At one AM (apparently in search of lost praise), I found the best book review I ever received. I first signed a book contract with New Republic Books in 1975 promising to deliver in less than a year. It was to be my first published book--as it turned out it was my third. My agent Marie Rodell who had taken me on as a client back in 1969 (shortly after graduating from Columbia College) explaining that she saw promise in my talent. Finally, Marie was delighted that my wandering from hither (The Village Voice) to yon (a newsletter on migrant agricultural workers), perhaps my promise might be warranted.
More than 10 years after signing the contract with New Republic Books, Marie’s successor Frances Collin arranged for the book to be moved to Sierra Club Books where it was finally published. The Los Angeles Times reviewed The Politics of Food on the first page of its book section.
Marie had represented Rachel Carson. A significant development in creating the environmental movement took place after Marie arranged for The New Yorker to publish Silent Spring. Rachel Carson biographers referred to Marie as Carson’s indispensable alter ego.
When Franklin D. Roosevelt took the oath of office (a machine gun nest poised to protect him), 25 percent of Americans lived in rural America. The dream of a secure agriculture base (shades of Thomas Jefferson) might have been realized. However, by the 1970s when U.S. farm population was less than five percent, reality took a back seat to wishful thinking.
“Under the direction of Roy Stryker, the RA/FSA photographers (Dorothea Lange, Arthur Rothstein, and Russell Lee, among others) were assigned to document small-town life and to demonstrate how the federal government was attempting to improve the lot of rural communities during the Depression. Evans, however, worked with little concern for the ideological agenda or the suggested itineraries and instead answered a personal need to distill the essence of American life from the simple and the ordinary. His photographs of roadside architecture, rural churches, small-town barbers, and cemeteries reveal a deep respect for the neglected traditions of the common man and secured his reputation as America’s preeminent documentarian. From their first appearance in magazines and books in the late 1930s, these direct, iconic images entered the public’s collective consciousness and are now deeply embedded in the nation’s shared visual history of the Depression.”
The images Walker Evans and Dorothea Lange vividly gave us all as a gift had turned into a Kafkaesque argument for preserving a way of life that no longer existed.
The beneficiaries of this deceit were rich farmers who tilled their multi-thousand acres from planes dropping seed and fertilizer on their crops hiring lobbyists to emit the magic phrase “family farm” (code phrase for greed).
I have been describing my third cancer experience at age 65 when I was diagnosed in April in State College PA and had a successful operation in August in New York City at Memorial Sloan Kettering Cancer Center.
How did I survive cancer three times?
How was I able to father two daughters after massive radiation treatment?
Why was cancer treatment responsible for my becoming a paraplegic?
What was my emotional state during these three experiences which otherwise might have forced me to concentrate on death rather than enjoying life?
Answers may be difficult to provide, but what follows is my first attempt to use language for the ineffable.
Five years after my experience with Hodgkin’s disease, my publication on the subject in The New York Times, my appearance on ABC’s Good Morning America, I received a book contract and proceeded to interview formally (receiving signed releases) and on tape the accounts of my:
Members of the therapy group who first learned I had cancer
Writing the book was difficult especially revisiting the radiation treatment room at George Washington University Medical Center where the chief radiologist had died from exposure to his own machines.
Making the difficult an easy read was also difficult and slow.
What follows is Chapter One of Learning to Live Again, My Triumph Over Cancer.
What follows is the entire chapter one of Learning to Live Again: My Triumph Over Cancer, published by Holt, Rinehart, and Winston, then a subsidiary of CBS.
I DO NOT HAVE CANCER ANYMORE. The disease was treated by conventional radiation therapy, and my physicians say that it has been eradicated. I believe that I have been cured, despite a recurring nightmare that a doctor is examining my body, checking for lumps.
Today, I had lunch with Laura in the oak-paneled dining room of the Hay-Adams Hotel. We each had two drinks and needed more. Our love affair became a casualty of the cancer cure. Too much intensity was confined to too short a period of time, time that always seemed to be running out. Although we tried afterward, we were unable to salvage our relationship. Today, I told Laura that I am engaged to marry another woman—Diana, whom I met after the cancer experience was over. Laura and I toasted to the future—a future that we will not share.
It is spring here in Washington. The cherry blossoms are out early.
Spring this year feels the same as it did five years ago. I continue to live in the same city and in the same apartment. At thirty-three, I am too young to write my memoirs. Yet that is what I am doing, reliving the period five years ago when I was diagnosed as having cancer and feared death. The diagnosis and its treatment—over a period of six months—was the worst experience of my life. Remembering how poorly I behaved is worse than remembering the physical pain and the fear.
Now, five years later, my statistical category has changed. Today I conform to the American Cancer Society’s definition of cured: five years without a recurrence of symptoms. A generation ago my type of cancer, Hodgkin’s disease, was described as “invariably fatal.” A generation ago I could not have survived five years. I would not have lived to interview family, friends, and physicians, nor to revisit the hospital in which I was operated upon and treated. The difficulties of remembering and surviving would have been denied me.
ON FRIDAY AFTERNOON, April 23, 1976, I am sitting in a doctor’s office worrying. Worrying is something that I do a lot and am good at. At the time I do not realize that I have much more reason for concern than when I normally worry about (a) money, (b) getting the article in on time, (c) my relationship with Laura, (d) finishing the book, (e) cleaning the apartment, and so on. Specifically, I am in the waiting room of Aaron Falk’s * office because there is a small lump—about the size of a golf ball—under my right arm. The lump does not hurt, and it is noticeable to no one but me. However, it has been there for a number of weeks, and several times a day I find myself feeling under my armpit to check whether it has gone away. The lump has joined my mental list of things to worry about.
Given how regularly I worry about my health—running to a doctor’s office at the first sign of a cold, a sore throat, or a backache—I do not anticipate that my first appointment with Dr. Falk will be noticeably different from previous appointments with other doctors. My experience as a mild hypochondriac is that doctors find my ailments boring. I leave their offices feeling embarrassed for bothering them and stupid for paying so much money to find out that there’s nothing wrong with me.
Indeed, I have made the appointment because I want to be reassured that nothing is wrong with me. This time I am sufficiently concerned about the lump that I am willing to risk the likely embarrassment and expense. However, the longer I sit in the waiting room, the more convinced I become that the lump is inconsequential and that it will probably disappear if I wait long enough. I am convinced that Dr. Falk, whom I have yet to meet, will be polite, but in a tone that will imply that doctors go to medical school to cure really sick people and why does he have to waste his time seeing obviously healthy people like me.
As I read the plastic sign welcoming patients to talk about physician fees with the physician, I decide that now that I am in the doctor’s office, I can stop worrying about the lump and start worrying about money. My concern about money at this time has a rational aspect to it. As a free-lance writer my income is precarious. I have difficulty obtaining insurance. My previous policy, with Stan, a friend of a friend who agreed to let me join his group plan, was terminated because Stan pocketed the payments rather than sending them to Blue Cross. That experience has made me feel insecure about my current plan, with the newly formed Washington Independent Writers. The paperwork is already fouled up. Despite the organization’s reassurance that my membership card has been processed and is in the mail, I worry that I may not be covered by insurance at all. So as I appraise the doctor’s office, which is in an expensive neighborhood, provides free parking for its patients, has its own laboratory on the premises, and offers a spacious waiting room (where a large potted plant has cedar chips covering the soil), I am concerned that the tests and doctor’s fee will be more than I can afford—and all for a complaint that will probably turn out to be nothing.
Aaron Falk begins, as doctors do, by asking why I have come to see him. I tell him about the lump under my arm, that it has been there for several weeks, that it doesn’t hurt, and that it hasn’t gone away. I ask, “Is it serious?”
He says, “I don’t know yet. First let’s get the usual questions out of the way. Then we’ll go next door where you’ll take your clothes off and I’ll examine you. We’ll take some routine blood tests and a chest X ray. When we’re done with that we’ll come back here and I’ll tell you what I think, assuming I think anything. Okay? Now, how old are you?”
“I’m a writer, specializing in agricultural policy.” We talk about that for a while.
We get along instantly. Our ability to communicate seems uncanny. There are not the usual barriers that separate doctor from patient. Dr. Falk is only seven years older than I, so we relate as peers. He is not condescending toward me, as are physicians who make themselves inaccessible because of their specialized knowledge.
BY THE END Of the day, I was calling him by his first name, because it seemed artificial for him to call me Joel while I was calling him Dr. Falk. In retrospect, I must have decided to trust Aaron as soon as we met, when I entered his private office and sat down on the wood-and-wicker chair.
At the time of this first visit, I knew nothing about his educational background. Dr. Falk graduated from Harvard College and went to the University of Pennsylvania Medical School. I also did not find out, until much later, that Dr. Falk and I shared a similar religious upbringing: he attended the Hebrew Academy of Washington; I went to the Hebrew Academy of Miami Beach. While I soon rejected the ritual and ever-present discipline of orthodox Judaism, Dr. Falk continued to observe it. Indeed given the additional distance I was then putting between myself and Judaism, if I had known about our shared religious background, it would have put distance between us.
AARON is the same height as I am-5 feet 10 inches. He is thin and although prematurely gray, he looks younger than he is. Our preliminary small talk clearly makes him impatient, an impatience he has difficulty curbing. He recognizes the necessity of getting acquainted, but fidgets as he sits, uncertain about what to do with his large hands and arms, patently restraining the impulse to dash down the corridor and “do something.” This impatient, almost distracted manner extends to his dress. He is wearing a regulation jacket and tie, but it is that and no more, he looks neither dapper nor even coordinated, his clothes the expression of a man who has more important concerns. He talks in spurts, the way professors do who are more comfortable with scholarship than students. Sentences are strung together rapid-fire, followed by long pauses while he weighs each word. He suspects that he’s transparent and that everyone knows what he’s thinking when he’s thinking it. So Aaron smiles a lot during his embarrassed pauses or when I am talking too long, as if to say, Dealing with people comes awkwardly, but I want you to like me. The smiles work. His eyes light up, expressing interest, even tenderness.
“Marital status?” Aaron asks.
I must be more frightened than I realize. Rather than say, “Single and divorced,” which is how I usually automatically answer the question, I launch into an exposition on the intricacies of New York State’s divorce laws, which five years previous made it more convenient to get an annulment than a divorce. When I respond to a simple question with a long, irrelevant answer, it means that I don’t want to deal with whatever’s going on.
On the way to the examination room he asks how I’ve been referred to him. I say, “I see Dr. Bernstein” (an ear-nose-and-throat specialist whom I visit for colds and allergy attacks). “I asked the secretary what kind of doctor specializes in lumps. She said an internist and gave me your name.”
“You certainly are lucky,” Aaron says. “Not only am I an internist, but this office’s specialty is hematology.” (He does not mention that the office’s other specialty is oncology—the treatment of cancer.)
We are now inside the examination room and he says, “Take off your clothes and I’ll be right back.”
He stops moving and answers. “It deals with disorders of the blood. It means, you might say, that lumps are our bag.”
What he says frightens me. Instead of asking the obvious—”Do I have a disorder of the blood?”—I revert to worrying about money. Telling him of my concern I say, “Tests are expensive and I’m short of funds right now. Can you go easy on the tests?”
Abruptly, he places his right arm against the door, as if to stop himself from exiting. Turning toward me, he seems suddenly angry as he says, “Nobody’s going to tell me how to practice medicine. If I order tests, it’s because I think they’re necessary. I’m a doctor and my concern is your health. I don’t give a damn about the money. If you can’t afford it, then you can’t afford it. We’ll work something out. You’ll pay me if you can, and if you can’t then you can’t. Money is the last thing we need to worry about now. I’m not going to let you tie my hands by telling me not to order the tests I need to practice quality medicine.”
After I take off my clothes, he feels the lump under my right arm, asking whether it hurts as he touches it. It doesn’t hurt. Kneading my skin with his fingertips, he feels for lumps under my left arm, under my ears and behind my neck, across my abdomen, and at my groin. There aren’t any other lumps.
He asks, “Do you have sudden chills or wake up sweating in the middle of the night?
“Have you been running a fever?
“Do you have sudden outbreaks of itching?
“Have you recently experienced sudden and unexplained weight loss?
“Do you suffer from loss of appetite?”
I answer no to all the questions, and when they stop, I say, “Why are you asking me this? What’s wrong with me?”
He says, “I don’t know that anything’s wrong with you. Go to the lab around the corner—he points the way—”and they’ll take some blood. The nurse there will direct you to the X-ray room. After you’re done with the chest X ray, get dressed and return to my office. Then, we’ll talk.”
If there were more room in the office, he’d probably pace, trying to figure out some way of saying what he wants to say without frightening me. Instead, he leans awkwardly against a bookshelf and, in a rush to get it over with, blurts out, “Look, I don’t know what the lump is. It’s probably nothing, but I don’t know. I think it’s a good idea for you to see a surgeon so he can remove the lump from your arm and we can examine it and find out what it is.” He is trying hard to convey as much information as possible, so I can understand his perspective and make a rational decision. He smiles abruptly, as if to apologize for what he’s just told me, and asks, “Are you willing to see a surgeon?”
“I guess so.”
“Can you do it right now?”
He gets on the phone and calls a surgeon named Cory Simpson and inquires whether he can see me right away. He can. Aaron says about me, “Yes, he’s perfectly capable of walking over. In fact, I’ll tell him to run over. He’ll be there in a few minutes.”
Aaron gives me Simpson’s address, which is about five blocks away. He says, “Look, it’s Friday afternoon and you’re lucky that Dr. Simpson can see you right now. I want him to have a look at your arm. Then come back here so we can talk.”
As I leave his office, he calls after me. “Hey, there’s nothing to worry about. I don’t want you to be alarmed. It’s best to do these things quickly, just to be on the safe side.”
As I am crossing L Street and New Hampshire Avenue, it does not occur to me to question why I am listening to this doctor’s urgent instructions or why I trust him. I am puzzled because never before has a physician taken my physical ailments quite this seriously. Fear is creeping up on me, fear because the doctor has asked me specific questions and because it seems that I have a specific disease; fear because he says he specializes in disorders of the blood and by implication that’s what I may have; fear because I am en route to a surgeon. I have never had an operation, and I’m a coward when it comes to pain. Fear because a doctor thinks that an operation is necessary at all. But I don’t actually feel frightened yet. I can tell that the fear is coming, but am able to put it off, not wanting to be afraid, too busy concentrating on getting to Simpson’s office and on obtaining as quickly as possible a new range of information that I’ll need to deal with this situation. I know that I’ll be frightened later, but for the moment my curiosity is stronger than the fear. I consciously decide—like Spock in “Star Trek”—to banish my emotions and concentrate on being logical.
I arrive at Dr. Simpson’s office and am filling out the insurance form when the doctor comes out. “Are you Mr. Solkoff?” Pointing to the insurance form, he says, “You can do that later. Why don’t you come into my office?”
Simpson is also not much older than I. He is tall, thin, and wears a tapered three-piece designer suit. Among George Washington University medical students, who are notoriously hard on their instructors, he has a reputation for being a very fast and very good surgeon.
Right away, I find him to be unpretentious and easy to understand. He feels the lump under my arm and says that he doesn’t think there will be any problem removing it. He reassures me that the operation won’t be painful (which I don’t believe), that I’ll be awake while he does it, and that I can return to work right away.
I say, “What’s the rush? Why did Dr. Falk tell me to run over here?”
“Aaron has a tendency to be enthusiastic. He probably thinks it’s a good idea to find out quickly what that ‘lump,’ as you call it, really is.”
“What do you think it is?”
“I don’t know. You’ll have to ask Aaron.”
SIMPSON’S ATTITUDE toward me, from the beginning, was matter-of-fact. Later, he told me, “In reality, as a surgeon I was actually put in the position of being just a technician. I was not making major decisions regarding your care. The major decisions were really made by Dr. Falk—and you, of course.” He explained that surgeons, like anyone else, would prefer to be creative and in a position of authority.
Instead, as often happens, he was asked to do a routine task which he had done hundreds of times before. He was perfectly willing to explain the procedure to me and consistently answered every question asked about surgery and possible complications. However, regarding speculations on my diagnosis and life chances he continually referred me back to Aaron, whom he regarded as my primary physician. Whenever I asked whether he thought a procedure Aaron recommended was necessary, he said yes, telling me that Aaron was a respected physician who specialized in conditions like mine and whose judgment was trustworthy.
Eventually Simpson told me, “You and I are relatively close in age, and since I could avoid thinking about your dying, I did.”
Simpson and I never became friends, as opposed to my relationship with Aaron. I still don’t know Simpson well, and I doubt that many people do. Yet I respected him. He was easy to be with during painful and stressful situations. Like Aaron, he has an off-beat sense of humor, which we shared and enjoyed, and while there was nothing memorable about our jokes and bantering, it made future events easier that we all “horsed around” (as Aaron put it), often in a self-deprecating way. Given the closeness in our ages, none of us took offense or felt threatened when I complained about Simpson’s sutures or Aaron’s plans for treatment or when they complained about my behavior. Had they been much older, or had I been much older, my relationship with my doctors would have been more decorous—making the whole experience grimmer.
BACK AT AARON’S OFFICE, I ask what he thinks the lump is. He says, “It may be nothing at all, just some fatty tissue.” “But you think it’s something else?”
“I don’t think it’s something else. I don’t know what it is. That’s why I want to find out.”
“What else might it be?”
“It’s probably a benign tumor.”
I am frightened by the word tumor. Having assumed that I’d never have to deal with a tumor, each time the word appears in conversation I tune it out. “If it’s benign, why is it swollen?” I ask Aaron.
“All tumors are enlargements, abnormal growths. Most just happen, for reasons which are complicated and about which we’re not entirely sure.
Most tumors are benign, which means they’re not serious, and when we remove them, there’s nothing to worry about. The chances are that yours is benign and that when Dr. Simpson removes it, you and I will be done and you can go about your business.”
“And if it’s a serious tumor?” I don’t want to say the word cancer.
“I don’t think it’s serious, but if it is, then we’ll cross that bridge when we come to it.”
We talk about scheduling for the operation. He wants the tumor out of me as quickly as possible. I realize that walking around worrying that I have “something serious” when I probably don’t is stupid, and the sooner I know the better. But I don’t want someone else or something else controlling my life. I have an article to complete on Cesar Chavez, which Marty Peretz, the owner of The New Republic, commissioned and is expecting. Already, I am beginning the process of negotiating, trying to fit the problem of my tumor into my schedule. Aaron says firmly, “Don’t wait too long. This is something that should be taken care of right away.” I promise to call Simpson’s office and schedule an appointment.
* While all characters in this book are real, several names have been changed.
Here is Tim McGraw singing on just this very subject.
He said I was in my early forties With a lot of life before me And a moment came that stopped me on a dime I spent most of the next days Looking at the x-rays Talkin’ ’bout the options And talkin’ ’bout sweet time”
I asked him
“When it sank in
That this might really be the real end
How’s it hit you
When you get that kind of news?
Man, what’d you do?”
“I went skydiving
I went Rocky Mountain climbing
I went 2.7 seconds on a bull named Fu Manchu
And I loved deeper
And I spoke sweeter
And I gave forgiveness I’d been denying”
And he said
“Someday I hope you get the chance
To live like you were dying”
“I was finally the husband
That most of the time I wasn’t
And I became a friend a friend would like to have
And all of a sudden going fishin’
Wasn’t such an imposition
And I went three times that year I lost my dad
I finally read the Good Book, and I
Took a good, long, hard look
At what I’d do if I could do it all again…
And he said
“Someday I hope you get the chance
To live like you were dying
Like tomorrow was a gift
And you’ve got eternity
To think about
What you’d do with it
What could you do with it
What did I do with it?
What would I do with it?