Fred Dickey's Island of Human Drama
Couple together faces prospect of double death
Couple together faces prospect of double death
By Fred Dickey San Diego Union-Tribune Dec. 19, 2016
If Job, even amid his Old Testament torments, were to compare his fate with that of the Graziano family, he would bless his good fortune.
The Grazianos live in their own modest house in Oceanside. The dad is an easy-going guy who would walk across the driveway to help carry a heavy box into your house. The stay-at-home mom would watch your 2-year-old while you run to the store.
Joey Graziano, 38, is a business analyst for a timeshare company. Maggie Graziano, 37, is a homemaker and home-schooler of their first-grader.
You would think great numbers of San Diegans would trade places with them, but no one would. This is why:
Joey has Stage 4 prostate cancer that was diagnosed in May.
Maggie has Stage 4 colon cancer, diagnosed six weeks ago.
Kai is their 6-year-old son. He was afflicted with pediatric neuroblastoma cancer as an infant and has endured surgery and chemotherapy. It seems to be quiet in his body now, but Maggie doesn’t trust that it won’t return.
Everett is 19 months old. Who knows what his future will be.
If bleak Norwegian artist Edvard Munch, he of the “Scream,” had been in the room with us, he would have reached for his palette. He would have painted what was before him — a young husband and wife, sitting at a breakfast table, discussing sorrows as dark and deep as the river Styx. He would not have missed eyes filled with deep-pit dread.
The sadness. It would have dripped off Munch’s brush.
The bravery. Munch might have missed that.
Maggie rests her elbows on the table. She is still in shock from being told that advanced cancer is eating at her insides. What she had assumed to be irritable bowel syndrome was revealed as a tumor mass the size of a golf ball that had spread to her liver and perhaps beyond.
A half-year earlier, Joey had been diagnosed with prostate cancer. The indicators for that are charted by two things: the Gleason Scale and PSA levels. PSA for a man his age should be about 2.0. His was 64.
When he says that, I ask, “Do you mean 6-point-four?”
“No,” he says, “64.”
The Gleason Scale measures prostate cancer as 1 to 10. Normal is 1 to 4. His was 9.
For Joey and Maggie, a fatal result would surprise no physician.
Maggie’s tumor is situated in such a dangerous area on the liver that surgery must await shrinkage by lengthy chemotherapy, which she began the first of this month.
After diagnosis, the first step for Joey was hormone therapy to reduce his testosterone level to zero. That retards cancer growth, but not permanently. An operation was the feasible way to attack his disease.
Surgery is both science and art. That’s a way of saying there are surgeons, and then there are surgeons.
He found himself in a dilemma often facing patients: Do I stay with my HMO (in-network) surgeon or go with one outside the network but who is strongly recommended? The problem with choosing the latter is that the cost becomes out-of-pocket for the patient.
Joey sensed that his assigned surgeon was indecisive about the operation, and he slowly lost confidence in the man. He conferred with two other specialists; both strongly recommended prostate cancer specialist Christopher Kane of UC San Diego Health, who performs more than 200 such operations each year.
Joey and Maggie labored over the decision. Maggie says, “At first, I was trying hard to think of reasons why we should stay with the guy in the HMO because it's a pretty scary idea to go into so much debt. But when it comes right down to it, we have to do the thing that's going to keep Joey with us longer.”
Joey says, “I don’t know how much time I have, but at that point, I was thinking I can’t leave my family in so much debt. But the question was, ‘Do I leave them without the debt or do I take a chance at a cure?’”
“Maggie completes the thought: “… and hopefully not leave at all.”
They chose Kane, deciding that maybe saving a life is worth more than saving money.
Following the surgery, an oncologist told Joey that because of his high diagnostic levels, it was almost certain he had “microscopic metastases” in his body that would require several rounds of chemotherapy before he moved on to radiation treatment.
The couple that has chemo together … well, that’s a couple that gets sick together.
Then the bill came due. The hospital sent an invoice of about $80,000. As hospitals often do, UC San Diego reduced it by negotiation, and the final tab came to about $50,000.
The Grazianos have thus far paid it down to about $30,000, but they’re now tapped out. The money’s gone, but not the obligation.
Joey says his employer has been greatly supportive and has allowed him to work at home. Still, he knows such things have limits, and he dreads having to go on disability at some point and having to cope with the reduced income.
Watching silently from the couch in the corner is 6-year-old Kai. His parents tell him as much as they think he can handle, but the boy seems to sense more than he can understand. He knows himself that cancer is something that hurts and makes you cry.
Kai hears the word chemotherapy, and it’s another big word he fears. He knows how it makes you feel, and the thought causes him to curl up and pull his blanket tighter.
When I consider the boy, I think of the bedtime prayer song from “Hansel and Gretel” and hope soft music fills all the days of his youth.
People like the Grazianos deal with debts on the first of each month by laying them out on the table next to the checkbook. But when the bills far exceed the ability to pay, the checkbook becomes empty and is returned to the drawer. All that’s left on the table is defeat, and an undeserved but real sense of failure.
Joey speaks guiltily of the health insurance plan he chose. “I just kind of regret we picked a cheaper, more limited one.” The results are co-pays and deductibles that eat at his salary like termites in a wood pile.
Maggie and Joey fear they’ll be forced to sell their house and move into a rental, which will cost them more than their mortgage, and with much less of a home.
It’s a harsh irony that even if a family is forced to think about the possibility of death, the pressures of living do not relent.
The Grazianos are not demonstrative people; they would consider overly emotional displays socially awkward. However, they cannot hide red eyes and an occasional hard swallow and lip quiver as they tell what has happened to them.
Joey has had several months to gather his thoughts, while Maggie is still fighting through numbness in formulating hers.
Joey pushes doggedly into reality like a man fighting a headwind. He becomes pessimistic, then finds the will to shove it back.
“We’re both kind of lucky; both still sort of curable, but it’s a really low chance for both us. Low chance for me and a low chance for her.
“We need to get the cancer out of (Maggie’s) liver because that’s what will continue to grow and affect her in the end.”
Maggie listens and then says, “It’s a little too soon for me to deal with my own stuff, and my own thoughts.”
Joey smiles encouragement across the table. “At (the first hospital), the doctor diagnosed her as pretty much incurable. They didn’t think they could do the liver surgery. That’s why we went down to UCSD. There's a liver transplant surgeon down there who thinks he can do it, if they can shrink (the tumor) a little bit.”
After the kids are asleep, do you two sometimes open a bottle of wine and sit around and say, “What’s happened to us?”
“Yeah, we do, when we have time alone, which isn’t a lot of times,” Joey says.
Maggie says, “It’s kind of hard for me to think like that because I'll spiral down and get really upset. I try to stay positive and stay away from self pity. It’s kind of something I learned when Kai was sick.”
Joey, you must have anger about all this.
“I was driving home from UCSD after she had emailed me her test results. I kind of knew it was cancer then. I remember yelling at the world for the whole hour (heading) home.
“My darkest time is trying to figure out how to make my family OK without me. Unfortunately, that’s gotten more complicated with her sickness. Now, it’s like, I’m kind of like I don’t know what the future has at all for us. It’s hard.
“I’m hoping and expecting that we get a cure. I know the chances are really low, and if you think about it realistically, there’s a really, really good chance we’re not going to make it. I think down the line, as we go through this a little more, we’ll start putting more thought into that and try to figure out what we’re going to do with the kids.”
You don’t want him to say that, do you, Maggie?
“Well, I don’t want to think it. But we have to do some grown up stuff, like making a will. We have to look into those things. It’s not like we have much to will, but we may have to will our children to someone.”
I can see you’re getting ready for Christmas.
Maggie looks around at the few decorations she’s put up. “I want to try to have a normal Christmas as much as we can. It’s going to be thinner than usual with the presents.”
If it’s not a surprise, what are you getting Joey?
“Actually, I was thinking I would fill his stocking with Cuties. You know, the little tangerines, because that’s like his favorite thing in the whole world right now.”
Joey laughs and nods. “I’d love that.”
Maggie says, “We’re in warrior mode. We’re going to do this, this fighting thing, this being-sick thing, for however long it takes. And then we’re all just going to Disneyland.”
The slow dying of hope is an affliction for which there is no cure and no balm. The Grazianos struggle every day to keep a future in their sights. They get up each morning, take care of the children, then go to the hospital to have poison injected into their bodies. As the chemo sickness returns, they wonder when — and how — this will end, this horrible thing.
When life’s light flickers, we can talk of bravery, of faith, of family. But it’s also in our nature to ask why. And why often doesn’t answer.
The days of our lives are numbered, and if they come up short, we can hope they will be filled with kindness.
Maggie and Joey have each other, and each other is the last and best thing a family can have.
Fred Dickey’s home page is freddickey.net
He believes every life is an adventure and welcomes ideas at [email protected]