Chapter Four: Regaining Hope

Look for Crooked Lines

Hope is a dangerous word once you’ve been given numbers.

Before the diagnosis, hope is abstract. It’s something people talk about casually, the way they talk about weather or retirement or someday. After a diagnosis like ours, hope becomes elusive. Everyone has an opinion about it. Everyone wants to hand it to you, redefine it for you, or take it away before you embarrass yourself by believing too much.

What we were told was simple and brutal.

Bilateral lung masses. By definition, Stage IV. Metastatic. A primary tumor and a secondary site that just happened to be in the other lung. No ambiguity in the language. No soft edges. When cancer shows up on both sides, the story is usually short. So then what?

Then you have limited choices. Chemotherapy. That’s it. Twelve to eighteen months, if things go well. A half-court shot at the buzzer, at best. That was the math. That was the science. And we were not people who rejected science.

We were fortunate—if that word can even be used in this context—to have fast access. Real access. Within days we were sitting with Dr. Weeks, hearing the same numbers again, only now with more explanation. Standard of care. Carboplatin and platinum-based chemotherapy, paired with Avastin, which at the time was still considered an emerging drug. Promising, but not magic. Never magic.

We enlisted Vanderbilt as well. Dr. Horn agreed with the plan. No drama. No competing theories. Just alignment. This is what we do. This is how we start. Interestingly, we were guided to watch for opportunities to enter a trial for the emerging class of immunotherapy-based drugs. You have seen them now in many forms—nivolumab was the one we were watching. We were not eligible, and it is now known as Keytruda. She was just a few years early for that, even though at the end we tried to qualify. We could not, but that is for later. With the line between Point A and Point B still feeling very straight, we forged ahead.

And then the machinery engaged.

Pathology needed to move quickly. I called Dr. Phil, who had been in practice with my father years earlier. A good man. A calm voice. He told me who to call. I called Dr. Smith, another lifelong connection, and the next day Brenda was in for a port. We knew treatment was coming. There was no reason to pretend otherwise.

The following day, Dr. Alan—another friend of the family, the next generation after my father—was ready to do the core biopsy. Broad typing. Fast turnaround. No delays. This had become our life, wrapped tightly around whatever business still needed attention on the edges.

Within days, we ruled out small cell. That mattered. We were now in the non-small cell “family,” a strange word to use, but one that carried a different set of probabilities. More treatable. Not good. But better. Common. The most common lung cancer, and the one most often treated by a roadmap of standard steps for twelve to eighteen months, he said, while she still had life. Would we get more?

A PET scan followed. And a full read from our friends. Full imaging from Donnie for the baseline too. And within fourteen days of Day One of the 1,670, we were underway.

That’s when something quieter showed up.

Not optimism. Not denial. Something else.

Courage, maybe. Or the absence of panic.

There was a finding on the spine. A small nodule in a vertebra. Contained. Ambiguous. Was it related? Was it nothing? The insurance company said it was not related and not part of the disease. Maybe they were right. The physicians said stereotactic targeting was highly recommended. We said yes.

In retrospect, it was the right decision. We never heard from that thing again.

What we did hear from—almost immediately—were the voices.

Don’t eat sugar.
Try this supplement.
Have you considered this clinic?
My cousin’s neighbor did it a different way.

People who had never put on her shoes were suddenly experts in walking this road. We listened politely. We nodded. And then we went back to what we were: pragmatists. Scientists. People who understood that hope without discipline is just noise.

And then, one day after the first treatment, something happened that neither of us had truly prepared for. You would think we would have, but we either forgot or completely denied reality. The first clump of her hair came out.

Beautiful, soft, strawberry-blonde hair. (And yes—only her hairdresser knew that exact shade.) It came out in her hand, suddenly and without ceremony. An outward sign of the war that was already underway inside her.

What I saw next stays with me.

The very next day, instead of letting it fall away slowly, painfully, piece by piece and even saving what had already fallen by the wayside, she went to see Sheila. Alone. Just the three of us in the salon. In the other room, Sheila gently cut her hair—not as a surrender, but as a gift. A donation. Something to be used by someone else who would need it.

When she walked out, she was proud. Not performative. Just settled. We went shopping for scarves and wigs afterward, like people still living their lives, because that’s what we were doing—living, while we could. We made the choices and decisions in the moment that were rational. Denial comes but strength of her rational mind would win out in the end always.

Radiation was added to the mix. Remember, we had that small spine nodule and we wanted to neutralize it no matter what the insurance company said. There was some overlap with chemotherapy. A calculated risk. A rational one. There were delays. Fatigue. The usual complications. But nothing that changed the plan.

Eventually, the first round of the standard protocol was complete.

And then it was time to see where we were.

We all start at Point A. And whether we admit it or not, we all have a Point B. We assume the line between them is straight as our time shortens. At least there is less time for a wiggle or a turn. We assume that if the ending is fixed, the path must be predictable.

It isn’t.

Donnie did the scan. He read it himself. That mattered. He didn’t editorialize. He never did. He simply told us what the images said.

“I don’t see any evidence of disease in the lung or elsewhere.”

We were scanning other soft-tissue sites as well. Places cancer likes to hide. Indeed where we would find in the end was the place that it would make its last stand. There was seemingly nothing there either.

A crooked line between Point A and Point B?

Remission of the lung masses. A PET scan followed. No other disease.

We weren’t naïve. We knew cancer is like dandelions in a winter field. You don’t see them, but they’re there somewhere, sending wisps of seeds into the air. That became our metaphor. Cancer doesn’t need to be visible to exist.

But here was the thing: who cared?

The insurance company said remove the lung masses. The doctors agreed. “Let’s see what we have.”

So we did. Weeks apart. For reasons I’ll spare you, you can’t do both at once.

What they found was necrotic tissue. Dead. Confirmation of Donnie’s read. There was no disease in the lung.

There would never be disease in the lung ever again. Never again in the spine. Never again anywhere but one place where a decision made might have made the last bit of line straighter than it needed to be.

But for now we had found a crooked line without knowing the length of it or how quickly it could turn back. And now Dr. Weeks had to eat some crow and I would say happily so. “I have no idea but the outcome is extraordinarily good for now.” And with that our treatment became much more tolerable.

And with it, something most people misunderstand when they talk about hope.

Hope isn’t believing you’ll beat the odds.
Hope is staying alive inside the uncertainty.
Hope is accepting that the path will bend, and walking it anyway.

From that point on, the pace of our life changed. Not because we were cured—we weren’t. Not because we were promised anything—we weren’t.

But because we had learned something essential:

Point B may be fixed.
The line between here and there is not.

And sometimes, if you’re paying attention, you might just end up with a crooked line.