Late effects cancers are brutal.

They not only mess with the body, but with the mind too.  Just when you think you’re out of the woods with a primary cancer that has created havoc in your life not once, but twice and doctors have been wise enough to attack the cancer with the right drugs and procedures to make it disappear, ‘boom,’ it comes back as a different cancer years later and is probably the result of a treatment that wasn’t quite as solid as it should have been.

That is the story of a young woman I met recently.  She was diagnosed with lymphoma at 20.  That’s bad enough, but she was living in a remote part of the old USSR and her treatment was not what it should have been.  When her cancer returned, she was coming to the United States and she made the choice to come to Johns Hopkins for treatment. Another very tough regiment of treatment that included a bone marrow transplant, and her lymphoma was sent packing.  N-E-D.  Cancer gone.  New bone marrow, new immune system; healthy body.

UNTIL a few years later and she’s now faced with an entirely different cancer and her doctors are pretty sure this rare cancer comes from her first cancer and treatment.

She’s a warrior and is fighting with gusto.  She says being a cancer veteran, she’s prepared for the worst but won’t allow herself to go there.  “There’s too much to live for” is the way she put it.

Late effects cancers have a way of making the past, the present all over again.

We just assume with a cancer diagnosis comes the willingness to go through treatment.

That really isn’t true.

I write this today, almost exactly 21 years to the minute that my Mom took her last breath.  She died of cancer six months after her diagnosis.  She made the decision not to have treatment. So many things went into that choice, some of them she shared with me and my sister and some of them she didn’t.  I know we knew her well enough not to challenge her.  It would have caused such anxiety between us that it made sense to make peace with it and do everything in our power to give her the best, last months of life.  There was only one vote here and it was hers to make.

So how strange is it that the last two days I’ve gotten phone calls from friends who have family members newly diagnosed with aggressive cancers.  Both patients are older and both are contemplating whether or not to have treatment.  One of these patients feels he’s at a point in his life where he’s content to see if the cancer really ends his life before natural causes of a long, happy life would step-in and do the same job.  He says “it’s tempting to let this play itself out.”

My Mom never lost HOPE in her final months: Her HOPE just changed course.  I suspect the same thing is happening with this patient too.

As we all know, treatment can be really hard on a body and mind.  Where we are in life, the places we’ve been, and where we see ourselves down the road all play a factor in deciding to treat, or not…..

“I’m back”…let me tell you why these two little words mean so much.

We’ve walked the canal together for many years.

Our footsteps have pounded dirt up and down the C & O Canal between Great Falls, on the Maryland side and the new and improved Marsden Bridge.  It’s been our turnaround land mark for as long as I can remember.  We give the dog a long, drink of water on that bridge.  We look for wayward turtles there, and have watched winter pick-up hockey games take place on the frozen canal just a few feet away, in the dead of winter

It’s our ‘go-to’ spot.

But we haven’t been walking to our bridge for many months now because of a breast cancer diagnosis that altered our course back in the Fall of 2016.  My friend Carol had no choice but to slow down and I can tell you that is not an easy assignment for someone as active and physically fit as this woman.

We really never stopped walking, but we shortened our treks and we slowed our pace.  When treatment used up most days on the calendar, I could tell by the time the weekend came around, fatigue had worked its way into Carol’s footsteps, but I never mentioned it.  Instead, we’d walk the path, catch up on current events  and talk some cancer talk too.  She was living in cancer world and I’ve had an address there for years, so it gave her a chance to ask about some things I had in my cancer tool box from long ago.

When treatment ended just a few weeks ago, I could tell she was anxious to reach for the bridge once again, but the body wasn’t quite up to it, yet.  Instead, we got back to our old pace.  We trimmed minutes off our walk.

Then yesterday, with no horns or streamers, just good conversation, we passed our old turnaround spot and kept right on walking.  I recognized that we were heading for the bridge, but never said a word.  Instead, she said it all…

“I’m back”

That bridge never looked so good.

I had a lucky day.  I met a warrior way to young to be in this fight.

The 13-year old is new to cancer world.  She has already faced brain surgery and is now beginning her radiation treatments.  She brings her best attitude to the radiation oncology unit.  If she’s afraid, she won’t let her cancer see it.  Instead, she approaches her radiation with confidence and HOPE.

Her Dad is so proud of his daughter.  He watches her, amazed at how brave she is, while he is just a breath away from breaking into tears.  He is the fragile one in this duo.

They sit and build puzzles together before it’s time for treatment. She’s just a kid; a teenage trying showing Dad how it’s done.  She finds puzzle pieces that snap together and she laughs and looks up at him with such loving eyes.  It’s almost like she’s sorry to be putting him through this misery.

The nurse comes into the room to say it’s time for treatment. She moves from puzzles to putting on a mesh mask that helps direct the targeted therapy to exactly the spot where those cancer cells have gathered.  A little radiation goes a long way and her treatment is over quickly.

Her Dad, waits patiently for his little girl who has become a grown-up in cancer world almost over night.

The young patient, taking care of the care giver.

It’s been a busy year of friends going through the stages of cancer.  It seems way too many women I know have come face-to-face with breast cancer.  My thinking is it’s because they are ‘Boomers’ and that age group is the sweet spot for certain cancers in people of a certain age.  I hate it when those stats you hear about actually become a part of reality.

So I’ve gone through the 1) Discovery part, 2) Diagnosis part, 3) Treatment part, 4) Scan part, and now the 5) Hope part.  It’s the last part that’s the long-lasting piece of this disease that bothers me the most.

Hope goes with the doctor’s words “You’re good to go.  See you back here in 6 months, resume your life.”  So slowly my friends have tried to slip back into those ‘normal’ days.  Instead of planning schedules around treatment, they have tried to go back to the old times.  Possible?  Maybe.

As I see them get healthier as the weeks go by because every day without chemo is a day when your body can shed those horrible chemicals that have found a way to be absorbed into the body.  Their eyes get clearer, they walk faster, the color of their skin is back in the pink versus yellow part of the color wheel.  Bottom line, the farther away from treatment they are, chemo or radiation, they act and sound like themselves again.  It’s a wonderful thing to watch.

I know they feel better and they are trying so hard to put those months of ‘cancer care’ behind them.  But every now and then, in conversation they will drop back into their ‘cancer patient mode’ and talk about the possibility of having to return to treatment days.  A new diagnosis; a relapse; a different cancer; a late effect cancer from prior treatment.

It is here, where I jump in with all the HOPE and positive vibes I can muster, and suggest they just don’t go there.  But they can’t help it and I know that because once a cancer patient….

Can you really prepare for loss?  Is there a way to build a wall around your heart, knowing that metastatic cancer is likely to end in the death of your loved one?  Is there some way to stop it from being one of the most painful experiences in your life?

Leroy’s cancer did not move quickly.  There were even months when it ran away and hid somewhere, leaving us with the false hope that all those bags filled with poison dripping into his veins had actually been successful killing all those cancer cells.  Or maybe it was the radiation that did the trick?  I remember how happy we were with the results and we certainly were not preparing for his death during that time.  For us, we just more of reason to look ahead, plan for a future without cancer, and get back to living.

So when the cancer returned and his prognosis turned to ‘terminal,’ we were stunned back into a reality that was heartbreaking, but still, there wasn’t any planned preparation that would have lessened the blow of losing him.

I’m not talking about getting his affairs in order.  I’m not talking about wills being checked and power of attorneys being updated.  That all has to be done regardless of prognosis and it’s not a fun thing to do.

I’m talking about preparing for the worst in your mind and in your life.  Some care givers think that can be done.  How?

How do you do that?  When that final breath comes, it’s not to be believed.  You really can’t anticipate it.  It takes your breath away too.

The free fall from this kind of loss doesn’t provide a soft landing. Not in the real world.

There was a line at the elevators this morning at the cancer center. It seemed we all parked, at the same time and we all met at the elevators, at the same time.

There were the patients with their masks on, dressed in jeans and Baltimore team jerseys.  Clearly they came comfortable, knowing that the morning would stretch into the afternoon.  Treatment is never quick.

There were the visitors carrying the latest magazines and get well cards.  They were dressed to inspire.  When you’re a cancer patient in the hospital, it’s always nice to see family and friends and if they dress in bright Spring colors, the mood in the hospital room is uplifted.  It’s a mental thing.  It might sound crazy, but it works.

And then there were the parents.  And there was the son.  I noticed them in the crowded elevator because the Dad was totally confused about what floor they needed to go to and how to navigate the lobby once they got there.  The Mom had the cancer center tote bag completely packed.  Newspapers, book, cell phone, notepad; she was ready for a day at Hopkins.  The son just walked purposefully to the check in area.  He was on a mission.

Everyone went their separate ways.  A typical day of treatment and outpatient care.

My day moved from meeting to meeting in the building I have come to know so well,  with the occasional flashback of cancer days with Leroy.

The day complete, I turned the corner to get to those same elevators and there was the “Mom” sitting in a lobby chair, reading her book.  I remembered this stranger from the elevator ride because of her bright blue blouse.  I stopped mid-step and turned back to say “Wow, you’ve had a long day?” She smiled, with tears in her eyes, and said “My son, he’s still in surgery.  It will be a few more hours.”

I asked if I could get her anything, she shook her head ‘no’ and I told her I hoped it would all work out.

She said “it will.”

The long days of cancer are exhausting.

She was leaning-in on him and weeping.

All he could do was put his arms around her and let her cry.

Every few minutes he would whisper something in her ear. Whatever he said,  had enough power to give her the strength to look up, into his eyes, but that magnetic pull lasted only a few seconds.  Her tears were much  more powerful.  They forced her head back into his chest where it must have found his heartbeat.  Her tears and his heartbeat, what better combination to absorb devastating news in a cancer infusion waiting room.

He finally eased her down into her wheelchair where she would catch her breath, hold her head in her hands and wait for the next tsunami of tears.  It didn’t take long for her to stand up, the tears flowing and shaking with fear.

They were frozen in that space.  He clearly felt this was the best place for them to ride out the news.  It wasn’t a private space, but it was far enough away from the world outside that was moving to a different beat.  They stayed, locked together in that pose for a long time.

Bad cancer news and so many tears.

Any one who has traveled down the ‘cancer path’ knows first hand, you can not do this alone.

From day one, it takes the support of so many members of the ‘TEAM” to get through the struggle.  On the good days when you want to share some positive news, you reach out to be lifted by your pals.  On the bad days, it goes without saying, you need them the most because a bad scan or new tumor can be crushing.

So from a distance, over the weekend, I said good-bye to one of the ‘TEAM.”

There wasn’t a day during Leroy’s battle that this member of our group wasn’t with us.  Every drive up to Baltimore this member was there.  Reliable, strong, always prepared, we knew we were in good hands.

We celebrated the good news by taking our ‘friend’ to our favorite diner off I-95 so many times.  We cried together at the devastating news when the doctor said Leroy’s cancer had moved to parts unreachable.  There was never a more dependable comrade.

A few years after Leroy died, I parted company with the JEEP, but it stayed in the family.  My nephew would drive it, and take care of it, because he knew the history that came with those four wheels.  But when he recently broke the news that he’d purchased a new car, the writing was on the wall.

So instead of selling the call to some new driver who would have no heart in the deal, we decided the best thing to do would be to donate the car to a needy military group. It was the perfect solution, considering Leroy’s history of covering war zones and his close attachment to the military.

Support, in a small way,  going to a group who supported him for many years.

It’s hard to say “good-bye” to such a trusted member of the team.