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September 14th, 2009
10:24 AM ET

When words fail you

By Andrea Kane
CNNHealth.com  Producer

September is National Ovarian Cancer Awareness Month. Each year in the U.S. about 21,500 women are told they have it; approximately 14,600 die of it. Detected early, it has a five-year survival rate of almost 94 percent, according to the National Cancer Institute. Unfortunately, only 15 percent of ovarian cancers are found when the disease is still localized.

A good friend of mine died of ovarian cancer six years ago. She was only 41. We weren’t talk-to-you-every-day best friends, but when we saw each other, we connected.

After I had a baby, we had less time to spend together. Still, she faithfully came out to visit the baby and me.

In 2000, shortly after my daughter turned 1 and my friend turned 39, her doctor found an ovarian cyst. Unfortunately, in the Russian roulette game of health and disease, she lost: Her cyst contained a malignant tumor – a one-in-a-hundred chance, she was told. The good news was that it was “only” stage 2 (In stage 1, the cancer is still contained in the ovary; stage 4 is considered terminal). But even stage 2 was not good enough.

Everyone agrees that ovarian cancer needs to be found earlier, but the question is how? Part of the problem is, the symptoms of ovarian cancer– bloating, increased abdominal size, changes in bladder and bowel function and a feeling of pelvic fullness or pain - can be also caused by a number of other maladies. And there is no accurate blood test.

For my friend, surgery was followed by chemotherapy, and more chemotherapy. Still, she found time to visit my daughter and me, and we found time to talk about motherhood, religion, relationships, life. Our parallel but sometimes intersecting lives went on.

At the end of 2001 I had a second daughter, and her cancer returned. I drove her to a couple of chemo appointments; she had more surgery and some radiation. We talked about dying, but only in the abstract – because neither one of us wanted to think it would happen to her.

But her worsening condition cracked our carefully constructed illusion. The drugs made her terribly sick — not that they were actually helping - and surgery was just a temporary fix. She knew her options were limited; she desperately looked to get into a trial for a new drug.

The last time she came to visit me, she told me that she recently had realized that this thing could actually kill her. But she still held some hope.

Then, before she could go into remission again, the complications started in earnest.

Her parents arrived from Florida to take care of her. The morphine made her sleep 20 hours a day. She stopped communicating with all but a very small group of friends; they gave the rest of us e-mail updates.

I desperately - and selfishly - wanted to see her, to talk to her one last time. And then I got my chance: My husband prepared some legal documents for her that required signatures. He asked her parents whether I could be the one to drop off the documents. They obliged.

I was nervous before seeing her; I didn’t know what to expect. On the appointed day, I headed over with my younger daughter.

Seeing her wasn’t exactly a shock, but she didn’t look like her old self: Her skin was yellow, her face looked gaunt and she sported a feeding tube. She didn’t smile – not even once. She and her mother both looked exhausted. I tried to be cheerful enough for the two of us.

After she signed the documents, we all sat on her back porch and chit-chatted about trivial matters: my daughter’s sandals, her nap schedule, my other daughter. Blah, blah, blah. We talked about everything except the pink elephant in the room. What I really wanted to ask was how she was doing emotionally: Was she afraid? Bitter? Angry? Or had she come to terms with dying? Was she at peace? I could not tell.

Impulsively, I asked her mother to take a photograph of us with a camera I saw sitting on the nearby table. Her mother snapped two photos and then my daughter and I left. The visit had lasted 15 minutes.

Maybe I couldn’t talk to her about the things that mattered most because her mother was there, or maybe because I didn’t want to upset her by openly acknowledging something she never had: She was dying. In any case, I will always feel that I missed my last chance to talk to her honestly and openly, to hold her close to me and whisper “Goodbye, I love you.”

Two weeks later Jennifer Lisa Bertoni died.

A while later I received an envelope in the mail: the two photos. As it turns out, they were the last ones taken of her. Surprisingly, in both of them, she gazes back at me, smiling.

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Filed under: Cancer • Women's Health

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soundoff (6 Responses)
  1. Alex Lickerman, M.D.

    What a moving account. Losing a loved one, whether a family member of cherished friend is always so difficult. Whether you were a caretaker or not, the link below might be of some comfort.

    http://www.happinessinthisworld.com/2009/02/15/letter-to-a-widow/

    September 14, 2009 at 11:45 | Report abuse | Reply
  2. Barbara Staubly

    Time Magazine wrote obese people (almost a quarter of U.S. population) are responsible for a $40 million jump in annual medical spending. Medicaid pays $230 more for prescription drugs.The obesity related ailments are diabetes and heart disease.

    One easy solution to control some of the obesity in U.S.A. is through the Food Stamp Debit Federal Program. Working at a popular discount superstore, I check-out the food items of Food Stamp Recipients and was appalled as to the poor choices and large quantities of junk foods selected. Instead of basic, balanced meals, most recipients chose: high sodium frozen dinners, 5-10 lb sugar, cream cakes, doughnuts, danish pastry, candy bars, potato and taco chips, sodas, popsicles, ice cream, ice cream bars, lollipops, etc. Seldom do I see food coupons to help stretch the budget.

    The Federal Government Food Stamp Debit Card program can eliminate the junk foods, high salt and sugar products and only provide healthy, basic choices. Therefore, the over weight ailments would strongly improve.

    September 14, 2009 at 16:08 | Report abuse | Reply
  3. nug

    My MIL had ovarian cancer, she compained about "female problems" almost from day 1 of meeting her. It was 1973, her docs sent her home with happy pills, probably patted her head and said 'there, there'.

    In 1976 she came by and told us she needed to enter hospital the next day for surgery, cancer. She was terminal, 6 months to one year IF she did chemo. She lived 11 months. 11 miserable months, she didn't do well on chemo.

    She died a terribe death. Nobody should have to do that. Ladies, please if you've got overies PAY ATTENTION to changes, especially if you are post menispausal, even if you not. If it feels wrong INSIST that your doc takes you seriously, even if you have to yell and scream, They may think you're a nut, but being a nut is better than being dead.

    September 15, 2009 at 02:06 | Report abuse | Reply
  4. Beatrice C.Robinson

    This is a very moving account. We are all so afraid of death, that we become tongue-tied and do not know what to say when someone is dying. I know you felt like you didnot have the closure you would have like, but at least the pictures gave some comfort. God blessed you for thinking of the idea.

    September 15, 2009 at 11:22 | Report abuse | Reply
  5. Sarah

    Wow, what a moving tribute to what was obviously a dear friend. I commend you on the story and the emotion behind it.

    September 15, 2009 at 15:19 | Report abuse | Reply
  6. Jackie in Dallas

    It is our culture here in the US; we won't talk frankly about death or dying. We opt to sanitize our lives of the unpleasant. In other countries, where a greater percentage of people opt for dying at home, death is considered a natural function of life. None of us can avoid it.

    I never got a chance to say goodbye to my Mom before she died from stage 4 cancer - I was away at school at the time, and came home after she was so far gone that she didn't recognize anyone. I learned my lesson. With my father, every time I saw him I was painfully aware it might be the last time. I made it a habit to tell him I loved him and that I missed him every chance I got. When he died of complications from surgery, although I missed him and greatly wished I had been able to be there, I didn't feel like I had left anything unsaid.

    Death is always the pink elephant in the room. No one knows when it will strike - quickly, from a stroke, a heart attack, a car wreck - or slowly through disease. Make it a habit to never put off saying the important things to those you love. Even just "I'm glad you are my friend" may make someone's day better - and it may be the last thing you have the opportunity to say!

    September 23, 2009 at 12:10 | Report abuse | Reply

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.