Ken Wells (c) 2014, Bloomberg News. HOUMA, La. — “Let’s go shoot Savannah,” Tom Galjour says as we bounce along in his vanilla-colored Dodge Ram pickup. He’s at the wheel. We’re on a sleepy blacktop road meandering through a sprawl of sugarcane deep in Louisiana bayou country outside of Houma, where he lives.
It’s an adventure riding with Tom. An oxygen machine pings from his cluttered back seat, supplying the clear-plastic cannula looped over his head and fixed to his nostrils. He soon trades it for a nebulizer, giving himself a breathing treatment as he steers one-handed.
Savannah isn’t a person. It’s Tom’s affectionate name for his gun and, well, not just any gun. It’s a single-shot, bolt-action ArmaLite .50 caliber rifle, 35 pounds and nearly five feet long. Equipped with a scope, it shoots a projectile that breaks the sound barrier.
Skilled military snipers have used .50 calibers to pick off enemy combatants from more than 1 1/2 miles away. The gun can penetrate six-inch concrete walls and pierce light armor. Tom, who once plunked a golf ball at 200 yards with Savannah, supplies these data points with deadpan glee. He paid $4,000 for the gun back when he had money and every shell he fires costs three bucks, but so what?
He loves Savannah, and in a way Savannah is returning the love, providing amusement and purpose in the fight of his life.
“It’s boring just having cancer,” says Tom, 64, a psychologist, as he pulls onto a dirt road. “If you can’t have fun while having cancer — what the hell.”
More than 2 1/2 years ago, Tom, a chain smoker, was diagnosed with Stage 4 metastatic small-cell lung cancer exacerbated by emphysema. He was given a few months to live at best. Spots peppered his lungs. Tumors had spread to a kidney and wrapped around his bronchial tubes like fat strangler vines. An initial round of chemotherapy shrank the tumors but left him weak, his immune system compromised.
He developed double pneumonia. He wasted to 88 pounds and in October 2012 lay at death’s door.
Then, Tom simply declined to die.
“He decided he would learn all he could about his cancer type, and then he would do everything he could to kick its ass,” says Judge Jude Fanguy, who presides over Houma City Court, where Tom once counseled juvenile offenders.
I’ve’ known Tom since 1968, when we were college classmates. We talked philosophy, played pool, dated women and drank a river of beer together. We lost touch for a long stretch, then reconnected about four years ago. I’ve caught up with him less than two weeks after his latest round of chemotherapy and 30 doses of radiation.
Over the course of a week, Tom’s strategy reveals itself. He supplements conventional treatment with intense research, healthy eating, a dash of alternative medicine and a physical regimen that would test many healthy men. To that you can add an implacable will, a dry sense of a humor and a small web of friends who share his understanding that much of the battle is defeating fear, depression and isolation.
Only two percent of patients diagnosed with his form of cancer survive five years. More than halfway there, he intends to be one of those — even as he has no illusions about what he’s facing.
“You want an analogy?” Tom says. “I wake up every day in the ring with a 6-foot-four, 240-pound heavyweight. I can’t afford to miss many licks — he’ll take me out.”
Tom brakes the Dodge under the moss-draped branches of a live oak. He points to the trunk of a previously scouted dead tree more than a quarter mile away across a fallow field. “I’ll shoot first and you can use my shot as your target,” he says.
Savannah, which he keeps in a sturdy black metal case padded with egg-crate foam rubber, requires some assembly. It’s 85 degrees, breezy, the air a swamp of humidity. Tom, separated from his oxygen, coughs sporadically but his breathing is fine. During what he calls his “bad breathing days” he sometimes gasps for breath so loudly he could be mistaken for a bear grunting in the woods.
He offers some pointers: “Pull her up hard on your shoulder. The kick’s no worse than a .12 gauge shotgun. But Savannah has no safety. Once she’s hot, she’s hot.”
He hands me padded ear muffs.
“I’ll send the first one,” he says. “When it hits, the tree should shake.”
Reversing his purple Louisiana State University baseball cap, Tom lies prone on an army-green mat. He clanks in a six-inch brass-jacketed shell, covering his head under a sniper’s shawl.
He’s under there for a long time, siting in, still as the day moon when Savannah explodes, belching a tongue of fire.
Even with ear protection, I’m not prepared for the shock wave that follows. I jump, almost dropping my camera. Leaves in the oak above me are quivering. A few flutter to the ground.
The target tree is shaking like Elvis’s hip.
Tom nods in satisfaction.
I suddenly have doubts about firing Savannah – she’s a beast. But I can’t back out. I eject Tom’s shell and put in mine, slapping the bolt shut. I scope out where his bullet hit.
The blast rattles my brain. The recoil sends the scope to nick me above the right eye, drawing blood. The tree, eight inches in diameter, is shaking again.
Tom hands me a tissue and peers through Savannah’s scope. “Damn, you hit it right above where I hit it,” he tells me, elated.
In the truck returning to Houma, Tom says, “Did you notice that my breathing was better when I was shooting — I didn’t need oxygen?”
Tom had schooled me on an important fact. Fighting cancer requires celebrating the small victories. They supply oxygen for the elixir called optimism.
“Yeah,” I tell him. “I noticed. That’s big.”
– – –
Lung cancer is a determined killer. Almost a quarter of a million new cases are diagnosed annually in the U.S., and about 159,000 Americans will die this year.
Ted Owens, an oil company logistics wrangler who thinks of Galjour as his brother, remembers the day it almost took Tom.
“He called me to drive him to the hospital. When I saw him he was blue, his fingertips were blue,” says Owens, 49. “He was gasping for breath like a fish – air starvation like nothing I’d ever seen. It was painful to watch. I thought it would be the last day I would see him.”
So did the doctors at Houma’s Leonard J. Chabert Medical Center. “He has hours, maybe days, but certainly not weeks,” an attending physician told Owens.
The protocol was straightforward — a one-way trip to hospice eased by a generous prescription of morphine. “Give him all he wants,” the doctor said.
Ex-wife Holly Smith Galjour remembers a call from Owens saying, “You better come, too — it’s time.” In the background, she heard Tom, rousing himself from the edge of one of the darkest places he’d ever been, saying, “Time? Time for what?”
Tom remembers that moment as one of molten anger as he ripped away the monitors that corralled his arms to the hospital bed and demanded to be sent home. “This is bullsh_t!” he thundered as nurses came running.
Tom refused hospice and went home with Owens. He remained weak, emaciated and semi-conscious. He wouldn’t take the morphine except to dab a little on the tip of his tongue now and then.
“He was in so much grief that at one point I wished he would die,” Owens says. “I know that sounds horrible, but I just didn’t want him to have to go through any more. I’ve never seen a human being suffer so.”
Then one day, maybe two weeks past his hospital discharge, Tom arched his eyebrows and said, “Hand me my guitar.”
“I couldn’t believe it,” Owens recalls. “He said, ‘Screw this, I’m just not ready to go today.’ He said ‘Help me up.’ I could tell he even looked perkier.”
And now? “It’s hard to believe,” Owens says. He laughs. “The guys at the office will ask, ‘How’s your friend who has cancer?’ And I have to say, ‘Actually, I don’t see him that much. He’s out and about, running around or visiting his girlfriend.’ “
– – –
Almost daily since his diagnosis, Tom spends some time on the Internet seeking insight into his disease. He knows that each day he survives could bring medical advances: Beneath those bleak lung cancer statistics lie what cancer experts see as promising developments.
Researchers have been using the science of genomics to chart mutations tied to tumor growth in the most common form of lung cancer, known as adenocarcinoma, and a rarer type, called squamous cell. The goal is to deploy existing drugs or develop new ones, called targeted therapies, capable of shrinking or killing tumors by turning off the growth-signaling mechanisms that are stuck in the on position. To date, the work has identified 18 key mutations in adenocarcinoma tumors and 11 such mutations in squamous cell.
Lung cancer specialists have also begun to show increased interest in what are called “exceptional responders” who stage radical comebacks against lethal cancers, particularly those who achieve remission when taking drugs that don’t work for the vast majority of patients.
World-class cancer centers such as Memorial Sloan-Kettering Cancer Center in New York and the Dana-Farber Cancer Institute in Boston have begun processing the genomes of these survivors, hoping to learn whether they possess gene variations that can help others by leading to new treatments, better targeted therapies or the revival of drugs once deemed failures. A survey of U.S. clinical trials shows that one in ten patients respond well to experimental medicines that end up being rejected for approval by regulators, according to the National Cancer Institute.
Tom’s small-cell variety is the most aggressive of all lung cancers, accounting for 10 to 15 percent of diagnoses and thus far the least studied in terms of its genetic profile. The explanation, says Bruce Johnson, a small-cell specialist at Harvard University-affiliated Dana-Farber, is that small-cell presents a slighter research pool and a dearth of actual tissue to analyze for genomic studies because most small-cell biopsies are done quickly using endoscopes that pinch off a tiny bit of tumor.
What research has been done so far shows small-cell has a complicated genome whose mutations are “heterogeneous and myriad” and more challenging to crack than the less complex non-small-cell varieties, says Johnson.
Dana-Farber is tackling that issue with new technology, known as next-generation sequencing, that lets them analyze small-cell tumors with as little as 1/200th of a teaspoon of tissue — so the game of cracking the small-cell code is on. “With small-cell, we are just getting around to the first step of trying to map out” the genomic mutations that in turn could provide targets for drugs, says Johnson, who has written a number of papers on long-term small-cell survivors.
Advances in non-small cell give researchers confidence that the small-cell puzzle is ultimately solvable. Already, non-small cell has a half a dozen gene-based therapies, including three in pill form, that can be thrown against it. Many of these have proven highly effective when used in combination with chemotherapy.
For small cell, what’s called combination chemo — usually two chemotherapy agents given simultaneously — and radiation are still the main treatments. Tom, who has studied both types assiduously, is keenly aware of the gap. “When I run into people with non-small-cell,” he says, “I tell them to take their pills and not to worry so much.”
– – –
Lacking a pill for small-cell, Tom decided to shore up his conventional treatment with his own unorthodox offensive. That meant pumping iron.
Bare-chested, a stars-and-stripes do-rag decorating his head rendered bald by chemo, Tom leans forward on a black padded weight-lifting bench, a study of abject concentration. A yellow and black oximeter, a device that measures his blood oxygen level, decorates his left index finger. It’s his constant companion.
The bench is in a small room with dim white walls and a beige tile floor cluttered with books and medical charts. This is his sanctuary within the cramped rental apartment where he lives alone on Houma’s east side.
Tom once lived in a three-bedroom house on six acres, but cancer has ravaged his bank account. He had to surrender his therapy practice because of the potential effects of chemotherapy and other drugs on his acuity. At Chabert Medical, an affiliate of the well-regarded Oschner Health System in New Orleans, he’s on a system called Free Care, awaiting a Medicaid designation.
Free Care, which he calls “a lifesaver,” has picked up tens of thousands of dollars of his bills, though he estimates he owes well more than $100,000 in charges racked up before the system kicked in.
But in his weight room, Tom puts such issues aside. He lies on the bench gripping the object above him, a barbell on a rack holding an imposing hodgepodge of plate-shaped weights. A slow arc of time flutters by when abruptly he rips the barbell from its rest, straightening his arms and letting the weights dip down before thrusting them back on the rack. This act of clanking violence consumes about five seconds.
He sits up, panting loudly. Recovery is aided by an asthma inhaler.
“Two hundred and forty pounds,” Tom says. “That was easy. I’ll be damned.” His previous post-cancer best was 220. “Now I’ve got to go for 260.”
His feat might be considered remarkable even for a healthy man his age and size: four months shy of 65, 5-foot-10, 150 pounds.
“Mr. Galjour,” says his oncologist, John Kennedy, “is an unusual character.”
– – –
It’s time for Tom’s regular monthly checkup at Kennedy’s office at Chabert Medical. Tom is strikingly poised about his cancer, yet this appointment has made him jittery.
We had come here on a Sunday two days before so a nurse could draw blood. Tom calls these Sundays the portal to “dread week” since the blood work is about spotting markers that could indicate his bronchial tumor is growing again. Momentum is everything, and the momentum had been going Tom’s way.
Before his last round of treatment, Tom had called to tell me about Kennedy’s decision, in consultation with a radiologist, to increase his radiation doses to 30 from 20.
Tom has an Ivy League IQ and formidable vocabulary. Yet he exudes the swagger of a welder you probably wouldn’t want to tangle with, speaks in a roux-thick Cajun accent and drops f-bombs like a rap star.
So this is Tom, paraphrasing Kennedy’s 30-dose approach to me: “I like this guy’s f_ing attitude. He told me, ‘Tom, you don’t look like a guy who has cancer. You look like a f_king guy who can take it.’ He talked about my tumor and said, ‘You know, the idea is to kill that son of a b-tch, not just shrink it.’ “
Tom paused, then said, “Kill the son of a b—-! Now we’re talking.”
Before going into Kennedy’s office, Tom had his vitals taken. A nurse ran him through a litany of standard questions. It was hard not to perk up at one series.
“Are you sexually active?”
“Men or women?”
Tom rolls his eyes. “Women. Well, woman, singular.”
The nurse smiles. They’ve been through this drill before.
“I hear you’re swimming,” Tom says.
“Yeah,” she says. “I’m trying to get in shape, lose my fat butt.”
“Don’t do that for me. I like it,” Tom replies.
She rolls her eyes, then laughs.
On this day, Tom’s dread of dread week is for naught.
“Your blood work looks good,” Kennedy tells him. “There’s nothing there to indicate anything we should be concerned about.”
Tom is visibly relieved. They talk strategy. Sometime soon, Kennedy will order a PET scan that will be their first look at how the bronchial tumor has fared under the latest bombardment. The trick is to time it for when the radiation will have done all its work.
“You know,” Tom tells Kennedy, switching gears, “I racked 240 this week. I can see doing 260.”
Kennedy looks at him and says, “Whatever it is you’re doing, you should keep doing it.”
Later, I ask Kennedy about the role of optimism in cancer treatment in general and Tom’s case in particular. Recent medical research finds little correlation between survival rates and “fighting spirit.” Still, at least one 1999 study of 578 British breast cancer patients indicated that those suffering depression and feelings of hopelessness had higher relapse and death rates than patients who didn’t.
Anecdotally at least, attitude sometimes seems to count a great deal. Kennedy tells the story of one of his own patients who far outlived his early prognosis and whose central trait was his happy, upbeat disposition. He thinks Tom’s push to remain engaged in the world and in his treatment is unquestionably helpful.
“From the start, he’s shown a huge amount of interest in his own case,” Kennedy says. “This isn’t a guy who’s just going to lay down and die. His rebound has been remarkable.”
– – –
Thomas Alton Galjour was born in 1949 on the banks of Bayou Lafourche in Larose, about 50 miles southwest of New Orleans, the only son of three children born to a farmer and a special education teacher.
Tom remembers working cattle, baling hay and hauling feed sacks from about the time he could walk. He graduated from South Lafourche High School, a tough place full of the sons and daughters of shrimp boat captains, fur trappers and oil field roughnecks. He enrolled at Nicholls State College in Thibodaux. He decided to major in psychology after observing a farm neighbor who had trained his mules to follow instructions in Cajun French.
Tom frequented a place called the College Inn, known for its cheap alcohol, live bands and fist-fights in the parking lot. Tom was in a few of those, including one in which a guy about twice his size spiked him on chain link fence, causing Tom, who had been an amateur boxer, to finally get mad and punch the big oaf into a bloody pulp.
I wasn’t there but I would never doubt a Galjour fight story. Tom saved my hash at Nicholls. Once, some liberal-leaning kids put up anti-Vietnam war posters, and a bunch of frat guys and jocks started tearing them down. As student body president, I was trying to mediate but soon found myself surrounded by the sign destroyers. Tom and some of his South Lafourche buddies waded into the scrum and surrounded me.
“Something bad is gonna happen here,” I recall Tom saying. “And it won’t be to us.” Though we were well outnumbered, the mob soon dispersed.
Tom earned his bachelor’s in psychology in 1971 and his master’s in 1977, doing stints as a state child protective services and probation and parole officer, and a public school counselor.
In 1978, he went into private practice. He was president of the regional mental health association, and counseled juvenile offenders.
“Tom has a very kind and generous heart,” says Judge Fanguy, who supervised Galjour’s work back then, “but he also slices right through the b.s. He deals with people the way they are, no pretense. He was also willing to try different things because all kids are different.”
His friend Owens, an Army marksman who got Tom into target shooting, attests to his lack of orthodoxy. “I’d busted up with my first wife and it had torn the guts out of me. I didn’t know a soul in town so I was looking for a counselor.” Wearing a hang-dog expression, he walked in to see Tom.
Owens gathers himself for a remarkable impression of Tom’s Cajun accent. “Tom tells me, ‘I can tell you right now, you’re a big boy. And if you’re coming in here looking for a f_king hug, you’ve come to the wrong place.’ ” And then he smiled.
“I loved him from that moment on,” Owens says. “We talked and after a while he said: ‘Brother, you don’t need a counselor. You just need time to heal.’ “
– – –
“You’re going to drive because I’m going to drink,” Tom says, handing me the keys to the Dodge.
It’s late afternoon and we’re heading to the High Tide for a meeting of the League of Extraordinary Gentlemen, Tom’s confederacy of billiard-playing friends. He swears he started the club long before the movie by that name debuted.
Tom has his oxygen bottle, his nebulizer, his Advair inhaler, his albuterol inhaler, his $1,200 Meucci pool cue.
He has studied billiards as hard as he’s studied psychology and cancer. “There are 99 pool shots,” he says. “If you learn them all, you can put the ball anywhere you want to. I shoot for the perpendicular bisector of centers of balls that are in clusters and then you can tell where every one of those balls is going. People look and go, ‘Lucky shot’ and I say, ‘It’s not luck.’ “
Billiards, like Savannah, offers camaraderie and cheer and gets Tom out of his gloomy apartment. “Tom’s a different person at the table,” says David Cannon, 66, an Extraordinary Gentleman. “By the way, he saved my marriage long ago.”
In candid moments, Tom will acknowledge his doubts and fears. Not conventionally religious, he believes in God and has had a recurring dream — of a dark, explicitly evil presence trying to claim him and a beneficent presence counseling him to resist.
Getting up every day is work. Fatigue is constant. “Mornings are the worse, but I only experience fear when I’m alone,” he says. “With my real friends, I can feel myself charging up.
“I have thought about suicide. But if I even mention that so I can talk about it in relation to what I’m going through, my friends go crazy. It’s like I do not have permission to die. They expect me to beat this,” he says. “I think it’s reasonable for me to ask them, ‘How long do you expect me to beat this?’ “
He’s not exaggerating about the number of people forbidding him to die. He’s been married five times — twice to Holly, who prays for him constantly. Tom helped raise her two daughters from another marriage. Now she helps him with his laptop and his medical records.
In the beery dimness of the High Tide, Tom orders a Miller High Life and plugs in his equipment near a pool table. He takes a sip of beer and gives himself a breathing treatment.
We shoot alone for a while. When he shoots, Tom is all business. When he’s not, he’s relaxed and happy.
At 6 p.m. he stops. It’s Advair time. The inhaler eases his emphysema and asthma symptoms, but at a cost. He takes a big puff and goes down hard on one knee in a spasm of coughing that lasts so long I wonder if he’s in trouble. He isn’t. He rises and returns to the table.
Tom makes one shot that is so outrageous — the cue ball hopping over another ball, smacking its target into a corner pocket and then reversing like a dervish to a stop in perfect position for the next shot — that I accuse him of voodoo.
Before I leave Houma, Tom will rack 260 pounds on the weight bench.
— — —
Tom has a daughter from his third marriage, Gabrielle Galjour, who had been expecting a baby. Shelby Broyles was born on Aug. 15. Tom texted me a picture of him holding his first grandson.
He also shared an email Gabby had sent him earlier. “No one can beat this but you can Dad,” she’d written. “You’re a fighter like nobody I know, come on, fight. Please.”
Tom says, “It doesn’t give me much choice, does it?”