his heart, he was back on the phone with me by noon. I was sitting on one of our kitchen stools when I took the call, and Charlie said, in a very matter-of-fact tone, “I hate to have to tell you, but the scan did show what looks to be a carcinoma—very small, but it’s being read as a carcinoma—in the upper lobe of your right lung.” I asked whether it could possibly be something else, scar tissue or something, and Charlie said that was possible, but it looked pretty definite. Since my father had died of lung cancer, and I had a good idea of how difficult it is to cure, I immediately asked, “This is it, then? My life is over?” But Charlie was very reassuring. Medicine had made great breakthroughs in recent years, he explained, and this was very small. Much could be done. He wanted to set me up immediately with Dr. Michael Salvatore, the leading lung specialist in our area, and he made an appointment for 11:45 the next morning.

I was stunned. I sat there for almost an hour, thinking this just couldn’t be true. I felt a deep need to tell somebody about it. For me, talking things out is the most helpful thing on earth. But Jim wouldn’t be back from Colorado until late that afternoon. Finally, I called my brother and shared the news with him. I spent the rest of the day swinging back and forth between thinking I was going to be fine, that I could fight this thing, and feeling somewhat blue and teary-eyed. I told two dear friends, Debbie File and Theresa Gardner, the mother of Courtney, my assistant at Handgun Control.

When Jim and Emmy got home, I first took Emmy aside for a private talk in our back bedroom. She says I was very upbeat, stressing how small the tumor was and how early it had been caught. When Emmy went home, I told Jim. For the life of me, I cannot remember anything about that conversation. I am sure he was upset, but being Jim—he’s very good at avoiding subjects he doesn’t want to think about—I imagine he put it out of his mind as quickly as possible. I am sure he told me then, as he does every single time I light up a cigarette, “You don’t need that.”

Of course the person I most dreaded having to tell was Scott. He was living in Washington at the time, and I knew I could not do this by telephone; I would have to make a trip there and tell him in person. But it was a little premature to think about that. First, I needed to find out more from the doctors.

The next day, I went in for my appointment with Dr. Salvatore. He examined me, looked at the scans, gave me some preliminary tests, and then spent almost two hours just talking to me. He described, clearly and in great detail, the nature of the disease. There are two types of lung cancer. Small-cell lung cancer is the extremely virulent form my father had—so aggressive that sometimes it has already spread to the brain and other organs by the time it is first detected in the lungs. Non-small-cell lung cancer moves much more slowly, and he could tell by the shape of my tumor that it was of the non-small-cell variety.

At first, I was absolutely thrilled about that. But there is one problem with non-small-cell cancer: it doesn’t seem to respond as well to chemotherapy. Dr. Salvatore said the very best thing would be to take out the entire upper lobe of my right lung, because in 99 percent of all cases, if the cancer hasn’t spread beyond the original site, the surgery puts an end to it once and for all. I was incredibly heartened by that idea. Dr. Salvatore said there was a wonderful oncological surgeon on staff, Dr. James Spellman. He set up an appointment for me that Friday, March 10.

Meanwhile, my brother had done a lot of research on his own. Among other things, Bill had contacted one of our cousins, John Dehner, who lives in Richmond, Indiana, and he suggested that I talk to him. John is an oncological radiologist who works at a community hospital about the same size as Beebe. I asked him whether there were any questions I should ask the surgeon when I saw him, and he said yes: I should be sure to ask whether there seemed to be any involvement of the lymph nodes, whether they showed any swelling. I told John about Beebe—a really terrific regional hospital, but not a huge cancer center like Johns Hopkins in Baltimore or Sloan-Kettering in New York—and asked whether he thought I should be going to one of those places instead. He said the most important thing was that I must be happy with the team I was working with. He advised me to go ahead and meet Dr. Spellman. “You’ll know after you meet him,” John said. “You’ll know whether you’re going to be happy with his experience and with the relationship.” He added that what I had been diagnosed with—technically, “speculated bronchogenic carcinoma,” a tumor two centimeters in diameter in the right upper lobe—was not rare, nothing unusual, and community hospitals across the country dealt with it every day.

I was pretty well-armed with information by the time I met Jim Spellman that Friday. We had a long meeting, and I liked him very much. He was extremely thorough in explaining exactly what my condition was and how he would like to proceed. I asked about the lymph nodes, and he said it looked from the scan as if some of them were swollen. That didn’t necessarily mean that the cancer had spread to them, he said; it might simply mean that they were overworking, or that there was a bit of infection because of the tumor itself. The only way to find out for certain was to test them.

Dr. Spellman described several different options, but suggested that the best course of action would be a procedure called a mediastinoscopy. I would be put under general anesthesia, and he would make an incision just below my neck, near the clavicle, allowing him to probe down into the area between the lungs and biopsy the lymph nodes. If the biopsy showed no cancer in the nodes, they would immediately go ahead and remove the entire upper right lobe of the lung.

He warned that removing the lobe was very difficult surgery. It would take at least five hours, he said, and he compared the effects of the operation to being hit by a Mack truck. Doctors would make a huge incision and break through several ribs, and it would take me a long time to recover. The good news, though, was they would not even proceed with the surgery unless the lymph node biopsy made them quite confident that I would come out of it entirely free of cancer.

I was extremely impressed with Dr. Spellman, as I had been with all the others at Beebe who would make up my team. I also liked the idea of staying near home, of being able to recuperate in my own house with my family and friends nearby. So I left that meeting convinced that Beebe was the right option and feeling extremely optimistic.

Now that I had a good idea of what was going to happen, I had to tell Scott. That same afternoon, I took off for Washington. On the way, I made a reservation at a motel near the house where Scott was living. I met him at the house—I hadn’t yet seen it, and he wanted to show it off—and then we went to dinner at a little Korean place in the neighborhood.

We ordered dinner, and then I had to tell him. It was one of the hardest things I have ever done. He is my only child, my baby, and we have been kindred souls for so long, through so much. I broke down, and of course he did, too. After the initial sadness, he began to get angry—angry that yet another problem had cropped up in our lives. This was just unfair, he felt, another example of things not going right for us. I reminded him that everyone has a cross to bear, even if some of them weren’t quite as obvious as ours. Eventually, I bounced back a little and said we had to be optimistic. It was early, and everything looked good. Hopefully, I could have this long operation, and although it would be painful, that would be the end of the cancer. And even if the surgery didn’t work, there were other things that could be done. Scott is resilient, and he recognized the hope. He was eager to come home and be with me before the surgery and help take care of me afterward. We ended the evening feeling pretty cheery, and the next morning, at breakfast, Scott seemed fine.

Dr. Spellman scheduled the surgery for Friday, March 17. The entire week before was filled with tests of various sorts, since they have to make absolutely sure you can withstand this kind of surgery. I went through it all with a combination of excitement and apprehension—excitement at the prospect of getting rid of the cancer and apprehension about the surgery itself. But there was so much to do that I couldn’t dwell too hard on what was ahead. Among other things, we had to make arrangements for additional help and relief for Emmy in the event that I was not able to do much for quite a while. After the big surgery, Dr. Spellman had warned, I would have to be in intensive care for several days and in the hospital for close to a week. Then I’d be pretty much out of commission for three months. It would be fully six months to a year before I’d feel back to normal.

On Wednesday of that week it occurred to me that Jim and I did not have a real will. So I made an appointment with Brandy Jones, an attorney we had used in the past, and the three of us discussed what we wanted in our wills and also drew up a living will for me, specifying that no heroic measures should be taken if they simply served to prolong life needlessly. I was very relieved to get those legal affairs out of the way.

By Thursday, everything was done. I had passed all my tests with flying colors. Scott and my brother, Bill, had arrived, and Theresa and Mickey Gardner came down, too. Thursday night, we all went out to one of our favorite restaurants, the Blue Moon, to eat and enjoy ourselves. We had a wonderful time.

The surgery was scheduled for 8 a.m., and I had to be there by 6. Bill drove me over, then went home to pick up Jim, Scott, and Emmy and bring them all to the hospital. Mickey and Theresa came on their own and looked in to say hello while hospital personnel were getting me ready for surgery. I was nervous, but there was so much going on that I was more or less distracted. They were going to put me on a respirator and get me ready for the full-blown, five-hour operation.

Of course, from the moment they start the anesthesia, you don’t remember a thing. But I do remember waking up. The moment I did, I realized that I was more or less free of pain. And immediately, I knew that I had not been able to have the full operation—that they had stopped after the lymph node biopsy. That meant the cancer had spread.

Dr. Spellman was there. “I didn’t get the big one, did I?” I asked. No, he said. I asked whether my family knew, and he said they did. I asked how Scott had taken the news. Pretty hard, he said, but they were all doing fine.

After Dr. Spellman left, they kept me in the recovery room to allow the anesthesia to wear off a bit more before I was sent to intensive care overnight. I napped for a while, then came to when they were getting ready to move me out of there. I’m a strange bird under anesthesia—always wake up pretty quickly, in a good mood. This time was no exception, but I was so thirsty I could hardly stand it. It must have been the effect of having that respirator tube down my throat. It was a horrible feeling, and I said to the nurse that I’d give the world for a Starbucks Frappuccino. By the luck of the Irish, one of them had a bottled Frappuccino, and she handed it to me. I downed it immediately. It was absolutely divine.

In intensive care, they hooked me up to all the monitors and gradually I became aware of the incision, just below my neck. It had a drain in it, a tube to carry out all the blood and other fluids that accumulated in the wound, and there was a kind of ball hanging out of the tube. It was uncomfortable enough so that I was given morphine. It was kind of scary. They wanted me to lie on my left side, and when I did, I was convinced that I would lie on that ball that hung from the tube, and I also got the distinct feeling that my head was going to fall off.

Jim, Scott, Bill, Emmy, and the Gardners came to see me soon after I was settled in the ICU. I was so glad to see them. They didn’t seem desolate, and I certainly didn’t feel that way. But I was sleepy, so they stayed only a few minutes and said they would come back later.

I slept through most of the afternoon, and when I woke up, I was absolutely ravenous. The hospital brought dinner very early, and I ate every bit of it. Not long afterward, in came Scott, bringing me a mammoth steak and cheese sandwich. I ate all of that, too. It tasted just wonderful. Then, not too much later, the Gardners arrived. Mickey had spoken to Dr. Spellman in the morning and gotten permission—Dr. Spellman had actually written it into his orders—to bring me martinis. He brought two huge ones, and they were delicious.

No one stayed too long that evening, and when they had all left, I decided to watch some basketball. It was time for the second round of the National Collegiate Athletic Association’s basketball tournament, and I’m always a sucker for March madness. I had brought in my sheet showing who was playing whom and when the games were on television. But I was too tired to pay close attention, and eventually I decided to sleep. Despite my fear of rolling over on that drain and having my head fall off, it was not a difficult night. By the next morning, I felt much better, and Dr. Spellman, after removing the drain, said I could go home.

Before I left, the nurses said they’d never seen a patient quite like me. They said most people just want to sleep after having heavy anesthesia and being on a respirator. Very few have any desire to eat, and those who do want only mild liquids. I, by contrast, had consumed a frappuccino, a regular hospital dinner, a steak and cheese sandwich and two martinis—although I confess, I didn’t actually finish the second one; on top of all the medication, it kind of did me in.

Jim should have been proud. It was definitely a performance worthy of a raccoon.

Posted with permission of AOL Time Warner Book Group,
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