On Cancer and Resilience

In May of 2015, two months after his 60th birthday, my dad went into the bathroom of a fancy restaurant and pissed blood. The next day, a CT scan revealed a large tumor in his bladder. My mom called as I was getting dressed in a Chicago hotel room, preparing to head out for a work dinner. I instantly recognized her remain calm voice, so I knew something was wrong. At 27, I’d finally gotten the call I’d been dreading my entire life. I collapsed onto the bed, and then got back up two minutes later and decided to go to the work dinner — I didn’t know what else to do with myself.

I flew home the next morning to be at the hospital for the initial surgery. My whole family was there, and I remember thinking to myself, ‘Hey, it’s nice to see everyone.’ The tumor was out but yes, we were told, it was cancer. Specifically, Stage 3 Bladder Cancer, which has a sub-50% survival rate. The scans also revealed that my dad had only one functioning kidney, significantly raising the risks of the aggressive chemotherapy he’d need to undergo prior to a massive, life-changing surgery.

This was unthinkable. He’d been healthy and active all of his life, and was as young a sixty year old as one could be. Just two months earlier we’d been skiing together and I’d had to convince him to call it a day after eight hours on the mountain. My dad, a psychiatrist, was known for being cool, calm and collected — unshakeable, even. He’s the guy people called for help when something went wrong because when he was around, everything was under control. I couldn’t even recall having seeing him sick, so I surely couldn’t process the idea that he was sick sick.

Never one to waste time, he began chemotherapy immediately. Chemo, I learned, is a drug treatment that uses powerful chemicals to kill fast-growing cells in the body, leaving a trail of organ damage behind in the process — poison the bloodstream, kill the cancer at all costs short of killing its host (in this case, my dad). Its side effects can be more accurately described as collateral damage, and my dad’s treatment was a particularly intensive one; he received a two drug cocktail that would keep him in a perpetual state of exhaustion and nausea for twelve weeks. He never complained, and he kept seeing patients throughout the treatment, missing just one day of work per week for the intravenous treatments. I had the most flexible schedule in the family, so I volunteered to take those Thursdays off too, joining my dad in the chemo ward at Memorial Sloan Kettering Cancer Center. I’d show up those mornings with a huge slice of impossibly rich coffee cake from the bakery next door, which we’d share while the nurses hooked him up to the IVs. When the cake was gone and before the worst of the nausea set in, he’d fold up the napkin and funnel the remaining coffee, sugar and cinnamon into his mouth. My dad and I spent hours and hours alone together with nothing to do but talk. As he drifted in and out of sleep, I asked him all of the questions I’d always wanted to ask. No, he really didn’t have a favorite child. Yes, he knew about the house party in ’04. No, he hadn’t been psychoanalyzing me for my entire life (“your mom’s much better at that.”). And yes, despite his steely demeanor, he was of course afraid of dying. I was legitimately surprised to hear this — at 27 years old, it seems I’d still thought that my dad couldn’t be fazed. And still, through all this, my dad never lost his sense of humor. He often joked that this experience had allowed my mom to discover strengths that she never knew she had — like “the strength to lift a recycling bin and carry it up the driveway.”

At some point, he began telling his patients — many of whom he’d been seeing for years or even decades — that he’d be missing some time for a medical procedure. Suddenly he was the vulnerable one in the room, and the experience turned out to be an odyssey in its own right, one that, in an extremely on-brand move, my dad would develop a process for managing and write about extensively. What began as an attempt to minimize what needed to be said changed into an essential sharing of a life experience that many patients made clear they needed to know enough about in order to incorporate it into their own treatment, and adapt to this new threat of change and loss. My dad guided their reactions like he would with any potentially overwhelming issue. He took pains to radiate stability and optimism, stating as fact that he’d be returning. After these conversations, inevitably, three additional things would happen. First, the well-wishes: “I really hope you get better.” Then, unprompted, his patients would tell him about the impact he’d had on their own lives: “I know you’re not my friend, but you’re like no friend I’ve ever had,” one said. And then, his patients would express feeling unentitled to receiving his help with their own ‘mundane’ problems, to which he would assure them that this feeling was misplaced:

“We are all operating in life on a spectrum between dealing with survival issues at one end, and seeking happiness and fulfillment at the other.” His patients’ issues were no less real today than they were yesterday, he told them, and nothing about their therapist-patient relationship need change. When my dad was around, everything was under control.

After finishing chemo, his beard thick as ever, it was time to prepare for surgery — they’d be removing his bladder, and cutting out a piece of his small intestine and repurposing it into a “neo-bladder.” But first, a break; he was given thirty days for his body to recover from the medical grade toxins that had been pulsating through his veins for the past twelve weeks. We still didn’t know anything about his prognosis — we wouldn’t find out until weeks after the surgery, and it could range from cured to terminal — but that didn’t stop us from enjoying the time. Finally, he felt good again, a feeling he hadn’t experienced in months. We had barbecues, went to ball games, and planned his 61st birthday. We told stories and took family pictures as if nothing was wrong. My brother and I returned to our normal routine of arguing about the most inane things we could find. On the night before the surgery we watched Jeopardy in my parents’ hotel room and went out for burgers and beers.

Before being wheeled into the OR, my dad held back tears as he said goodbye to my brother and sister and me. “Everything I’ve ever taught you will always be with you.” We left the room, leaving my mom and dad alone.

I turned to my siblings. “I think Dad just tried to say his last words to us.” The surgery was not without its risks, and he was hedging his bets.

Over the past four months, I’d watched my dad process his own mortality — examining it, reasoning with it, yelling at it, counseling it, internalizing it, and most of all, just dealing with it through a remarkable combination of positivity and practicality. Now it was game time, and he’d confronted it head on.

I, on the other hand, had not. Sure, I was suffering too, and I knew there was a chance he wouldn’t survive, but was I doing this right? I remember these very specific moments when I’d witness another member of my family experience the weight of it all, and I’d feel like a spectator. My mom speaking to me about some future event with my dad and then correcting herself — “well, hopefully dad is there.” For a moment, she receded into her thoughts and a glazed look came over her eyes. My brother and sister — both med students at the time — having a pedantic conversation about my dad’s prognosis that seemed to reach some dark place. When I asked what the hell they were talking about, they exchanged a worried look before insisting on changing the subject, hesitant to say it out loud in plain English. And of course there was my dad, who on one or two occasions let his guard down in front of me, overcome with pain and fear and sadness and everything else, falling out of my reach.

I certainly had my own moments of crippling fear — suddenly I’d be a kid again, terrified of losing my dad, sick to my stomach and unsure how I’d even survive. But those moments were fleeting; after I’d be down, I’d get back up, and I’d go about my day. I still had to eat, sleep and go to work. I still watched TV, read books, drank beer with my friends, and laughed. I dated (not very well) and even trained for the marathon. My dad’s cancer was never far from my mind, but overall, my life went on. A friend commented “I don’t know how you’re dealing with this so well.” Funny enough, I’d wondered the same thing about various friends in the past while watching them deal with an ailing parent, thinking to myself, ‘I’d be a wreck.’ Now it was my turn, and suddenly, I was just dealing with it. Eventually I realized, that’s exactly what the rest of my family was doing, too.

Let me be clear about something — I’m under no illusion that this can be fully generalized. I do not speak for my dad or anybody dealing with illness firsthand, and there are of course experiences far worse than what I went through. We’re also extremely fortunate to have had such a strong support system, and access to one of the best cancer treatment centers in the world. But having said all of that, I do feel like I learned something about myself — something that I think can be generalized to people at large. The human mind is pretty damn resilient, and it doesn’t let us stare into the void for too long without blinking. No matter what life throws our way, we seek to get through it and find moments of happiness. We face things when we need to and we spectate when we can, and we carry on with our lives — it’s part of our survival instinct. Throughout his illness, my dad never stopped fantasizing about becoming healthy enough to ski again. My family and I continued living our own lives, being there for each other, and perhaps subconsciously planning for both the best and worst-case scenarios, because there’s no alternative. And in the chemo ward, we heard far more laughs than cries.

The surgery was a success. In the recovery room, my dad’s sister commented that he had an “angelic look on his face despite the devilish business they did to him.” We asked what he was thinking about.

‘Happy things,’ he said.

The recovery was tough, and we didn’t get the news that we’d hoped for. Live cancer was found in the bladder, which meant that the chemo wasn’t totally effective, and it was possible that undetectable cancerous cells were still floating around. There was no additional treatment to be done, though, so my dad would need to return to the hospital for scans every three months for the foreseeable future. If cancer was spotted again — and there was a ~60% chance it would be — it would likely be untreatable.

The immediate aftermath of receiving this news was the worst period of all. The treatment, as difficult as it was, had kept us all occupied and with a clear sense of both purpose and hope. Now it was simply a waiting game, and the dream of being fully cured was extinguished. There was anger. There were tears. There was a sense of despair. A realization settled in that things wouldn’t be returning to normal.

But even those feelings didn’t last. A few weeks after the surgery, my dad came out to watch me and six coworkers run the NYC marathon (for which we’d raised over $30K in his name for the Memorial Sloan Kettering Cancer Center). He soon returned to his normal working schedule — 40+ hours per week of tabling his own issues, helping his patients deal with theirs. With each negative scan, the probability of recurrence decreased, and the burden on my dad lightened a bit. Six months post-surgery, my dad and my brother and I went on a four-day hiking, eating and drinking trip through the mountains of Banff. Another six months after that and he was back to skiing. My parents finally started taking the regular vacations that they’d deserved — there was uncertainty, yes, but they had living to do. Gradually, the cancer’s potential return stopped feeling like a dark cloud following my family around.

Three years after the surgery, just this past September, my dad’s doctors finally declared him cancer-free. And before we could finish celebrating, my brother and his wife had a healthy baby girl, Zoey, and my dad became a grandfather.

We are now four years removed from his initial cancer diagnosis, and the whole ordeal feels like a distant memory. There are lasting effects, yes, but my dad got through it, we all did, and we’re closer for it. He’s since told me that when he’d catch his own mind going down a rabbit hole of dark thoughts — and those moments were certainly more severe and frequent than my own — he learned to consciously pull himself out by telling my mom exactly what he was feeling, reaching out for connection. And then, relatively speaking, he’d be okay again — he’d go about his day.

To state the obvious, we had a happy ending, and I don’t know where we’d all be if things had gone the other way. But, notably, I don’t feel the need to speculate about it, nor do I worry about how I’ll get through it the next time, or the time after that. I just know, I will, we all will.