The Two Faces of Cancer

Improbably, we received both calls on the same late-January day, at nearly the same time. As I sat in the family room hearing about my brother Geoff’s throat cancer diagnosis, Barbara was in the dining room speaking with her brother Alan. He’d just been informed he had non-small cell lung cancer, very likely terminal. When I hung up with my brother, Barbara came in to share the news about hers.

For several minutes, we just sat together, wide eyed, incredulous, overcome with grief.

Two cancer diagnoses in a single hour.

Now, I have written extensively about my own experience with stage-three prostate cancer; so I’m familiar with the dizzying array of feelings that sweeps over a person upon receiving a scary diagnosis. As the laws of irony would have it, I had just celebrated five years of problem-free PSA tests when the calls from Geoff and Alan came in. So, for what felt like about twenty minutes, I had relegated cancer to a more distant and comfortable corner of my consciousness. Then we heard that the disease had breached the family defenses not once but twice.

The weeks following those phone calls involved a familiar sequence of events: regular text updates about oncologist meetings, CT scans, PET scans, and blood tests. With each test result an incrementally clearer picture of the two diagnoses formed. My brother Geoff, who is just two years older than I, had his cancer downgraded from what appeared to be stage-three to stage-one after an encouraging PET scan. That he caught his cancer early meant his five-year survival rate could top 90 percent. Hearing this, we all breathed a great deal easier. Even so, we had come to learn that throat cancer treatment—including that of early-stage malignancies—is frighteningly medieval in its depredations, often leaving the patient in intense pain, incapable of swallowing, and in need of a feeding tube.

Alan, on the other hand, had discovered his cancer when a vicious case of COVID landed him in the hospital. By the time his doctors identified a large mass in his lung, the cancer had metastasized, dropping his five-year survival rate to a hope-crushing 9 percent. Making matters worse, his struggle with COVID had left him with a large hematoma that impinged on a nerve in his leg, leaving him wheelchair-bound and dispirited.

Two Stories, Two Different Endings

As our brothers grappled with their respective diagnoses and treatments, Barbara and I passed messages of encouragement between them. They had this terrible disease in common now, these two charismatic men who had only met a couple of times; and they felt a sort of war-time kinship. However, as Geoff went through his seemingly endless rounds of radiation and chemotherapy, and as Alan’s one attempt at chemotherapy and immunotherapy failed, their paths diverged. In mid-April, Geoff walked out of his last radiation treatment at Orlando Health Cancer Institute and rang a bell to announce the end of his six weeks of torture. His voice was hoarse and he coughed frequently, but otherwise he looked like my older brother on a typical Florida day. In May, his doctors will conduct tests to make sure the radiation completed its mission. Until then, he will drink high-calorie smoothies and take naps and wait for the effects of radiation to slowly burn out. Then he will get back to living his life.

Alan’s story ended differently. In late March, after suffering one setback after another, he lost his battle. All his extended family visited him in those final days, crowding around his bed to hear him talk. He held court as he always did, smiling often (though weakly), his eyes as arrestingly blue as ever. He’d lost a lot of weight by then, and his barrel chest no longer looked barrel-like in his hospital gown. Nor had he shaved in weeks, and his beard gave him a sage quality that befitted a retired Army colonel. Barbara, Mattie (my daughter), and I were lucky to spend time with him on his last lucid day; when we said goodbye the following morning, the pain medication had left him only intermittently conscious. Knowing this day was approaching, I had wondered how I would say goodbye—the last I’d ever say to a man I’d loved and feared and guffawed with for over nearly four decades. I worried I’d lose my nerve and say something safe and insincere like, “We’ll see you again, Alan.” But when the moment came, after Barbara turned away from him in tears, I grasped his hand and told him I loved him. His shoulders were slumped and his blue eyes were barely open now, but he told me he loved me, too.

Those were the last words we spoke to each other; and I am both haunted and sustained by the memory.

Cancer’s Signature Look

Days later it occurred to me that, in the strange convergence of Geoff’s and Alan’s stories, we had witnessed two different but related faces of the disease Siddhartha Mukherjee called “the emperor of all maladies.” After his brush with throat cancer, my brother’s life will never be the same. Even if the cancer cells in his body are reduced to smoldering embers and Geoff recovers his sense of taste, his beard grows back, and his throat returns to normal—even then he will be forever altered by that diagnosis. He will likely see life from a different vantage point now, assign priorities differently, and count every cancer-free day as an extraordinary gift. He may also live with the fear, sometimes vague, sometimes acute, that the disease could return. That’s just how cancer works—its signature look, if you will.

Alan’s cancer experience, on the other hand, is now inscribed in those who knew him and carry his struggle as memories. They are also altered, though differently. Their recollections are at once devastating, chastening, terrifying, and hopeful—as one would expect when memories span a human lifetime. Alan’s loved ones no more escaped cancer than he did, and their faces, like Geoffrey’s, register the legacy of a dread diagnosis. No one meets the emperor of maladies and escapes untouched.

That’s the peculiar, Janus-faced power of cancer, how it leaves its mark on the world. But in every encounter with this terrible affliction, we also witness the astonishing resiliency of survivors, and the sad, tenacious love of those left behind.