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Martin J. Murphy, Jr., Executive Editor, The Oncologist
Joel Siegel, a celebrated American television personality, died on June 29, 2007 ... with his wife, Ena, and his son, Dylan, at his side. He would have been 64 years young a few days later. He died of metastatic cancer of the colon ... at diagnosis, nine years ago, he already had advanced disease.
Since his diagnosis, he had been a passionate and wonderfully articulate spokesman for cancer prevention and cancer research. Nothing stopped him from expressing his appreciation for those devoted to this causeÃ¢â‚¬â€an example of which was when he pledged to speak to a gathering of the trustees of the American Cancer Society Foundation in September 2005. We vividly remember that he came directly from the hospital to be our keynote speakerÃ¢â‚¬â€he still wore his hospital admittance bracelet when he delivered one of the most moving tributes to courage and hope.
After almost a decade of chemotherapies, multiple surgeries, and radiation treatments, Joel began and ended every talk on a note of gratitude. Yes, his first comments were of thanks to those who are devoted to doing something about this intolerable disease. He then gave his powerful story ... tinged with profound pathos blended with his magical good humor. But he always came back to his thankfulness to oncologists and oncology nurses. He was deeply grateful that they helped him live to see the birth of his only child, Dylan; to have experienced the joy of watching Dylan grow old enough to "steal the sports section of the paper" from him one recent Sunday morning. And to have Dylan look up at him and ask admiringly, "Dad, did you really name the ice cream flavor Ã¢â‚¬Ëœpralines and creamÃ¢â‚¬â„¢?"[The answer is "yes" ... in the 1970s when he worked at the ad agency that had the Baskin-Robbins account.
Joel was generous with his precious momentsÃ¢â‚¬â€even at the end of his life. When we asked him to close the CEO Roundtable on Cancer on May 10, 2007, as weak as he was, he insisted that he would make it ... and he did. Yes, he opened and closed this, his final speech, with thanks to all who foster cancer awareness and education, cancer research and care, and cancer advocacy. Less than two months later, we lost him.
We must not, however, lose Joel's special spirit, and to hold it hallow, we reprint here the text of a letter that he wrote two years ago which we published in The Oncologist . His words serve as our tribute to him ... for there is nothing we could write that will be more memorable.
A photo of Joel, Ena, and Dylan on May 14, 2007, speaks volumes ... it speaks to each of our hearts, hearts that ache for Ena and Dylan ... and for all who loved and who now miss him.
EDITOR'S NOTE: The following is reprinted from The Oncologist2005; 10:558Ã¢â‚¬â€œ560.
As oncologists, you often talk about very large numbers: thousandsof deaths, millions of cases, billions of dollars. I would liketo remind you that you save lives one at a time.
And one of those is mine. And I thank you.
But I'd better start at the beginning so you know why I'm gratefulto you.
"I don't have good news." These aren't words you easily forget.Especially when they're said by a doctor who's just finishedgiving you a colonoscopy.
It was the summer of 1997, I was 54 years old, and 1 week beforewe'd had very good news. My wife, Ena, was pregnant. The babywas due in February. The American Cancer Society's Web sitesaid that, all things considered, I had a 70% chance of beingalive to witness the birth.
I had surgery 1 week after the diagnosis. The surgery was farmore difficult than expected, the cancer far more serious. Iwas given a colostomy. There were nodes; the cancer had probablyspread. Treatment would include simultaneous radiation and chemotherapy.The odds of my witnessing the birth of my first and only childdropped to 60%.
One day, when Ena was visiting me in the hospital, I noticedshe was starting to show. I started to cry.
I remember looking out the hospital window at a tree, a treethat had somehow managed to grow large and lush even thoughits seed had somehow taken root on a 2-foot-wide spit of landbetween FDR Drive, one of the busiest highways in the U.S.,and the East River, one of the most polluted bodies of waterin the world.
I began charting the coincidences that had brought me, in thewords of a Jewish prayer, "to this season." My grand- motherhad crossed this same river 6 days a week to work in a sweatshop;I'd been invited to the White House, met four Presidents, andhad voted for only one of them. If whoever had given this tome wanted to take it back, I decided I could do it. I couldgive it back. Somehow knowing I was able to give up life gaveme the strength to hold on.
My grandmother, my father's mother, was diagnosed with coloncancer at 80. I knew that.
She died at 90 from, I thought, something else.
I got a call from my Auntie Annie while I was recovering fromthe first surgery, to find out how I was doing. She told methree of my mother's first cousins had colon cancer. I didn'tknow that.
Had I known that, would I have insisted on having my first colonoscopyat 50 or before? Perhaps. Had my doctors known that, would theyhave insisted on a colonoscopy at 50 or before? Most definitely.
The good news is I learned I am much healthier and far moreresilient physically and psychologically than I ever dreamedI was.
The bad news is I have had far too many occasions to discoverjust how healthy and resilient I am.
The chemotherapy of choice for colorectal cancer was 5-fluorouracilwith leucovorin. I had a port dug into my chest, and a plastictubing connected the port to a pouch the size of a cereal box.Inside the pouch, a battery-powered pump would dribble the exactamount of the chemical through the tubing and into the portto my jugular vein. I slept with it, wore it, carried it 24/7,like some kind of briefcase from hell.
Two nurses came to our apartment to hook me up to the chemotherapy.They told us that if the chemical should somehow leak or spill,"Do not under any circumstances touch the chemicals."
They gave us a 24-hour emergency number to call. They wouldcome day or night to clean the mess; it's that toxic. And Ithought, "That's on the outside. What is it doing to my inside?"
I found out almost instantly. I got sick and stayed sick.
I also began a series of radiation treatments three morningseach week at Memorial Sloan-Kettering Cancer Center. In preparation,they created a three-dimensional, computer-generated model ofmy tushie; an "X" marked the spot the radiation had to hit.I never saw the modelÃ¢â‚¬â€œI never wanted toÃ¢â‚¬â€œbut a fewtimes a year I'm solicited for personal items for celebrityauctions and I do think about calling Sloan-Kettering to seeif the model is still around.
The major side effect of radiation is exhaustion. The effectsare cumulative. By the end of the course I was so exhaustedI have one memory: lying on a couch, a glass of water on a coffeetable about a foot away from my hand. I was too tired to movemy arm to grab it.
One of the side effects of chemotherapy, I was told, is lossof appetite. What I wasn't told is that food would become demonized.Dry toast, which I tried to down, was like biting into a two-by-four.Rice pudding came to life in the spoon, the grains of rice turninginto maggots.
Cancer is infantilizing. You can no longer take care of yourself,adding insult to injury.
And cancer is insidious. It attacks where you are most vulnerable.
My last day of chemotherapy was the day we took Dylan home fromthe hospital.
My follow-up consisted of regular computed tomography (CT) scansto make sure the cancer did not spread.
Just before Dylan's second birthday, I got a phone call frommy oncologist, the scan I had taken that morning was clean.I was standing on 5th Avenue when I received the call, walkedinto a shop and bought Dylan a cashmere sweater for his birthday.Not the wisest present for a 2-year-old boy. If I'd been onPark Avenue in front of the Mercedes dealer, I would've boughthim a car.
The next day I got the "Oops" call.
A lesion on my left lung. I would lose the lower lobe of myleft lung. My doctors were hoping it was a new cancer, unrelatedto my colon cancer (I was a smoker but had quit smoking 20 yearsbefore). Primary lung cancers found this small have a 90% curerate. It wasn't lung cancer. My colon cancer had metastasized.
A few months later, they discovered something on my right lung.Scar tissue, they were hoping. Perhaps it came from an undiagnosedcase of pneumonia. Let's watch it, wait to see if it grows.
One of the rules of my profession as a journalist is: neverask a question unless you really want to know the answer. Whichis why I never asked my doctors: "If it's scar tissue, why wasn'tit there before?" Of course it wasn't scar tissue. More surgery.I lost the middle lobe of my right lung.
The meds prescribed to deal with the pain after lung surgery,the depression of the cancer diagnosis, and the lower gastrointestinalproblems of learning to live with a foot and a half less intestinethan God intended created an unholy cocktail with sometimessevere physical and psychological reactions. Working with apsychiatrist whose specialty is psychopharmacology, it tookus a year to balance the meds, often by trial and error. Whenone commonly prescribed antidepressant seemed to be causinganxiety and irritability rather than eliminating them, the psychiatristconfessed, "This is an art more than a science; the symptomsfor too much of this drug are exactly the same as the symptomsfor too little."
And then, after 6 years, three surgeries, chemotherapy, radiation,a temporary colostomy... it came back. Last September, a routineCT scan showed multiple lesions in what is left of both my lungs."Small volume, bilateral stage 4 metastatic colorectal cancerto the lung," is the diagnosis. The prognosis is very good,the lesions are too small to be treated effectively; it maybe a year, may be two, before treatment is called for. In themeantime, it is like waking up in the middle of the night andthe room is dark and all you can hear is a ticking clock.
The terrible truth is that if I had done one simple thing, allof thisÃ¢â‚¬â€the pain, the surgery, the time, the anxiety,the fearÃ¢â‚¬â€could have been avoided.
I broke one of the rules of my profession and asked a questionI did not want to know the answer to. I asked my oncologist,"If I'd had a colonoscopy at 50, would I have cancer?"
He said, "Probably not. Most likely not." There would have beena polyp or two, most likely precancerous. They would have beensnipped. I would have been told, "Come back in a year." Therewas, he estimated, a 75%Ã¢â‚¬â€œ80% chance my cancer would havebeen literally nipped in the bud, and I would have been cancerfree.
Dylan, who just turned seven, is a very healthy boy. He knowshis daddy has had cancer. He knows his daddy spends more timein the bathroom than other daddies. In preschool, when he wasfour and kids were asking questions about death and dying, oneof his teachers overheard Dylan say, "My daddy might die."
I would give anything to have spared him that.
In fine medical journals like The Oncologist, you are used toreading about very large numbers: thousands of deaths, millionsof cases, billions of dollars. I would like to remind you thatyou affect lives one at a time. And one of those lives is that of my son, Dylan.
And I thank you from the bottom of my heart.