When they asked me what I loved most about life, I smiled and said you.
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Liên Kết Nhanh
Biên tập viên
Cập nhật: It's Not About the Bike: My Journey Back to Life
ePub
A4CHAPTER FOUR
B
AD TO WORSEI THOUGHT I KNEW WHAT FEAR WAS, UNTIL I
heard the words You have cancer. Real fear came with an unmistakable sensation: it was as though all my blood started flowing in the wrong direction. My previous fears, fear of not being
liked, fear of being laughed at, fear of losing my money, suddenly seemed like small cowardices. Everything now stacked up differently: the anxieties of life– a flat tire, losing my career, a traffic
jam–were reprioritized into need versus want, real problem as opposed to minor scare. A bumpy plane ride was just a bumpy plane ride, it wasn’t cancer.
One definition of “human” is as follows: characteristic of people as opposed to God or animals or machines, especially susceptible to weakness, and therefore showing the qualities of man.
Athletes don’t tend to think of themselves in these terms; they’re too busy cultivating the aura of invincibility to admit to being fearful, weak, defenseless, vulnerable, or fallible, and for that
reason neither are they especially kind, considerate, merciful, benign, lenient, or forgiving, to themselves or anyone around them. But as I sat in my house alone that first night, it was
humbling to be so scared. More than that, it was humanizing.
I wasn’t strong enough to break it to my mother that I was sick. Not long after I arrived home from Dr. Reeves’ office, Rick Parker came over because he didn’t think I should be alone. I told
Rick that I simply couldn’t bear to call my mother with the news. “I don’t want to tell her,” I said. Rick offered to do it for me, and I accepted.
There was no gentle way to say it. She had just gotten home from work and was sitting outside in her garden, reading the paper, when the call came. Rick said, “Linda, Lance is going to need
to talk to you about this himself, but I just want to let you know what’s going on. He’s been diagnosed with testicular cancer, and he’s having surgery tomorrow at 7 A.M.”
My mother said, “No. How can this be?”
Rick said, “I’m sorry, but I think you need to come down here tonight.”
My mother began to cry, and Rick tried to comfort her, but he also wanted her to get on a shuttle to Austin as quickly as possible. My mother changed gears. “Okay,” she said. “Okay, I’ll
be right there.” She hung up without even speaking with me, and immediately threw whatever she could think of into a small bag and raced to the airport.
After Rick hung up from talking with my mother, I broke down again. Rick calmly talked me through it. “It’s natural for you to cry,” he said. “It’s even good for you. Lance, this is curable. It’s
a speed bump. We need to get on with whipping this thing.”
Shored up, I went into my study and I began to make calls to the other people I felt I needed to tell immediately. I called my friend and Motorola teammate Kevin Livingston, who was in
Europe racing. Kevin was like a younger brother to me; we were so close that we had plans to get an apartment together in Europe the following season, and I had persuaded him to move to
Austin to train with me. When I reached him in Italy, I still felt spaced out. “I have something to tell you–something bad has happened.”
“What? Did something go wrong with a race?”
“I have cancer.”
I wanted to tell Kevin how I felt and how urgently I wanted to see him, but he was in an apartment with three other members of the U.S. national team, and I didn’t want them to know.
So we had to talk in code.
“You know,” I said.
He replied, “Yeah. I know.”
And that was it, we got off the phone. The very next day, he was on a plane for home.
Next, I reached Bart Knaggs, perhaps my oldest and best friend in Austin, a former cyclist who was working for a start-up computer-technology company. I found him at his office, where he
was working late, like always. “Bart, I have testicular cancer,” I said. Bart stammered, not sure what to say, and then he said, “Lance, they do wonders with cancer now, and I think if you have
to get it, that’s a good one to have.”
I said, “I don’t know. I’m sitting here alone in my house, man, and I’m really scared.”
Bart, typically, entered a search command into his computer, and called up everything there was to know about the disease. He sat there until late, researching testicular cancer, and printed out
what he found until he had a pile a foot high. He called up clinical trials, studies, and treatment options, and downloaded it all. Then he gathered it up and drove over to my house. He had to
go to Orlando early the following morning with his fiancee, Barbara, but he came by to tell me he loved me, and gave me all of the cancer material.
One by one, my friends and family began to arrive. Lisa came, after I paged her; she had been studying in the library and she was glassy-eyed with shock at the news. Next, Bill Stapleton
arrived with his wife, Laura. Bill was a young attorney for a firm in Austin, and I had chosen him to represent me because he exuded loyalty. He was an ambling sort outwardly, but he was a
competitor, too, a former Olympic swimmer from the University of Texas who still had the look of an athlete. When he came in, I fixated on what I was sure was the loss of my career.
“I’m done racing,” I said. “I won’t need an agent anymore.” “Lance, we just need to deal with this one step at a time,” Bill said. “You have no idea what this means, or what’s going to
happen.”
“You don’t understand, Bill. I’m not going to have an agent anymore. I’m not going to have any contracts.”
“Well, I’m not here as an agent, I’m here as your friend. How can I help?”
It was one of those moments when everything shifted. I was obsessing over the fact that I was going to lose my career, when there were more important things to attend to.
“You can pick up my mother at the airport,” I said.
Bill and Laura immediately got up from the sofa and drove to the airport to get my mother. I was just as glad not to meet her flight, because as soon as she saw Bill, she broke down in tears
again. “This is my baby,” she told Bill and Laura. “How could this happen? What are we going to do?” But during the drive to my house, my mother collected herself. She was born without an
ounce of self-pity, and by the time she reached my driveway she was strong again. As soon as she walked in the house, I met her in the center of the living room and gave her a bear hug.
“We’re going to be okay,” my mother said into my ear. “This isn’t going to get us. We’ve had too many things to deal with. This is one thing that won’t happen. Don’t even try this with me.”
We both cried a little then, but not for very long, because there was too much to discuss. I sat down with my friends and my mother, and explained to them what the diagnosis from Dr.
Reeves was. There were some issues to go over and some decisions to be made, and we didn’t have much time, because I was scheduled for surgery at 7 A.M. I pulled out the X ray that I’d
brought home from Dr. Reeves, and showed it to everybody. You could see the tumors, like white golf balls, floating in my lungs.
I was concerned about keeping the illness quiet until I’d had time to tell my sponsors and teammates. While I continued to talk to my mother, Bill called the hospital and asked that my
diagnosis be kept confidential and that I be checked in under an assumed name. Also, we had to tell my sponsors, Nike, Giro, Oakley, and Milton-Bradley, as well as the Cofidis organization,
and it would be necessary to hold a press conference. But first and foremost I had to tell the people who were closest to me, friends like Och, and Chris, and my teammates, and most of
them were scattered overseas and difficult to reach.
Everyone reacted differently to the news; some people stuttered, and some tried to reassure me, but what all of my friends had in common was their urge to come to Austin as quickly as
possible. Och was at home in Wisconsin having dinner when I reached him, and his reaction was, in retrospect, pure him.
“Are you sitting down?” I asked.
“What’s going on?”
“I’ve got cancer.”
“Okay. What does that mean?”
“It means I’ve got testicular cancer and I’m having surgery tomorrow.”
“All right, let me think about this,” Och said, calmly. “I’ll see you tomorrow.”
Finally, it was time to go to bed. The funny thing was, I slept deeply that night. I went into a state of absolutely perfect rest, as if I was getting ready for a big competition. If I had a tough
race in front of me I always made sure to get the optimum amount of sleep, and this was no different, I suppose. On some unconscious level, I wanted to be in absolutely peak form for
what I would be faced with in the coming days.
The next morning, I reported to the hospital at 5. I drove myself there, with my mother in the passenger seat, and I walked through the entrance in a baggy sweatsuit to begin life as a cancer
patient. First came a series of basic tests, things like MRIs and blood work. I had a faint hope that the doctors would do all their tests and tell me they had been wrong, that my illness wasn’t
that serious. But those words didn’t come.
I had never stayed overnight in a hospital, and I didn’t know about things like registration, so I hadn’t even brought my wallet. I guess I was always too busy throwing away my crutches and
taking out my own stitches. I looked at my mother–and she immediately volunteered to take care of the paperwork. While I was having blood tests done, she filled out the stack of forms the
hospital required.
I was in surgery and recovery for about three hours. It seemed like an eternity to my mother, who sat in my hospital room with Bill Sta-pleton and waited for me to come back. Dr. Reeves
came by and told her that it had gone well, they had removed the tumor with no problem. Then Och arrived. True to his word, he had gotten on an early-morning plane for Austin. While I was
still in surgery, my mom filled Och in on what was happening. She said she was determined that I was going to be okay, as if the sheer force of her will could make things all right.
Finally, they wheeled me back to my room. I was still foggy from the anesthesia, but I was alert enough to talk to Och as he leaned over my bed. “I’m going to beat this thing, whatever it is,” I
said.
The hospital kept me overnight, and my mother stayed with me, sleeping on a small sofa. Neither of us rested well. The aftermath of the surgery was very painful–the incision was long
and deep and in a tender place, and every time my mother heard my sheets rustle, she would jump up and come to my bedside to make sure I was all right. I was hooked up to an IV, and
when I had to go to the bathroom she helped me out of bed and wheeled the pole for me while I limped across the room, and then she helped me back to bed. The hospital bed had a plastic
cover over the mattress, and it made me sweat; I woke up every couple of hours to find the sheets under my back were soaking wet, but she would dry me off.
The next morning, Dr. Youman came in to give me the initial results of the pathology reports and blood work. I was still clinging to my notion that somehow the cancer might not be as bad
as we’d thought, until Dr. Youman began to tick off the numbers. He said it appeared from the biopsy and the blood tests that the cancer was spreading rapidly. It was typical of testicular
cancer to move up the blood line into the lymph glands, and they had discovered some in my abdomen.
In the 24 hours since I’d first been diagnosed, I’d done as much homework as I could. I knew oncologists broke testicular cancer down into three stages: in stage one, the cancer was confined
to the testicles and patients had excellent prognoses; in stage two, the cancer had moved into the abdominal lymph nodes; and in stage three, it had spread to vital organs, such as the lungs.
The tests showed that I was stage three, with three different cancers in my body, the most malignant of which was choriocarcinoma, a very aggressive, blood-borne type that was difficult
to arrest.
My chemo treatments would begin in a week, via a Grosjean catheter implanted in my chest, and they would last for three months. I would require so many blood tests and intravenous drugs
that it was impractical to use standard individual IV needles, so the Grosjean catheter was unavoidable. It was frightening to look at, bulging under my skin, and the opening in my chest
seemed unnatural, almost like a gill-
There was another piece of business to discuss: I would be at least temporarily sterile. My first round of chemotherapy was scheduled for the following week, and Youman advised me to bank
as much sperm as possible before then. It was the first time the subject of sterility had come up, and I was taken aback. Youman explained that some chemotherapy patients recovered their
virility, and some did not; studies showed about a 50-percent return to normalcy after a year. There was a sperm bank two hours away in San Antonio, and Youman recommended I go
there.
That night, before we came home from the hospital, my mother went by the oncology unit and picked up all the supplies for my catheter, and my prescriptions for anti-nausea medications, and
more literature on testicular cancer. If you’ve never been to an oncology unit, let me tell you–it can be unsettling. She saw people wrapped in blankets, with no hair, hooked up every which
way to IVs, looking pale and deathly sick. My mother gazed around the unit as she waited for the supplies. When they came, she piled it all into a large canvas bag that became our traveling
cancer kit, and made her way back to my room. She said, “Son, I just want to let you know that when you go for your treatment, it’s not a pleasant sight. But I want you to keep one thing in
mind. They’re all there for the same reason you are: to get well.”
And then she took me home.
ON SATURDAY MORNING I ROSE EARLY AND WENT INTO the bathroom and looked in the mirror–and I stifled a scream. My catheter had a huge blood clot in it and my chest was
swollen and caked with blood. I went back into the bedroom and showed Lisa, who stared at it, mute with horror. I yelled for my mother. “Mom, could you come in here!” I said. My mother
came racing into my room and examined the catheter. She didn’t panic; she just got a washcloth and calmly cleaned it out, and called the hospital. A nurse explained to her that it wasn’t
uncommon for catheters to clot, and went through a procedure with her for how to prevent it from being infected. But it still looked awful.
My mother hung up and ran to the store, and when she came back she had a box of Band-Aids that glowed in the dark. She put one on the catheter, and that got Lisa and me to laugh. Next,
she reached Dr. Youman on the phone. She said, “This catheter is not looking good. I’ve tried to clean it as much as I can, but maybe we should have it taken out.”
Dr. Youman said, “Well, don’t do anything yet, because I’ve decided Lance needs to move up his first chemotherapy treatment. He starts Monday at one o’clock.”
“Why?” my mother asked.
I took the phone. Dr. Youman explained that more results had come in from the pathology reports and blood work, and they were worrisome. In a mere 24 hours, the cancer had
progressed. Oncologists use something called blood markers to track the progress of the disease: the levels of various proteins in your blood such as human chorionic gonadotropin (HCG) and
alpha-fetoprotein (AFP) indicate how much cancer is in the body. My blood counts had risen, in a day.
The cancer was not just spreading, it was galloping, and Youman no longer thought I could afford to wait a week for chemo. I should begin treatment directly, because if the cancer was
moving that quickly, every day might count.
I hung up the phone, dispirited. But there was no time to brood; I would have one chance and one chance only to go to the sperm bank in San Antonio: that very afternoon. “This is pathetic,”
I said to my mother, disgustedly.
The ride to San Antonio was grim. The only thing that relieved the tension was that Kevin Livingston had come home, and he made the trip with me for moral support. I was glad to see
him; he has an open face and vivid blue eyes under his cropped black hair, and he always looks like he’s on the verge of laughing. It was hard to be in a bad mood around him. We got more
help, too: a young man named Cord Shiflet, the son of my architect and friend David Shiflet,
offered to drive us.
I sat in the back seat silently as the miles went by, with one nervous thought after another running through my mind. I would have only one chance to bank. I might not be able to have
children. I was going to have my first chemo treatment. Would it make me sick?
Finally we arrived at the medical office in San Antonio. Cord and Kevin sat with my mother in the waiting area while a staff nurse escorted me into a private room, and Kevin managed to
crack a bad joke, trying to break the terrible mood. “Hey, Lance, you need a magazine?” he said. I grinned, weakly.
I was shown into a room with a lounge chair, a sort of recliner. The lighting was dim, an attempt at ambiance, I guessed. On a small table there was a stack of, yes, magazines. Porn, I
saw, disgusted. I hobbled over to the chair, and sighed heavily, and nearly cried. I was in severe pain; the cut from the surgery was right at the top of my groin and met my abdomen. I was
depressed and falling apart emotionally from the shock of the diagnosis, and now I was supposed to summon an erection? There was no way. As I lay in the chair, I thought, This isn’t
the way it was supposed to happen. Conceiving a child was supposed to be wreathed in hope, not this sad, solitary, desperate procedure.
I wanted to be a father–quite badly–but I had always assumed it would happen when I was in love. In my early 20s, I’d gone through romantic relationships one after the other. I’d date a
woman for a while, and then burn out after just a few months, and stray, and break it off. I dated a girl I’d gone to high school with, I dated a model from Holland, but I was never in a
relationship for more than a year. My teammates teasingly named me FedEx for the speed with which I changed girlfriends. The FedEx slogan was “When you absolutely, positively have to
have it–overnight.” I wasn’t married, I had no ties, and it wasn’t the deepest period of my life. With Lisa Shiels, though, things were different. By the time I was diagnosed we were very
close. She was a bright and serious-minded young woman who was absorbed in her classes at Texas, and the idea of marriage and kids with her had certainly occurred to me. I wasn’t sure we
were right for each other long-term, but I knew I wanted to be a husband, and I knew, too, that I wanted to be a better father than the ones I had encountered.
I had no choice; I closed my eyes and I did what I had to do.
Out in the waiting room, my mother and my two friends sat, silently. I learned later that while they were sitting there, my mother suddenly turned to Cord and Kevin and said to them, almost
angrily, “Now, you boys listen to me. When he comes out, I don’t want to hear one word from you. Not one word!” She knew. Somehow, she knew that this was one of the most distressing
and utterly cheerless experiences of my life.
When it was over, I came out and handed the vial to a doctor. Cord and Kevin were quiet. I filled out some papers, hastily, and told the nurses I would send the rest of the information in
later. I just wanted to get out of there. But as we were leaving, the doctor came back out.
“It’s a very low count,” he said.
The doctor explained that my sperm count was only about a third of what it should have been; it seemed the cancer had already affected my reproductive capacity. Now the chemo would take
its toll, too.
The drive on the way back was even grimmer than on the way down. I don’t even remember if we ate. I talked to Kevin and Cord about the magazines. “Can you believe they give you that
stuff to look at?” I said. Kevin and Cord were great; they acted like it was no big deal, nothing to be embarrassed about, just a very sensible errand, something that had to be done. I was
appreciative, and I took my cue from them; it was the last time I was self-conscious about the nature of my illness.
I SPENT THE REST OF THE WEEKEND ON THE COUCH RE-
covering from the surgery. The anesthesia made me woozy, and the incision was excruciating. I rested and watched football while my mother cooked for me, and we both read up on cancer,
exhaustively. “No stone unturned,” my mother said. In between our reading sessions, we talked about what to do. “How are we going to get rid of this stuff?” I asked her. We acted as if we
could somehow formulate a plan to beat it, like we had trained in the old days.
That first week my mother picked up all of my prescriptions, collated my medical records, scoured bookstores for cancer material, and organized my schedule. She bought me a journal to
keep notes in and a visitors’ book to keep track of who came to see me. She would schedule my friends in staggered fashion, so that I would never feel too alone. We called it the “community
calendar,” and I had revolving vision its, never too many at one time, but never so few as to leave me time to get low, either.
She drew up a three-month calendar to keep track of my chemotherapy treatments, and made lists of my medications and at what time I should take each one. She ran my illness as if it was a
project and she was the project manager. She had colored pencils, charts, and timelines. To her, organization and knowledge would facilitate a cure.
She made an appointment with a nutritionist. I limped off the couch and we drove over, and the nutritionist gave us a guideline for fighting cancer and a list of foods compatible with the
chemotherapy drugs: a lot of free-range chicken, broccoli, no cheeses or other fats, and a lot of vitamin C to help combat the toxins of chemo. Immediately, my mother began steaming huge
bowls of broccoli for me.
But beneath all of the manic activity, I could tell that my mother was struggling. When she talked to other members of our family on the phone, I could hear a tremor in her voice, and
finally she quit calling them when I was around. She tried not to show me all that she felt, but I knew that at night she would go into her room and cry.
On Monday morning, it was time to go public. I held a news conference to announce that I was ill and would not be cycling. Everyone was there, Bill, Lisa, my mother, and several sponsors,
and there was a conference call for reporters from Europe as well. Also on the phone were representatives from Cofidis, the French team I was supposed to join in the upcoming season.
The room was filled with cameras, and I had to deliver a prepared speech. There was an audible murmur when I said the word “cancer,” and I could see the shock and the disbelief on the faces
of the reporters and cameramen. A gentleman from Cofidis chimed in on the phone: they pledged their total support in helping me get through the illness and back on the bike.
“I’m determined to fight this disease,” I concluded. “And I will win.”
THAT AFTERNOON, I WALKED INTO YET ANOTHER NON-descript brown brick medical building for my first chemotherapy treatment. I was taken aback by how informal it
was: a simple waiting room with some recliners and La-Z-Boys and assorted chairs, a coffee table, and a TV. It looked like somebody’s living room full of guests. It might have been a party,
except for the giveaway–everybody was attached to his or her very own IV drip.
Dr. Youman explained that the standard treatment protocol for tes-ticular cancer was called BEP, a cocktail of three different drugs, bleomycin, etoposide, and cisplatin, and they were so
toxic that the nurses wore radioactive protection when handling them. The most important ingredient of the three was cisplatin, which is actually platinum, and its use against testicular
cancer had been pioneered by a man named Dr. Lawrence Einhorn, who practiced at the Indiana University medical center in Indianapolis. Prior to Einhorn s discovery, testicular cancer was
almost always fatal–25 years earlier it had killed a Chicago Bears football star named Brian Piccolo, among many others. But the first man who Einhorn had treated with platinum, an
Indianapolis schoolteacher, was still alive.
Had I lived 20 years ago, I would have been dead in six months, Youman explained. Most people think Piccolo died of lung cancer, but it started as testicular cancer, and they couldn’t
save him. He died in 1970 at the age of 26. Since then, cisplatin has become the magic bullet for testicular cancer, and Einhorn’s first patient, the Indianapolis teacher, has been cancer-free for
over two decades–on his anniversaries they have a big party at his house, and Dr. Einhorn and all his former nurses come to visit him.
I thought, Bring it on,give me platinum. But Youman warned that the treatment could make me feel very sick. The three different anticancer toxins would be leaked into my system for five
hours at a time, over five straight days. They would have a cumulative effect. Anti-emetics would be given to me along with the toxins, to prevent me from suffering severe nausea, but
they couldn’t curb it entirely.
Chemo is so potent that you can’t take it every day. Instead it’s administered in three-week cycles; I would take the treatment for one week, and then have two weeks off to allow my body
to recover and produce new red blood cells.
Dr. Youman explained everything carefully, preparing us for what we were about to face. When he finished, I had just one question. It was a question I would ask repeatedly over the next
several weeks. “What’s the cure rate for this?” I asked. “What are my chances?”
Dr. Youman said, “Sixty to sixty-five percent.”
My first chemo treatment was strangely undramatic. For one thing, I didn’t feel sick. I walked in and chose a chair in the corner, the last one along a wall in a row of six or seven people. My
mother kissed me and went off to do some errands, and left me with my fellow patients. I took my place among them.
She had prepared me to be disturbed by my first encounter with other cancer patients, but I wasn’t. Instead, I felt a sense of belonging. I was relieved to be able to talk to other people who
shared the illness, and compare experiences. By the time my mother got back, I was chatting cheerfully with the guy next to me. He was about my grandfather’s age, but we hit it off, and we
were jabbering away when my mother walked in. “Hey, Mom,” I said brightly. “This is Paul, and he’s got prostate cancer.”
I HAD TO KEEP MOVING, I TOLD MYSELF. EVERY MORN-
ing during that first week of chemo I rose early, put on a pair of sweats and my headphones, and walked. I would stride up the road for an hour or more, breathing and working up a sweat.
Every evening, I rode my bike.
Bart Knaggs returned from Orlando with a Mickey Mouse hat he had picked up at Disney World. He handed it to me and told me he knew I would need something to wear when I lost
my hair.
We would go riding together, and Kevin Livingston often joined us. Bart made huge maps for us, as large as six feet in diameter. He would get maps of counties from the Department of
Highways and cut and paste them together, and we would stand over them choosing new routes for ourselves, long winding rides out in the middle of nowhere. The deal was to always find a
new road, someplace we hadn’t been before, instead of the same old out-and-back. I couldn’t stand to ride the same road twice. The training can be so monotonous that you need newness,
even if half the time you end up on a bad piece of road, or get lost. It’s okay to get lost sometimes.
Why did I ride when I had cancer? Cycling is so hard, the suffering is so intense, that it’s absolutely cleansing. You can go out there with the weight of the world on your shoulders, and
after a six-hour ride at a high pain threshold, you feel at peace. The pain is so deep and strong that a curtain descends over your brain. At least for a while you have a kind of hall pass, and
don’t have to brood on your problems; you can shut everything else out, because the effort and subsequent fatigue are absolute.
There is an unthinking simplicity in something so hard, which is why there’s probably some truth to the idea that all world-class athletes are actually running away from something. Once,
someone asked me what pleasure I took in riding for so long. “Pleasure?” I said. “I don’t understand the question.” I didn’t do it for pleasure. I did it for pain.
Before the cancer, I had never examined the psychology of jumping on a bicycle and riding for six hours. The reasons weren’t especially tangible to me; a lot of what we do doesn’t make sense
to us while we’re doing it. I didn’t want to dissect it, because that might let the genie out of the bottle.
But now I knew exactly why I was riding: if I could continue to pedal a bike, somehow I wouldn’t be so sick.
The physical pain of cancer didn’t bother me so much, because I was used to it. In fact, if I didn’t suffer, I’d feel cheated. The more I thought about it, the more cancer began to seem like a race
to me. Only the destination had changed. They shared grueling physical aspects, as well as a dependence on time, and progress reports every interval, with checkpoints and a slavish reliance
on numbers and blood tests. The only difference was that I had to focus better and harder than I ever did on the bike. With this illness, I couldn’t afford impatience or a lapse in concentration; I
had to think about living, just making it through, every single moment. The idea was oddly restorative: winning my life back would be the biggest victory.
I was so focused on getting better that during that first round of chemotherapy, I didn’t feel anything. Nothing. I even said to Dr. Youman, “Maybe you need to give me more.” I didn’t
realize that I was extremely lucky in how my body tolerated the chemo. Before it was over I would meet other patients who had uncontrollable vomiting after the first cycle, and by the end
of my own treatments I would experience a nausea that no drug could get a grip on.
The only thing that suffered at first was my appetite. When you undergo chemotherapy, things taste different because of the chemicals in your body. My mother would fix me a plate of food,
and she’d say, “Son, if you’re not hungry and you don’t want to eat this, it won’t hurt my feelings.” But I tried to eat. When I woke up from a nap, she would put a plate of sliced fruit
and a large bottle of water in front of me. I needed to eat so I could keep moving.
Move, I told myself. I would get up, throw on my warmup clothes, put my Walkman on, and walk. I don’t even know how far. I’d walk up the steep hill and out of the front gates, and trudge
on up the road.
As long as I could move, I was healthy.
Within days, the Porsche was gone. I did it for two reasons, first and foremost because I thought I might need every dime for my treatment, and I’d have to live on what was left for the rest of
my life. But I think, too, that I was beginning to need to simplify things.
A COUPLE OF DAYS AFTER I STARTED CHEMO,WE OPENED
a notification letter from the hospital: Our records show that you have no health insurance.
I stared at the letter, uncomprehending. That wasn’t possible. I had a health plan with Motorola, and I should have been fully covered. Irritated, I picked up the phone and called Bill Stapleton
to read him the letter. Bill calmed me down, and told me he would check into it.
A few hours later, Bill called back. It was a lousy piece of timing, he said. I was in the midst of changing employers, and although my contract with Cofidis had taken effect, the cancer was a
preexisting medical condition, for which I was not covered by the Cofidis group plan. My insurance with Motorola had expired. I would have to pay for hospitalizations and the
treatments myself, unless Bill could figure something out.
I had cancer, and I had no health insurance.
A lot of terrible realizations hit me one after another in those first few days, and this was only a material matter. Still, it was potentially ruinous. I looked around my house, and started thinking
about what to sell. I was wiped out financially, I assumed. I had just gone from making $2 million a year, to nothing. I had some disability insurance, but that was about it. I would have no
income, because the companies that sponsored me or paid me would cut me off, surely, since I couldn’t race. The Porsche that I so treasured now seemed like an item of pure decadent
self-indulgence. I would need every penny to pay the medical bills. I started planning the fire sale. I’d get rid of the Porsche, and some art, and a few other toys.
I BECAME A STUDENT OF CANCER. I WENT TO THE
biggest bookstore in Austin and bought everything there on the subject. I came home with ten different volumes: diet books, books on coping emotionally, meditation guides. I was willing to
consider any option, no matter how goofy. I read about flaxseed oil, which was supposed to be “a true aid” against arthritis, heart infarction, cancer, and other diseases. I read about soy
powder, a “proven anti-cancer fighter.” I read Yoga Journal, and became deeply if only momentarily interested in something called The Raj, “an invitation to perfect health.” I tore out
pages of Discover magazine, and collected newspaper stories on far-off clinics and far-fetched cures. I perused a pamphlet about the Clinic of the Americas in the Dominican Republic,
describing “an absolutely certain cure for cancer.”
I devoured what Bart had given me, and every time he called, I said, “What else you got?” I had never been a devoted reader, but now I became voracious. Bart went to Amazon.com and
cleaned them out on the subject. “Look, do you want me to feed you what I find?” he asked.
“Yeah, I want everything. Everything, everything.” Here I was, a high-school graduate who’d received an eclectic education in Europe, and now I was reading medical journals. I had always
liked to study financial magazines and architectural-design magazines, but I didn’t care much for books; I had an impossibly short attention span and I couldn’t sit still for that long. Now all of a
sudden I had to tackle blood counts and basic oncology. It was a second education, and there were days that I thought, Well, I might as well go back to school and try to
become a doctor, because I’m becoming so well-versed in this.
I sat on the sofa flipping through books, talking on the phone, reading off numbers. I wanted to know exactly what my odds were, so I could figure out how to beat them. The more research I
did, the better I felt my chances were–even though what I was reading suggested that they weren’t very good. But knowledge was more reassuring than ignorance: at least I knew what I
was dealing with, or thought I did anyway.
There was an odd commonality in the language of cancer and the language of cycling. They were both about blood. In cycling, one way of cheating is to take a drug that boosts your red
bloodcell count. In fighting cancer, if my hemoglobin fell below a certain level, the doctors would give me the very same drug, Epogen. There was a baseline of numbers I had to meet in
my blood tests, and the doctors measured my blood for the very same thing they measured in cycling: my threshold for physiological stress.
I mastered a whole new language, terms like ifosfamide (a chemotherapy drug), seminoma (a kind of tumor), and lactate dehy-drogenase (LDH, another blood marker). I began to throw
around phrases like “treatment protocol.” I wanted to know it all. I wanted second, third, and fourth opinions.
I began to receive mountains of mail, get-well cards, best wishes, and off-the-wall suggestions for cures, and I read them all. Reading the mail was a way to keep from brooding, so in the
evenings Lisa and my mother and I would sort through the letters, and answer as many as possible.
One evening, I opened a letter with an embossed letterhead from Vanderbilt University’s medical center. The writer was a man named Dr. Steven Wolff, the head of the bone-marrow
transplant department. In the letter, Dr. Wolff explained that he was a professor of medicine and an oncologist, as well as an ardent cycling fan, and he wanted to help in any way he could. He
urged me to explore all the various treatment options, and offered to be available for any advice or support. Two things about the letter drew my attention; the first was Wolff’s obvious cycling
knowledge, and the other was a paragraph that urged me in strong terms to get a second opinion from Dr. Larry Einhorn himself at Indiana University because he was the foremost expert on the
disease. Wolff added, “You should note that there are equally effective chemotherapy treatments that could minimize possible side effects to not compromise your racing capabilities.”
I picked up the phone and dialed Wolff. “Hi, this is Lance Armstrong,” I said. Wolff was taken aback, but he recovered quickly, and after we exchanged a few pleasantries, he began a hesitant
inquiry about my treatment. Wolff explained that he was reluctant to encroach on the authority of my doctors in Austin, but he wanted to help. I told him that I was on the standard treatment
protocol for testicular cancer with lung metastasis, BEP.
“My prognosis isn’t good,” I said.
From that moment on, my treatment became a medical collaboration. Previously, I thought of medicine as something practiced by individual doctors on individual patients. The doctor was
all-knowing and all-powerful, the patient was helpless. But it was beginning to dawn on me that there was nothing wrong with seeking a cure from a combination of people and sources, and
that the patient was as important as the doctor. Dr. Reeves was my urologist, Dr. Youman my oncologist, and now Dr. Wolff became my friend and treatment advocate, a third medical eye
and someone to whom I could turn to ask questions. Each doctor involved played a crucial role. No one person could take sole responsibility for the state of my health, and most important, I
began to share the responsibility with them.
“What’s your HCG level?” Wolff asked me.
HCG is the endocrine protein that stimulates women’s ovaries, I had learned, and it was a telling blood marker because it should not be present in healthy males. I shuffled through the papers,
looking at the various figures. “It says a hundred and nine,” I said.
“Well, that’s high,” Wolff said. “But not extraordinary.”
As I stared at the page, I saw another notation after the number.
“Uh, what’s this ‘K’ mean?” I asked.
He was silent for a moment, and so was I.
“It means it’s a hundred and nine thousand,” Wolff said.
If a count of 109 was high, then what was 109,000? Wolff began to ask me about my other marker levels, AFB and LDH. I shot questions back at him. “What does this mean?” I asked
bluntly.
Wolff explained that there was too much HCG in my body, even with the lung tumors. Where was it coming from? He gently suggested that perhaps I should explore other therapies, more
aggressive treatment. Then he let me have it: the HCG level automatically put me in the worst prognosis category.
Something else bothered Wolff. Bleomycin was extremely toxic on the liver and lungs, he explained. In his view, treatment was very personal; what might be right for one patient wasn’t
necessarily right for another, and for my case, bleomycin might be the wrong choice. A cyclist needs his lung capacity the way he needs his legs, and prolonged exposure to bleomycin would
almost certainly end my career. There were other drugs, Wolffe suggested. I had choices.
“There are some guys who are the world’s best at treating this,” Wolff said. He told me he was a friend of Einhorn and the other oncologists at the Indiana University medical center in
Indianapolis. He also recommended two other cancer centers–one in Houston and one in New York. Moreover, he offered to arrange consultations for me. Immensely relieved, I accepted.
Once again, my mother leaped into action. By the next morning, she had gathered all of my medical records and faxed them to Houston and Indianapolis for the consults. I was out riding
my bike at about 10 A.M. when a reply came from the Houston facility. Two doctors were on a conference call, both oncologists. My mother listened to two disembodied voices as they
discussed my case with her.
“We’ve reviewed the information,” one said. “Why haven’t you had an MRI done on the brain?”
“Well, why would we need that?” my mother asked.
“His numbers are so high that we believe he has it in his brain, too,” he said.
“You gotta be kidding me,” my mother said.
“Normally when we see numbers like that, it’s because it’s in the brain. We feel he needs more aggressive treatment.”
Stunned, my mother said, “But he just started chemotherapy.”
“Look,” one of them said. “We don’t think your son is going to make it at this rate.”
“Don’t do this, okay?” she said. “I have fought for this child my entire life.”
“We feel you should come down here immediately, and start treatments with us.”
“Lance will be back in a little while,” my mother said, shakily. “I’ll talk to him, and we’ll call you back.”
A few minutes later, I walked in the door, and my mother said, “Son, I’ve got to talk to you.” I could see that she was a wreck, and I had that familiar sinking sensation in my stomach. As my
mother tremulously summarized what the doctors had said, I didn’t respond, I just sat there silently–it seemed like the more serious matters grew, the quieter I became. After a minute, I
calmly told her that I wanted to talk to the doctors myself, and hear what they had to say.
I called them back, and I listened as they reiterated what they had already told my mother. Wearily, I told them that I wanted to go to Houston and see them as soon as possible. After I
got off the phone, I paged Dr. Youman. I gave him a brief encapsulation of my conversation
with the Houston doctors. “Dr. Youman, they think I have it in my brain. They say I should have a brain MRI.”
“Well, I was going to have you in for one tomorrow,” Youman said. “You’re actually already scheduled for noon.”
Dr. Youman told me that he had scheduled the MRI because he had been thinking along the same lines, that it had probably moved into my brain.
I called Steve Wolff, and told him about the conversation. I said that I intended to go to Houston the next day. Steve agreed that I should go, but he again recommended that I also talk
to the people at Indiana University, because it was the epicenter for dealing with testicular cancer. Everyone took their treatments from the protocols established by Einhorn, so why didn’t
I go straight to the source? Steve told me that Einhorn was traveling in Australia, but he offered to refer me to Einhorn’s chief associate, Dr. Craig Nichols. I agreed, and he called Nichols to ask
for a consultation on my behalf.
The next morning, I reported to the hospital for the MRI. For moral support, Lisa, my mother, and Bill Stapleton all came with me, and my grandmother flew in from Dallas as well. As soon
as I saw Dr. Youman, I said fatalistically, “I fully expect that I have it in my brain. I already know that’s what you’re going to tell me.”
A brain MRI is a claustrophobic procedure in which you are passed through a tunnel so tight that it practically touches your nose and forehead and makes you feel that you might suffocate. I
hated it.
The results of the scan came back almost immediately. My mother and grandmother and Bill waited in the lobby, but I wanted Lisa with me in Dr. Youman s office. I gripped her hand. Dr.
Youman took one look at the image and said, reluctantly, “You have two spots on your brain.”
Lisa covered her eyes. I was braced for it, but she wasn’t. Neither was my mother, who sat in the lobby waiting for me. I walked outside, and I simply said, “We need to go to Houston.” That
was all I had to say; she knew the rest.
Dr. Youman said, “Okay, why don’t you go to talk to the Houston people. That’s a very good idea.” I already knew he was an excellent doctor, but now I appreciated his lack of ego. He
would remain my local oncologist, and I would see him for countless more blood tests and checkups, but thanks to his generous spirit and willingness to collaborate with others in my
treatment, he also became my friend.
Lisa and my mother could not keep from crying; they sat in the lobby with tears running from their eyes. But I was oddly unemotional. It had been a busy week, I thought to myself. I was
diagnosed on a Wednesday, had surgery Thursday, was released Friday night, banked sperm on Saturday, had a press conference announcing to the world that I had testicular cancer on
Monday morning, started chemo on Monday afternoon. Now it was Thursday, and it was in my brain. This opponent was turning out to be much tougher than I’d thought. I couldn’t seem to
get any good news: It’s in your lungs, it’s stage three, you have no insurance, now it’s in your brain.
We drove home, and my mother composed herself and sat at the fax machine feeding more papers into it for the doctors in Houston. Lisa sat in the living room, seeming lost. I called Bart,
and told him about my plans. Bart asked if I wanted company on the trip, and I said yes. We would leave at 6 A.M. the next day.
But believe it or not, there was a certain relief in hearing the worst news yet–because I felt like that was the end of it all. No doctor could tell me anything more; now I knew every terrible
thing in the world.
Each time I was more fully diagnosed, I asked my doctors hard questions. What are my chances? I wanted to know the numbers. My percentage was shrinking daily. Dr. Reeves told
me 50 percent, “but really I was thinking twenty,” he admitted to me later. If he was perfectly honest, he would have told me that he nearly wept when he examined me, because he thought
he was looking at a terminally ill 25-year-old, and he couldn’t help but think of his own son, who was my age. If Bart Knaggs had been totally candid, he would have told me that when his
prospective father-in-law, who was a doctor, had heard that the cancer had moved into my lungs, he said to Bart, “Well, your friend is dead.”
What are my chances? It was a question I would repeat over and over. But it was irrelevant, wasn’t it? It didn’t matter, because the medical odds don’t take into account the unfathomable.
There is no proper way to estimate somebody’s chances, and we shouldn’t try, because we can never be entirely right, and it deprives people of hope. Hope that is the only antidote to fear.
Those questions, Why me? What are my chances? were unknowable, and I would even come to feel that they were too self-absorbed. For most of my life I had operated under a simple
schematic of winning and losing, but cancer was teaching me a tolerance for ambiguities. I was coming to understand that the disease doesn’t discriminate or listen to the odds–it will decimate
a strong person with a wonderful attitude, while it somehow miraculously spares the weaker person who is resigned to failure. I had always assumed that if I won bike races, it made me a
stronger and more worthy person. Not so.
Why me? Why anybody? I was no more or less valuable than the man sitting next to me in the chemo center. It was not a question of worthiness.
What is stronger, fear or hope? It’s an interesting question, and perhaps even an important one. Initially, I was very fearful and without
much hope, but as I sat there and absorbed the full extent of my illness, I refused to let the fear completely blot out my optimism. Something told me that fear should never fully rule the heart,
and I decided not to be afraid.
I wanted to live, but whether I would or not was a mystery, and in the midst of confronting that fact, even at that moment, I was beginning to sense that to stare into the heart of such a fearful
mystery wasn’t a bad thing. To be afraid is a priceless education. Once you have been that scared, you know more about your frailty than most people, and I think that changes a man. I
was brought low, and there was nothing to take refuge in but the philosophical: this disease would force me to ask more of myself as person than I ever had before, and to seek out a
different ethic.
A couple of days earlier, I had received an e-mail from a military guy stationed in Asia. He was a fellow cancer patient, and he wanted to tell me something. “You don’t know it yet,” he wrote,
“but we’re the lucky ones.”
I’d said aloud, “This guy’s a nut.”
What on earth could he mean?
