Downtown Keene, NH
I arrived for my appointment with Dr. Wu the next morning at 10:30 sharp. This time I didn’t have to wait. The receptionist, Renee, ushered me into the examining room and I spent a couple minutes to myself, trying to calm my racing thoughts.
Online, I had discovered that bone lesions were abnormal growths that had embedded themselves into the bone, and often were associated with cancer. A brief rap on the door announced his arrival. Whippet thin and nervous-seeming, Dr. Wu plunged right into the bad news.
“That lesion on your left arm, it’s actually cancer,” he said, nodding to himself nervously. “Kidney cancer or renal cell cancer. It’s one of the most common cancers that goes to bone.”
The words echoed in my head. I felt very alone all of a sudden, and in fact my wife Katharina was not with me this morning. I had told her that she didn’t need to make the trip with me, and I would be perfectly happy to patch her in to my appointment with Dr. Wu using my cell phone. It was time to bring her into this conversation. I dialed her number and she picked up after the first ring.
“Hello?” Katharina’s voice sounded hesitant, worried and far away.
“Hi Katharina, it’s Peter. And I’m here with Dr. Wu, so you can maybe listen in to the conversation.”
“That would be nice,” she said. “Thank you.”
Dr. Wu continued.
“Katharina, I just told Peter that the lesion on his left arm is connected to kidney cancer that has metastasized from the kidney to the left arm,” he said. “The first thing to do is to move forward with an orthopedic appointment because the radiologist said the left arm is so fragile that by routine activities you could cause a fracture of that arm.”
Dr. Wu sat at a desk and tapped at a computer keyboard.
“Here’s what we know from the CT scan of the chest, abdomen and pelvis,” he said. “Let me just pull that up. The primary lesion is on the kidney, and the radiologist said it looks like a classic kidney cancer lesion; it’s 7.1 centimeters, something like 2 by 3 inches.”
“A lesion is a tumor?” I asked.
“Yep,” he said. “And the other finding on the bone scan was a second bony lesion not just in your left arm, but also in the right femur – the long bone of the leg. It doesn’t sound as though the lesion on the right femur is as severe as the lesion on the left humerus, but obviously Dr. Fallon – he’s the orthopedic surgeon — would need to consider whether or not that would need a procedure also.”
Wu continued what was obviously a difficult conversation for him.
“The two other doctors who would be involved with your case would be a urologist, because if the primary tumor in the kidney or the kidney itself needs to be removed, it’s a urologist who removes kidneys, and then the oncologist because the oncologist is the person who manages the radiation or chemotherapy afterwards.”
I didn’t have much to say. This was a lot of information coming at me and I could only think, how is a man who has been diagnosed with cancer supposed to react? Should I scream? Should I show emotion? Should I cry?
Instead, I nodded and maintained eye contact with Dr. Wu, depending on him to keep talking and explaining while I struggled to absorb his words.
“Kidney cancer tends to be in people who are a lot older than 46, that’s for sure,” he said, seeming slightly puzzled. “But I actually have a different patient who’s in his 30s who was diagnosed with kidney cancer within the last 6 months. They did a partial kidney resection and he seems to be doing OK. I was going to send you to the same urologist that he was going to because both he and his wife felt they had very, very good treatment and very understanding, compassionate treatment.”
The urologist and the patient who’s been through kidney cancer – that was a concrete step to latch onto, along with a bit of good news.
“So the urologist – is he around here?” I asked.
“Florence,” he said, referring to a small town near Northampton.
My thoughts turned my future, and whether I had one: Am I going to die soon?
“And in the range of cancers to get,” I asked, “how bad or good is the prognosis?”
“It spans the range,” he said. “I mean my uncle was diagnosed with kidney cancer probably 4 or 5 years ago and he’s doing pretty good.”
So that was good news, but I was worried about the fact that the cancer was in my bones, too. That can’t be good.
“Do bony lesions indicate any worse type?” I asked him.
“Yeah, that means it’s left the kidney itself,” he said. “So that definitely implies a more severe case. So I’ll set up the referral to these people.”
He glanced at his desktop computer and then looked back at me.
“Other questions that come off the top of your head?”
There were plenty of them, but they were half-formed and panicky: Will I need chemotherapy? Can I beat this cancer? Can I keep on working? I decided to ask something that was more focused on the here-and-now.
“Well,” I said. “I know this may seem real short-term in the grand scheme of things, but this trip we were planning to Belize; we’re going to be leaving the 12th and coming back the 19th or the 20th. What do you think about that?”
Not much, as it turned out. Dr. Wu told me the radiologist believed my arm to be “really, really fragile.”
“It could easily fracture just by simple activities,” he said. “Dr. Fallon would probably want to fix that as soon as possible. It’s not really realistic to consider going on that trip.”
Katharina had done the planning, and arranging of details for this trip. I shifted toward the phone.
“Did you hear that Katharina?”
It turned out that she hadn’t heard a lot of what had been said. I moved the phone closer to Dr. Wu.
“Fallon is the orthopedic surgeon, right?” I asked. “What would he be doing?”
“Typically the orthopedic surgeon would put in a metal rod to stabilize that bone,” Dr. Wu said. “Dr. Fallon is going to start working on that. I really can’t say exactly when, but based on what the radiologist said, being out of the country away from top rate medical facilities would be too risky for such a weak arm.”
My future was changing, quickly. I felt like I had just been strapped into the scariest roller-coaster ride imaginable, one that goes through dark tunnels, stomach-churning drops and body-twisting corkscrews.
“What starts taking place?” I asked. “Do I have to start making arrangements for taking a medical leave from work or go on disability?”
“It’s pretty likely you’ll have to go on some sort of disability,” he said. “That arm surgery’s going to be a pretty big surgery. I’m not a urologist so I don’t know if they would plan on removing part or all of your kidney, but either way that’s a pretty big surgery too.”
Then I asked the question that had been lurking in my mind as the news had been settling in.
“And what’s the mortality rate for kidney cancer?”
“Basically the best person to ask that would be either the urologist or the oncologist; that’s their field,” he said, sidestepping the question. “I wouldn’t want to misquote and give you a horrible prognosis or a falsely hopeful prognosis.”
“Right,” I said. “OK.”
“Do you have any questions, or anything you want repeated?”
Katharina weighed in: “So if you’re talking about an oncologist that means it’s cancer?”
Ahh, technology – she hadn’t heard all the news. She added: “Is it malignant at this point?”
Wu patiently replied:
“For a definitive diagnosis you need tissue for a biopsy,” he said. “There’s a fair chance that will still happen. On the other hand, the radiologist indicated this is pretty classic. There wasn’t the hint of doubt in his mind when he described the findings of this test.”
“Peter, are you writing down what kind of cancer?” Katharina said.
“It’s kidney cancer,” I said to the cell phone. “And a tumor of about 3 inches by 2 inches in one of my kidneys.”
“In one of your kidneys?”
“Yup,” I said. “And a significant lesion in my left arm and another one in my right long leg bone; the femur bone.”
“Peter, did you say kidney?” her voice wavered slightly. “That there was a tumor in the kidney?”
“Well that’s what Joy had.”
“Is that a relative or a friend?” Dr. Wu asked.
“A friend of ours who Katharina helped take care of,” I said, adding to myself: and she died, as did her husband, both of cancer.
“If there is cancer in the kidney, we have a friend who passed away from kidney cancer,” she said, having trouble finishing the sentence. “This, this sounds really serious.”
“It is serious,” Dr. Wu said. “That’s why we want to coordinate things and get things underway as quickly as possible.”
“Can we get appointments as soon as possible for Peter?” she asked.
“Oh yeah; I’m working on getting those lined up.”
“Peter, do you want me to come down?”
WE LIVED ABOUT 45 MILES north of Amherst, in Keene, a picturesque New Hampshire town of about 25,000 tucked in the southwest corner of the state that had been the setting for the movie Jumanji because of its quaint New England charm. Located about 15 miles from the nearest Interstate, and surrounded by hills and woods that were a natural barrier to the Midwest sprawl I had left behind, Keene had a thriving downtown, diversified economy and tolerant vibe that attracted progressives and Libertarians alike. We’d lived there since 1997, when I quit my job as a reporter in Illinois, and with my wife Katharina, and two sons, then aged 10 and 4, moved east for a change of scenery and a new career for me in non-profit public relations. Instead of digging up stories about corruption and wrongful prosecutions, the goal in my new job as an account executive at Gehrung Associates was to generate positive coverage for my clients, which were colleges, universities, think tanks and foundations from around the world.
My sense of what a story was – and wasn’t – came in handy in my new role as publicist. After some initial regrets about leaving journalism, I came to love my new job for its variety. It turned out that pitching stories to reporters, editors and producers at outlets like The New York Times, The Wall Street Journal, USA Today, Associated Press, NPR and influential trade publications like The Chronicle of Higher Education and later Inside Higher Ed was only one part of the job. Just as important was working with my PR counterparts at colleges and universities to uncover their best stories. That meant interviewing professors about their research, and presidents about what they thought their institutions’ best stories were.
As the years passed, I began scouting for new clients, too, and there was talk at the firm that I might someday take it over. But my boss wasn’t looking to retire for a number of years and though I wasn’t looking, I certainly was intrigued when an email from a search firm consultant working for Amherst College popped up in my inbox one Spring day in 2008, inquiring whether I’d be interested in exploring the vacant public affairs director’s position there.
I learned that the job would entail transforming myself from a publicity generating specialist to a communications generalist with a staff of 11, responsible for the college homepage, the alumni magazine, sports information, events, media relations and above all, safeguarding the reputation of one of the nation’s most highly regarded colleges. I breezed through three rounds of interviews confidently, probably because I wasn’t desperate to leave Gehrung, while becoming increasingly intrigued with Amherst College, which one trustee with whom I interviewed likened to a finely crafted Swiss watch.
“From the outside, it seems to work effortlessly,” he said. “On the inside, there are incredibly complex mechanisms, and it takes a long time to figure out just how those inner workings are able to function so well. And of course, there are many jewels, including the faculty, the students and the staff.”
I was offered and accepted the position. I began in September 2008, just about a month before the stock market crashed the college’s endowment of $1.8 billion plummeted by about a quarter in a few weeks. Amherst was still a very wealthy school, but now considerably less so, and I soon realized that what I thought might be a cushy gig at a small college turned out to be amazingly complex and nuanced, with its potent mix of extremely bright students and faculty, and a demanding president committed to expanding the school’s enrollment of low-income students across all races, even if that meant denying admission to many of the privileged prep school students who had once represented the lion’s share of admitted students.
President Marx had been remarkably successful in achieving this noble mission during his eight-year tenure, and there were regular rumors of him being a candidate for other college leadership positions. So it surprised few when he had announced in January 2011 that he was leaving the college at the end of June to take on the presidency of the New York Public Library. A search for his successor was underway. I had been through presidential transitions working as a consultant; I knew they were vulnerable times for administrators like myself, because new presidents frequently jettisoned many of their senior staff members as they built their own team. However, I also I was confident that I would impress the new president, whoever he or she may turn out to be.
In fact, with our younger son Jakob now a senior at Keene High School, Katharina and I had been looking at houses in and around Amherst, in our efforts to move closer to work and eliminate the hour-long commute I faced each day. Assuming we could sell our house in Keene, the plan was to move to the Pioneer Valley region sometime during the summer after Jakob’s graduation.
Now those plans were obviously on hold, as was my whole future working at the college. All of a sudden, staying put in Keene, with our comfortable home and access to our network of friends and family members, seemed like a no-brainer.
No move in the near future for me. One stressful, life-changing event at a time is enough to deal with.
“Peter, did you hear me? Do you want me to drive down and meet you?”
“No, that’s all right,” I said. “I think I’ll just come home. But maybe I should go back to work and let my boss know what’s going on.”
“You could do that if you wanted to,” Dr. Wu said. “Or you could just go home and not worry about the work situation right now. Work places are pretty understanding about serious illness. You might want to go home and try to compose yourself over the weekend and mentally prepare yourself for tough things ahead.”
“You have a point,” I said. “I think I’ll do that.” I stood up from the examining table and began to get dressed.
“Boy,” Dr. Wu said. “When you came in on Tuesday I was really hoping it would just be an orthopedic situation.”
“Me too,” I said, and my thoughts turned to a question that would surface again and again. “I’m just thinking back about how this all could have been caught any earlier.”
“Basically you weren’t symptomatic earlier,” he said. “Perhaps that jerking the wheel was actually a good thing,” Dr. Wu said. “It could have been another month or two or three if that didn’t happen.”
My head was spinning; thoughts were still racing through my brain, but nothing coherent came out of my mouth.
“Well there’s a lot of information for me to process,” I said. “My life has changed, obviously.”
“Yeah,” Dr. Wu said. “You’re going to be busy with appointments in the immediate future with the people you really need to see.”
And how do I know if these are the right people to be treating me? How do I ask that without sounding snobby and elitist?
“If I get people telling me ‘you should go to this person,’ or ‘you should go to Boston,’” I said, “How do I go about evaluating the quality of the care and the specialist?”
“I think starting with local specialists is a good idea, no matter what you end up deciding to do,” he said. “Myself, I wouldn’t be able to say whether or not a certain specialist in Boston was the person to see or not. They would, though. And the local specialists aren’t bad either.”
“We’re going to go through this process together,” he added, as he shook my hand and began heading out the door. We’ll get those appointments scheduled for you next week and I’ll keep watching your case.”
He closed the door, and I was alone in the room, with Katharina still on the line.
“Katharina, it’s just us again,” I said. “How are you feeling?”
“I’m feeling OK, Peter. How are you?”
“I’m OK too. I’m actually looking forward to the drive home. I can start thinking about my situation, and how we tell the boys about this. I’ll see you in about an hour.”
“Drive safe,” she said. “I love you. We’ll get through this together.”
“I know we will,” I said. But I didn’t see how.