Illness in the Public Eye News spread quickly on Tuesday when doctors announced that Senator Ted Kennedy had a malignant brain tumor. Guests and callers discuss the difficult decisions public figures and their families must make when faced with serious health problems.
NPR logo

Listen to this 'Talk of the Nation' topic

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript
Illness in the Public Eye

Illness in the Public Eye

Listen to this 'Talk of the Nation' topic

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript

Elizabeth Edwards and Sen. Ted Kennedy (D-MA) pictured together on May 8 at a hearing on "Cancer: Challenges and Opportunities in the 21st Century." Kennedy was diagnosed with a malignant brain tumor just weeks later. Tim Sloan/AFP/Getty Images hide caption

toggle caption
Tim Sloan/AFP/Getty Images

Elizabeth Edwards and Sen. Ted Kennedy (D-MA) pictured together on May 8 at a hearing on "Cancer: Challenges and Opportunities in the 21st Century." Kennedy was diagnosed with a malignant brain tumor just weeks later.

Tim Sloan/AFP/Getty Images

'Saving Graces'

Read an excerpt from Saving Graces, Elizabeth Edwards' book about dealing with private losses in public.

News spread quickly on Tuesday when doctors announced that Senator Ted Kennedy had a malignant brain tumor. Like other public figures who have faced serious health problems, Kennedy will have to handle his condition in the public spotlight.

Some celebrities grappling with serious diagnoses do their best to preserve their privacy, while others choose to use public interest in their illness as an opportunity for outreach and education.

Elizabeth Edwards, wife of 2004 Democratic vice presidential nominee John Edwards, talks about her experience being diagnosed with breast cancer just weeks before the presidential election. In her book, Saving Graces, she chronicles what it's like to deal with personal health issues under the watchful public eye.

Dr. Barron Lerner, professor of medicine and public health at Columbia University Medical Center, talks about his book, When Illness Goes Public: Celebrity Patients and How We Look at Medicine.

Understanding Sen. Kennedy's Cancer Diagnosis

Understanding Sen. Kennedy's Cancer Diagnosis

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript

Massachusetts Sen. Edward Kennedy was diagnosed with a malignant brain tumor Tuesday after a related seizure sent him to the hospital over the weekend.

The 76-year-old senator was transported to Massachusetts General Hospital in Boston following the incident at his Cape Cod home. In a statement released by the Kennedy family, the seizure was attributed to a malignant glioma, a type of brain cancer.

Dr. Andrew Norden of the Dana-Farber Cancer Institute in Boston spoke with Michele Norris about possible treatments and the prognosis in Sen. Kennedy's situation.

What is a glioma?

It's a primary brain tumor, meaning it starts in the brain. It's not the kind of brain cancer that's spread by metastasis from another organ. Gliomas are the most common primary brain tumors in adults. When they are malignant, they can be quite difficult to treat. We see about 10,000 to 15,000 of them newly diagnosed in the U.S. each year.

What are the treatment options?

It's difficult to say for sure which treatment would be recommended for the senator because there are a number of different types of malignant gliomas and we don't yet know which type he has. But in general, the treatment consists of radiation and chemotherapy, given together for six weeks. Then there is a brief treatment break, followed by chemotherapy alone, in monthly cycles for six to 12 months.

The chemotherapy usually used for gliomas is an oral chemotherapy called temozolomide. It's well-tolerated by most patients.

Would there be an effort to remove it by surgery?

Yes, I think so. Typically, treatment for this type of tumor begins with maximal surgical resection. What that means is that a surgeon tries to take out as much of the tumor as can be safely done without causing the patient any harm. We don't know what kind of surgery the senator has had, but I imagine an attempt at a surgical resection was undertaken.

Would age be a factor, since the senator is 76?

Age is a factor. We know that on average older patients — which means over 80 in this population — don't have as favorable of outcomes as younger patients do. That said, there are older patients who do quite well, particularly healthy ones. And my understanding of the senator's current medical condition is that it's quite good, so I would expect him to do better than average.

Has the senator already undergone surgery?

He has. We know that he has had a biopsy according to the press release. It's difficult to know what is meant by the term biopsy in this situation, but every biopsy involves at least taking a piece of tumor to a pathologist to review and determine the type.

The tumor is said to be in the left parietal lobe. What does that tell you about prognosis and function, since this lobe controls sensory comprehension and visual control?

In general, the left parietal lobe is thought to be primarily important for sensory function on the right side of the body and also for visual sensation on the right. Because the parietal lobe is rather large and because every individual has somewhat different brain anatomy, it's very difficult to say in any individual case exactly what might be affected.

It's certainly possible to have a tumor in that location that causes no symptoms whatsoever; it's possible to have a tumor in that location that causes only occasional seizures, which might be managed with medication; or it's possible to have a tumor in that location that causes very significant numbness of the right side of the body and perhaps some difficulty seeing off to the right side. So without examining an individual patient it's difficult to determine, but those are the spectrum of things one might see.

What about speech?

In general, with a tumor in the parietal lobe, one would not expect significant speech difficulties. The speech centers are generally thought to be in the bottom portion of the frontal lobe and the top portion of the temporal lobe. One troubling problem with brain tumors, though, is they tend to have a fair amount of surrounding swelling.

So if this tumor in the left parietal lobe has some swelling involving speech areas, either in the frontal or temporal lobes, then it's possible to have difficulty either with expressive speech — finding words or simply getting fluent sentences out — or to have difficulty understanding speech, either spoken or written. But, again, one would need to examine an individual to determine if those deficits are present, and it's possible one would have no symptoms at all.

Because of high blood flow to the brain, is there worry that the tumor might be fast growing?

In general when one speaks of a malignant glioma, which is what they're calling Sen. Kennedy's tumor, we're talking of a tumor that is fast growing. Gliomas are graded on a scale of 1 to 4 by the World Health Organization, and grades 3 and 4 are also called malignant gliomas. That doesn't mean that they spread, but that they have the potential to grow quickly.

The most common gliomas are grade 4 tumors, which are called glioblastomas. But until we have a final pathology report, I don't think we'll know if that's the diagnosis.

The Kennedy family has reported that Sen. Kennedy has had no further seizures, is in good overall condition, and is up and walking around. What does that tell you?

That's a good sign. It indicates he hasn't had any serious consequences of the surgery. It also indicates that any swelling around this tumor is in reasonably good control. I suspect he's on medication to control swelling and also on medication to prevent further seizures. The fact that he's able to be up and about, watching television, which I understand he did over the weekend, indicates that he has made a good recovery, and I suspect he may be ready to leave the hospital in the next few days.

Questions and answers have been edited for content and clarity.

Excerpt: 'Saving Graces'

'Saving Graces' Cover

My face was tilted toward the stream of water from the shower-head. Water spilled from the corners of my closed eyes as my fingers outlined the unfamiliar lump in my right breast. Around and around again, I traced its edges. Try as I might, it wouldn't go away. How could I have missed something this size when I showered yesterday? Or the day before? Or ... but it didn't matter. I'd found it today, this lump, firm and big on the side of my breast. I kept my eyes closed and finished rinsing my hair.

Until that moment — until the lump — October 21, 2004, was meant to be an ordinary day, if such a thing can exist on a campaign trail two weeks before a presidential election. An 11:00 A.M. town hall meeting at the Kenosha United Auto Workers hall. A rally later that day in Erie, Pennsylvania. Scranton in time for dinner, and Maine by sunrise the next morning. I would speak to at least two thousand people, prepare to tape a segment for Good Morning America, discuss Medicare premiums with senior citizens, talk college tuition with parents, and, if it was a very good day, influence at least a few undecided voters. Just another ordinary day.

But I had learned long ago that it was typically the most ordinary days that the careful pieces of life can break away and shatter. As I climbed out of the shower, I heard the door to my hotel room click shut. I knew instantly who it was, and I was relieved. "Hargrave," I called out from the bathroom, wrapping myself in a towel, "come feel this." Hargrave McElroy was my dear friend of twenty-three years, my daughter Cate's godmother, a teacher at the high school my children had attended, and now my assistant and companion on the road. She had agreed to travel with me after John had been named the Democratic vice presidential nominee. I had previously chased away a couple of well-intentioned young assistants who aroused my desire to parent them instead of letting them take care of me, which was wearing me out. I needed a grown-up, and I asked Hargrave to join me. She had no experience on campaigns, but she was a teacher and what's more, the mother of three boys. That's enough experience to handle any job. Choosing Hargrave was one of the best decisions I would make. She instinctively knew when to buy more cough drops, when to hand me a fresh Diet Coke, and, I now hoped, what to do after one discovers a lump in her breast.

Hargrave pressed her fingers against the bulge on my right breast, which felt as smooth and firm as a plum. She pressed her lips together and looked at me directly and gently, just like she was listening to a student in one of her classes give the wrong answer. "Hmmm," she said, calmly meeting my eyes. "When was your last mammogram?"

I hated to admit it, but it had been too long, much too long. For years, I had made all the excuses women make for not taking care of these things — the two young children I was raising, the house I was running. We had moved to Washington four years earlier, and I had never found a doctor there. Life just always seemed to get in the way. All lousy excuses, I knew, for not taking care of myself.

"We better get that checked out as soon as we can," Hargrave said.

I had a feeling she meant that very morning, but that was not going to be possible. We had less than two weeks before the election. Undoubtedly people had already gathered in the union hall to listen to the speakers scheduled before me, and there were young volunteers setting up for a town hall in Erie, and — as the King of Siam said in the musical — "et cetera, et cetera, et cetera." My lump would have to wait; the ordinary day would go on as scheduled. Except for one thing. Today, I planned to go shopping.

The previous evening, I had spotted an outlet mall on our way to the hotel. We had spent the night in a Radisson — a fact I discovered that morning when I read the soap in the bathroom. Since I started campaigning, it had been a different hotel in a different city each night. We would arrive late, traveling after it was too late to campaign, and we would enter and exit most hotels through the same back door used to take out the trash. Unless the trash dumpster bore the name of the hotel, I'd figure out where we were only if I remembered to look at the soap in the bathroom.

As soon as we spotted the outlets, Hargrave, Karen Finney — my press secretary — and I started calculating. The stores would open at ten, and it was a ten-minute drive to the UAW hall. That left about forty-five minutes to shop. It wasn't a lot of time, but for three women who hadn't been shopping in months, it was a gracious plenty. Despite the lump and everything it might mean, I had no intention of changing our plan. We had all been looking forward to the unprecedented time devoted to something as mindless, frivolous, and selfish as shopping. The clothes I had in my suitcase that day were basically the same ones I had packed when I left Washington in early July, and it was now nearing November in Wisconsin. It was cold, I was sick of my clothes, and, to be honest, I wasn't particularly concerned about the lump. This had happened before, about ten years earlier. I had found what turned out to be a harmless ¿brous cyst. I had it removed, and there were no problems. Granted, this lump was clearly larger than the other, but as I felt its smooth contour, I was convinced this had to be another cyst. I wasn't going to allow myself to think it could be anything else.

In the backseat of the Suburban, I told Hargrave how to reach Wells Edmundson, my doctor in Raleigh. With the phone pressed to her ear, she asked me for the details. No, the skin on my breast wasn't puckered. Yes, I had found a small lump before.

At the Dana Buchman outlet, I looked through the blazers as Hargrave stood nearby, still on the phone to Wells. I spotted a terrific red jacket, and I waved to Hargrave for her opinion. "The lump was really pretty big," she said into the phone while giving me a thumbs-up on the blazer. There we were, two women, surrounded by men with earpieces, whispering about lumps and flipping through the sales rack. The saleswomen huddled, their eyes darting from the Secret Service agents to the few customers in the store. Then they huddled again. Neither of us looked like someone who warranted special protection — certainly not me, flipping through the racks at manic speed, watching the clock tick toward 10:30. Whatever worry I had felt earlier, Hargrave had taken on. She had made the phone calls; she had heard the urgent voices on the other end. She would worry, and she would let me be the naive optimist. And I was grateful for that.

She hung up the phone. "Are you sure you want to keep going?" she asked me, pointing out that our schedule during the remaining eleven days until the election entailed stops in thirty-five cities. "It could be exhausting." Stopping wasn't going to make the lump go away, and exhaustion was a word I had long ago banished from my vocabulary.

"I'm fine," I said. "And I'm getting this red blazer."

"You're braver than I am," she told me. "From now on, I will always think of that blazer as the Courage Jacket." Within minutes, she was back on the phone with Kathleen McGlynn, our scheduler in D.C., who could make even impossible schedules work, telling her only that we needed some free time the next Friday for a private appointment.

While I bought a suit and that red jacket, Hargrave set up an appointment with Dr. Edmundson for the next week, when we were scheduled to return to Raleigh. Through the phone calls and despite her worry, she still found a pale pink jacket that suited her gentle nature perfectly. All the plans to deal with the lump were made, and the appointments were days away. I wanted to push it all aside, and thanks to Hargrave and the thirty-five cities in my near future, I could. We gathered Karen and headed out for that ordinary day.

The town hall meeting went well — except at one point I reversed the names of George Bush and John Kerry in a line I had delivered a hundred times, a mistake I had never made before and never made after. "While John Kerry protects the bank accounts of pharmaceutical companies by banning the safe reimportation of prescription drugs, George Bush wants to protect your bank account. ..." I got no further, as the crowd groaned, and one old man in the front good-naturedly shouted out that I'd gotten it backwards. "Oops." I said it again, right this time, and we had a good laugh. I looked at Hargrave and rolled my eyes. Was this how it would be for the next week? Fortunately, it was not. We flew to an icy Pennsylvania, where the two town halls went well enough, or at least without event. I had my legs again. And then on to Maine for the following day.

I could tell by the look on the technician's face that it was bad news. Hargrave and I — and the Secret Service agents — had ridden to Dr. Edmundson's office as soon as we landed back in Raleigh the following week, just four days before the election. I had told Karen and Ryan Montoya, my trip director on the road, about the lump, and the Secret Service agents knew what was going on because they were always there, though they never mentioned a word about it to me or to anyone else. Ryan had quietly disappeared to my house in Raleigh, and the Secret Service agents respectfully kept a greater distance as Hargrave led me inside. I was lucky because Wells Edmundson was not only my doctor, he was our friend. His daughter Erin had played soccer with our daughter Cate on one of the teams that John coached over the years. His nurse, Cindy, met me at the back door and led me to Wells' office, dotted with pictures of his children.

"I don't have the equipment here to tell you anything for certain," Wells said after examining the lump. Ever the optimist, he agreed that the smooth contour I felt could be a cyst, and ever the cautious doctor, he ordered an immediate mammogram. His attitude seemed so very positive, I was more buoyed than worried. As Hargrave and I rode to a nearby radiology lab for the test, I felt fine. One thing I had learned over the years: hope is precious, and there's no reason to give it up until you absolutely have to.

This is where the story changes, of course. The ultrasound, which followed the mammogram that day, looked terrible. The bump may have felt smooth to my touch, but on the other side — on the inside — it had grown tentacles, now glowing a slippery green on the computer screen. The technician called in the radiologist. Time moved like molasses as I lay in the cold examining room. I grew more worried, and then came the words that by this point seemed inevitable: "This is very serious." The radiologist's face was a portrait of gloom.

I dressed and walked back out as I had walked in, through a darkened staff lounge toward a back door where the Secret Service car and Hargrave waited for me. I was alone in the dark, and I felt frightened and vulnerable. This was the darkest moment, the moment it really hit me. I had cancer. As the weight of it sank in, I slowed my step and the tears pushed against my eyes. I pushed back. Not now. Now I had to walk back into that sunlight, that beautiful Carolina day, to the Secret Service and to Hargrave, who would be watching my face for clues just as I had watched the image on the ultrasound monitor.

"It's bad," was all I could manage to Hargrave.

As the Secret Service backed out onto the road for home, Hargrave rubbed my shoulder and silent tears snuck across my cheeks. I had to call John, and I couldn't do that until I could speak without crying. The thing I wanted to do most was talk to him, and the thing I wanted to do least was tell him this news.

I had mentioned nothing to John earlier, although I spoke to him several times a day during the campaign, as we had for our entire marriage. I couldn't let him worry when he was so far away. And I had hoped there would be nothing to tell him. Certainly not this. I had promised myself he would never have to hear bad news again. He — and Cate, our older daughter — had suffered too much already. Our son Wade had been killed in an auto accident eight years earlier, and we had all been through the worst life could deal us. I never wanted to see either of them experience one more moment of sadness. And, after almost thirty years of marriage, I knew exactly how John would respond. As soon as he heard, he would insist that we drop everything and take care of the problem.

Sitting in the car, I dialed John's number. Lexi Bar, who had been with us for years and was like family, answered. I skipped our usual banter and asked to speak to John. He had just landed in Raleigh — we had both come home to vote and to attend a large rally where the rock star Jon Bon Jovi was scheduled to perform.

He got on the phone, and I started slowly. "Sweetie," I began. It's how I always began. And then came the difference: I couldn't speak. Tears were there, panic was there, need was there, but not words. He knew, of course, when I couldn't speak that something was wrong.

"Just tell me what's wrong," he insisted.

I explained that I had found the lump, had it checked out by Wells, and now needed to have a needle biopsy. "I'm sure it's nothing," I assured him and told him that I wanted to wait until after the election to have the biopsy. He said he'd come right home, and I went there to wait for him.

Excerpted from Saving Graces by Elizabeth Edwards. Copyright (c) 2006 by Elizabeth Edwards. Excerpted by permission of Broadway, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Books Featured In This Story