Like most people, Deborah Shemesh never thought skin cancer could kill. Now, after 14 years of surgery and treatment, she's beginning to wonder.
By Mary Murray
Photo Editor: Judith White
A toxic tan.
I try not to have preconceived ideas in situations like this, because I want to see what the subject brings to the shoot,” says Mary Ellen Mark, who photographed melanoma patient Deborah Shemesh for a “A Deadly Tan” this month. “Deborah wanted the pictures to be strong, so she really exposed herself and allowed me to see a very, very vulnerable side of her. The power you see in the images is what she brought to them.”
A retrospective of Mark’s work, “Mary Ellen Mark: 25 Years,” is currently on an international tour.
Deborah Shemesh was curled up in bed with her four-year-old son, Adam, one Sunday in April 1987, trying to get him to stop pestering her about going to the playground. It was hard to explain to such a little boy just why they had to waste a balmy afternoon in Beverly Hills. But Deborah was feeling awful. Suddenly a wave of nausea drove her into the bathroom. As she bent over, blood poured from her mouth. "Mommy, what's wrong?" Adam screamed.
"Go out!" Deborah shouted, pushing him out the door and trying to hold it closed even as she sensed the next wave rising. She bent over again; this time she felt as if she was choking to death. Finally a large blood clot came out.
"I couldn't figure out what was happening to me," Deborah says now. "I had no idea what could make anyone throw up so much blood. I panicked. I could actually feel my heart racing. I was desperate to do something, but I didn't know what to do, who to call, where to go, what to say to Adam."
The cause of the bleeding was skin cancer-a melanoma that had lethally traveled from her arm to her stomach-but on that Sunday afternoon the possibility never occurred to her. Seven years earlier, when she was a successful swimsuit model, doctors had removed a tumor from her left arm. They warned her then that the cancer was likely to recur, but "I never, never thought it could go inside me," she says.
It could, and it did. Silently, stealthily, melanoma had invaded her stomach. It had planted its seeds and grown a tumor the size of a baseball. When a physician gave her the news the next day, she was dumbfounded. "I thought I'd already won the battle, and suddenly everything was spinning out of control. I hadn't won. I was losing. I was a failure."
But the stomach tumor was only the first chapter in what was to be a long nightmare. For over the next seven years, melanoma would return again and again. Since the spring of 1987, when Deborah had more than half her stomach removed, doctors have found tumors on her pancreas, her right ovary, and her left thighbone. To fight them, she has endured three operations that have left her with disfiguring scars all over her once model-perfect body, an experimental vaccine that created oozing wounds, and immunotherapy that made her so weak she thought she'd die from the treatment.
"I'm a survivor-and a tough one at that. But sometimes I just feel so very, very tired," she says in a languid monotone that is the result of heavy daily doses of painkillers, tranquilizers, and sleeping pills. After 14 years of cancer, she is still pretty, but her face is drawn, there are circles under her eyes, and her head often seems like a heavy weight on her shoulders. "If there's one thing I've learned, it's that I'll never be able to stop worrying." Death, she says, "is a possibility I have to live with. I can fight. I can also survive. But even if I do, the cancer will always be lurking somewhere in the background."
Technically, Deborah is in remission, because doctors can see no clear signs of new tumors in any X ray or MRI picture. But lately she has begun to feel pains in her left thigh and right calf, pains that could be a sign of new tumors that are still too small to show up in tests. Even worse, for the past three years, Deborah has been having epileptic seizures, possibly a sign of brain metastases.
Many people mistakenly believe, as Deborah once did, that skin cancer is not dangerous. And it is true that basal- and squamous-cell carcinomas rarely spread to other organs and therefore are rarely fatal. But melanoma is in a class by itself. Once it gets a foothold, it begins to metastasize -and it spreads faster than any other form of cancer- to the stomach and other digestive organs, the ovaries, the lungs, the bones, or the brain. And once it spreads, it is usually fatal.
But few people in this still tan-crazed country make the connection between death from melanoma and sunlight overexposure -a connection that should be as well-known as the link between lung cancer and cigarettes. And yet the rate of melanoma cases in the United States is increasing exponentially. The number of Americans who get it has roughly doubled every ten years for most of this century. During the 1980s, the incidence rose at the rate of 7 percent a year -far faster than that of any other kind of cancer. Today 1 in 100 Americans is expected to contract melanoma at some time in his or her life. If the rise in incidence continues apace, by the year 2000, 1 in 75 will. Eighty-five percent of melanoma victims will be diagnosed before the disease has metastasized, when surgery can cure them, but most of those whose cancer has spread will probably die within a year.
The mole that started Deborah Shemesh’s long battle with melanoma was tiny, but the scar left after surgery “looked like teeth marks, exactly as if I’d been bitten by a shark.” She had it narrowed by a plastic surgeon.
And for some reason, those victims are becoming younger every year. "Ten years ago it was unusual to see someone under age 40 with melanoma," says dermatologist Darrell Rigel of New York University. "Now we're commonly seeing people in their 20s."
Deborah was 26 when she first noticed a mole "about the size of the nail on your little finger" on her left arm. "Not large enough, I would have thought, to cause so much trouble."
She was making $ 1,000 a day modeling bathing suits for Catalina and Cole. Even though the mole was in an inconspicuous place, she was embarrassed by it and hid it as much as possible under long sleeves. But it bled each time she bumped it against a file cabinet or a car door. When she showed it to her family doctor, he told her not to worry.
In fact, melanomas are often difficult to recognize in their earliest stages. Even dermatologists can sometimes fail to diagnose many of the smallest growths. But in Deborah's case, the bleeding should have been a red flag. Fourteen years later, she says, with great pain, "I hate that doctor whenever I think about it. I would sue him, but he died years ago."
A year and a half after the mole first appeared, Deborah's gynecologist saw it and asked what it was. "I told her I'd had a doctor look at it and he'd said it was fine." She said, "It's not fine" and sent Deborah to a surgeon, who excised the mole and closed up her arm with seven stitches.
A week later, she got the phone call that changed her life. The pathology report indicated she had melanoma, said her surgeon, and it had penetrated to the lowest layers of her skin.
"I knew from the sound of his voice that this was serious," Deborah remembers now, "but I couldn't imagine how serious. I was only 26 years old. You don't die of cancer -or anything else- when you're that young. I didn't believe I could be so vulnerable."
The second operation was devastating. Surgeons at the University of Southern California Medical Center in Los Angeles removed a large chunk of skin and muscle from Deborah's left forearm -so large they needed to cut a piece of skin from her hip to cover the wound. They also removed 11 lymph nodes from her left armpit. The tumor had penetrated more than an eighth of an inch down into her arm, deep enough to indicate that the cancer might already be spreading to the nodes, so they had to be taken out and checked for signs of cancer.
The human lymph system acts as a barrier against all kinds of cancers, catching malignant cells before they can travel to other parts of the body. Once the lymph glands are full of metastases, the patient's prognosis is poor.
Deborah's nodes were free of tumor cells. Her cancer did not seem to have spread beyond her left arm. Still, because of the depth it had penetrated to, her doctors warned her that the cancer might return.
When the surgeon came into her room, she was sucking on a lollipop, "because I still couldn't eat regular meals after the operation. I must have looked unconcerned about my cancer, because he shook his finger at me and said, 'You're taking this very lightly, aren't you? But this cancer will be back within five years. It could be two years, it could be six months from now, but sometime within five years.'
"I suppose I was a little unconcerned about the possibility of more cancer. But at the same time, I was mortified by what had already happened. I had been so proud of my body, and now I had these big wounds on my arm and my hip and my underarm. For the first time, I looked at myself and I was so disfigured. And that made me so ashamed." Her left arm was enveloped in a huge red circular scar, surrounded with ugly jagged remnants of the stitches. "They looked like teeth marks, exactly as if I'd been bitten by a shark," she says.
As months and years passed after the surgery, Deborah avoided seeing an oncologist -avoided finding out whether the cancer was still growing. "I just did not want to think about it," she says. "I preferred to just assume I'd be OK. I thought if I saw a doctor, I'd get bad news, and there was no reason to go looking for trouble."
She just wanted it to go away, and two years after the melanoma had been removed, she had a plastic surgeon narrow her wound by pulling the outside edges together and cutting away as much of the scar tissue as possible. "I went back twice more so they could keep making it smaller and smaller," she says.
“She took care of me when we were kids. Now it’s my turn to take care of her,” says Deborah’s brother Mark Schultz. She recently moved to San Francisco to live with him so he could help with her son, Adam, now that she can’t drive.
Deborah kept her cancer a secret from everyone except her family and Sam Shemesh, the man she married a year after her operation. She covered her arm under long sleeves and quit modeling without ever telling anyone why. She took her first secretarial job at Capital Cities ABC in Century City.
Deborah's skin is not the type the textbooks describe as being most susceptible to melanoma. Most commonly, the disease strikes people with white-white skin, prone to sunburn. Such people have relatively little pigment to protect them against the sun's damaging ultraviolet rays. Especially vulnerable are fair-skinned people who have close relatives who've had the disease (about 5 percent of melanomas run in families) and those whose bodies are peppered with moles. Moles, which are nothing more than little pockets of melanin, are usually as harmless as they appear. But on occasion they somehow give rise to melanoma -which begins its attack on the cells that produce melanin. The moles most likely to turn cancerous are those that dermatologists describe as being dysplastic, which means that they have jagged edges or irregular coloring, or are otherwise different from the usually round brown moles.
Deborah, in contrast to those at highest risk, has olive skin. Her father was of northern European extraction (half Dutch and half German), but her mother was half French and half Blackfoot Indian. Deborah's skin, much like her mother's, turns a deep, rich brown when exposed to the sun. Though she has a couple of prominent beauty marks, one next to her nose and one below the corner of her mouth, there are fewer than a dozen moles on the rest of her body. And no one in her family has ever had melanoma.
Now, of course, she wonders about what caused the melanoma, and memories of innocent days at the beach are laden with bitterness, not nostalgia. Summers when she was a girl, living on the South Side of Chicago with five brothers and sisters, her mother would load all the kids and a shopping bag full of bologna sandwiches onto a bus headed for Rainbow Beach on Lake Michigan. Unprotected by clothing or sunscreen, Deborah would burn, then tan, and with each consecutive visit, burn a little more before tanning a little darker. "We went every Saturday, and we certainly didn't care how much sun we got," Deborah says. "I thought, The more the better. Suntans were great."
After moving to Los Angeles, at age 19, Deborah would sunbathe three days a week on the nude sunbathing deck of the Beverly Hills Health Club. She would cover her face to keep it tan-free-the way the makeup artists working on models liked it-but the rest of her body was exposed.
"I liked to be tan," she says, shrugging her shoulders. ”Who didn't? I thought it looked healthy. I also liked to lie out there and relax. Nobody ever told me to stay out of the sun. Anyway, if they had, I don't know that I would have listened."
Scientists don't understand how sunlight causes melanoma, but they know it plays an important role. There's no other way to explain why those most prone to melanoma are fair-skinned people living close to the equator, where sunlight is most intense.
Melanomas typically grow on parts of the body that don't see too much direct sunlight: the back, the trunk, the legs, and the arms. What's more, people who are out in the sun every day are less likely to contract melanoma than those who go out only on the weekends or during the odd vacation. One explanation-the best one anyone's come up with so far-is that melanoma is caused by intermittent sunburns rather than by a cumulative dose of sunlight. Perhaps the reason melanomas sprout on relatively obscure body parts is that these areas suffer the most severe burns when exposed.
Studies of people who have moved from northern to southern climes indicate that sun exposure during childhood is especially dangerous. "Where you grew up as a child -how close to the equator- bears more on whether you get melanoma than where you live as an adult," says Alan Houghton, chief of clinical immunology at Memorial Sloan-Kettering Cancer Center in New York.
Contrary to conventional wisdom, a tan is no protection. "In order to get a tan, you have to basically injure your skin to start with," explains Darrell Rigel. "The skin produces melanin pigment because it senses it's been injured. And even though people who burn easily appear to be at greatest risk, we have no evidence to suggest that a tan offers protection against melanoma." Thinking back on her tanning years, Deborah Shemesh would have to agree. "I never burned very much, just a little, and then it would turn to tan," she says. "But I guess that was enough."
During the years after the mole on her arm was removed, Deborah married, had a son, and eventually divorced her husband. She continued to ignore the possibility her cancer might return. That is, until the April afternoon in 1987 when she began vomiting blood. A few weeks later, a surgeon at Cedars-Sinai Medical Center removed the top two-thirds of her stomach and part of her lower esophagus. He then pulled up what was left of her stomach and attached it to her truncated esophagus. Ever since that operation, Deborah has had to consume every morsel she puts into her mouth slowly and methodically. "I have to chew my food a hundred times, and I can only eat things that are light and easy to digest, like pasta and fish. The other thing, of course, is that I can't eat very much at one time."
In her fifteenth year of cancer, Deborah is well acquainted with medical procedures. Here, a nurse draws blood during a checkup.
At the end of an exhausting day and still another medical examination, Deborah breaks down in front of oncologist Donald W. Northfelt.
A CT (computed tomography) scan done before the surgery had revealed a growth on Deborah's pancreas and another on her right ovary. Although the surgeon suspected they might be more tumors, he decided not even to try to remove them at the time; the extra surgery might be too taxing. Nor did her oncologist suggest going in for a second operation later on. Given the condition she was then in, it wasn't clear that Deborah could survive very long.
"I was lying in my hospital bed after the surgery, and my oncologist came in and basically told me I was going to die within six months. She seemed so calm, even though she was telling me such horrible news, it made it hard for me to even believe what she was saying. She said I should get my life in order, make a will, and find a family to adopt my son. I was stunned."
As she recovered from surgery, Deborah thought of almost nothing except her prognosis. "I cried constantly. I was panicked," she says. "And I began to believe that the whole thing had been my fault. I decided the cancer on my skin had been a punishment for being so vain. And it had come back to my stomach because I had been too weak to keep it away. I had failed."
After two months, Deborah could no longer bear to stay alone with her thoughts. "I had to do something," she says. "I couldn't just give in and die. I felt a very strong need to find a way to fight back."
But there were no clear-cut ways in which she could fight back. Chemotherapy was not an option, because melanoma rarely responds to the standard drugs. "Chemotherapy can shrink some people's tumors, but only for maybe five to six months and that's all," explains Malcolm Mitchell, an oncologist who recently became director of the Center for Biological Therapy and Melanoma Research at the University of California at San Diego.
Lab technicians at Cedars-Sinai hospital had looked for some evidence that Deborah might be one of the rare patients chemotherapy could help. They placed fragments of her stomach tumor in test tubes and treated them with standard chemotherapy drugs. But the tumor cells proved resistant to the drugs. Radiation is also usually futile against melanoma, except to the extent that it can help alleviate pain.
So Deborah had the choice of doing nothing or trying an experimental therapy using a vaccine. "Nobody made any promises," she says. "Nobody offered any hope that a vaccine would keep me alive. But when you have a 4-year-old son and you're only 33 years old, you have to try something. Even if it was just to show Adam a positive attitude, even if it was just to give myself a little hope, I had to try something."
She signed up at the University of Southern California Medical Center in Los Angeles for a trial of an experimental vaccine against melanoma. The vaccine contained deactivated melanoma antigens, the parts of melanoma cells that are recognized by the human immune system, and BCG, a drug that boosts the immune system. The idea was to introduce enough melanoma antigens into Deborah's body to kill the melanoma.
In the years since Deborah started her experimental treatment, melanoma vaccines have turned out to be promising. Although they seem to help only about 20 percent of patients, Mitchell has found that in some cases tumors disappear and patients go on to live cancer-free for more than five years -some ten years or more.
The large scar that bisects her body was the result of surgery after the melanoma had metastasized. A surgeon removed the top two-thirds of Deborah’s stomach and part of her lower esophagus, then pulled up what was left of her stomach and attached it to her truncated esophagus.
But while vaccines appear to be safer than chemotherapy-which causes disabling nausea, hair loss, loss of appetite, diarrhea, and infections- they are not without side effects. Indeed, Deborah found the weekly treatment barely tolerable. Each week she would get 16 shots -4 placed a few inches below each armpit and 8 in a row across the top of her pubic hairline. "The shots hurt," Deborah says flatly, "and then afterward they would pus over and ooze an ugly yellow-green infection. It was awful. I had bandages everywhere, under both arms and across my stomach." Worse than the discomfort was Deborah's fear that the vaccine wouldn't work. "I didn't want to let anyone down, especially Adam, but I was afraid I couldn't pull it off. I felt so responsible for getting well, and not just well, but cured."
Meanwhile, friends realized that they couldn't provide all the support that Deborah needed. Several of them happened to see a segment on the Wellness Community on 60 Minutes and recommended the group to Deborah. At the Wellness Community in Santa Monica, cancer victims and their families hold weekly meetings to talk out strategies for living with cancer.
Looking back, Deborah says that enrolling in the Wellness Community "was probably the best thing I ever did. You know, when you talk to your friends and your family, everyone says 'I understand,' but they don't. The people at the Wellness Community really did understand because it was happening to them too. I could see that as soon as I went to my first meeting: It made me so emotional. I got up and said, 'My name is Deborah Shemesh, and I have...' and I just broke down."
One important theme that underlies the discussions at the Wellness Community, Deborah says, is that each person can fight back against cancer. "Cancer patients are sometimes helpless, hopeless, passive victims. But they tell you to fight for your own recovery, participate, fire your doctor if necessary. It might help you turn a corner, and even if it doesn't, it will make the life you have left more worth living."
Among the friends she made in her group was comedienne Gilda Radner, who had ovarian cancer. "She was like all the people there," Deborah says. "She always seemed to be as concerned with everyone else's trouble as with her own. She helped me find a new surgeon when I needed one, and she was always there to talk to me when I needed a friend." They would talk for hours on the phone "about cancer, about keeping up a good attitude. She told me I could never give up," recalls Deborah.
It's difficult to say to what extent Deborah's participation in the Wellness Community helped to keep her melanoma at bay. At least two psychological studies have indicated that cancer patients who join support groups can increase their survival time. And based on unscientific observation, many cancer physicians say they know it's important for patients to find strategies for establishing a positive outlook. But Deborah herself is convinced it made a difference. "I could feel the strength it gave me," she says.
In October, the dread six-month mark that the surgeon had forecast came and went, and Deborah felt a burst of confidence. "I had been counting the months, and suddenly there were none left to count," she says. "I felt damn lucky to be alive. But I was still worried about what would happen next."
She continued her weekly vaccine shots well into the next year-until the next spring, when a laparoscopy (a procedure in which doctors poke a slender scope into the abdominal cavity and look inside) revealed that the tumor on Deborah's right ovary had grown. The next thing she knew, she was again scheduled for surgery, to have her right ovary and Fallopian tube removed.
"My mother flew in from Chicago for this one," Deborah says, "and she had tears in her eyes when she saw me and hugged me. A few days before the surgery, Mom, my brother Mark, Adam, and I went to the park, and I sat on the swing with Adam crossed over face-to-face in my lap. Suddenly I felt so much at peace. I wanted to lock this moment of happiness into my memory so that if I felt any desire to give up, it would encourage me in some way to keep on fighting."
After the surgery, Deborah stopped her vaccine therapy. "I figured that the tumor on my ovary was proof that it wasn't working," she says. Once again she found herself in a hospital room with a doctor telling her to prepare for death. "My oncologist's words just kept echoing in my ears," she says. "Make plans to take care of your business now. Find a place for Adam."
Returning home after the surgery, she wrote in her journal, "I'm feeling awfully depressed, wondering why my cancer came back. I want to live. I want to see Adam's children. I want to live to be a hundred."
The doctor did give Deborah one ray of hope. She told her about an experimental program at the City of Hope National Medical Center in Duarte, about 20 miles east of Los Angeles, in which melanoma patients were being treated with the immunity-boosting drugs interleukin-2 and gamma interferon.
"I latched onto the idea right away," Deborah says. "I was so happy to have something else to try. I wanted to talk to other interleukin patients. I wanted to apply right away. I was scared because it seemed like it was my last hope."
Once Deborah was accepted into the program, she had to come up with the money to pay for it -$10,000, a cost not covered by insurance. She appealed to three women executives she'd met at ABC, and they set out to collect donations on her behalf.
"They worked out an incredible plan," Deborah says. "They sent around a letter saying Deborah Shemesh is in dire financial need. They said they would accept contributions as small as a dollar and on up to $200, and they raised $10,000. They were so wonderful. I still don't know if they realize how much I appreciate what they did."
In midsummer of 1988, she began the three-month therapy. The first week was spent entirely in the hospital, where doctors could monitor her body's reaction to the interleukin-2 and gamma interferon dripping into a vein in her arm. After that, a friend would drive her an hour and a half out to Duarte three afternoons a week for four-hour sessions with the drip.
"It started out easy, but they kept increasing the amount of gamma interferon and interleukin2, and it kept getting harder," Deborah recalls. "I got fevers. I was nauseous and constipated. I would sweat and get so weak I could hardly move."
When the doctors at City of Hope asked her to return for another 12-week session, she refused. "I just couldn't take it anymore," she says. "I also knew that the same therapy had been lethal to other people, and it had made me so weak I was afraid it might kill me too."
Interleukin-2 is believed to work by stimulating the body's production of T cells, white blood cells that orchestrate immune response. Although, like vaccines, interleukin-2 seems to help only about 20 percent of melanoma patients, those who do benefit show dramatic improvement. A small proportion of patients treated with interleukin-2 go into total remission. But, as Deborah learned, there are serious side effects. Capillaries begin to leak, leading to weakness in a number of organs -kidneys, lungs, liver, and heart- and, in some cases, to death. In recent years, medical scientists have sought to avoid such intense side effects by injecting patients not with interleukin-2 itself but with copies of the gene that makes interleukin-2 naturally in the human body. So far this approach seems to produce far fewer side effects.
The second drug Deborah was given, interferon, is believed to work by biologically flagging tumor cells, making them more recognizable to the immune system. Interferon, too, has proved to be useful in about 20 percent of cases. However, most of the successful experiments have been done with alpha interferon, not gamma interferon, which Deborah had.
Today she and her doctors suspect that her therapy was useful, that it may be the reason the growth on her pancreas disappeared. A laparoscopy done in the fall of 1989, a little more than a year after Deborah finished her treatment with interleukin-2 and gamma interferon, indicated that the tumor that had been growing on her pancreas was gone. Perhaps, too, her earlier vaccine therapy had strengthened her immune system, paving the way for the interleukin-2 to be effective.
Even as she took part in the interleukin program, Deborah followed her doctor's advice to get her affairs in order. She wrote her will, and she began searching for a family to adopt Adam. In September 1989 she received a letter from Marti Paskal, a woman who had heard of Deborah's plight through someone from the Wellness Community, a woman who offered to bring Adam into her family in case Deborah died. Marti and her husband, Joe, had five grown children and one little girl just Adam's age.
"I hope with all my heart that you are one of the cancer success stories," Marti wrote, "that you are able to raise your son yourself... If, though, you could still use another family-to help out when you're not feeling well, or if you're just feeling alone-please keep us in mind." Deborah read the letter over and over, crying.
So began a lasting friendship between the Paskals and Deborah and Adam. Over the years, they have spent countless weekends and holidays together. Deborah has not yet decided where Adam would go if she were to die-to his father, to the Paskals, or to her brother. Still, she says, "it's been very reassuring to know there is this wonderful, loving family out there, a family that Adam is comfortable with and that would take good care of him."
Deborah got a break for the first several months of 1991, but by fall a new problem was beginning. She was feeling intense pain high in her left thigh. "It felt exactly as if someone were sawing on my thighbone with a knife," she says.
X rays showed three small tumors growing in her femur close to her hip.
In November she began a nine-week course of radiation treatments, three doses a week. Radiation is rarely effective in shrinking melanoma tumors, but it is frequently used to ease pain, especially in bone metastases. And it can work to keep the tumors from growing larger. In Deborah's case, it took the pain away and stopped new growth.
The growths near her hip were the last measurable tumors Deborah had. For the past 2 1/2 years, she has been in remission. But that doesn't mean the end of her worries. At about the same time that the leg pain began, she began having blackouts. "I didn't know what they were at first," she says. "I just know I would suddenly wake up and find myself on the floor-in my bedroom or in the living room. It was difficult to explain it to my doctor."
In fact, these episodes -which turned out to be epileptic seizures- were not diagnosed until she had one in the hospital, where she was being treated for pneumonia, in the summer of 1991, when a girlfriend who was visiting watched her have one and called the doctor.
Deborah has continued to have seizures every couple of months or so when she is under stress. But for the most part, she controls them with Dilantin and tranquilizers.
In the late summer and early fall of 1992, Deborah began feeling intense pain in her abdomen. MRI scans showed no metastases there, but the pain kept getting worse. "I reached a point where the pain was so bad I really didn't care if I lived or died," she says. "That's when I finally got over my fear of dying. I was in such pain. I had no quality of life."
At that point, her oncologist, Barry Rosenbloom, fitted her with a portable morphine pump. It consisted of a two-pound reservoir that hung around her neck and a tube leading into her left arm. The pump delivered a continuous dose of morphine to keep the pain from building up. Three times a week a nurse would come to fill the tank.
Soon after getting the pump, Deborah moved to Kauai, Hawaii, to live with the Paskal family. Her bosses at ABC arranged for her to work at the local affiliate there. She lived there for one year, and in the middle of her stay she was able to switch from using the morphine pump to taking morphine pills.
But when she returned to Los Angeles last fall, Deborah's stomach pain intensified. This time Rosenbloom found that she had developed gallstones. In surgery, he removed 33 of them. It was, says Rosenbloom, an unfortunate fluke, a medical problem that appeared to have nothing to do with her cancer or the various treatments.
In the months since that operation, Deborah has regained her strength only gradually. "It feels like I never have any energy," she says. Friends have noticed that she is weakening.
Added to the sapping of her energy are other complications. When her convulsions started, she had to give up driving, which in Los Angeles is equivalent to house arrest. And Adam, at 11, needs more care. But Deborah has trouble getting his dinner, taking him to movies, to ball games. So recently she made a decision to move to San Francisco, where her brother Mark Schultz lives. There he can help manage both her affairs and Adam's.
She has given up, for now, the idea of any further treatments. "I don't think they worked that well for me," she says. "If they had, I wouldn't have had tumors on my ovary and my leg. Besides, I don't want to deal with the inconvenience."
Rosenbloom understands and endorses her decision. "There's no guarantee any of the experimental therapies would help," he explains. "Anyway, Debbie has her disease under control."
That is not to say he considers her cured. "Cured' means the cancer is gone, and it's never going to come back. She has melanoma. It's a peculiar disease, and every patient reacts differently to it. Debbie's body is somehow controlling the disease now, luckily for her. Her body has it down to some dull roar. But it sort of pokes its head through every so often. The expectation is that it will resurface again."
For the moment, Deborah can hope that her persistent leg pain and the continuing seizures do not signal any resurfacing. Indeed, the fact that she's had seizures for three years now with no tumors appearing on her brain scans is a good sign, because three years is plenty of time for a brain tumor to grow to a noticeable size.
But her weariness with the disease seems stronger every day. As she packed for the move to San Francisco, she came across a red Pendaflex file some four inches thick. "Look at this," she said, thumbing through the stack of papers, her eyes wide in awe at the sheer enormity of her medical history. "And these only go up to 1991.
"It's been an incredible ordeal, but it has changed me. I no longer take anything for granted. I appreciate every day, every meal. I appreciate every chance I get to see Adam."
Meanwhile, things seem to be going well in San Francisco. She has found a new oncologist. Her brother is glad to be helping. "We're planning our lives together," Mark says, "and I hope that will make her feel she has a secure future. In a couple of years, we're planning to move up north of the city and get a bigger house. I hope that gives her a long-range goal to shoot for.
"You know, she's my older sister. She took care of me all those years when we were kids. Now it's my turn to take care of her."
The view from her bedroom is spectacular. Because Mark's house is high on a hillside, her window looks out over the rolling Noe Valley, over rows and rows of pastel Victorian houses, now set aglow by the late-afternoon sunlight. But Deborah is too tired even to steal a glance. She lies back against the piles of pillows on her bed.
"I'm going to keep fighting, and I think this is the best place to do it. I'm very happy to be here now," she says. "I know I can count on Mark to be there for me. No matter what happens." •