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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