The Big C
When you’re the wife of an oncologist, cancer is a common topic of conversation. But Liza Marshall and her husband, John, never expected it to happen to her.
Photo by Michael Ventura
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We all know the traditional Hollywood version of the breast cancer story. From the tearjerker Terms of Endearment to the indie Pieces of April, the tale typically involves a terminal cancer patient with a dysfunctional family who must deal with the devastating diagnosis and finally manages to connect with loved ones before it’s too late.
This isn’t that story.
This is the story of the Marshalls, an Arlington family of four who managed the diagnosis and treatment of mom Liza’s breast cancer with pragmatism, openness—even humor.
“We joked that we were the cancer family—all cancer, all the time,” says Liza’s husband, John, an oncologist at Georgetown University Hospital’s Lombardi Comprehensive Cancer Center. There, he heads up the hematology/oncology division and serves as director of the hospital’s Ruesch Center for the Cure of Gastrointestinal Cancers, where he does clinical research on new medications and treatment strategies.
And yet, close friends say what’s significant about the Marshalls’ story isn’t the extent to which cancer overtook their lives during Liza’s treatment. It’s the extent to which it didn’t.
“We did try to keep things as normal as possible without hiding anything,” says Liza, a former communications attorney with a law degree from the University of Virginia, who was 43 at the time of her diagnosis. (Their kids, Charlie and Emma, were then 14 and 10, respectively.)
Basketball games, sports practices, church, doctor’s appointments and what Liza called “chemo camp”—they all went on the family calendar. “We just treated it like one more thing to schedule,” Emma remembers.
Liza’s transition from oncologist’s wife to cancer patient began with a simple observation in 2006: Her right breast just didn’t look quite right. She had already had one scare that proved to be nothing, but she scheduled a mammogram and biopsy anyway, just to be safe. “I’m not sure we were that worried,” says Liza. “I just didn’t think it was anything.”
She was wrong.
Her diagnosis, it turns out, was triple-negative breast cancer, an aggressive cancer that can be harder to treat than other forms of the disease. Women with triple-negative breast cancer lack the hormone receptors that are normally found in breast tissue, so hormonally based drugs, such as tamoxifen or Herceptin, typically don’t work for them.
Studies show that triple-negative breast cancer is also more likely to recur and to metastasize, according to the nonprofit Breastcancer.org. In a 2007 study of 50,000 women, 93 percent of those with other types of breast cancer were still alive five years later, compared with only 77 percent of those diagnosed as triple-negative.
No cancer is kind, but this was definitely a “meaner cancer,” John says. “In many ways, the good thing about bad, scary cancer is that it keeps you very busy so you don’t get scared.”
But of course they were. John’s own mother had died of non-Hodgkin’s lymphoma when he was 14—the same age as Charlie when Liza was diagnosed. They had known another parent at their kids’ school, Alexandria Country Day, who died of cancer. And given the aggressive nature of Liza’s disease, they realized that treatment might not work.
“I knew my dying was a real possibility,” Liza says, matter-of-factly. “But I was trying not to behave toward the children as if this was our last year together.”
With all that in mind, the couple moved forward. They chose Georgetown University Hospital and oncologist Minetta Liu (now with the Mayo Clinic) for Liza’s treatment, and opted for surgery—a mastectomy—as the first step.
“I just wanted it out of me,” Liza says.
They told their kids. They told their extended families. They told their friends.
“It was very Liza-like,” recalls Susan Parker, a Donaldson Run resident and friend to the Marshalls ever since their daughters were toddlers at Arlington Unitarian Cooperative Preschool. “She was calling not to say, ‘I have cancer,’ but ‘Could you pick up Emma because I learned over Thanksgiving break that I have breast cancer and I need to have surgery.’ It’s never about her. It’s always about everybody else. Liza wasn’t calling for sympathy. She was calling about logistics.”
Meanwhile, family and friends were reeling at the news. “You know a lot of people who get this, but you always think it’s something that happens to someone else,” says Liza’s sister, Lucy Alexander, who lives in New Jersey and describes her older sister as “indomitable.”
The Marshalls did enter the treatment process with some notable advantages—among them, a supportive community, good health insurance and top-quality care just a short drive from their home in Leeway Overlee. Another advantage was their familiarity with the disease itself.
Liza had long supported cancer-related organizations. She was a founding board member of Hope Connections, a cancer support nonprofit based in Bethesda, Md.
Charlie and Emma had not only been privy to dinner-table conversations on experimental cancer treatments, they had even accompanied their dad on rounds at the hospital. “I grew up knowing so much about cancer, so I always felt the situation was under control,” says Charlie, now 20 and majoring in computer science at Case Western Reserve University in Ohio. “I was pretty sure no one was going to be dying anytime soon.”
And then there was John, who, as an oncologist, saw 40 to 50 patients every week—many of them seriously ill—all the while orchestrating clinical trials (he has spearheaded more than 150) to develop new drug therapies. “For many people, cancer is a foreign land, but for us, it was our own backyard,” he says.
However, nothing could have prepared John and Liza for the psychological jolt of a cancer diagnosis. There were times, John realized, when his medical training hurt more than it helped. “Really, in my world, she has a headache and I think it’s a brain metastasis,” he says with a gentle smile. “I know it isn’t, but I can’t turn my brain off.”
John also realized he wasn’t as prepared as he might have expected for the day-to-day realities of Liza’s treatment.
“It’s different when it’s you,” he says, measuring his words. “As doctors, we don’t really know what it’s like to wait for medications at the pharmacy; what the fatigue of chemo is really like; what the neuropathy—the tingling nerve pain—feels like [to the patient].” And if you’re the spouse, he adds, “It’s a full-time job. You have to step up your game. I didn’t really understand that before.”