The first question people ask me after learning that my husband died of lung cancer is whether he was a smoker.
I understand, of course, why they want to know. If he had been a smoker, then his cancer would have been self-inflicted and not something random that can potentially strike any of our loved ones.
I fear that I disappoint them with the truth: he was never a smoker.
As November is Lung Cancer Awareness Month, it’s important to cite the frightening statistics of this disease: lung cancer, caused by both smoking and non-smoking, is the second most common form of cancer for both sexes. It’s also the most lethal cancer. More people die from lung cancer than from colon, breast, and prostate cancer combined.
Aside from not smoking and not being exposed to second-hand smoke, radon, asbestos or diesel exhaust, there’s nothing known that prevents the risks of getting lung cancer. About 10-20 percent of lung cancer victims are non-smokers and that number has been rising.
This is the story of one of them.
It began six and a half years ago, when my husband returned home to Tel Aviv from a business trip to China feeling run down. That didn’t seem alarming. He was a lifelong insomniac, who often existed on four hours sleep, and a workaholic. His recurrent cough sounded especially bad, but since he had suffered for many years from acid reflux, that also didn’t seem like something worrisome.
Several weeks later, he was eating a take-out Reuben sandwich for dinner when he dissolved into a terrible coughing fit which knocked him to the floor unconscious. He came to immediately, insisted he was fine and adamantly refused to go to the emergency room. (Men can be so stubborn that way, sometimes). He continued to finish eating the sandwich and dinner conversation resumed.
About a week later, the same thing happened again during dinner. Again, he refused to go to the hospital, but I called my family doctor, who told me this was non-negotiable. Within two days, we had an ambitious family/work trip planned to South Africa, where my husband had been invited to speak at the Limmud conference, followed by talks in several different cities and going on a safari. We never made that trip.
The diagnosis was pneumonia — he had a lot of water and blood in his lungs – and he was admitted to Ichilov. He was in the hospital for two days, when I, having come home to shower and change my clothes, received a hysterical call from him. He reported that a doctor on rotation told him he had cancer.
I called the family doctor, one of those dedicated Kupat Holim practitioners who work for grushim and seem to have unlimited time for all their patients. He had even arranged for my husband to be put on the hospital ward where he worked shifts, even though at that stage, he wasn’t even his doctor.
When I told him what the other doctor had said, he told me to come to the hospital immediately. He would meet us there.
The doctor walked into the room, pulled up a chair for me and shut the door. He sat down himself. It was one of those cloudless, lazy August days and outside the hospital window, one could see the sprawling skyline of Tel Aviv, this city where my husband had wanted so desperately to live.
“You have Stage IV lung cancer,” he said.
“Am I going to die?” My husband asked.
“At some point.”
“How long do I have? Six months? A year?”
“We may live in the Middle East, but I don’t bargain with such numbers. All I can tell you is this, you will die of this disease. But no one can tell you when.”
Shortly after, my husband wrote in his blog: “The best thing to do is to accept everything calmly — bargaining, hysteria, rage, won’t do any good — and then decide that one is going to fight with the object of beating the disease. Unlike much of political life, this is not caused by malevolent forces.”
After he finished his hospital treatment two weeks later, we went privately to a top oncologist in the field. He was cold and impersonal, but we didn’t care. We were looking for a ruthless dragon-slayer.
The oncologist’s advice was to immediately start taking a so-called biological medicine called Tarceva known for its effectiveness with non-small cell lung cancer, the kind my husband had. Tarceva had many advantages over traditional chemotherapy: it could be taken at home and had much fewer side effects.
But it didn’t work on everyone and it was very expensive. Our Kupat Holim would only pay for it once proven effective.
“If you can afford to, start it immediately, you have nothing to lose,” the oncologist suggested.
Two days later, sitting in our living room with one of our many cats by his side, my husband took the first, small blue pill that would give us a year of life.
By the time of the first monthly CT-scan, even the unemotional oncologist looked impressed. The Tarceva had dramatically shrunk the tumors. Our Kupat Holim was also sufficiently impressed to pay for the medication.
Within two weeks, my husband felt better than he had in years. The only visible sign of his cancer was scattered small red dots on his face, a trademark of Tarceva. Those spots became a badge of honor since there is some evidence that the more spots the more effective the pills.
“It’s the first time I’m happy to look like I have acne,” he said.
Over the next year, he worked on his blog, the research center he directed, and wrote two books. He spent a lot of time with our two children and we took walks each evening down Rothschild. We talked about traveling, something we all loved doing in the family. I was nervous about leaving the country and asked the family doctor for advice.
“Absolutely do it,” he said. “Do everything when he’s feeling well because you won’t be able to do anything when he’s not.”
I tried to ignore the last part of that sentence and what I was learning online: Tarceva would not work forever.
We took two family trips to Italy – our favorite country – where we set out with truffle-sniffing dogs in Piedmont, stayed in a refurbished cave in Matera and hiked around the seaside villages covered with vineyards and smelling of lemons in Cinque Terra.
My husband and son participated as reenactors in the 150th anniversary of the Battle of Gettysburg, a grueling but exhilarating event that included wearing wool Union army jackets and toting muskets and marching on a field in the middle of a humid July day.
Yet he was feeling good. After talking about his illness so positively to an acquaintance whose brother had died of the disease, she stopped me.
“It’s lung cancer, Judy, lung cancer.”
Not long after that conversation, my husband woke up one day and found it hard to use his laptop, a virtual appendage since he was an exceptionally prolific writer who was always writing something. Now his hands acted as if they had forgotten what they were supposed to do. Cancer had metastasized to the brain, common in lung cancer patients, and for which there is no blue pill.
The only treatment option was radiation, a sucker punch to the body and, in his case, ineffective. While he was recuperating from the radiation, we received the next piece of bad news. Our beloved Tarceva had run its course, which meant doing traditional chemotherapy for the lung cancer.
My husband never gave up trying to beat his disease, even when it left him unable to write, bound to a wheelchair, and barely able to stand. But 18 months after his diagnosis, he fell into a coma from which he never recovered.
After you lose someone so close to cancer, you wonder what could have been done differently. I blamed one of his old Kupat Holim doctors who never scheduled a CT-Scan when his cough seemed bad in the past and that might have detected cancer at an early stage. I blamed my husband for not exercising or eating enough vegetables. I blamed myself for not pushing him or the doctor.
But in truth, he was just unlucky, even as he was lucky in so many other areas of his life.
If there’s anything we should be aware of during Lung Cancer Awareness Month it is that we should control whatever we can — especially smoking which continues to be a problem in Israel. But in those matters when we have no control we must just accept. That’s something I’m still trying to learn.