“There’s absolutely nothing that would have prepared me for this kind of extremely vivid confrontation with the reality of my mortality,” Professor Clifford Marks tells me of the brain cancer that nearly took his life. “You know, it’s a cliché; the next day might be your last.” He laughs. “It’s not a cliché.”
One night in late 2001, he was at home watching a movie with his seven-year-old daughter when he abruptly went into a series of grand-mal seizures that put him in stasis. “Most of the time, with grand mal seizures … your brain’s out of whack, and it kind of rights itself. It wasn’t righting itself.” His daughter ran to the neighbors’ for help. “Nobody was home, so she called 911. If it wasn’t for her, we wouldn’t be having this pleasant conversation right now.”
We are sitting in the Business building on campus. Marks has agreed to let me interview him for this article, even though I fully expected him not to. He has always seemed to me somewhat unapproachable. He is known around the University of Wyoming for being eccentric and, often, a little intimidating. He is very tall, over six feet. His straight, black hair falls in chunks down to his ears, and a graying goatee adorns the lower part of his face. A long scar, unconcealed by his hair, trails from the peak of his forehead to his right temple. Near the scar, at the crown of his head, is an oddly shaped, quarter-size bump. Every now and then he shakes his head, flipping the hair out of his face and away from the scar. “I never mention this to my students. … You’re the first student ever to ask me about my scar,” he tells me. “I understand both the fascination with it and the reluctance of people to pry into my personal life … but I’m cool with talking about it.”
The seizures Marks had in October, 2001, were the first and only indication that a low-grade tumor had formed in his right frontal lobe. It was relatively benign, and he had his first brain surgery to remove it a month later. “But the problem with low-grade brain cancer is that it’s very hard to distinguish between which cells are tumor and which cells are brain, because they look a lot alike. So when the surgeon in Denver took the tumor out in 2001, there were little bits and pieces of the tumor remaining in my brain.”
Less than a year and a half later, in February, 2003, Marks had another grand mal seizure. He later wrote on yasg.com, a website for brain cancer survivors, “I was sitting in a cheap plastic chair poolside at a Comfort Inn reading Emily Dickinson, when I pitched forward and broke my fall with my face (I broke my nose, ruined my septum [and] left orbital bone, suffered a concussion, bruised my shoulder, and needed sutures in three different areas on my face).”
An MRI revealed that the cancer had come roaring back as Glioblastoma Multiforme, Grade 4: a very malignant, dangerous form of brain cancer. GBM4 has a survival rate of less than 5 percent. He says, “It was one of the worst cancers you could ever get. I highly recommend not getting brain cancer.”
Marks had his second brain surgery a week later. He wrote afterward, “The doc removed the new tumor, plenty of margin (re: brain), and placed Gliadel Wafers in what was once my right frontal lobe. … Oddly, I’m feeling lucky.”
By coincidence, Marks and his wife had stumbled across a “60 Minutes” episode about Duke University’s brain cancer research center in 2002. After his second surgery in Denver in 2003, he went with his family to Durham, North Carolina. The doctors at Duke performed Marks’ third brain operation, to see if he qualified for a clinical trial and experimental drugs.
The median survival for GBM patients after diagnosis is 12 months. Marks told me, “None of my doctors ever said, ever, ‘You have x amount of time.’ … [And if they had], I would have rejected their treatment. … In fact, [the doctors at Duke] said, ‘Don’t look at statistics. Read survival stories. If you want to do research, read survival stories. And there are lots of them out there. … People survive this.’ … And that was my attitude. My attitude was, I’ve been dealt this bad hand — but you can play a game of poker with a bad hand.”
Marks’ mother and, incidentally, my own grandmother had the same disease. Unlike most brain cancer patients, Marks never lost his sensibility. Patients with frontal lobe injuries can have a broad range of symptoms anywhere from inappropriate social behavior to inability to recognize boundaries to loss of speech. Fortunately, GBM rarely runs in families; Marks’ case was unusual in that aspect.
My grandma, who had a GBM4 in a different area of her brain, died three months after diagnosis. Before that, she went absolutely, completely batty. According to her, there were men in the basement of whom she could ask favors (“Just ask the men in the basement,” she would say); she needed to hide her jewelry in the dryer at night; and she wholeheartedly believed that someone had picked the house up off its foundation and moved it.
Marks, however, is still quite functional. “It’s extremely unusual. Brain cancer is a horrible thing, and it’s very dangerous. But my tumor expressed itself in a part of the brain that allowed me to continue living my life the way I was living it before. I mean, I’m an English professor. I have to, you know, think. I can still think, and I am still not completely inarticulate.”
Marks met his wife in grad school; they moved to Laramie in 1989. Marks was finishing his PhD and could only be a lecturer. “One of the great things about Wyoming is that when we moved here, I thought, ‘Well, [my wife] is the hot property, and I’m just kind of this piece of baggage.’ But nobody ever treated me like that … I immediately felt welcomed.” He finished his dissertation in 1994, and the university hired him as an assistant professor.
I asked him if the tumor changed his teaching style. “No, you know, the thing that changed my teaching style the most — if I ever really changed it — was when we adopted my daughter. I started
seeing my students as just larger versions of my little baby who needed my help getting through the world. I’ve always been a student-centered teacher, and I’ve always felt that my job was to help students learn how to figure things out as opposed to telling students what they should figure out. … If you can’t teach a student to pick up a piece of literature and get something out of it that can help you think about your own life in some way, then what’s the point of teaching?” The tumor did not change that. In fact, he says, it reinforced it.
He tells me, “I always felt it was harder for those around me than it was for me … I always felt I had a reason inside to be positive and optimistic. And that there was nothing heroic about it. I was lucky. … I mean, I think it’s heroic if you save somebody’s life. I don’t think it’s heroic if you save your own or if you survive a dangerous disease. The people who are heroic in that situation are the people who help you do that, which would have been my wife and my family. … That’s heroic. Not, like, pulling the baby out of the burning building heroic, but it’s more heroic than being knocked unconscious by Propofol and being operated on. The doctor — he’s heroic. He’s cutting into somebody’s brain to fix the disease that could kill him, but I’m just lying on a table. I mean, nothing heroic about lying on a table.” Marks is, if anything, self-effacing. He once said these humble words during a lecture: “Having an education doesn’t make you a better person. It just means you’re more educated.”
When we started the interview, he asked me, “Can one be interesting in a good way?” He paused and shifted in his chair. “Or can you be interesting only if you’re—off-kilter?” I replied, “Is it always bad to be off-kilter?” He laughed. “I mean, off-kilter, like—stealing napkins from Jimmy John’s? I dunno.” He leaned forward, his elbows on the table, and swiveled in the chair next to me.
“I mean, I am brain damaged. There is no — when my surgeon in Denver removed the GBM in 2003, he cut out a part of my brain, which constitutes brain damage. But I don’t have the kind of brain damage that would significantly impact my day-to-day life. … The one thing that it probably affected [is] it probably dampened me emotionally. Which I recognize. … But they have medicines to un-flatten you,” he says with a wry smile.
Marks’ third and final brain surgery, in North Carolina in 2003, was both a success and a disappointment. He later wrote on yasg.com, “The good news from that surgery was that they could find no live cancer cells (which paradoxically excluded me from the study). They then put me on their aggressive radiation/chemo program.”
Had Marks qualified for the trial, the doctors would have put radioactive iodine into his brain, to kill any remaining cancer cells. “Which is what this bump is,” he tells me, patting his head. “It’s like a little container with a line into the cavity where the tumor was.” Instead, he had seven weeks of daily radiation blasts, combined with a year of chemotherapy and monthly MRIs.
“I mean, every way you could be lucky in this kind of situation physically,” he taps the desk for emphasis with each word, “I’ve been lucky.” The chemotherapy never made him sick. “I got nauseous the first night I took the first chemo pills, and that was mostly because I’d had a mushroom swiss burger at Winger’s. … The radiation made me tired, but that was it.”
He pats his head with both hands and says, “But that’s why, you know, you see my hair is not here — but, it is here. That’s because the radiation really pounded this area and killed the hair roots over there.” The lopsided hairline gives him a haphazard appearance, especially because the scar is so noticeable. “It’s weird. It’s both a private and public thing. I could have a hairpiece made to keep it covered up, but my hair still grows—” He shrugs.
Marks is now seven years out from the end of chemotherapy and still cancer-free. “I am well aware of my mortality. And so, I think that that’s — it’s a good lesson. You know, I wouldn’t recommend to anyone having a brain tumor of any kind to realize that your time on this planet is short. … I know I’m not always successful, but I’ve tried to make the most of my time since this happened. … I do things every day to remain mindful of the gift of life, and I do things every day to keep reminding myself to fight the recurrence or return of the brain tumor. It’s not—I design exercises for me, every day, that are meant to keep in mind that some cells or a cell went bad inside my brain and tried to kill me, and so I design these mental exercises where I send, like, miniature super-heroes to kill cells
that might go bad. … When [the tumor] did come back, and it came back as bad as it could come back, I decided that I had to be mindful about it, that I couldn’t just assume that the surgery, the radiation, the chemotherapy, all the things that I did were going to be enough. So every single day of my life since then, I do something to—to fight it. And I don’t know that that’s ever going to change.”
Marks wrote in 2005, “I feel like I’m well on my way to beating this thing. I attribute this success to great doctors, tremendous support from friends and family, many blessings from friends and strangers, and this gut belief that it just wasn’t my time and that I could triumph over a GBM.”