Nothing seemed to work, but his family and doctor refused to quit

08:51 AM EST on Monday, December 29, 2003

BY GERALD M. CARBONE
Journal Staff Writer

The doctor consulted all the experts nationwide. They told him: You can't save this kid.

He might be able to hold back the cancer for a while, but he had done everything possible.

So on Jan. 3, a Friday, Dr. Edwin Forman called the Fox family into his office at Hasbro Children's Hospital to break the bad news.

The family circled around the small, round table in the doctor's office; papers spilled across the table from a thick folder documenting Cory's yearlong fight with cancer.

This is what the mother, Louanne Fox, heard the doctor say: "I don't think we're going to be able to cure this."

The patient, Cory Fox, then 18, heard this: "It could be anywhere from three weeks to three months."

Louanne broke her own no-crying rule. Walking through the hospital corridors almost 12 months ago with her mother-in-law, she wiped at tears. "We're just going to have to pray a little louder and a little harder," she said.

To the Foxes, Forman had been a "grandfatherly" figure, at their side from the day of Cory's cancer diagnosis. With a white mustache and laugh lines around brown eyes, the man had been a source of comfort through the ups and downs of the past year. Even when treatments had failed, he always seemed to have a backup plan.

For nearly half of his 69 years, Forman had been helping kids with cancer at Hasbro; he was the director of pediatric hematology/oncology at Hasbro, but his office was a small, unpretentious place, and he never acted too busy to talk.

Forman had prescribed the best-known therapies for Cory's cancer, but a few lingering cells had developed an immunity to all the drugs he'd tried. Now those cells were sprouting new tumors throughout Cory's torso, his back and his lungs.

The doctor told the Foxes, "I might be able to cage the tiger" by prescribing an old class of drugs, the type they used to use more than 20 years ago. The old chemotherapies could retard cancer growth, but it was time to begin thinking about "palliative care," a euphemism for keeping Cory comfortable while his cancer killed him.

HOURS AFTER hearing his death sentence, Cory Fox went to the Friday night basketball game at the Cumberland High School gym. He had decided that he wouldn't do much different with the three weeks or three months that he had left. He'd "chill" with his best friends and girlfriend, Jennah Attwood, who had stayed with him through everything.

Journal photo / Kathy Borchers BEATING THE ODDS: Diagnosed with cancer during his senior year at Cumberland High School, Corey Fox, went through several different treatments of chemotheraphy before his doctor tried an outdated combination of drugs that worked.

At the basketball game, he got paid to run the clock, parceling out the seconds for a team to take a shot before time expired.

Louanne went to the game that night, too; just a year earlier Corey had been Cumberland's starting center, so she knew a lot of the parents and kids. As she broke the news that night to friends, she could not help but cry; through her tears she could see Cory, across the court, tracking the seconds.

Cory was Louanne and Michael Fox's only child. He'd grown to be tall -- 6 feet, 4 inches -- and had the passion to be a good basketball player.

But in January last year, Cory's senior year, his game began to slump. He complained that his back was killing him; growing pains, Louanne thought, and his pediatrician told him to take Motrin. The coach gave Cory less and less playing time, and it annoyed Mike to see his son sitting on the bench while senior season slipped away.

Then at breakfast on Sunday, Feb. 24, 2002, Cory Fox told his parents that he felt sick. His father, Mike, suspected that Cory was faking, trying to buy another day to write that senior term paper he'd been putting off.

Louanne Fox heard a wheeze in her 17-year-old son's breathing, and gave him the benefit of her doubt. Maybe he had pneumonia.

Cory knew that he wasn't faking; he folded his long legs in the passenger side of his mother's car, and he could feel a pain like knives in his lungs. He found that if he trained himself to breathe in shallow gulps he could tolerate the pain.

At a clinic in Johnston, they took x-rays. The negatives showed that fluid had flooded the lining around Cory's heart, engulfing it in a kind of water balloon. It was hard for his heart to beat against that fluid.

A doctor suggested that Cory should go to Hasbro Children's Hospital. Louanne grabbed her coat and purse, rushing to drive him. No, the doctor said, in an ambulance.

Louanne called Mike to tell him that their son, their only child, was being taken to Hasbro by ambulance with fluid around his heart. Boy, Mike joked, this kid would do anything to get out of writing that term paper.

Mike figured that Cory probably had an infection that a heavy dose of antibiotics could clear out in no time.

At around 5 p.m., the emergency room doctor stepped into the curtained area where the Fox family waited, and clipped Cory's x-ray to the lighted glass.

It looked to Mike like "a lot of cotton balls" were in that chest x-ray. "A lot them," he recalls, "like 60."

The doctor explained what they were: tumors. At 17, Cory Fox's torso was riddled with metastatic cancer.

In a single day -- Feb. 24, 2002 -- the Foxes' lives had gone from fretting about term papers and playing time to worrying whether Cory would live.

THE ODDS were in their favor, that's what Dr. Forman, told them.

When Forman first saw Cory, he saw a "good-looking, very tall kid who was full of life." He had a steady girlfriend, a strong family, and a good attitude -- qualities that could help him heal.

Cory had grown a testicular cancer, and had just never noticed the painless, tumescent swell of his right testicle.

The cancer had spread up through his abdomen, taken root in his back, and sprouted in his lungs.

"He had a snowfield of metastatic lesions in the lungs, and large effusion around his heart," Forman recalled. "His heart was surrounded by a bag of water, and the water was full of cancer cells."

Journal photo / Kathy Borchers Cory's mother, Louanne prayed and ordered a shirt for him that bore the image of Mother Teresa.

The results of Cory's blood work struck Forman as "dramatic" for the high counts of a cancer byproduct he saw in the blood. The type of tumors that grew in Cory leak into the blood a protein called Beta HCG; the blood of pregnant women holds high levels of this protein, but in healthy males the reading for Beta HCG should be less than 2.

Cory's level read more than 710,000. They had to bring this down, and fast.

Forman reminded the Foxes that bicyclist Lance Armstrong had won the Tour de France, several times, after losing a testicle to cancer. But, he said, "Cory's is a little bit of a different kind" of cancer. With Armstrong's testicular cancer, the cure rate was about 90 percent; with Cory's cancer, choriocarcinoma, the rate of cure initially was about 60 percent to 65 percent.

Forman prescribed the best therapy known: a mix of three drugs that would kill cancer cells, but would also kill healthy cells. Cory would need four to six treatments with these drugs, and each treatment required a week of hospitalization followed by long bouts of sickness at home. He warned the Foxes that this new class of chemotherapy could be highly toxic; the drugs are poison.

After his first round of chemotherapy, Cory went home and showered. As he lathered, clumps of hair came out in his palms.

His mother remembers opening the door to the basement TV room, and seeing her tall, teenaged son crawl past on the floor. Standing made him dizzy.

The chemo made him vomit until he had nothing left in his stomach, and then he'd heave some more. Sometimes he'd fall asleep in front of the toilet.

In one month, after two chemotherapy treatments, Cory's weight dropped from 190 pounds to 130. His cheeks were sunken and sallow. All of his hair dropped out, even his eyebrows. He took to smoking marijuana to ease the nausea, to restore his appetite. The herb was the only drug that worked.

In February, he had been a starter on the varsity basketball team, taller and stronger than most of his peers. Now, a month later, he was the kid with cancer -- bald, sunken-cheeked, too weak to stand. Time spent among friends could sometimes provide a brief respite, could make him feel normal. But every time he looked in the mirror he was reminded again.

THE RESULTS of Cory's blood work came on March 21, 2002. His Beta HCG level -- what his mother calls "the cancer count" -- had dropped to 15,108. Every couple of weeks, the clinic would call Louanne Fox with the latest numbers. She'd sit on the hardwood floor in front of her unlit fireplace with her cell phone beside her, waiting sometimes hours for that call. While she waited she strung beads and medallions, making beautiful rosary beads that she'd give to families she met at the Hasbro clinic.

While most of Cory's classmates were worrying about their SAT scores and where they'd go to school after graduation, his focus was on his cancer count -- and whether he'd live.

The second count was not good, the number had increased slightly; the third one dropped dramatically to 665; just before Cory's graduation from Cumberland High, he got his best reading, 453.

Then the count began a climb: 498, 580, 2,584.

The toxic treatments had been in vain. The best cancer drugs available were not working. Cory's cancer cells had grown resistant to them; it was a matter of time before the tumors came marching back.

Even though the numbers weren't promising, Cory continued treatment. His attitude surprised his parents; they just never knew how tough and resilient he was.

One day in summer 2002, when the cancer was growing even as the chemo coursed through his blood, Cory put on his best khakis and a button-down shirt so he'd look good for dinner at an Olive Garden restaurant with his girlfriend and her parents.

Louanne dropped him off at Jennah's, and watched as he tottered up the walkway in his stiff khakis. Suddenly he listed to one side; he fainted, dropping into the bushes.

Louanne, his mother, was crushed. He'd been looking forward to this night out. Now his clothes were muddy and full of needles from the shrubs. It looked like the night was done.

Cory came to, and she helped pull him to his feet. He got his bearings; and then he laughed. Instead of crawling back to his bed in shame and embarrassment, he found it funny that he'd passed out at his girlfriend's house. He went home, changed, then went out to eat with the Attwoods.

THROUGH AUGUST 2002, the cancer count continued to rise: 4,633, 5,643.

The Make A Wish Foundation asked Cory what he'd like. He told them he wanted a car stereo with two, 15-inch woofers, two speakers, amplifiers for both the woofers and the speakers. The Foundation delivered, and everything was top of the line. It made Cory happy just to sit in that car with the bass vibrating in the pit of his stomach.

At the end of August, Forman reached into his bag of tricks for one more proven therapy: a dose of cancer-killing drugs that was so strong it could kill a man by destroying his bone marrow.

Before they could drip these drugs into Cory's blood, doctors at Massachusetts General Hospital would have to remove some of Cory's bone marrow, freeze it, then give it back to him after the chemo ran its course. The drugs were so toxic that they could destroy nerve endings. The doctors had to do this "autologous bone marrow transplant" not once, but twice.

On Sept. 2, the night before his first bone-marrow transplant, Cory and Jennah took the train to Boston to shop and have fun. He parked his car at the South Attleboro train station; when he returned to the parking lot that night, he saw his parking slot was empty. Thieves had stolen his car.

Cory smiled. He liked that car, with its top-of-the-line stereo; but compared with his other problems the theft seemed small and absurd. Police soon found the car, a black Jeep Cherokee, in Central Falls, stripped of even its spare tire.

EACH BONE marrow treatment required 21 days of isolation. Until the marrow grew back, his count of white blood cells would be low, his risk of infection high. The few visitors he could see had to wear shower caps, gowns, gloves, and bags over their shoes.

Twenty-one days in the same bed in the same room. Again he felt the nausea. These drugs had damaged nerves in his feet; sharp pains pulsed from Cory's soles. The doctors prescribed OxyContin for the pain.

Cory came home in late October, just before the clinic called with his latest cancer count: 45. The lethally high doses of chemotherapy had not knocked out his cancer.

On Nov. 6, the count was 410; in December, it was 512. On Jan. 2, 2003, Forman saw the results: 15,859, and he knew it was time to tell the Foxes that Cory could not be cured.

Forman has a reputation around Rhode Island Hospital as being a doctor who gives bad news well. He teaches the residents how to deliver bad news because, as an oncologist, he's been doing it for much of his life.

"I always like to keep an element of hope in it, if I can," Forman said recently. "But sometimes I worry that I'm being too optimistic."

With the Foxes, he'd be completely candid. A doctor he respected had just published an article in the New Yorker, making a strong argument that doctors had to sow the seeds of reality when giving bad news. They had to begin the process of shutting down hope; they had to begin a discussion of palliative care.

What he remembers telling the Foxes is: "I cannot cure you. But I think I can cage the tiger."

Forman had pulled old charts from the 1980s to refresh his memory on the kinds of drugs they used then, when he was in middle age. He said these might retard the growth of Cory's cancer for a while.

Mike Fox, the father, remembers Forman saying that maybe they could extend Cory's life long enough for a new breakthrough in oncology.

Forman tried to turn the subject to palliative care. He said he was willing to treat Cory for as long as his body could take it; but what then?

Louanne said she didn't want to discuss it. They'd try these old drugs and they'd continue praying for a miracle.

That night Cory's grandmother, Karen Fox, called a sister in California who said she'd read an article about a mother who cured her son's cancer by placing a picture of Mother Teresa over the tumor.

The next day, Louanne went to the mall, where she had a photograph of Mother Teresa printed on a tank top. When she told Cory to put it on, he gave her "one of those looks," but for her sake he wore it daily, even to chemo treatments and to bed, taking it off only long enough for his mother to wash it.

Neither Mike nor Cory did much praying; they figured Louanne was doing enough for them both. Cory found an outlet in writing and performing hip-hop songs. He discovered a "hunger" for writing in what promised to be his waning days. In a piece he called "End of the Book," Cory wrote:

I'm sure it's not too long before I'm gone and they bury me/

My body isn't tough enough to handle chemotherapy/

Thanks to everybody for the cards that you sent me/

I hope you can visit me sometime at the cemetery.

ABOUT A week after Forman treated Cory with a concoction of old chemotherapy drugs, his cancer count fell from more than 15,000 to 5,579. On Jan. 21, 2003, Louanne sat on the floor, praying and stringing rosary beads while awaiting the latest count: 3,400.

Two weeks later, it was 117. On Feb. 24, 6; 3 days later, 5.

On March 19, as daylight pushed winter darkness into the margins, Louanne waited for the count with her mother-in-law, Karen Fox. Forman's assistant, Patricia Flynn called Louanne.

"Less than two," Flynn said.

"Less than two?"

"Undetectable." Flynn paused. "Undetectable."

Louanne and Karen Fox jumped up and down, crying and dancing an impromptu jig.

Subsequent testing confirmed it: Cory's cancer was gone.

X-rays still show shadows in Cory's lungs. "We think that's dead tissue," Forman said. "That's dead cancer."

The lesson that Forman will take from Cory's case is: "Number one, never take away hope completely, because you just don't know everything about life," he said. "No physician should be so arrogant as to say there's no hope."

Forman said he has no good explanation for why an old class of drugs that had little success in curing cancer clicked in Cory's case.

"It's either luck or God calling on us," he said.

LOUANNE CREDITS Cory's cure to both medicine and miracle. The miracle, she feels, was what gave Forman the inspiration to concoct the right mix of medicines.

Cory has seen some changes in himself. His hair is growing back, and he's working with light weights to build his strength.

His dream now is to be a hip-hop recording artist; with his buddy, Cory Nolan, he performs as Skrach and Sniff. But he has a fallback plan.

Before his cancer he wanted to be a cop; now he attends the Community College of Rhode Island, where he's learning to become a radiology technician, specializing in pediatrics. He met a lot of sick children in his time at Hasbro; they seemed to be drawn to him, the big guy who was one of them. He thinks he'll be good at that, working with sick kids.

A few weeks ago, Cory's father caught him in the basement sucking crushed OxyContin pills up his nose through a straw. After a confrontation, Cory confessed to an addiction. He went through a detoxification program at Butler Hospital that hurt as much as the chemotherapy; now he takes a different painkiller to quell the agony in his feet, and some methadone to wean himself from the OxyContin.

As a new year approaches, Cory Fox has resolved only to make no resolutions. A resolution, he says, presumes too much; he can't tell you what he'll do tomorrow. He knows only that there are no guarantees.