Good evening, Heavy Hitters of the Pan-Massachusetts Challenge. I am deeply honored to speak to you this evening.
There is a Zen saying that happiness is planting a tree knowing that you will not be there to enjoy its shade. Tonight, I am thinking about the meaning of that saying in the context of cancer and cancer research that is supported by men and women such as yourselves.
Mr. Starr has asked me to speak to you about my own experience, my own struggle with cancer, a struggle which occupied the three years of my life immediately after college, as well as the three transcontinental bicycle rides which helped me to recover physically and mentally from my cancer ordeal. I do have a doctorate in philosophy from Stanford, which he mentioned, and he asked me to share with you all the philosophical and inspirational lessons I learned from these ordeals. I told him if I share all of the lessons, this is going to be a very short speech.
I should tell you that I've never spoken publicly about cancer, and only rarely privately, to a handful of friends. And to borrow a line from Oscar Wilde, I warn you that you would have to have a heart of stone to listen to the story of my struggle with cancer without laughing. I'll be laughing and you're welcome to join in at any occasion. Also, I should tell you that I've always declined requests to speak about cancer because I feel as though I’m boasting, “Hey look at me, I cheated death.” And in general that’s just a bad idea, because I think in the end, he will take the last round.
So with such caveats in place, per Billy's request, I will tell you my story of cancer, pausing to note such meager philosophical and inspirational lessons as I may.
Shortly after I graduated from college in 1985 I woke from what was supposed to be exploratory surgery on my kidneys to learn that cancer had metastasized basically everywhere through my body and that my right testicle had been cut off. (I'll pause here for guys in the audience to squirm.) The next several days of testing brought repeated and increasing bad news about the thoroughness of metastasis. My vena cava – the vena cava is the main blood supply from the lower half of the body – was apparently occluded by a tumor pressing on it, so the doctors rushed me to emergency open-chest surgery in the hope of cutting it away. Instead, they found that my vena cava and the center of my lungs were completely tumorized, as one doctor put it. He said, candidly, “There's nothing we can cut: it's all tumor.”
Within nine days, I had three open-chest surgeries. All three were on an emergency basis, and before all three my family and I were told it was unlikely I would survive and that no alternative existed. Now here's the punch line…that's when things started to get really bad.
I will spare you further gory details, mentioning only those that remain relevant. I had over 20 pulmonary embolisms, each of which feels something like getting this microphone stand through the side of your chest. My blood thickened and eventually the blood supply on my right leg congealed; it was blocked from the hip down until my foot and leg turned black. The next day, I was told that, if I lived, I would probably never walk, or if I did, it would be with the aid of crutches and braces, so severe was the muscle and nerve damage in my leg.
In these first ten months, I had 10 surgeries and lost 60 pounds. On many occasions my family and I were told I would not survive this or that crisis or procedure, that there was no option. We would hear this in subsequent months and years so often that I began to wonder if it were not the medical profession's equivalent of when you pick your date up to take her to dinner and you tell her she has a nice dress on, something you learn to say automatically, whether or not you're really sure you know it.
This went on deep into the fall that year. Unless you think I practice simple Irish blarney, I will relate one last story from that period. I was at Memorial Sloan-Kettering Cancer Center in New York, attended by Dr. George Bosl, a wonderful doctor with a superbly candid approach to patient relations. He is now the head of medicine at Sloan- Kettering, and I understand from people I met today at Dana-Farber Cancer Institute that he has become quite well known in his field.
I started getting visits from packs of doctors, four or five together, to interview me. I was an old hand at this point and knew enough to recognize these were not the standard entrance exams, nor standard interns. They were senior doctors. I saw a new group every other day for a couple of weeks. Finally I asked Dr. Bosl what it was all about. He said, “Well, Pat, I presented your case in a medical conference. There were 70 doctors there and we decided that with 2,000 years of combined medical experience among us, we'd never heard of anyone have so much go wrong with them and not die. You see, you think you're getting better, but you're still well below the point people usually just die,” he said cheerfully. “These doctors want to know what's going on in your head.”
So here's my first inspirational lesson, such as it is. I remember telling the doctors over and over what was going on in my head. It was Coach Joe. Coach Joe was one of my earliest wrestling coaches, a huge Greek, built like a fire hydrant but with thicker shoulders. He was the toughest, meanest, baddest man any of us kids had ever seen. If he had a last name, none of us had the courage to ask him. Coach Joe used to have us end practice with endless push-ups and sit-ups and pull-outs and sit-ins and sit-in-turnouts and so on and so forth, until somebody fainted. Literally, that was his way of keeping track of when it was time to end practice.
And one night he did this and this lad Steven something-or-other, whose last name I don't recall, fainted from heat exhaustion in our sauna-like wrestling room and was taken away in an ambulance. The next evening as we walked into practice, Steve's mother was in there yelling at Coach Joe, threatening him with lawsuits and loss of a coaching job, and all kinds of repercussions. We could see that Joe was barely holding his temper. Finally she said something like, “We're going to send you to jail.” And Joe snapped back, “Hey lady, why don't you send me some place I ain't been before, like Hawaii?”
Now, I'm guessing that that seems crude, crass and vulgar, but when you're 14, you think that is by God the coolest thing you're ever going to hear anybody say in your entire life. I waited years for a chance to deliver that line. And it never came. Until one morning, at 4:00 a.m., two interns come to my bed with tears in their eyes, a man and a woman whom I had gotten close to in the preceding few weeks. They were not much older than I, and they knew I understood the implication of what they were telling me. They said, “We're sorry, Patrick, you're bleeding in your pericardial sac, tamponod something-something. We have to do another open-chest surgery. We've called your parents to come in. We don’t expect you to survive but we have no choice. We're taking you to the operating theater now.” And I finally got to croak out, as nonchalantly as I could, “Hey, why don't you take me someplace I ain't been before, like Hawaii?”
Now, if you say things like that, people look at you a little strangely, but it works. So the lesson is, I promise you, I am the least tough person in this room. I hate pain, especially now, and I'm a true wimp. But if you ever go through something like this, what you do, if you don't feel tough enough, is you think of the toughest, baddest, meanest cat you know, and you just pretend you're him. It works, it just does – pretend like that guy, act however you think he or she would act and say, and you'll get through it. At least, it gives you something to do.
I'll skip ahead a few months. Cancer had gone into remission. Dr. Bosl released me from the hospital. Something made me ask him, “If cancer comes back, what are my chances?” He said, “If it returns you have a 20 percent chance of beating it.” Some weird instinct made me ask again, “What if it comes back and I beat it, but it comes back again?” “At that point, Patrick, you'll go into something called salvage therapy, where we try to make you comfortable and salvage as many weeks and months of your life as we can.” My parents wheeled me from the hospital, and we climbed into a taxi. The cabby turned around and said, “Have you heard? It's on the radio, the space shuttle just blew up.” So that's where I was when the Challenger blew up.
That was sometime in January or February, and I had been in the hospital more or less straight since the previous end of July. Staring up at the ceiling, throwing up 30 or 40 times a day, pretending to be a wrestling coach I hadn't seen in ten years, those had not been my immediate post-college plans.
I'm the youngest of three sons, a classic Irish-Catholic family, and my family had been wracked by the strain of my illness. My oldest brother John quit his job to spend some time with me. I saw a physical therapist a number of times and did exercises for my leg, which was stiff and swollen and numb on the side. When I tilted my head forward, I would experience a strong shock sensation in my hands and feet, and I lost my balance a lot.
John and I went on a golfing vacation in the south. Well, John went on a golfing vacation in the south and he brought me along, and I would hobble a few hundred yards here and there or else ride in the cart. A friend of mine, a philosophy professor named David Luban, mentioned to me that bicycle riding might be good for me as there was no impact and it worked the heart and lungs. Two days later, John and I flew to San Diego and bought bicycles. We joked that we were going to ride across the country. Actually we figured we would have a few nice days, bicycling slowly across the desert.
The first day we went three miles. I would ride a few hundred yards and lie down in the grass in the shade of some strip mall while John waited. The next day, not much farther, nor the next. So that by the end of three days, we had reached Julian, California. I checked recently on a map and Julian is about 30 miles inland from San Diego. Not a blistering three-day pace.
Then, a funny thing happened. We became increasingly inspired by that most beautiful aspect of the relationship that exists between brothers, unmatched in any other human bond: sibling rivalry. Neither of us was going to be the guy to say, “Let's quit.” So he would wait for me miles ahead under a bridge as I rode weaving along some state highway in the desert, when I reached him he'd say, “Had enough?” I would say, “What, are you kidding me?” Later, pushing our bikes up Texas Canyon, east of Tucson, in the noon heat – this is, you know, June in Arizona – I'd look at him and he'd be hunched over the front of his bike, and I'd say, “Gee, John, you look pretty done in. You want to call this a ball game?” John would say, “Not me. Just enjoying the view. That is, unless you want to quit.” And so on and so forth for 2000 miles. Until one day, we're eating a sandwich in Mississippi, (my brother Mark got out of a job and joined us in Texas). On that day in Mississippi we start to realize we're actually going to bicycle across country. And that's what we did. We did centuries the rest of the way in to the waves in Jacksonville, Florida.
I was well and fit, but still fairly shell-shocked. I went off to Stanford to pursue a master's in mathematical logic and walked the sunny hills of what was then, in 1986, the quaint California Silicon Valley. But in my heart, I knew something was wrong. And in December, I woke with a gurgling in my chest. X-rays revealed a silver-dollar-sized spot in my lungs. So – round two.
People in my corner were worried. They knew the 20% odds. I do not mean to sound cocky or as though I take any of this for granted, but I will tell you the truth. Deep down, I was not worried. Remember your high school English course, and the concept of dramatic irony, where the reader knows more about what's going on than the characters in the novel or the play? I was experiencing dramatic irony. It was as though I had flipped to the end of the book, I had read the last page, I knew the guy lived. I’m not sure how, but I knew it, and I tried to act appropriately worried, but it didn’t come easy. I felt tremendously sorry for those people around me who were worried about me, and of course there was no way to explain to them that I had read the ending already and knew the hero came out okay. More than anything, I was curious, because it sure did look like our hero was in a bit of a fix, and I wanted to hang around to see how he got out of it.
I don't mean to say, of course, that it was pleasant. As in round one, the kind of chemotherapy I had was intense enough that I had to be knocked out every day with Thorazine. When I woke up, I would throw up dozens of time throughout the afternoon and evenings. My white cells sailed way over the horizon and it was generally impossible for me to leave the hospital, even between chemotherapy cycles.
I also had my first face-to-face encounter with medical research, properly performed. Dr. Bosl was running a study comparing the effectiveness of inpatient and outpatient chemotherapy. He was letting some patients get Thorazine in a special outpatient clinic, get their chemotherapy, and then go home for the evening. I expect this is now probably fairly standard, but then it was a clinical trial. I desperately wanted to get into that study. I had spent so many nights staring at the hospital ceiling. I begged him to let me in, told him I was going crazy month after a month in the hospital. Every time I seemed close, some little scratch would turn into an infection or some other problem would arise and I would be on my back for 14 days of antibiotics and get off it just in time to start another five-day chemotherapy cycle.
Finally they told me that for the last cycle, as everything seemed right, Bosl was going to let me participate in the outpatient study. I was so grateful. He asked me if I was sure I wanted this. With tears of joy and thankfulness in my eyes, I said, “Absolutely.” Bosl pulled out a coin and flipped it, saying, “Call it. Heads/tails, nope you lose, you're in the control group, back in bed.”
At least I did know what was going to happen on the last page. I met a fellow patient named Andy Yu, whom I am proud to call a friend. Andy often stopped in to see me. A few years older than I, Andy had been working at an insurance agency in Long Island when he was diagnosed with leukemia. Sometimes I would walk a lap around the halls and stop to chat with Andy, and sometimes Andy would stop in to see me in the mornings. I don't remember seeing Andy having many visitors, so he was always eager for the company, eager to stretch it into a long conversation when all I had in mind was a few words.
I wanted neither to commiserate nor swap experiences. I wanted to be quiet. He was always too goddamn chipper for me. Everything was always great with Andy. “No problem” was his answer to everything. The chemo nurse would call him, “I gotta run, Pat. Chemo waiting.” “No problem,” he'd say, “We're gonna get on top of this stuff, Pat. No problem.”
I am ashamed to say that there were times I was barely polite, I'm sure. I did not acknowledge that there was something to get on top of. Hell, I'd read the end of my book. Maybe I was just too exhausted. More often than not, I let my mother take over, if she were there, or barely spoke if Andy and I were alone. Once my mother berated me, telling me I could make an effort to be friendlier when Andy came, instead of just lying listlessly in bed and barely answering him. I remember Andy backing out of my room a couple of mornings, with a sad look saying, “Well, I can see you're busy, I'll come back tomorrow.”
I finally did get out of the hospital for awhile, just as Andy was coming in for his bone marrow transplant. Oddly, he was looking forward it, like a kid waiting for a present. I was peppy as well, because I was packing and knew that unless I ran a fever, I would have a good two weeks out of the hospital before another chemotherapy cycle began. For once, we were both up and cheerful. We chatted about our plans for when we got out of the hospital for good.
Two weeks later, I checked back in. Phyllis, my favorite nurse, was helping me unpack my bag into the night stand. “How's Andy doing?” I asked. She flinched, then quietly said, “Andy didn't make it.”
I think about Andy sometimes. I wonder who else out there still thinks about him. My mother and I mention him every couple of years to each other.
Here’s another of Coach Joe's pearls of wisdom. In one of our rare moments alone, I remember him telling me about winning the East Coast heavyweight college wrestling championship. I was already familiar with the tendency of older guys to exaggerate their bronze medals into gold. I said, “Coach, are you saying you were the champion, or one of the champions?” Joe stood up, and sort of slapped his hands. He said, “Byrne, there's only one champion. Everyone else is last.”
I don't know about that anymore. I think there may be many champions. But I know this: Andy was a champion. And he was my friend.
Just one last inspirational story – I did beat the 20 percent odds, made the cut. My cancer went into remission, and one month later, I was celebrating with my family. I pulled a muscle in my side, but o be on the safe side I went to the hospital for a work-up. Lying there in the hospital room that night, I heard my family coming down the hall, Bosl intercepting them, then long conversations in hushed tones.
My father came and sat next to me and started talking about bridge, which he had taught me in my early teens. We chatted about what a stimulating game it was for the memory, for the analytic muscles of the brain. And he steered the conversation around to the structure of a hand, how you study your cards, bid your hand, and then the first few plays really determine the outcome. The rest is just the playing out of the hand. Life was like that, he pointed out to me. By the time you're in your 20s, you've figured out who you are, you've bid your hand, played your first few cards, and the rest is just routine, playing out of the hand.
I didn't really like the direction the conversation was taking, so I said, “What's your point here, Pops. Are we throwing in the jock strap or something?” He said simply, “Cancer's back. Dr. Bosl says you're not going to make it. He's starting you on salvage therapy.”
(Incidentally, those of you in the medical profession ought to consider hiring a marketing consultant to help you here, because that term is just never going to sell the product.)
You can imagine how confused I was about this. I knew that it all turned out all right by the last page. I could not for the life of me figure out how we went from here – it looked like we were pretty close to the last page and how could it still turn out OK?
So here’s the third and last pearl of wisdom from Coach Joe. One night he had me doing push-ups in return for some imagined slight. He had me doing sets in front of the team until I literally could not lift my face from the mat. And he stood over me screaming, “What are you doing, Byrne?” And I replied, quite carefully, “I believe I'm considering quitting, Coach. I believe that's what I'm doing.” Joe thought for a bit, and I remember this long silence in the wrestling room while he searched for something pithy to say, and then he finally said the kind of thing that only someone like Coach Joe could get away with saying. He said, “Byrne, don’t you never quit at nothin'.”
So I did not quit at nothin', but I sure started to think about it a lot, especially when we learned the cancer had spread at last into my bones, where given the limited blood supply, chemotherapy is largely ineffective, or was. I confess that I began to wonder if perhaps I had read the wrong ending because we seemed to be getting pretty close to that last page and I couldn't quite see any angle that worked out, and quitting sure looked a lot easier. As corny as it sounds, I look back, and I know what tipped the scales: my mother.
To really appreciate this you'd have to meet her, but when I run into people I knew from high school, 20 years ago, invariably the first thing they say to me is, “How is your mother? I met her that one time and I thought of her so many times ever since.” She is the classic Irish mother, sweet and caring, and hard as rock. Even my dad and the doctors, Dr. Bosl, were afraid of her. And as best as I can see it now, she just never believed the doctors and she never gave me permission to quit. I sure felt like quitting, but my mom had spent the better part of two and a half years literally sleeping in a chair by my hospital bed, upright. She had straightened out every nurse who had not brought my painkiller on time. And she just wasn't going to give me permission to quit. If you knew Dorothy Byrne, you'd know how much weight that carries.
Dr. Bosl presented me with an opportunity to participate in an early stage experiment. There were six lads in the same situation around the country. All of us had failed twice, we were all going into salvage therapy. Bosl wanted to hit us with large doses of iphosphamide, a drug then being used in Germany for breast cancer. I was warned that the side effects themselves could be lethal and would certainly be as unpleasant as any of the chemo we had tried to that point. They said they would dose us to the point of kidney failure, so I started drinking water like a madman as they started therapy. Within two months, four of the six of us died. News of this came to me though the nurse grapevine. The fifth, a nice fellow from Lebanon, two months ahead of me in the treatment, went briefly into remission, then the cancer returned and he went home to die. And then there was me.
After the last round of Iphosphamide, they cut two ribs out of my side and the woman who did it said that the bone had nearly petrified from the cancer in it and that two interns had to use some kind of bolt cutters together to snap the ribs. To everybody's surprise, all the cancer, even in the bones, was dead.
In China, when you open a new hall or a new store, typically you have a Buddhist monk come and bless it with a scroll that he's drawn. There's a Chinese story about a man opening a new shop and a Chinese monk comes to the opening party to present the scroll. A whole crowd is there. They unroll the blessing – and this may sound a little morbid at first, but bear with me – they unroll the blessing, and the blessing is: “The grandfather dies, the father dies, the son dies.” Everybody is horrified: what kind of awful blessing is that? Until finally a wise man in the audience explains it, that it is a blessing. The grandfather dies, the father dies, and the son dies; not the grandson and the father and then the grandfather.
Part of embracing life, as terrible and morbid as it may sound, is embracing this aspect of it, that it is the natural order of things. And as awful as it seems to lose somebody, an ancestor or a father or grandfather, there's no such thing as embracing life without embracing that side of it, and at least having tolerance for that side of it.
But the flip side of that is just the one memory I've never been able to get over. It’s the memory of the day I pressed the wrong elevator button and ended up exiting on the children's cancer ward. And I just think there must be no worse place that that, and I would rather go through what I went through a hundred times than to see my own child go through that.
So, moving on…Samuel Johnson said that if you tell a man he is to be hung in a fortnight it tends to focus his mind tremendously. I didn't know, of course, that cancer was gone. I got out as soon as I could, I biked across country again. That, oddly enough, was for a girl who lived in D.C. who told me that she didn't quite see me as dependable and stable. So I biked to see her, I biked from L.A. to D.C. to prove my stability. Oddly, this tactic didn't work. When I finished, I said “Never again.” Never again will I do this. Never again will I bike across country.
The next year I rode across country again, and this time I came very close to leaving the bicycle in the waves. I almost gave it away to some kids there. I just never wanted to look at a bicycle again. I've made a few small trips in the nine years since then, but nothing major. That was the end of my cancer and the end of my biking career.
…Until six weeks ago. I got a phone call from Mr. Billy Starr asking if I would speak here. I can't tell you how many requests I've turned down to speak, and it's quite selfish I'm sure. Requests from doctors and so on. I just never have done a single one of them, never accepted a single invitation. But within about three or four minutes I found myself agreeing to come here and speak to you. Odd how that happens, Billy. And then even more oddly, I began to suspect I was on the phone with a Jedi Knight. On his end he was saying, “Why don't you come speak?” And then he said, “Would you consider riding to the Pan-Mass Challenge from Salt Lake?” And I found my mouth saying, “Yes. In fact, why don't I just do it from San Francisco?” So I am leaving next Friday from San Francisco and I will meet you on August 5th in Sturbridge.
Billy persuaded me to do that but there is something else that I decided to do myself. Billy sent me videotapes about you and about the history of the Pan-Mass Challenge. Given that he had set a fairly rigorous challenge for me, I decided to return the challenge to Billy. I know that you raised $8.7 million last year, and I've made a challenge pledge of a million dollars contingent upon you folks raising $11 million this year.
I flew in last night and I met Billy this morning for the first time. We went to Dana-Farber and I was, as he says, “love-bombed.” I'd like to comment philosophically for a moment on this concept. A friend of mine recently – actually, the same fellow, Dave Luban, whom I mentioned, who suggested bicycling in the first place, which I have to thank him for – he invited me to his daughter's Bat Mitzvah. He is a philosopher and he explained to me that – in Hebrew, in the Judaic tradition – “mitzvah” is both the word for commandment, as in the ten big ones, and the word for a good deed. I'm very interested still in philosophy and philology and how concepts get buried in language. The concept of an obligatory good deed is such an appealing concept. In English we don't have that concept exactly. In English the nature of a good deed is something that is supererogatory, it's not something that you have to do. But in this case, I feel having been exposed to the Pan-Mass Challenge and Dana-Farber, I can't imagine not doing any of these things, not doing this ride or not making this challenge grant.
In closing, we all rest in the shade of trees we didn't plant. Andy did. I know I live everyday in the shade of a tree I did not plant. They were planted by you and people like you. On behalf of all of us who rest in such shade, thank you very much.
