My Friend Gina

A month ago yesterday, I lost a friend.

It's taken me awhile to find the right words.  Our relationship had been such a journey, like no other I have had, and like no other I will have again.  

I met Gina DePalma on line in 2005. I spent a good amount of time back then on the Slow Travel Website drumming up interest for Piemonte, Italy and our Bed and Breakfast.  It was there that I met someone named Stella (the Italian word for star).  She and I seemed to share a similar sense about Italy and Italian food.  Stella messaged me privately and we started having some nice "conversations" that way.  

One day, she asked me if I had ever heard of Mario Batali.  I told her no, and asked her who he was.  

She wrote back, "Diana, I think I love you."

Gina was Mario's executive pastry chef at his flagship restaurant, Babbo, and was considered one of the top pastry chefs in the country. The reason why she was so happy I didn't know Batali was that it released her to be able to trust me.  Gina had been, alarmingly often, used as a stepping stone by people trying to get through to Mario and Joe Bastianich, both of whom she protected fiercely.  My having been isolated on a hill in Piemonte long enough to have no idea what was going on on The Food Channel in the states forged a bond between Gina and I that would never be broken.

We talked about food, about the restaurant business.  My extended family, with the exception of my parents, had all been Italian immigrants in the restaurant industry in New York.   I shared the story about Julia Child coming into my grandfather's kitchen where he worked as a saucier and looking over his shoulder;  she shared stories about having to work on nine eleven and the Wall Street types that ordered $500 bottles of wine for lunch.  

Gina came to Rome at the end of 2005 with her mother - it was the first time that we were able to meet in person.  She was in the editing process with her book, Dolce Italiano,  and was hoping at some point in the not too distant future to come to Italy to live.  She felt strongly the in order to research her next book, she wanted to be in Italy and be able to tour around to anchor the authenticity of what she was writing.  

For me, the years flew by as our B&B became popular and fully booked during 2006 and 2007. Hundreds of emails flew between Gina and I.  She came to visit in the winter of 2007, her very first to Piemonte.  One of my favorite memories of her is the two of us sitting in our guest suite, candles lit, walls glowing green,  blankets wrapped around us, chatting.  

Gina complained often about not feeling well, and didn't visit the doctor often enough.  She put it down to stress;  trying to finish up at Babbo and train a successor while planning a year in Rome took all of her time and energy.  But she finally did it - she found a sweet apartment, owned by a friend, and moved to Rome in late 2007, right after the publication of Dolce Italiano.  

We spoke frequently in the winter of 2007/2008 and she was enjoying her time in Rome.  It was productive and she was beginning to think that her second book would be a deepening and widening of her first book, which was being received well.  

She was also complaining about terrible stomach cramping.  

Her landlords and friends, Shelly and Ale, became so concerned that they convinced her to head to the hospital.  Nothing was diagnosed, but the doctor there told her she should follow up with her own physician in New York.  

A couple of months later, Gina, a five time James Beard Award Nominee, was awarded Pastry Chef of the Year for 2008 by Bon Appetit Magazine.  She decided to go to New York, visit her mother, and attend the award ceremony, and at the same time, visit her doctor.

I was running the B&B by myself as my husband had taken a job out of the country for the year. Prior to the B&B opening, I had run the massive construction site alone that winter and spring. A roof and partial building collapse sent me into an emotional and psychological tailspin. My mother and my brother in law were diagnosed with cancer in early 2008 and I was locked into staying in Italy coping with a construction project gone off the rails.  I was worn thin from the stress of feeling pulled.  I felt guilty for not being in two places at the same time and exhausted by an insane exchange rate that ate away at both our capital and guest reservations.  I was looking forward to the end of the season before it even began. 

But things were about to get much worse. 

Then the telephone rang. The second week of June.  

"Diana, I went to the doctor.  I have cancer.  Ovarian cancer, Diana, Stage Four."

She started to weep.

"Tell me this is a blip." She begged me. "Everyone`s trying to tell me it's a blip.  But I know if you tell me it's a blip, then it's really a blip."

I couldn't say that.  I couldn't say it was a blip.  Because stage four is never a blip. People were telling her it was a blip because they didn't know what to say.  Cancer does that to people. 

She told me she was already scheduled for surgery and that it was going to be huge.  A week later, doctors at Mount Sinai removed tumors and tissue from just about every organ, along with her uterus.  The healing was to be a monstrous undertaking. But the doctor told her the words every cancer patient wants to hear.  "We got it all," he said. She lived with her mother while she healed, having given up her apartment in Brooklyn before moving to Italy. Her healing was difficult and she endured a tremendous amount of agony as the wounds just would not heal. 

In the mean time,  I organized a collection to go and retrieve Gina's cats from her apartment in Rome, where they were stuck.  So many people contributed and in a grand joint effort, my friends Michele and Becky braved Rome in the August heat to each carry one cat back to New York.  

While she was still trying to recover from surgery, chemo began.  At the end of the first round, which included a drug trial and all the related complications, she was in remission. That part of 2009 was glorious for Gina.  She went back to work at Babbo, and found a sweet apartment in the most northern part of Manhattan near Overland Park.  

That apartment became her absolute sanctuary. 

She was finally awarded the James Beard Pastry Chef of the Year in 2009, after five nominations.  

But then remission ended. 

The team that had put her back together at Mount Sinai had since gone in different directions and Gina ended up at a doctor who is considered one of the top in the country. I refer to him as Dr. Number Two.  The complication was that Dr. Number Two was not in her insurance "network". Because of the grave nature of her cancer, he agreed to accept whatever payment her insurance company would give him.  

But when the insurance company delayed payment, Dr. Number Two's assistant called Gina and told her they would not give her treatment anymore if the insurance company didn't pay up immediately. 

In other words, they were ready to kill her for a few thousand bucks.

I happened to be in the states during this fiasco and I can promise you, there is no hell like being denied life saving treatment.  The stress that those two weeks put on Gina's body were the perfect consumption material for the cancer.  She screamed, she cried, she fretted, she made herself sick, she frantically called her insurance company multiple times.  Finally the doctor in question let her know that she would be given treatment even with the book keeping delay. 

Generous, I thought.  

I should be kinder.  But I had just witnessed something no one should ever, ever have to go through.  I hope they fired that doctor's assistant.  She had no business dealing with cancer patients. 

I wish I could write here that that was the only time the health care system threatened Gina within an inch of her life.  But fighting insurance companies became part of Gina's survival strategy, out of necessity. Gina let me know on every conceivable occasion how fortunate I was to be part of a European universal health care system, where you don't risk losing everything when you get seriously ill.  

I watched cancer treatment eat at her finances.  Co-pays, premiums, uncovered doctor visits.  The sheer stress that the financial worry caused her fed her cancer.  She knew this.  But what could she do?  She had to fight for everything, our Gina.  And she fought like a champion.

She made the decision to have a double mastectomy as her cancer resulted from the BRCA-1 gene mutation and the likelihood of a breast cancer diagnosis was very high.  The surgery was very, very difficult, and she required 6 follow up procedures because her body rejected the skin stretchers that were inserted in order to make room for implants. They had to remove the skin stretchers so that she could heal.

By this time, she had lost so much.  Her good health, her uterus, her breasts, and any semblance of financial security she had ever had.   She took it all with the fierceness of a lioness. She suffered so much.  

But whenever I came to the states, I visited her and she would calm my raw nerves (visits "home" are always stressful for expats who try to do too much, spread themselves too thin and end up going back exhausted), make me a beautiful meal and be very concerned about how I was feeling and if I'd be ok to fly back. 

We would sit on her sofa with her cats and watch TV and laugh.  

She went into remission after the second round of chemo.  Unfortunately it did not last long.

When she was diagnosed again, she ended up at Memorial Sloan, the "gold standard" of cancer centers.  Or so they say.  

By this time, I knew more about cancer drugs than I ever wanted to know. I knew that platinum - the metal - was the best chemo for her kind of cancer but it was often the first to be discontinued because after it built up in the system the body can easily develop massive allergic reactions to it reactions that can come close to killing you - as was the case with Gina on a couple of occasions.   

On one of my visits home, Gina arranged to take her best friend Nancy and I to Babbo for dinner. It was the first and only time I have ever been there.  There was some fun schadenfreude that we got to sit at the best table while the people who normally occupied that table, Kelsey Grammer and his new wife, looked on with scowls.  

But by far the highlight of the evening was that the kitchen prepared every single one of Gina's desserts for us to taste.  I always knew she was one of the best in the country, but at that moment I was aware I was in the presence of culinary genius.  

She worked at Babbo during chemo until she simply couldn't stand up any more.  Letting go of her job was such a grave loss for Gina, even though the Babbo kitchen fired up her body with inflammation and stress.   She did not know if she'd ever get back to work again.  But she kept the attitude that being out on disability would be temporary - that she would go back into remission and this time, it would be for good. 

The drugs at Sloan stopped working, and she started feeling intense pain in her abdomen.  Water - ascites - around the growing tumors was becoming unbearable. 

The Sloan doctors started making noises about hospice and making preparations. This is the image I will carry of Memorial Sloan to my death - they gave up on her two years before she actually died. That's what happens with advanced cancer treatment. In the end, it's cookie cutter, and after the experts have exhausted their bag of tricks, they usher you out of their office to die.

But with Gina, they did it way too soon. 

Meanwhile, she made an appointment with Doctor Number Two, the one who wasn't in her insurance network and who had the assistant from hell.   He recommended a cancer clinic in the Bronx that specialized in cases just like hers.

He also told her that if she could get the tumors shrunk down enough, he'd go in and take them out.  

Bruckner was a clinic was a clinic outside of the mainstream.  Instead of loading a person up with one type of cancer drug, they developed individual cocktails using small doses of different drugs. This would keep allergic reactions to a minimum.

 Going to Bruckner was no picnic.  The chemo clinic was deep in the crappy part of the Bronx, and there were no fancy chemo chairs with nice magazines.  It was a low budget, brown chaired chemo center for those everyone else had given up on. 

Gina started at Bruckner and saw results almost immediately.  Her tumors started to shrink, and she started to feel better - that is, on the weeks she didn't have chemo.  On the weeks she did, she was really sick. 

I realize here, in telling this story, that it is underpinned with the constant thought about what would happen.  What would the future hold?  How would she ever be able to reclaim her life?  We spent hours and hours talking about this.

Gina so desperately wanted to live.

So desperately. 

For her mother, for her sister, for all of us.  She wanted to do things - so many things.  Not many people know this about Gina, but she she had a very deep sense of social justice.  Everything she had lost with the cancer had served to make her believe that the system she found herself flailing in was inhuman and wrong - on so many levels.  She had wanted to go into politics way before she had ever entered a kitchen.  I could have seen her fighting for the rights of the underprivileged class.  

Gina cared deeply.  About everything.  She wanted the best for everyone.  She was cast into the public eye and appeared on shows like Martha Stewart and knew everyone who was anyone, but she was an old fashioned girl.  Her true loves were her mother, her sister, her cats - and Italy.  She understood Italy like she understood the back of her own very graceful hand.  

We used to talk about how we were both raised on pastina and broth.  My godmother's name was Evalyn; her mother's name was Evelyn.  We both understood the importance of over-ripe fruit on the table in an Italian household.  We were both deeply and irrevocably Italian American. It gave us a secret language.  

When we sold our B&B in Italy, Gina was deep into her treatment at Bruckner.  When I felt the carpet being pulled out  from under me through depression and a deep sense of loss during that time, she reminded me:

I have a healthy body.  I have the obligation to keep moving forward and hold my head up.  The obligation. 

She watched several people come and go during her time at Bruckner.  It was a station for the very seriously ill.  People died, and she felt like everyone was leaving her. When GIna's drugs stopped working, they changed up the mixture.  As good as they were at Bruckner, it became clear that they were reaching and guessing.  

Because, at the end of the day, cancer can't be cured. 

The tumors started growing again this past summer, and Gina went back to Doctor Number Two who agreed to take them out. 

I worried about that decision.  First of all, two years earlier, Dr. Number Two had said he could get them out if they had shrunk. The tumors had shrunk a great deal (this was the point she should have had the surgery but with advanced cancer one always has the hope, when tumors are shrinking, that they will go away on their own with the drugs) but now they were growing again, and that profile did not fit the situation that Dr. Number Two had spelled out for surgery almost two years prior. 

I also worried because I knew how poorly she healed from both the first cancer surgery and the mastectomy.

But we had all gotten so used to Gina beating the odds that... well, at least I did not allow myself to think about it going terribly wrong. And we all knew that the surgery, with its infinitesimal chance of succeeding was the only hope she had of not dying in a matter of weeks. 

But it did go terribly wrong.  I don't want to talk about what transpired because it doesn't matter now. But I will say this - my opinion of what cancer treatment is about has shifted dramatically as a result of what I witnessed from 3,000 miles away.  

The last time I talked to Gina was the beginning of December.  Well, we didn't talk.  We sobbed. We sobbed and I said I love you, my darling, darling friend and I am so sorry you have to suffer like this.  

I knew it was goodbye. 

When it finally came to an end, 7 and a half years after her diagnosis, I knew it would take me a very long time to put it all in a place that makes sense.  Because the lessons hidden inside all of the years of facing death's door are so many and so precious.  

But this is the first step.  Just telling the story.  Telling what happened. 

Dear Gina,

I am very grateful I had the chance to walk the path with you. 

You are very brave.  And very special.  

There will never be another like you.  

Thank you for being my friend and for caring about me.  I know how much you cared about me. 

I will miss you all the days of my life. 

I love you.

There never will be starry night that I don't look up and think of you.  

Because you are and always will be one of those stars shining back at me.  

Stella. 

Love, 

Diana