Relating to cancer's turbulent effects

When cancer strikes, the entire family is affected. It's difficult for a loving mate to stand by and helplessly watch as the disease takes its toll. Richard Schuetz, who recently married Las Vegas Mayor Jan Laverty Jones, tells of their experience in dealing with cancer and how it made them focus on the truly important things in their lives.

Like most men, I am not particularly good at remembering dates. But I will always remember Jan. 3, 1998. This was the day I was told that the person dearest to my heart was suffering from cancer.

Cancer. What an ugly word. There is none uglier.

As we drove home from the clinic, we didn't say much. Jan was still under the twin effects of shock and anesthesia, and I didn't know what to say. When we arrived home, I helped her to bed. I then held her. I wanted the hug to make it all go away -- make that terrible word vaporize from our lives as if it were nothing more than a bad dream. But this was cancer, and it will never go away.

I then phoned friends and family. The first call was to Jan's best friend, Marsha, not because she was her best friend, but because I needed to practice telling them Jan had cancer. Marsha wouldn't be overly critical if I did it badly.

Then there were Jan's parents, brothers and sister, her other friends and, of course, her ex-husband, Ted.

If you haven't been there, don't even try to imagine what it is like to pick up a phone to tell two people that their daughter has cancer. After that call, the others were easier. One of the many things cancer teaches you is to adjust.

About the time I was becoming reasonably competent at using the phone to tell people who loved Jan that she had cancer, Kaitlyn, her 14-year-old daughter, came home from an overnight excursion. Since I've already said you can't imagine what it's like telling parents, there is certainly no way that you can imagine what it's like telling a child her mother has cancer.

My approach with Kaitlyn -- and with all the children -- was complete honesty. After we talked, Kaitlyn went to her mother's room. Jan was sleeping. Kaitlyn leaned over the bed and kissed her mother, then crawled into bed to lay beside her. It was, without question, the most beautiful sight I have ever seen. I just stood there, watching the concept of love being taken to an entirely new dimension.

The other children, Patrick and Maura, were with Ted in Sun Valley. I knew how difficult it would be for him to sit down with them. Ted and I have never discussed this, and we probably never will, but I know how very hard it was for him. Ted's love for his children and their mother is immeasurable.

I spent the next few days at Jan's side, bringing her tea and medicine, and hassling with the phone. The appliance of convenience and necessity was becoming an instrument of terror in our home. Jan, the children and I could barely have a conversation without the phone blaring. We received 50 calls a day. We could not take the phone off the hook because we were awaiting calls from Jan's doctors.

We could not share our love, fears and thoughts without a phone interruption. If you ever learn a friend has this terrible disease, don't run to the phone. While your intentions may be good, understand that this is an extremely personal time for the family. Drop a fax or leave a note at the door. Let the person know you love him or her and that you care. Let them know you are there to help, if needed, and how to get in touch with you. But don't run to the phone.

Like most folks, I fear the unknown. On Jan. 3, my collective knowledge of cancer was that I knew how to spell and pronounce the word. Through the assistance of Barnes & Noble and the Internet, my knowledge quickly expanded. But the fear didn't go away. Cancer does not play by any set of defined rules. It is, at times, seemingly random and unpredictable. And to make this scene just a bit too real, it has the potential of causing a painful and miserable death in very short order. Cancer has its own agenda, and you are its victim.

There was one decision Jan and I made shortly after the cancer was discovered that did not involve any research or advice of family, doctors or friends. It was the decision to get married immediately. We did not know of the future we were facing, but we were certain we wanted to face it together.

On a Saturday evening, seven days after Jan's cancer was detected, we were married at our home. The bride was incredibly beautiful and radiant; the groom demonstrated his typical shortcomings. Engraved inside Jan's ring were the words "in sickness and in health."

Our honeymoon took us to three major breast cancer centers in the United States. As time passed, we learned more about Jan's cancer. We learned it was estrogen and progesterone negative, which wasn't a good sign. We learned it had an S-phase of 20 -- again, bad news. What all this meant, in layman's terms, was that Jan's body was harboring a very nasty cancer. And it was a cancer that we had evidence to suggest had not been completely removed in the first surgery.

With cancer, time is of the essence. That means you need to make enormously significant decisions without the luxury of time. Our first reports from the doctors indicated Jan would probably need both her breasts removed. This terrified her.

At this time in our understanding of cancer, there were still several things we didn't know. There can be a number of suggested treatments to the same series of medical facts. One doctor will feel comfortable with one treatment; another will feel comfortable with another treatment. We didn't know this. We assumed that medical knowledge was such that all doctors would respond with a common voice to a set of medical circumstances. Our friends who are cancer survivors taught us differently: Get multiple opinions.

Many medical practitioners, especially from the older schools of thought, believe that the most surefire treatment of breast cancer is a mastectomy. This well-intentioned view seems based on a notion that survival of the patient is the singular objective. But there are other concerns that are better understood by a woman than a man. Unfortunately, the vast majority of doctors are male.

One of the first studies I ran across on the Internet used a sample of 3,000 breast cancer victims. The study noted that a woman's first concern is saving her breasts; the second, her life. This was a breakthrough for me because, being male, I was evaluating Jan's disease from a man's perspective, in concert with male doctors.

In pursuing our due diligence for Jan's treatment, we gained access to three of the finest breast cancer clinics in the world. These were not clinics that deal with the entire array of cancers, but clinics whose entire efforts were directed at the detection, eradication and treatment of breast cancer.

The first characteristic we noticed about these clinics was the absolute commitment of their staffs. They were people who fought cancer as if their very lives depended on the outcome. They were people who showed up for work at 7 a.m. and left well after 8 p.m. They were obsessed; they gave every bit of their time and energy to make people live. I wish we, as a society, could make these people role models for our children instead of athletes and rock stars.

Within these clinics we also noticed an incredible effort to do everything possible to save the patient's breasts. While they agree that removal of one or both breasts is a safe treatment, they also believe breast preservation is a critical goal in breast cancer treatment. These breast cancer specialists believe that removing the breast is to give ground in the fight against cancer; their goal is to eradicate the cancer and save the breast.

These fighters cite with pride statistics showing that women who have a lumpectomy securing clear margins, followed by radiation treatment, have the same survival rates as do women who have a mastectomy. While you could argue that these treatments have done nothing to increase survivability, they have allowed innumerable women to experience less drastic and invasive surgery, caused less disruption of a woman's perception of her femininity and sexuality, and left fewer emotional and psychological scars. This is not to suggest that a mastectomy isn't necessary at times, but it is to say a mastectomy isn't always necessary.

Until we met these breast preservation specialists, it seemed that all the news about Jan's cancer had been bad. What these people were telling us was the first good news in our battle. If we could get clear margins around the tumor site with a lumpectomy, followed by radiation treatment and chemotherapy, there would be no immediate need for any additional surgical procedures on Jan's breast.

When dealing with cancer, there are two major issues: local control and systemic treatment or control. The first entailed removing all the cancerous growth from Jan's breast. The latter was to ensure that any cancer cells that migrated from the local tumor had not set up home in any other part of the body. Jan's local treatment was surgery, followed by radiation. The systemic control was chemotherapy.

Whether the lymph nodes are harboring cancer is a strong first sign that there may be systemic involvement. Lymph node involvement is not good news. Negative lymph nodes is better news. The nature of the chemotherapy would depend on whether lymph nodes were involved.

With cancer, the patient and family go through various emotional stages. The first is shock, and we clearly spent some time there. The second is research and securing several opinions. The third is the decision to proceed -- the "let's get it on" phase. We would proceed with a lumpectomy and, during the surgery, the doctors would also take a sample of Jan's lymph nodes. The worst-case scenario was that there would be no clear margins around the tumor, and the lymph nodes would test positive.

Choosing the surgeon for this procedure was easy. No matter where we went, we heard the name of Armando Giuliano. Dr. Giuliano is a workaholic who spent many years at UCLA until he migrated to the more intimate and controllable environment of the Joyce Eisenberg Breast Center of the John Wayne Cancer Institute at Saint John's Health Center in Santa Monica. When people spoke of him, there was a tone to their voice that convinced us he was of God-like proportions. Armando Giuliano is the absolute best. He is of that group of true heroes in the world who have given incredibly to cure and treat breast cancer. So Dr. Giuliano it would be.

It warrants mention here that Jan's experience with cancer is not normal. I have been lucky enough in my life to accumulate a significant amount of money. Jan has a whole lot of money, and Jan's father has a whole lot of money to the sixth or seventh power. This has allowed us to travel throughout the country and visit with the best of the best. Jan and I often talked during these visits about women who don't have significant financial resources. Their treatment becomes more random. They often must take what they can get, which can be -- if they are lucky -- excellent treatment. A bit of bad luck, and their treatment may lack.

Also, because of Jan's position and notoriety as mayor, the doctors were always there when we needed them. If we had a 10 a.m. appointment, our appointment started at 10 a.m. The doctors typically adjusted their schedules to accommodate ours. Given that one's emotional state is a strong factor in the treatment and recovery of cancer, people who must wait to get in to a doctor and then must wait a long time to see him are not in an emotional state that's conducive to their health.

I also had the luxury of dropping whatever I was doing and dedicating my entire efforts to helping Jan. Many mates can't do that. It clearly helped us.

Approaching this surgery was an incredibly emotional trip. Would her breasts be saved? Would there be systemic involvement? What type of chemotherapy would be necessary? These were huge issues that would get right to the basics of not only the quality of life that Jan could expect, but whether -- and how long -- she could expect to live. It was a terrifying and special time for us.

Let me explain "special." One might assume that when cancer enters your family that only bitterness and terror follow. That's not always the case. With us, there have been many positive moments, not the least of which was our marriage. Cancer can help you think about an array of topics that we probably neglect to consider under normal circumstances. Cancer can provide new insights into every aspect of one's relationship with family and loved ones. Let me share two short examples.

After the first surgery, it was important for Jan to rest. She needed her strength to fight the cancer as well as to prepare for her second surgery. But that wasn't always easy. For me, it was out of the question. I used to lie by her side for hours on end, trying my best not to move, waiting until she would fall asleep. I knew when she was asleep because -- here's a scoop -- the mayor snores a bit. Before Jan's cancer, I never had an affinity for snoring. But now it was music to my ears, for I knew Jan was resting and at peace. It was the most beautiful sound imaginable, and I would just lie there with a smile on my face and love in my heart listening to that music.

A second thing was that I got to know Jan's right hand. In all the doctors' offices and after all the surgeries, I sat by her side and held that hand. I came to understand that this was the most beautiful hand in the entire world. It was strong, it was feminine and it was sensual. When Jan was sedated, asleep or under anesthesia, I would communicate to her through this hand. I would let any strength and power that I had in my body flow through her through this hand. Every ounce of my love flowed into this hand. It became my conduit.

So while cancer brings a strong element of terror into your life, so does it allow for a depth of thought and emotion that was unimaginable in our pre-cancer state. For these reasons, I am not always bitter about the cancer. Just sometimes.

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