The Big Chill—dedicated to Beth Ivy

By Nanette F. Santoro, MD

She is the first of my cohort to die. Age 46. Endometrial cancer.

We were childhood friends, both of us tomboys and somewhat misfits. We lived on the water in Long Beach, on a street that abutted the canals of Reynold's Channel. We grew up on rafts, rowboats, and dinghies with small 5 HP motors.

Beth was the friend who struck terror in my parents' hearts. Everyone has a friend like this—a unique chemistry wherein the two of you manage to synergize in a way that begets more trouble than either could accomplish individually. Beth's house was a menagerie of oddball pets: a toucan, two Chihauhas, two Great Danes, and two monkeys. When I'd run over after school, the din would be absolutely outstanding. Beth was the friend whose house I'd go to when I wanted to stay up all night. We'd sneak out the window, climb down a tree, and wind up on the beach, writing giant messages in the sand until dawn. One night, we pinched cigars from her father's humidor and surreptitiously puked quietly over the dock, into the water, while telling each other how fabulous cigar smoke was.

We used to cruise on my raft up and down the bulkheads of our canal, hunting for crabs, all Spring and Summer long. Crabbing involves a lot of patience and lying in wait. You've got to wait and be fast and decisive: if you give the little crustaceans a chance, they will take it. Beth was more agile than I, but what was most impressive was her sheer persistence. A crab that eluded her was never forgotten. She kept mental track of its direction of escape, and went after it again and again, until she caught it.

After high school, we pursued different interests: Beth became "Beth Ivy" and got into music. She grew closer to my younger sister, who shared her interests. We kept in touch when she moved to the West Coast, endured a disastrous marriage, divorced, moved back East, then West again. I always made time to see her when I was in her neighborhood and we always connected the way childhood friends do. In her early 40s she began to get some recording deals, and her musical career picked up, freeing her more and more from her "day job" as a dental hygienist.

In 1999, Beth was diagnosed with endometrial cancer. She called me, and I was surprised. She lacked all of the "risk factors" we gyns look for: she was slim, no history of glucose intolerance, had normal blood pressure, regular menses. I sent her to the two best gynecologic oncologists I knew for confirmation of the diagnosis and consideration of alternate therapies: she told me from the outset that she would never have a hysterectomy. I saw the writing on the wall when she complained about both of the doctors. I tried to talk her out of her denial, and to convince her to undergo the life-saving surgery that she needed. Knowing how strong-willed Beth was, I doubted I could convince her.

Beth began pursuing all sorts of holistic and "alternative" treatments for her cancer. She went on a strict, macrobiotic, "raw foods" diet, insisting that she felt great. She got thinner. I felt jealous. She got too thin. I got scared.

In the end, she developed bony metastases to her pelvis but told no one until she became critically ill. Her brother flew from New York and literally chased her into the hospital. By then, it was too late to do anything except control her pain for the last 10 days of her life.

Of course, the doctor part of my brain knew this would happen, was happening. Yet, my belief in my friend's ability to will her desires into reality put me into a more primitive emotional realm. Maybe she could beat the bad medical hand she had been dealt. Maybe the diagnosis was wrong.

A year before Beth died, she cut her first CD, "Survivor," which had some local success. My husband loved it. My kids still have the Dream Catchers she made for them. I have a rock I picked up from the ground at her gravesite. It sits inside a plant pot in my study.

DR. SANTORO is Professor and Director, Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, N.Y., and a member of the Contemporary OB/GYN Editorial Board. She is the Principal Investigator for two clinical trials: SWAN (Study of Women's Health Across the Nation) and KEEPS (Kronos Early Estrogen Prevention Study). Now in its 10th year, SWAN is the first multiethnic longitudinal study of the menopause ever done in the US. A 5-year study of hormone replacement therapy, KRONOS is aimed at providing prospective data on the risks and benefits of early menopausal hormonal intervention, particularly as it relates to the progression of atherosclerosis.

 

Nanette Santoro. Sign Out: The Big Chill--dedicated to Beth Ivy. Contemporary Ob/Gyn Jul. 1, 2004;49:108.