[2021-04-26] Perspective
I woke up early this morning and decided to continue listening to Martin Short's autobiography, I Must Say. I reached the chapter in which Martin describes his wife's illness and ultimate death from ovarian cancer. I was struck by some of the parallels in our stories: the chance discovery of ovarian cancer, the similar treatment, the regular CA125 tests for follow-up. What I didn't expect was the revelation that Nancy had had breast cancer ten years before being diagnosed with ovarian cancer. Martin explains:
This was not Nancy's first go-round with the terrifying word cancer. Ten years earlier, in 1997, she'd had a double mastectomy after her doctor discovered carcinoma in situ, an early-stage form of cancer, in both breasts. It was obviously traumatic to us, but because Nancy didn't have to go through chemotherapy and radiation, she charged through the unpleasantness with her typical unshakable Mountie spirit, and that was that—cancer gone. Unfortunately, at the time, they hadn't yet developed what is known as the BRCA gene test, in which a patient's blood is analyzed for mutations in her BRCA1 and BRCA2 genes, which naturally suppress tumors. Mutations to these genes indicate a higher susceptibility to ovarian cancer as well as breast cancer. Had the test existed then, Nancy might have undergone a preventive hysterectomy as well.
Martin doesn't reveal whether Nancy was ever diagnosed with a BRCA change, but I suspect that she was. In 1997, it had been only a few years since the discovery of the BRCA1 and BRCA2 gene changes. But by 2007, genetic tests for these mutations were likely more commonplace.
Nancy underwent two surgical procedures in spring 2007. Martin details her progress:
Nancy rallied remarkably well from the debilitated state in which she found herself after the surgeries. Then we entered the realm of chemotherapy, hair loss, and regular trips to the doctor to get the latest blood numbers. We learned all about CA-125, the protein used as a biomarker for ovarian cancer detection; an elevated CA-125 level means trouble.
Following surgery and six rounds of chemotherapy, Nancy's CA125 dropped to 15—well below 35, which is considered normal. A PET scan in November was also normal. The Shorts celebrated a happy Christmas.
Three months later, however, Nancy's CA125 number had risen to 48. Six weeks later, it had jumped to 94. Martin writes:
The cancer wars were once again the headline on our front page, and a new game plan had to be formulated. We were told definitively that Nancy would never be cured of cancer but that the doctors would attempt to keep it at bay through a series of maintenance chemo infusions to be administered every six weeks.
The strategy worked. By early 2009, Nancy's CA125 was once again hovering around 15. The Shorts had settled into a routine that Martin described as workable.
But by spring 2009, Nancy's CA125 number rose to 20. By October, it was 52. Radiation was the next step. In December, it had skyrocketed to 160.
Nancy would undergo an additional round of chemotherapy, but would ultimately succumb to the disease on August 21, 2010. Martin writes:
Terminal illness is so deceptive. There are wonderful days when the sick person rallies and it seems like there is genuine reason for hope, and rough days when the illusions come crashing down.
In hearing Nancy's story this morning, I wondered whether I was suffering from my own illusions. The disheartening thing about cancer, or any life-threatening disease I suppose, is that no one knows. Will my fabulous string of 8s continue in future CA125 tests? Will the drug I'm taking keep my ovarian cancer from recurring?
I also wondered anew about my BRCA-positive status and my risk of breast cancer. Might I suffer the same fate as Nancy, only in reverse: ovarian cancer followed by breast cancer rather than the other way around? Unlike Nancy, I know—after my first (and let's hope only) brush with cancer—that I have the BRCA2 gene change. I could opt for a double mastectomy, in addition to my hysterectomy, to greatly reduce my risk of developing breast cancer. Perhaps, as Martin wrote, Nancy would have opted for a preventive hysterectomy, in addition to her double mastectomy, had she received genetic testing back in the 1990s the way I did in the 2020s.
I didn't choose to read Martin Short's book because of his wife's ovarian cancer. In fact, I had no idea to whom he was married, for how long, and whether they were still together. The book came up randomly in one of those "if you liked that, you might like this" moments in Audible. I had always liked the comedian and so when I discovered that his book was available in both audiobook and ebook formats through the Ottawa Public Library, I downloaded them and laughed my way through most of Martin's story.
Thankfully, Martin doesn't end his memoir at the passing of his wife. He concludes his story several years into the future, noting that his natural tendency is to be happy, no matter what difficult period he is going through. He sees this as a trait inherited from his mother and shared with his siblings. He writes:
Scott Wittman likes to joke that, of all the comedy people he knows, and he knows many, I am "the only one who's truly laughing on the inside." But my upbeat nature is also a function of resilience: a firm belief in what I told my son Henry that night before Nancy died—that tough experiences Teflon-coat you and strengthen you against further adversity. This lesson is, I suppose, a major reason I wrote this book: because along the way I've picked up the wisdom that bad things happen, and yet the sun still comes up the next day, and it's up to you to carry on living your life and keeping your setbacks in perspective. You also have to understand that on some level, these horrible and sad things happen to everyone; the mark of a man is not just how he survives it all but also what wisdom he's gained from the experience. My cheerfulness on TV talk shows isn't faked, but it is also far from the product of a life gone perfectly.
The sun did come up this morning. I got up, showered, had breakfast and, despite the cold, got out for my morning walk. Nancy's story was still weighing on my mind, but I repeated to myself what a friend had told me: Do not die while you are yet alive. I can take heart, from Nancy's life, that she lived it to the very end: playing tennis, traveling with Martin, seeing friends and family.
Writing about my emotions is a way of processing them: acknowledging my fears, working through them, and ultimately gaining some perspective. Sharing those reflections is a way of admitting that I occasionally have tough days amongst the mostly optimistic ones.
