BOOK EXCERPT: 'Promise Me' By Nancy G. Brinker

Editor's note: The following is an excerpt from the new book "Promise Me" by former Ambassador Nancy G. Brinker.

My waking memories of my sister have grown hazy over the years, but Suzy still passes through my dreams as animate and vivid as a migrating butterfly. Her face is fresh and full of energy, her hair windblown but still beautiful. In a freshly ironed skirt and patent leather ballerina flats, she defies gravity, scrambling over a pile of slick rocks, Roman ruins stacked like unclaimed luggage on a hilly roadside in southern Spain.

Suzy, be careful, I call as she climbs higher.

Oh, Nanny, she waves me off , mugging for the boy with the camera. (Boys could never keep their eyes, or cameras, off her.) He tells Suzy tosmile. Say queso! But she’s already smiling. In studio and fashion photos, she was always slightly Mona Lisa, never haute couture haughty. Almost every candid photograph I have of Suzy seems to have been snapped just as she’s bubbling up to giggle, that precise moment when you can see the laughter in her eyes and feel the active upturn of her mouth, but the not- quite sound of it is forever suspended in the air, teasing like the unplayed eighth note of a full octave. Even in the dream, I ache for the unfinished music of her life.

Back home, Suzy would write something silly on the back of the photo of the Roman ruins— I swear, it was like this when we got here!—while I’d carefully record the date and precise location where the picture was taken. I’m simply not gifted with silliness like Suzy was. I appreciate it as an art form, and I try not to be frustrated by it, but gifted with it? No. I am not.

Suzy wasn’t serious or “bookish” like me, but all her teachers loved her, and I always thought of her as the smart one. In addition to her savant silliness, she was gifted with emotional intelligence, empathy, our mother’s generous heart, an unfairly fabulous sense of style, and a humming, youthful happiness that made her naturally magnetic. She had a shy side, but people loved her to her dying day because she was just so much fun to be around.

I can be a bit of a task to be around, I’m afraid. I have no talent for sitting still. I’m not capable of pretending something is fine and dandy, when in fact it’s not. If something needs to be said, I’m compelled to say it, and I do it as diplomatically as I can. But let’s face it, candor’s less endearing than coquettishness on any playground. My gifts were sturdy construction, a stalwart sense of justice, and the ability to whistle, ride horses bareback, and skip stones over water as well as any boy. I was a natural bridge builder. Even as a little girl, I was the ambassador between my high- spirited sister and our rightly starched father. She was three years older, but when Suzy was grounded, I was the hostage negotiator. When Suzy exceeded her curfew, I was the peace envoy.

When Suzy died, my life’s work was born. Her meaning became my mission.

Born on Halloween, 1943, in Peoria, Illinois, a gentle and generous place that embodies the very soul of Americana, Suzy was three when I came along in December 1946. Mom says she peered at me over the edge of the bassinet and said, “Well! She’s quite a character.” We were thick as thieves from that moment on. Suzy was always a queen bee in the neighborhood gang, and I was thrilled to be Suzy Goodman’s little sister. I was her entourage, her liege, her cheerful sidekick, ambitiously pedaling my tricycle in the wake of her fleet- footed, inventive escapades. I can’t remember a single instance of her telling me to buzz off or leave her alone or go play with the other kindergarten babies so she could hang out with the big girls who had more sophisticated things to do.

As our mother ages so gracefully, I can’t help thinking what a couple of grand old ladies Suzy and I would have been together. That was our plan from the time we were little girls. My sister and I expected to age gracefully, set up housekeeping, cultivate a nice cutting garden, and sit in lawn chairs, watching our grandchildren play. We never discussed the fate of our beloved spouses; we just naturally assumed we’d outlive them in some “God’s in his Heaven, all’s right with the world” kind of way. It never crossed our minds that we’d be hip- broken or infirm. Not us. We’d be the spry old dames delivering Meals on Wheels, organizing holiday toy drives,knitting mittens for the underprivileged, quilting lap robes for all the tragic polio children.

The muggy summer of 1952 teemed with mosquitoes and clingy midwestern humidity. The school year ended (I was fresh out of first grade, Suzy liberated from fourth), but instead of that lazy, hazy wide- open summer feeling, we found ourselves in a world of closed doors and shuttered windows. It seemed to Suzy and me as if the city of Peoria had pulled into itself like a turtle, afraid to poke so much as a toe out to do anything. The ice cream parlor and candy store closed up shop. The streets and sidewalks felt muted and unfamiliar. Women hurried through the grocery store, holding the cart handle with a fresh hanky or dishcloth. We’d already been told there would be no movies, no carnivals, no concerts in the park. When Mother told us the municipal pool was closed, Suzy groaned.

“What about the lake?” she asked.

“They’re letting a few people swim there,” said Mother. “Invitation only.”

I raised the possibility of the swimming pool at Uncle Bob and Aunt Helen’s house or the wading pool at the park or even our little plastic pool in the backyard, but Mother shook her head.

“Dr. Moffat says children can get polio from going in the water.” “Clean water right out of the hose?” I said skeptically. “How would that give a kid polio?”

“I’m not sure,” said Mom. “It’s a virus, and it’s very contagious. Now scientists are saying not to swim. I saw it in the newspaper. You girls should tell the other kids. Help spread the word about that. Even if it looks perfectly clean— and I don’t care how hot it is— you girls don’t go near the pool. Understand?” And knowing us as well as she did, she added, “Nancy, I’m counting on you to obey me.”

Suzy tucked her knees under her chin, wrapping her arms around her legs, and I put my arm across her shoulders. She wasn’t pouting; it made her sad to think about the poor polio children with their wizened limbs and squeaky little wheelchairs, their drawn curtains and dilated eyes longing for outside. It terrified her and broke her heart whenever we heard of another child in our neighborhood tumbling into the bottomless well of his own little bed.

These days we’ve all but forgotten what a scourge it was, but in 1952, there was a global epidemic. “Infantile paralysis” was a malevolent phantom that shadowed every summer day and haunted every cricket-filled night, poised to cripple and kill with one touch to the spine, the most deeply dreaded childhood disease of the twentieth century worldwide. Mom stroked Suzy’s strong shinbone.

“Right this minute, scientists are working to develop a vaccine,” she said. “We have to do everything we can to help. Like this bake sale.” She set a Tupperware container on the table. Through the milky-opaque plastic, we could just make out mounds of pink-tinted frosting topped with maraschino cherries. “Every little cupcake will do its part to end the epidemic. The money helps the scientists, the scientists help physicians, and if lots more mothers and daughters collect lots more money, and the scientists keep working, someday, they’ll be able to give people a shot and—” She snapped her fingers. “No more polio.”

Of course, in the oppressive heat of that long, sequestered summer, this grand vision sounded as ridiculous to me and Suzy as a cure for breast cancer sounds to all the naysayers presently telling me how impossible that is.

But in that first prosperous decade following World War II, the idea was still fresh in the American mind that we could accomplish anything when we all pulled together for the good of our nation. An entirely new form of media— television— swept the country faster and more infectiously than any virus, creating (or perhaps simply awakening) a scaly but soft hearted dragon, the mass audience, provoking awareness that a viable vaccine was agonizingly close.

Mothers saw their children standing on knobby pony legs just this side of that tipping point, mothers who’d recently awakened to the idea that the hands of women— women’s voices women’s work— could build bombs as well as grow roses. In that moment, a singular need met its cultural match. Grassroots philanthropy sprang up, money rushed forth, and before the clock ticked into the sixties, a solution was discovered, a bridge was built between science and society, and the phantom was vanquished.

In the United States alone, 58,000 people were stricken with poliomyelitis in 1952. More than 3,000 died; another 21,000 were left disabled. Jonas Salk’s vaccine was licensed in 1955 and was being widely distributed by 1959. In 1962, there were fewer than 1,000 cases of polio reported. In 1963, there were fewer than 100. These days, polio is a quarter- page sidebar in a history book.

Along the way, of course, skeptics in all their towering intellect persistently pointed out the many reasons the virtual eradication of polio could never be accomplished.

My mother respectfully disagreed, efficient and undeterred in her daily purpose. Suzy and I were bundled into the family station wagon every weekend to accompany Mom on her various missions. It wasn’t up for debate; it’s what we did. I’m in the habit of saying Mom was  “tireless volunteer,” but putting that on paper, I realize it’s ridiculous. Of course, she was tired. She must have been exhausted by all she did, but she did it anyway, and without complaint, which makes her all the more remarkable. In addition to her organized charity work, there were always little personal mercies: a casserole for someone just out of the hospital, a freshly folded laundry basket of diapers, the weeding of a flowerbed, whatever she could do to lighten a neighbor’s load.

That summer she had to be careful. Rather than risk bringing the virus into our home, she’d put together a basket of food and other necessities and leave them on the recipient’s porch with a light tap on the front door. The lady of the house would move the curtain aside and wave waiting to open the door until Mommy was safely out on the sidewalk. “Instead of dwelling on all the things you can’t do,” said Mother, “figure out what you can do. What you will do. My mother used to say, ‘If you have to ask what to do, get out of the kitchen.’ I’ll bet you girls could come up with something if you put your heads together.”

We piled into the station wagon and set out on our appointed rounds. Sweltering in the backseat, Suzy and I complained and deviled each other like a couple of spiny pill bugs.

“Girls, that’s enough.”

Mom sent a few ominous warnings over the transom as she negotiated the stop-and- go downtown traffic, but Suzy and I kept at it until the old station wagon swung to the side of the street and lurched to a halt. Suzy and I rarely saw our mother’s patience fail. Every once in a great while, there might be a flare of angry words or a swift slam of the silverware drawer, but even that was as startling and incongruous as a griffin landing on the Sunday dinner table.

Mother didn’t raise her voice, but her tone crackled with aggravation. “Out.”

Suzy and I looked at each other, looked out at the unfamiliar neighborhood. Surely, she didn’t mean—

“I said, out.

Our parents didn’t believe in corporal punishment; Mother disciplined by eye contact. We met her withering gaze in the rearview mirror for a tense Don’t test me moment, then Suzy opened her door. We shuffled out onto the curb, and I instinctively reached for Suzy’s hand, knowing she’d take care of me now that we were on our own in the world and would have to get jobs in factories or join the army or find a band of nomads to camp out with.

Mother stood in front of us in the blazing sun, shielding her eyes with her hand.

“People have died for this country,” she said. “People have sacrificed their lives so you could live in peace and freedom, and all that’s asked of you is that you take care of it. Stewardship. That’s all. You care enough about your community to look after those who aren’t as fortunate as you. When you see someone in need, you give. When you see something wrong, you fix it. Because this is your country, it’s your community. You can’t sit around on your duff waiting for someone else to make it better. It’s up to you.

She shook her finger at us, genuinely angry. Suzy and I stared down at our Mary Janes, waiting for something we hadn’t heard a thousand times.

“If you girls devoted half the energy you use complaining and bickering to actually doing something for somebody else, I think you’d be amazed at what you can accomplish. So can I count on you? Are you willing to be good stewards for your country?” asked Mother. “Because I’ll tell you right now, you’re not getting back in that car until I hear you say it. Both of you.”

“I’ll be a good steward,” Suzy responded immediately.

Mother cut her pointed gaze over to me, but I locked my arms in front of my round little middle, sun prickling at the back of my neck. I’m five,I wanted to tell her. Big enough to know I wasn’t big enough to do anything huge or meaningful or missionary. But there was no use arguing that angle with Ellie Goodman, Standard Bearer, Doer of Good, Righter of Wrongs, Mitzvah Maven.

Suzy jimmied me with her elbow and hissed, “Just say it so we can go.”

“I’ll be a good steward,” I said without budging the square set of my jaw.

Mother opened the car door. Suzy and I climbed in, thoroughly abashed. Returning to the road before her, Mom steered back into the traffic and proceeded with her errands, and we trooped dutifully, if not cheerfully, behind her. That night, as I lay thinking wistfully about cold hose water in a plastic pool, Suzy bounded onto my bed.

“Nanny! I know what we should do to be good stewards.”

“What?” I yawned.

Variety show.” Suzy hatched her brilliant idea like a magician turning a pigeon out of a top hat. “A song- and- dance variety show and you can sing and dance and I’ll sell tickets. We’ll get everybody to help.” It was an ambitious undertaking, but I had no doubt Suzy could rally all the neighborhood children into cast and crew and sell tickets to all the adults, because everyone loved Suzy and would pretty much give her whatever she asked for. I could belt out all the words to “The Secretary Song.” (Remember that great old Rosemary Clooney number with the “bibidi boo bot” chorus?) Just in case, I fortified my stage presence with a Donald Duck hat that actually quacked. A bit of the razzle- dazzle, I figured, to compensate for any vocal prowess that might be slightlylacking.

By noon the next day, all twenty- three children who lived in our neighborhood were on board. Suzy and I were like a couple of Broadway impresarios, auditioning talent, casting acts, herding crew. Suzy had most of the roughneck little boys corralled with her irresistible smile and I strong- armed the stragglers. A grand theater was jury- rigged, employing the side of our garage as a backdrop. Something right out of a Mickey Rooney movie. Suzy went out and sold sixty- four tickets. That evening, friends and neighbors gathered on the lawn with folding chairs and picnic blankets.

I can’t begin to remember what was on the program. Some of the kids were genuinely talented, but there were a few painfully unpracticed performances on school band instruments, I suppose, maybe a mangled magic trick or two, a few fruits of tap and ballet class, some cheerleading and gymnastics, but of course, the whole program was inherently adorable because our appreciative audience was composed of people who adored us. I trotted out for my Rosemary Clooney number and delivered that thing like a wrecking ball.

Understand that I was a chubby little girl— and not endearingly chubby like Darla in The Little Rascals. More of an ungainly chubby. Like Chubby in The Little Rascals. But I’d never been made to feel self- conscious about it, so when the time came, I put myself out there, completely confident, uninhibited, the way consistently loved children naturally are. (How I wish I could go back and bottle a little of that chutzpah for my grown- up self.) Thinking back to that moment, it’s plain to see that the first thing Mom did to prepare me and my sister for a life of service was to nurture in us a sense of self- worth. The very first step toward giving to others is grateful recognition of our own assets. They say you’re happiest doing what you did as a child, and those were the moments I remember most: when Suzy and I were fully engaged, performing— not in the sense of putting on a show to generate applause— performing in the sense of doing. Performing an act of kindness— or an act of will. Generating a response. I probably could have been a good theater producer.

“If there’s a dog that needs biting,” Daddy used to say, “Nancy’s the one to bite it.”

I’ve always excelled at backstage cat- herding and organization, but I’m a pretty good entertainer, too, and you have to entertain people at least a little if you want them truly on your side. Suzy was the visual artist. She understood the dynamics of drama and spectacle, what it takes to sweep people in and make them fall in love with an idea, a place, or a cause. In retrospect, I understand how moving it must have been for these terrified parents to see their healthy children dance. Our neighborhood variety show was a resounding success. There was no lack of applause for the Clooney number, but my “bibidi boobot” may have been a little off, because the next day, Suzy tactfully suggested, “Next time, Nanny, it might be better if I sing and you sell tickets.”

Mother drove us to St. Francis Hospital on Glen Oak Avenue. Elated, Suzy and I marched to the administrative desk in the front lobby and presented the receptionist with a crisp white envelope containing $50.14 in pure polio- killing, spine- saving, all- American do- gooding cash. A few days later we got a thank- you note from Sister Walburga, the hospital superintendent, assuring us the money would be “put to very good advantage.”

Nuts and bolts. Dollars and cents. Cause and effect. The lesson wasn’t lost on Suzy or me. This is where the rubber meets the road, I realized. This is where will meets way.

A fundraiser is born.

So began Suzy’s and my charitable life together. It was my earliest inkling of what goes into the chemistry of change: moment meets messenger, information becomes action. Hearts and minds shift to a new paradigm, money happens, and it all comes together.

A Brief History of the Beast

The earliest documented cases of breast cancer appear in the Edwin Smith Papyrus, one of several existing papyri that detail ancient Egyptian medical practices. The unknown physician who crafted this document described a number of ailments and injuries and how they should be treated with surgery, magic, or medicinal herbs. Warm tumors in the breast were likely the result of an infection. The remedy: cauterization. A shuddering thought, but the patient probably lived to tell about it. In the case of hard, cold tumors deep within the breast, the scroll states simply, “There is no treatment.”

This wasn’t a disease the Egyptian physician saw oft en. Malignant tumors of all kinds were noted with about the same frequency in most of the same gender and age demographics that apply today. Since he recognized that breast tumors varied in nature, it’s possible this physician may have also observed that those presenting in younger women tended to kill with a swift , unstoppable virulence. But breast cancer is far more prevalent in women over fifty, and most women in ancient Egypt didn’t live past thirty- five, so this patient was rare.

One woman in thousands.

Given what we know about this disease and about ancient Egyptian culture, I imagine One Woman watched with interest as the physician carefully recorded her case. She almost certainly didn’t know how to read or write. There is no treatment, he told her, straightforward but not without compassion, I think. He seems like a “good doctor” sort in his other writings. Perhaps he offered her a tincture made from alcohol and flowers, a prayer, a little stone god, some comfort she could cling to. One Woman went home to her family and went on with her life. The tumor in her breast grew steadily over the coming months. The breast itself seemed larger, the skin thick and red, spidered with veins and stretch marks, but she felt strong and went about her daily business. Some days were better than others, and she felt a flash of hope. She laid fruit in front of the little stone god, whispered in its ear. Then came another day, and her hope faded.

The cancer metastasized, spreading from breast to breast, then riddling lymph nodes, lungs, spine, and liver. First, she felt a firm bulge under her right arm. Her fingers tingled and burned with neuralgia. She dropped things sometimes. Then there was a stabbing pain in her spine when she bent to lift her small child. Eventually, she had to sit on the floor and let him climb into her lap, holding him over on the side where she could still stand the pain if he leaned against her breast. When she laughed or yawned, there was a stitching pull deep inside her chest. It seemed to form a tight fist in her lung at times. She’d wake up coughing, struggling for breath. It made the baby cry, but when she tried to go to him, she was dizzy and nauseous. She was bent with the effort of getting up in the morning. Her complexion yellowed. The coughing spells settled into a nagging pattern of hoarse, painful barking. Under her linen dress, her breasts were visibly misshapen and distended now. When she was naked, she could see a shadow rising to the surface. The skin became translucent purple and gradually gave way like a slit in a temple curtain. The lesions wept a thin blackish- bloody fluid. The skin crusted and opened, an unblinking eye with the slick, eel- colored tumor at its center. Her sisters tried to clean and care for her, but on a cellular level, the tumors were dying as rapidly as they multiplied, so the bulging tissue became necrotic, and the smell of death hung in the air, permeating the bedclothes, lingering in her hair. The woman’s strength leaked out of her Loved ones tried to feed her broth and soft meal cakes, but she was quickly wasting away barely a thread of herself.

At the end, her sisters sat next to the bed, whispering to each other. Isshe breathing? Did you see her eyelids flicker? They were terrified to touch her now. What if this dark disease was contagious? They had to think of their children. Lying in bed at night, they moved their hands over their own breasts, afraid to exhale. Here? Didn’t she say it started here, with a bump like a small pebble?

It would be nice to think someone who loved her held her when she died.

A thousand years went by.

Four centuries before the birth of Jesus— about the time Siddhartha became the Buddha and Malachi the last of the Hebrew prophets— the Greek scientist Hippocrates observed coal-black tumors erupting through the skin of his patients and concluded that the malady was a manifestation of too much black bile or melanchole in a woman overly influenced by the element of earth, an internalization of autumn’s dry cold. Tentacled tumors examined during autopsies spidered into the body, evoking the image of a crab.



There was no hope of treatment or cure, so it was better, Hippocrates hypothesized, to prolong the life of the afflicted by making her as comfortable as possible in all other respects. He discouraged his students from surgically excising tumors from their patients’ breasts, based on his assumption that pervasive black bile was a systemic problem. Barring intervention by the gods, the disease would invariably return with swiftly killing insistence.

For two thousand years, his conclusions remained the conventional wisdom. There was a glimmer in 200 c.e. when Galen, a devoted follower and biographer of Hippocrates, recorded his observation that not all breast tumors were created equal; some were slow and insidious, others quick and virulent. Not all had the iconic crab legs; some blossomed deep in the bosom and remained isolated from surrounding tissue like a lily floating in a pond. Galen treated patients with opium, licorice, castor oil, and incantations, but ultimately, he confirmed the six- hundred- year- old findings of Hippocrates: Breast cancer was a systemic disease caused by the darkest humor, surgery was contraindicated, sufferers were doomed. This remained the final word on breast cancer for another fifteen centuries. Roughly around the time of the American Revolution, in an effort to discredit the time-honored ideas of humoral medicine, French physician Jean Astruc placed a slice of a breast cancer tumor in the oven next to a slice of beef, cooked both to a jerkylike consistency, chewed each one thoroughly, and declared that they tasted exactly the same, proving (among other things I can’t even bear to joke about) that the breast cancer tumor contained neither bile nor acid.

Out with the old superstitions; in with empirical state- of- the- art methods. Now the true cause of breast cancer was wide open for speculation. One school of thought pointed to the high incidence of breast cancer among nuns as evidence that breast cancer was caused by a lack of sex. Because breasts are sexual organs, n’est- ce pas? Without the fulfillment of their bountifully natural purpose, what could they do but atrophy and became cancerous? (I imagine there was no shortage of selfless lads willing to hurl themselves between innocent young women and this dreaded disease.) In women who did voluntarily engage in “relations”—randy wives and scurrilous hookers— tumors were said to arise from a lymphatic blockage caused by an overly vigorous libido. Another popular theory cited constriction of lymphatic vessels due to depression. Others blamed the curdling of unexpressed milk and the coagulation of blood caused by a sedentary lifestyle.

And so, in the enlightened age of Mozart, after three thousand years of observation and experimentation, it was scientifically deduced that if a woman presented with breast cancer, it was due to frigidity, promiscuity, craziness, laziness, or all of the above in some combination with the unknowable will of God.

One Woman after Another passed into ancient history, each less than a grain of sand, and there are places in the world where nothing has changed. Today women in developing countries echo the story of the woman in the papyrus and face their fate as if the last three thousand years never happened. I’ve seen One Woman’s face, and I can’t forget her. Sitting on a wooden stool by an ancient stone wall, wearing clothes right out of a Cecil B. DeMille Bible epic, she looked up at me and asked, “This disease— is it contagious?”

She has to think of her children.

At this writing, according to statistics, breast cancer is the leading cause of cancer death for American women between forty and fifty- five years of age. In One Woman’s corner of the world, there are no statistics, never mind screening or even the possibility of treatment. Breast cancer comes and goes unnoted, misunderstood, taking thousands of lives with it.

One Woman at a time.

Excerpt taken from "PROMISE ME" by Nancy G. Brinker with Joni Rodgers.

Copyright © 2010 by Nancy G. Brinker, published by Crown Archetype, a division of Random House Inc.