It's Not About the Bike: My Journey Back to Life (10 page)

after a six-hour ride at a high pain threshold, you feel at peace. The pain is so deep and strong that a curtain descends over your brain. At least for a while you have a kind of hall pass, and

don’t have to brood on your problems; you can shut everything else out, because the effort and subsequent fatigue are absolute.

There is an unthinking simplicity in something so hard, which is why there’s probably some truth to the idea that all world-class athletes are actually running away from something. Once,

someone asked me what pleasure I took in riding for so long. “Pleasure?” I said. “I don’t understand the question.” I didn’t do it for pleasure. I did it for pain.

Before the cancer, I had never examined the psychology of jumping on a bicycle and riding for six hours. The reasons weren’t especially tangible to me; a lot of what we do doesn’t make sense

to us while we’re doing it. I didn’t want to dissect it, because that might let the genie out of the bottle.

But now I knew exactly why I was riding: if I could continue to pedal a bike, somehow I wouldn’t be so sick.

The physical pain of cancer didn’t bother me so much, because I was used to it. In fact, if I didn’t suffer, I’d feel cheated. The more I thought about it, the more cancer began to seem like a race

to me. Only the destination had changed. They shared grueling physical aspects, as well as a dependence on time, and progress reports every interval, with checkpoints and a slavish reliance

on numbers and blood tests. The only difference was that I had to focus better and harder than I ever did on the bike. With this illness, I couldn’t afford impatience or a lapse in concentration; I

had to think about living, just making it through, every single moment. The idea was oddly restorative: winning my life back would be the biggest victory.

I was so focused on getting better that during that first round of chemotherapy, I didn’t feel anything. Nothing. I even said to Dr. Youman, “Maybe you need to give me more.” I didn’t

realize that I was extremely lucky in how my body tolerated the chemo. Before it was over I would meet other patients who had uncontrollable vomiting after the first cycle, and by the end

of my own treatments I would experience a nausea that no drug could get a grip on.

The only thing that suffered at first was my appetite. When you undergo chemotherapy, things taste different because of the chemicals in your body. My mother would fix me a plate of food,

and she’d say, “Son, if you’re not hungry and you don’t want to eat this, it won’t hurt my feelings.” But I tried to eat. When I woke up from a nap, she would put a plate of sliced fruit

and a large bottle of water in front of me. I needed to eat so I could keep moving.

Move, I told myself. I would get up, throw on my warmup clothes, put my Walkman on, and walk. I don’t even know how far. I’d walk up the steep hill and out of the front gates, and trudge

on up the road.

As long as I could move, I was healthy.

Within days, the Porsche was gone. I did it for two reasons, first and foremost because I thought I might need every dime for my treatment, and I’d have to live on what was left for the rest of

my life. But I think, too, that I was beginning to need to simplify things.

A COUPLE OF DAYS AFTER I STARTED CHEMO,WE OPENED

a notification letter from the hospital: Our records show that you have no health insurance.

I stared at the letter, uncomprehending. That wasn’t possible. I had a health plan with Motorola, and I should have been fully covered. Irritated, I picked up the phone and called Bill Stapleton

to read him the letter. Bill calmed me down, and told me he would check into it.

A few hours later, Bill called back. It was a lousy piece of timing, he said. I was in the midst of changing employers, and although my contract with Cofidis had taken effect, the cancer was a

preexisting medical condition, for which I was not covered by the Cofidis group plan. My insurance with Motorola had expired. I would have to pay for hospitalizations and the

treatments myself, unless Bill could figure something out.

I had cancer, and I had no health insurance.

A lot of terrible realizations hit me one after another in those first few days, and this was only a material matter. Still, it was potentially ruinous. I looked around my house, and started thinking

about what to sell. I was wiped out financially, I assumed. I had just gone from making $2 million a year, to nothing. I had some disability insurance, but that was about it. I would have no

income, because the companies that sponsored me or paid me would cut me off, surely, since I couldn’t race. The Porsche that I so treasured now seemed like an item of pure decadent

self-indulgence. I would need every penny to pay the medical bills. I started planning the fire sale. I’d get rid of the Porsche, and some art, and a few other toys.

I BECAME A STUDENT OF CANCER. I WENT TO THE

biggest bookstore in Austin and bought everything there on the subject. I came home with ten different volumes: diet books, books on coping emotionally, meditation guides. I was willing to

consider any option, no matter how goofy. I read about flaxseed oil, which was supposed to be “a true aid” against arthritis, heart infarction, cancer, and other diseases. I read about soy

powder, a “proven anti-cancer fighter.” I read Yoga Journal, and became deeply if only momentarily interested in something called The Raj, “an invitation to perfect health.” I tore out

pages of Discover magazine, and collected newspaper stories on far-off clinics and far-fetched cures. I perused a pamphlet about the Clinic of the Americas in the Dominican Republic,

describing “an absolutely certain cure for cancer.”

I devoured what Bart had given me, and every time he called, I said, “What else you got?” I had never been a devoted reader, but now I became voracious. Bart went to Amazon.com and

cleaned them out on the subject. “Look, do you want me to feed you what I find?” he asked.

“Yeah, I want everything. Everything, everything.” Here I was, a high-school graduate who’d received an eclectic education in Europe, and now I was reading medical journals. I had always

liked to study financial magazines and architectural-design magazines, but I didn’t care much for books; I had an impossibly short attention span and I couldn’t sit still for that long. Now all of a

sudden I had to tackle blood counts and basic oncology. It was a second education, and there were days that I thought, Well, I might as well go back to school and try to

become a doctor, because I’m becoming so well-versed in this.

I sat on the sofa flipping through books, talking on the phone, reading off numbers. I wanted to know exactly what my odds were, so I could figure out how to beat them. The more research I

did, the better I felt my chances were–even though what I was reading suggested that they weren’t very good. But knowledge was more reassuring than ignorance: at least I knew what I

was dealing with, or thought I did anyway.

There was an odd commonality in the language of cancer and the language of cycling. They were both about blood. In cycling, one way of cheating is to take a drug that boosts your red

bloodcell count. In fighting cancer, if my hemoglobin fell below a certain level, the doctors would give me the very same drug, Epogen. There was a baseline of numbers I had to meet in

my blood tests, and the doctors measured my blood for the very same thing they measured in cycling: my threshold for physiological stress.

I mastered a whole new language, terms like ifosfamide (a chemotherapy drug), seminoma (a kind of tumor), and lactate dehy-drogenase (LDH, another blood marker). I began to throw

around phrases like “treatment protocol.” I wanted to know it all. I wanted second, third, and fourth opinions.

I began to receive mountains of mail, get-well cards, best wishes, and off-the-wall suggestions for cures, and I read them all. Reading the mail was a way to keep from brooding, so in the

evenings Lisa and my mother and I would sort through the letters, and answer as many as possible.

One evening, I opened a letter with an embossed letterhead from Vanderbilt University’s medical center. The writer was a man named Dr. Steven Wolff, the head of the bone-marrow

transplant department. In the letter, Dr. Wolff explained that he was a professor of medicine and an oncologist, as well as an ardent cycling fan, and he wanted to help in any way he could. He

urged me to explore all the various treatment options, and offered to be available for any advice or support. Two things about the letter drew my attention; the first was Wolff’s obvious cycling

knowledge, and the other was a paragraph that urged me in strong terms to get a second opinion from Dr. Larry Einhorn himself at Indiana University because he was the foremost expert on the

disease. Wolff added, “You should note that there are equally effective chemotherapy treatments that could minimize possible side effects to not compromise your racing capabilities.”

I picked up the phone and dialed Wolff. “Hi, this is Lance Armstrong,” I said. Wolff was taken aback, but he recovered quickly, and after we exchanged a few pleasantries, he began a hesitant

inquiry about my treatment. Wolff explained that he was reluctant to encroach on the authority of my doctors in Austin, but he wanted to help. I told him that I was on the standard treatment

protocol for testicular cancer with lung metastasis, BEP.

“My prognosis isn’t good,” I said.

From that moment on, my treatment became a medical collaboration. Previously, I thought of medicine as something practiced by individual doctors on individual patients. The doctor was

all-knowing and all-powerful, the patient was helpless. But it was beginning to dawn on me that there was nothing wrong with seeking a cure from a combination of people and sources, and

that the patient was as important as the doctor. Dr. Reeves was my urologist, Dr. Youman my oncologist, and now Dr. Wolff became my friend and treatment advocate, a third medical eye

and someone to whom I could turn to ask questions. Each doctor involved played a crucial role. No one person could take sole responsibility for the state of my health, and most important, I

began to share the responsibility with them.

“What’s your HCG level?” Wolff asked me.

HCG is the endocrine protein that stimulates women’s ovaries, I had learned, and it was a telling blood marker because it should not be present in healthy males. I shuffled through the papers,

looking at the various figures. “It says a hundred and nine,” I said.

“Well, that’s high,” Wolff said. “But not extraordinary.”

As I stared at the page, I saw another notation after the number.

“Uh, what’s this ‘K’ mean?” I asked.

He was silent for a moment, and so was I.

“It means it’s a hundred and nine thousand,” Wolff said.

If a count of 109 was high, then what was 109,000? Wolff began to ask me about my other marker levels, AFB and LDH. I shot questions back at him. “What does this mean?” I asked

bluntly.

Wolff explained that there was too much HCG in my body, even with the lung tumors. Where was it coming from? He gently suggested that perhaps I should explore other therapies, more

aggressive treatment. Then he let me have it: the HCG level automatically put me in the worst prognosis category.

Something else bothered Wolff. Bleomycin was extremely toxic on the liver and lungs, he explained. In his view, treatment was very personal; what might be right for one patient wasn’t

necessarily right for another, and for my case, bleomycin might be the wrong choice. A cyclist needs his lung capacity the way he needs his legs, and prolonged exposure to bleomycin would

almost certainly end my career. There were other drugs, Wolffe suggested. I had choices.

“There are some guys who are the world’s best at treating this,” Wolff said. He told me he was a friend of Einhorn and the other oncologists at the Indiana University medical center in

Indianapolis. He also recommended two other cancer centers–one in Houston and one in New York. Moreover, he offered to arrange consultations for me. Immensely relieved, I accepted.

Once again, my mother leaped into action. By the next morning, she had gathered all of my medical records and faxed them to Houston and Indianapolis for the consults. I was out riding

my bike at about 10 A.M. when a reply came from the Houston facility. Two doctors were on a conference call, both oncologists. My mother listened to two disembodied voices as they

discussed my case with her.

“We’ve reviewed the information,” one said. “Why haven’t you had an MRI done on the brain?”

“Well, why would we need that?” my mother asked.

“His numbers are so high that we believe he has it in his brain, too,” he said.

“You gotta be kidding me,” my mother said.

“Normally when we see numbers like that, it’s because it’s in the brain. We feel he needs more aggressive treatment.”

Stunned, my mother said, “But he just started chemotherapy.”

“Look,” one of them said. “We don’t think your son is going to make it at this rate.”

“Don’t do this, okay?” she said. “I have fought for this child my entire life.”

“We feel you should come down here immediately, and start treatments with us.”

“Lance will be back in a little while,” my mother said, shakily. “I’ll talk to him, and we’ll call you back.”

A few minutes later, I walked in the door, and my mother said, “Son, I’ve got to talk to you.” I could see that she was a wreck, and I had that familiar sinking sensation in my stomach. As my

mother tremulously summarized what the doctors had said, I didn’t respond, I just sat there silently–it seemed like the more serious matters grew, the quieter I became. After a minute, I

calmly told her that I wanted to talk to the doctors myself, and hear what they had to say.

I called them back, and I listened as they reiterated what they had already told my mother. Wearily, I told them that I wanted to go to Houston and see them as soon as possible. After I