Warren Zevon, Tony Soprano, and Life After Cancer

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Looking back on that long and anxiety-filled Fourth of July weekend 10 years ago, I can honestly say there wasn’t a moment when I actually thought I had cancer.

Not during the eye exam conducted by my optometrist, Dr. Mark Bolstein, when he spotted what appeared to be a nevus (a mole-like colored growth) inside my right eye. Concerned by what he saw, Dr. Bolstein insisted that I go down to Wills Eye Hospital’s Emergency Department in Philadelphia the next day because most local ophthalmologists’ offices were closed for the holiday, and he didn’t think I should wait until after the weekend to have it checked out.

Not during the interminable Friday afternoon I spent at the Wills Emergency Department waiting to be examined while the doctors dealt with scores of patients brought in with eye injuries suffered while shooting off fireworks. (The holiday weekend started early in 2009, since the Fourth was on a Saturday. I was told the holiday was always one of the busiest times of the year at the Wills Eye Emergency Department.)

And not even after the Wills doctors confirmed that I did indeed have a growth, a tumor, on the choroid (or back part of the eye), but assured me it was likely benign. They told me they wanted me to return to the hospital Monday to be examined at Wills’ Ocular Oncology Service because it had the specialized, state-of-the-art ultrasound and imaging technology needed to determine what exactly was going on.

Although I’ve needed glasses almost my entire life, I had never even considered wearing contact lenses because I was so sensitive—OK, squeamish—about my eyes. So I was utterly unprepared for the battery of tests I underwent at the Ocular Oncology Service, including having an oiled probe rolled over my eyes to create the ultrasound images and enduring a series of blindingly bright white lights needed to create the detailed images of the interior of my eyes. The various tests took almost all day, with long waiting periods in between while many others in the crowded waiting room went through the same routine.

Still, I never thought it would actually be cancer. I was somehow sure that whatever was going on in the back of my eye was benign, not malignant. I guess I was playing the odds because I had read that eye cancer was very rare. I was so confident that I had told my wife, Cathy, not to take the day off work to accompany me on the train ride down to Wills Hospital, saying I would just be getting tests and sitting around all day and once it was done, we’d figure out what I needed to do about it.

Of course, I had never even heard of eye cancer when it all started, innocuously enough, during a Wednesday afternoon matinee at the Ambler Theater the week before. I had just recently gotten a new pair of glasses, and it seemed odd that the vision in my right eye was blurry as I watched the movie.

I mentioned it to Cathy after the movie, and for once in my life, took the advice I had written and edited for so many health books and articles over the years. I immediately called Dr. Bolstein and made an appointment to come in the next day to get my vision checked.

That call may have saved my life.

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Going Five for Five

It was only after I was called back to a small examination room down a long hallway at the back of the Oncology Service on the 14th floor of Wills Eye Hospital that doubt started to creep in. I sat in that room, alone, for what seemed an eternity. As I recall now, I was there for at least an hour, probably more, as the doctors reviewed the results from all the sophisticated tests my right eye had been subjected to over the course of the long day to divine what the images meant.

When Dr. Carol Shields—who along with her husband, Dr. Jerry Shields, was co-chief of the Ocular Oncology Service at the time and literally wrote the book on eye cancer—finally came in, she was flanked by more than a dozen earnest young interns in white lab coats. It struck me kind of funny, like college kids trying to cram into a phone booth.

Except I was in the phone booth. And it occurred to me that if everything was fine and this was just a routine medical issue, my exam room probably wouldn’t be filled with interns eagerly waiting to observe what happened next. I remember thinking: This isn’t good.

It wasn’t. Dr. Shields introduced herself, shook my hand and, in a very measured, calm voice, told me that I had a tumor on the choroid in my right eye, that it had grown sufficiently to impair my vision, and that there are five markers to determine whether a tumor is malignant, including whether it has orange pigment and thickness over 2 mm.

I went five for five. Not exactly the time you want to be Ted Williams.

Dr. Shields explained that my condition, known as uveal melanoma, is exceedingly rare. The odds of getting it are just six in a million. To give you an idea what that looks like, statistically speaking, only six people in the entire state of Delaware would have uveal melanoma at any given time.

There were no known genetic, environmental, lifestyle, or other risk factors. It does, however, typically occur in fair-skinned men and women with blue or green eyes. As a pasty white Irish-American lad with blue eyes, I once again went two for two.

So there’s no real rhyme or reason for who gets uveal melanoma and who doesn’t. It’s almost like winning the lottery. Except you lose.

Without skipping a beat, however, Dr. Shields told me that it appeared the tumor had been caught early, which was extremely important, and that it was treatable with a procedure called radioactive plaque therapy. That entails surgically applying a radioactive plaque the size of a nickel directly on the tumor inside the eye, and leaving it there for four or more days. The plaque has carefully placed radioactive seeds that provide 8,000 centigray of radiation to the entire tumor. The rest of the body receives only the equivalent of one chest x-ray. When the plaque is done zapping the tumor, it is removed in the operating room and the patient can go home the same day wearing an eye patch.

It was somewhat overwhelming. But Dr. Shields exudes confidence that is contagious. It’s no surprise that the world-class surgeon and researcher was a standout on Notre Dame’s first women’s basketball team in the 1970s, leading the team in scoring her junior year, serving as co-captain three times, and going on to become the first woman to win Notre Dame’s highest student-athlete award, the Byron V. Kanaley Award for academics, athletics and leadership.

“We have three goals: to save your life, your eye, and your sight. In that order,” she told me, looking me squarely in the eye. And I believed she would do everything possible to achieve those goals.

It was close to 5 p.m. on Monday, July 6, 2009. Dr. Shields told me that she personally would be doing my surgery, and that radioactive plaque therapy was done on Thursdays at Wills Eye Hospital. After surgery, I would be transported to a nearby hotel that was used for recovering patients and stay there until the following Monday, when I would be brought back to the hospital to have the plaque removed.

Without hesitation, I asked if we could do it on Thursday of that week, just two days away. It meant getting my pre-surgery physical in a hurry, letting family and friends know what was happening, and finding someone to take my tickets for a Bob Dylan concert that weekend. But the last thing I wanted to do was sit around for a week thinking about having cancer. Especially when the option was to do the one thing that gave me the best chance of not having cancer.

So we scheduled the radioactive plaque therapy for Thursday, July 9. Exactly 10 years ago today.

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One of the Survivors

I’m a cancer survivor. It’s a weird term, one I’m still not terribly comfortable with.

About the time I was going through my bout with eye cancer, I had two friends and colleagues from my first job at the Delaware State News in Dover who also were dealing with cancer. J.L. Miller, Tammy Brittingham and I had all been reporters together in Dover when we were young. When J.L. and Tammy found out I had joined the “club,” so to speak, both reached out to me and were incredibly kind and generous in encouraging me and letting me know about resources that might help.

J.L. and Tammy didn’t survive. And yeah, there are still days when I have to wonder why I’m here and they aren’t.

The tumor behind my right eye is now a shrunken scar, which blurs my vision just enough to remind me whenever I suffer doubts about just how fortunate I am.

Fortunate to have an optometrist, Dr. Bolstein, who recognized a troubling growth inside my eye and insisted that I get it checked out without delay. Fortunate to live a mere train ride from Dr. Shields and all of the amazing specialists at Wills Eye Hospital. They are simply the best in the world at what they do. Ten years later, I still have my life, my eye, and my sight. Going three for three on that score has made all the difference.

Fortunate to have Cathy Croft, my wife of 42 years now and love of my life, who had to sleep in a separate room during the four days I was radioactive, but who stayed with me then, and through and all the years before and since. Fortunate to attend the weddings of both of my daughters, Bernadette and her husband Brian, and Amelia and her husband Kurt. And fortunate to still be here to see my granddaughter, little Aria Louise Croft Greer, born to Bernadette and Brian in April.

Fortunate for all my family and friends. On this day, I especially think about Ernie Tremblay and Ed Claflin, who came to visit me in the hotel room the night after my surgery 10 years ago, bearing a bottle of Jameson’s Irish Whiskey. The three of us had worked together at Rodale Press back in the day, and had planned weeks in advance to meet up for drinks that night. When I called to let them know I unfortunately now had other plans, they simply asked if I’d still like some company. Even after mixing Jameson’s and Percocet, their friendship and support remains clear.

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My Own High Holy Day

Among the rituals of my life, my annual follow-up visit to the Ocular Oncology Service at Wills Eye Hospital in Philadelphia each September has become a personal High Holy Day.

It is a day of remembrance and thanksgiving and self-examination. And despite the fact that I have been cancer-free for a decade now, and my genetic testing places me in the lowest percentile for the cancer coming back, it is also a day of high anxiety.

The train ride down, retracing my steps from the eye exam room to the ultrasound machine to the high-tech imaging machines, hoping that Dr. Shields or one of the other doctors will come in at the end and tell me that I’m in the clear for another year. Having expected the best, and hearing the worst, on my first visit in 2009, I’ve learned not to take anything for granted.

Once I get the all clear, my annual ritual includes a celebratory lunch at McGillin’s Olde Ale House, the oldest bar in Philadelphia. I started going there in the months after my surgery, when I had to return to Wills for a series of six eye injections of Avastin, a breast cancer drug used off topic to counteract possible side effects from the radiation treatment in eye cancer. My order is always the same: the corned beef special, O’Hara’s Irish Stout, and, of course, a Jameson’s. Or two.

Each year before I return to Wills, I’ve had MRIs, CT Scans, and/or x-rays done of my liver and lungs—the two areas most likely to be affected if the cancer were to reappear. And each year, they’ve been clear. At this point, I know that the odds of the cancer returning are slim. But the anxiety is there nonetheless, year after year.

And it’s not as though it’s irrational. After all, my odds of getting eye cancer in the first place were just six in a million.

Wisdom from Tony Soprano and Warren Zevon

Along with survivor’s guilt, I also sometimes find myself wondering why I haven’t gained some profound insight into the mysteries of life. Why I don’t seem to have learned some deep, life-changing lesson from my bout with cancer.

Instead, I too often find myself recalling something Tony Soprano, as portrayed by the marvelous and deeply missed actor James Gandolfini, said to his therapist, Dr. Jennifer Melfi on The Sopranos: “You know my feelings: Every day is a gift. It’s just, does it have to be a pair of socks?”

Like Tony, there have been more times than I’d care to admit over the past decade when I’ve questioned why the gift has to be a pair of socks. But maybe simply recognizing that life is indeed a gift, even if it’s not what you may have been hoping for, is profound enough.

So at least for today, I’m doing my best to remember how precious our time is. Every day is a gift. That’s true. And that knowledge should change how we look at life, not in some huge, life-changing way, but in the small things we do every day.

As he did so often in life, the brilliant but criminally underrated singer-songwriter Warren Zevon put it best. His friend David Letterman devoted an entire show to Warren and his music after he was diagnosed with mesothelioma, an inoperable cancer that would eventually claim his life in 2003.

Toward the end of the show, Letterman asked him: “From your perspective now, do you know something about life and death that maybe I don’t know now?”

Zevon replied: “Not unless I know how much — how much you’re supposed to enjoy every sandwich.”

That’s it. Enjoy every sandwich. That’s why I started getting the corned beef special at McGillin’s each September after my annual follow-up appointment at Wills Ocular Oncology. To remind me to enjoy every sandwich. Unfortunately, I don’t always appreciate and celebrate the small things that make life better every day.

But I’m trying to do better. When I was in third grade in White Plains, N.Y., my teacher bestowed “Avis: We Try Harder” buttons to kids in the class who made the effort to improve. I got one on the very last day of school. I’m hoping I don’t wait as long this time.

Maybe I learned something profound after all.

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Coda: Dr. Carol Shields, Trailblazer

Meet Dr. Carol Shields, now chief of Wills Eye Hospital’s Ocular Oncology Service.

Coda: Warren Zevon’s Last Interview with David Letterman

I’ll admit: I can’t watch this without crying. Here is the complete show of Warren Zevon’s final appearance with David Letterman. To me, it remains the most authentic, generous, humane, and moving program I’ve ever seen on television. For the “Enjoy every sandwich” quote, go to 25:58. But I highly recommend watching the entire show.

Coda: ‘Every Day Is a Gift’—Tony Soprano and Dr. Melfi

This clip reminds us of just how much we lost when James Gandolfini died in 2013. “What’re you gonna do? It’s the human condition.”

4 thoughts on “Warren Zevon, Tony Soprano, and Life After Cancer

  1. Great piece Jack. Takes me back to the time when I was getting surgeries and monthly injections in my eyeball for my wrinkled retina condition before an off-label time-release implant by a highly-respected Boston specialist/researcher seemed to do the trick. I still go into Boston for the annual imaging tests, but I don’t visit a bar. Maybe I should add that to my repertoire.

    Liked by 1 person

  2. Lyn, I am learning the pleasures of being a grandfather myself, and I would not disagree with you. Although I’m not sure it has to be an either/or proposition. Sunday afternoon, we’re taking our granddaughter to a restaurant/bar in New Hope to see John Eddie and his band.

    Like

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