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.
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.”
For Liza, each progression to the next stage of treatment—mastectomy, followed by five months of chemotherapy and six weeks of radiation—proved especially difficult. As friends and family members ferried the kids to and from school, Boy Scouts and sports during those times, she struggled to contain her fears.
“At the commencement of each phase, I’d have a crying jag,” she remembers, sitting in her formal living room, with its rose-colored walls and pastel portraits of the kids. “Once I knew what to expect, I could steel myself, but the first encounter with everything was just shocking to me. I had to have time to process that.”
Outwardly, though, Liza seemed indomitable.
“The only thing I saw was that she’d get tired,” Parker recalls, looking back on Emma’s basketball games, which Liza still managed to attend while she was in treatment. “She’s a very disciplined person, so I’m sure she pushed herself as much as she could.”
“I can’t recall a single time where I’ve seen Liza with her feathers ruffled,” says Paula Rothenberg, president and CEO of Hope Connections. “She’s very even-keeled.”
If pragmatism was the Marshalls’ first line of defense against cancer, dry humor was the second. “Cancer is a great excuse for a lot of things,” Liza says, telling the story of one fellow patient who had trumped all of her family members’ justifications for avoiding the dishes with the ultimate get-out-of-chores card: “Well, I have cancer!”
Similar quips were quick to fly at the Marshalls’ house once Liza’s diagnosis was shared with friends and neighbors. She remembers Emma receiving an unexpected invitation to a classmate’s house and asking her mother, “I’m being invited over because you have cancer, right?”
Liza’s reply: “Yes, probably, but go and have a good time.”
When Liza began chemotherapy and lost her hair, she declined to act on Emma’s suggestion of a blue Mohawk wig.
She expected others to follow suit, telling John to please ban his colleagues from giving her the “mournful oncologist” look—that expression of well-intended sympathy that made her mind leap to the worst possible scenarios. “I’d run into people at Georgetown that I knew, and they’d give me this somber look,” she recalls. “They were just concerned and trying to be nice, but I thought, ‘Oh my God, they know something I don’t know.’ ”
That was a revelation to John, who realized just how much people tiptoe around cancer patients and, as he soon discovered, their families.
“I’d run into people in the community and they would ask, ‘How’s your wife?’ as in ‘I hope she’s not dead,’ ” he says. “People treat you differently.”
It’s just one of the many lessons John, now 51, has since taken to heart in his interactions with his own patients. “I always prided myself on being a good, sensitive doc before, but I wasn’t even close,” he says. “I’m much more personal, less private now. I point to the person in the room [with a patient] who doesn’t have cancer and say, ‘I’ve sat in that chair.’ ”
Recalling the innumerable ways that friends and family helped during Liza’s illness, John now makes sure, during consultations, to “assess the village,” asking patients about their support network and how much help—both practical and emotional—their friends and family may or may not be able to provide, knowing it will be needed.
And he’s tuned in to what he calls the “ripple effect”—how the words doctors use with patients will be repeated, over and over, to anxious friends and loved ones, through email, verbal conversations and social media, like a 21st-century version of the game “telephone.” He chooses his words carefully, recognizing the weight they carry.
He also knows just how much humor is appreciated. “I know I’ve had a good day in clinic when I can make a person who is dying of cancer laugh,” the oncologist says.
Six years have passed since Liza’s diagnosis. She now wears her hair in a short crop and has taken up running—a sport she once found intimidating—noting that regular exercise decreases the likelihood the cancer will come back. In the process, she has raised upwards of $35,000 for Hope Connections and other cancer-related causes through participation in half-marathons and other sponsored races. Her typical workout is a 4-mile loop through the streets of North Arlington, which she often runs with John or with Emma, who is now 16 and a junior at Sidwell Friends School in the District.
As a result of this new regimen, Liza has racked up the everyday aches and pains of a runner—plantar fasciitis, a stress fracture—but she keeps them in perspective.
“I do really personally appreciate, or try not to complain about, the side effects of being alive,” she says.
At 49, she is considered cancer-free, in that the risk of recurrence for triple-negative breast cancer is greatest in the first three years. “If it was going to come back, it would have come back by now,” she says.
But she’s not taking any chances. Late in 2012, Liza had surgery to reconstruct the breast she lost—at the same time preemptively removing and reconstructing her other breast to minimize the chances of recurrence. She’ll undergo a final reconstructive surgery later this year.
“It’s nice to have cleavage again,” she jokes, relieved to be rid of the prosthesis she wore prior to the surgery. “The silver lining for many breast cancer patients is that you end up with better breasts.”
Liza remains an ambassador for Hope Connections, although her perspective has changed. She’s still connected to the cancer community through her husband’s work, but she’s also a cancer survivor who knows what it’s like to argue with an insurance company by phone; or to stay in bed because chemotherapy has left your mouth too sore to eat, your skin dry to the point of cracking, your feet too painfully sensitive to walk.
Her memories of “chemo camp”—the phrase she adopted for the art projects, dance stretches and other hospital programs that kept her sane while hooked up to an IV line of toxic medications for hours on end—are bittersweet. She still keeps one of those art projects in her kitchen. It’s a sheet of copper cut into the shape of a leaf and then pressed between two pieces of glass.
But the core of Liza and her life—her family, her enduring friendships, her community and that dry sense of humor in the face of adversity—remains much the same as it ever was, even long before the months of chemo camp and meal deliveries.
“A psychiatrist told me that people who are unhappy with their lives change everything when they get cancer, but people who are happy with their lives just go on,” Liza says. “Cancer didn’t change the large things for us.”
It didn’t need to.
How to Help a Friend with Cancer
When a friend or neighbor is diagnosed with a serious disease, many of us want to help—but we don’t know how. “I think it’s much harder to be the friend or family member of a patient,” says Liza Marshall. “Trying to figure out the right thing to say or do is very hard.” Here are a few suggestions from the Marshalls and those who helped them:
- Reach out to the person. “The impulse to give them privacy, to not intrude, to not be pushy, is in some ways a nice one, but it’s also a way of coping with our own discomfort with illness,” says Marianne Szegedy-Maszak, a Cherrydale resident and longtime friend who organized meal deliveries for the Marshalls during Liza’s treatment. Let your friend know you’re there and ready to help.
- Avoid open-ended questions like “What can I do?” that force the sick person to figure out what they need. Instead, offer to give practical help such as mowing or raking their lawn, washing clothes or arranging for house cleaning. “You want to make your assistance truly helpful instead of another burden,” Szegedy-Maszak says.
- Remember the kids. Susan Parker, who is also executive director of Arlington Unitarian Cooperative Preschool, says offering to transport a patient’s kids to afterschool activities or hosting young ones for an afternoon with friends can be very helpful. “People are trying to keep their children’s lives as normal as possible,” she says.
- Propose to cook or pick up a meal, especially if the person diagnosed is the one who typically handles the grocery shopping and cooking, Parker says. MealTrain and SignUpGenius offer free online tools for managing meal deliveries by friends and family. If you do bring dinner, keep your visit brief. “People are under such stress and so tired from the treatments,” says Szegedy-Maszak. “It’s OK to just drop off the food and leave.”
- Offer to provide transportation to and from appointments. Caregivers of patients can end up missing a lot of work as they accompany the patient to ongoing medical appointments, so having another driver available can be a “huge help,” says Liza Marshall.
- Ask if having company during a chemo treatment would help. The infusion process can take anywhere from several hours to all day, depending on the cancer, the patient and the nature of the treatment plan. Having a friend there for conversation and moral support can sometimes help the day go faster.
- Send a care package to lift their spirits at difficult times. A friend of the Marshalls sent Liza a basket of gifts for her to open at each chemo treatment. The items—things like hand lotion or a Sudoku book—were typically small, thoughtful gifts that she could use while hooked up to an IV.
- Follow up. If your initial offer of help is declined, keep in mind that things can change. The side effects of cancer treatment can be cumulative, so a patient may feel fine in the beginning, but more fatigued or nauseated as they receive more and more treatment. Don’t be afraid to offer your help again; assistance that was initially rejected may be gratefully welcomed by your friend later in the process of treatment.
Local Resources for Patients and Caregivers
Many large, national organizations, such as the Susan G. Komen Foundation and the Avon Walk for Breast Cancer, focus on fundraising to support cancer research.
Local groups, on the other hand, tend to focus on cancer patients, survivors, friends and family who need direct support and assistance during treatment and beyond.
Here are three such programs in our area:
Hope Connections. A favorite of the Marshalls’, the organization hosts support groups, mind-body classes, education programs and community events for cancer patients, cancer survivors and their friends and families. Programs are free at the Bethesda, Md.-based nonprofit, which will be moving its offices to 9650 Rockville Pike (also in Bethesda) on April 1.
Life With Cancer. Affiliated with the INOVA Health System, this Fairfax-based organization offers programs and classes for cancer patients, cancer survivors and their friends and families, including a handful of Spanish-speaking sessions. Programs are free; participants need not be patients at INOVA to attend.
Virginia Hospital Center. Through its Cancer Resource Center, the hospital offers a library of research materials, general and specialized support groups for patients and caregivers, exercise and wellness workshops, and even donated wigs and scarves for those who have lost their hair during treatment.
Alison Rice is a freelance writer in Arlington.