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"Hello, Beautiful People!" A Tribute to Pam Notaro
By Claire Nixon on October 16th, 2015 Categories: The Breast Cancer Journey
Pam Notaro had just taken over as office manager at Medical Broadcasting Company, a digital health agency in Philadelphia where I worked, when I was diagnosed with breast cancer. Her energy was immediate and different. I didn't get to know her well until after I'd completed treatment a year later. She was pure Italian vital force from South Philly — beautiful, salty, radiant, hilariously blunt in her delivery at times. She made her own tomato sauce every summer, and she loved a good glass of wine. And she got things done — thoroughly, even relentlessly. She was more dependable with details than anyone on staff, and she'd chase you down until she got what she needed.
Two years after I'd finished treatment, my hair back to its original state and the experience in the near-past, I had gotten to spend more time hanging out with Pam during and after work. Her joy of life was infectious. She was funny even when she was annoyed.
One day in 2001, I was at my desk when my phone rang. I saw Pam's office extension on the screen. A coworker's voice asked, "Can you come in here?"
Pam was looking down on her keyboard. "They found breast cancer," she said. Impulsively, I sprang into action, rattling off all the relevant questions. It was early stage. This was good. There was a lot to figure out, but her mother Diane Pirollo — a registered nurse — and her husband Joe were by her side to assist.
Pam had been a smoker until the diagnosis and immediately made moves to quit. She wore nicotine patches and on some days, like many people, swore her way through it to eventual success.
Over the next few months, we would get Pam fitted for a custom wig and sip margaritas while the wig designer shaved any remaining hair strands. Although the new hair was incredibly convincing, Pam tossed it on the floor in frustration later, saying it was uncomfortable. She opted for scarves. She was always practical. And she was tenacious, working through almost all of her treatment.
I went with her to her first chemo infusion. Diane was there, too, always. Pam sat there as the Adriamycin and Cytoxan went into her port, and she laughed and told jokes and exuded love and giggles to everyone in the room. After it was over, we walked towards her car.
"Go home and rest. I'm headed into work," I said.
"So am I," she said. "Get in." She meant it. "No way am I going home. I have things to do."
I had had the same treatment, and I knew her hair would fall out in about 2 weeks. She knew it, too, but it wasn't quite real, a dramatic physical identity change that would be impossible to grasp until it happened. For now, it simply loomed.
We were headed up Broad Street when she flipped on the radio. AC/DC's "Hell's Bells" blasted out — raw, primal, that low roar that threatens to erupt out of your throat. She looked at me with fire in her eyes. "I am SO PISSED OFF!!"
"I know," I said.
She banged her fist on the dash a few times and promptly disintegrated into laughter. "I'm crazy!"
"It's all crazy. The whole thing."
"Yes!!" she said, laughing.
In the moment of a cancer diagnosis, feelings come in a rapid-fire flood or not at all, if you're in shock. This makes no sense, my body betrayed me, it's not fair, oh my God my family, my children, the universe doesn't want to see me happy, I'm terrified, I can't move, I'm filled with rage, I want to destroy something, time has no meaning. Within 24 hours, you've met with life-altering realities, faced your mortality, and made decisions you could never imagine making as the previous version of yourself. The version of you from a day ago.
I tended to deal with my diagnosis by eventually accepting and walking into the fire of what I had to do, because it gave me a sense of control. If I walked into it willingly, even with gusto at times, I felt as though I was still retaining a lot of my personal power. "Fine. Bring it. I'm ready." I don't know if that qualifies as "fighting," and I was never sure if battle imagery resonated for me. It was more about resisting nothing. More yin, less yang.
Pam wanted to fight. And sometimes making that decision is one of the most exhilarating, life-giving things you can do for yourself. To be the director of your own experience. She was determined to quit smoking, go to all her treatments, arrive at the office on time, and take care of numerous other life responsibilities. She was committed to getting it all done and having a great breakfast to boot. There was little she loved more than a stack of pancakes with friends. She turned a morning in an IHOP booth into a phantasmagoric culinary experience. "Pamcakes" was an oft-used term of endearment.
As Pam was finishing chemo, I'd started traveling. I wanted to see more parts of the world than I had before the cancer. When I was preparing for a long flight to London, Pam slid me some leftover Zofran from her stash of anti-nausea meds. She gave me a knowing look only understood by few. "Here. You're gonna need this." To someone who's been through chemo nausea, those little pills are pure gold. It was a big deal.
Pam learned that she'd need to take tamoxifen for several years to reduce the risk of the cancer returning. After being on the regimen for a while, she felt like she was gaining weight. She decided to do something about it. She started working out, and working out more, and becoming very involved in her gym. She started teaching spin classes, and she loved it. She greeted her students with, "Hello, beautiful people!" This quickly became The Phrase Owned by Pam. No one said it quite the way she did, with that gigantic smile.
It was around this time that I'd started working for Breastcancer.org, and I wasn't seeing Pam as often. And she was doing really well. More bluntly, she was completely kicking ass. "I went to war with the drugs," she said, flaunting newly pronounced muscle.
Pam would continue to transform through physical fitness. Every time I saw her, she was more ripped, and more ecstatic. In 2008 she started teaching Zumba at Future Fitness in New Jersey. Fellow spin instructor Tammy Peters says, "We took each other's classes. And then we went to the first course of Zumba and we laughed the whole time. Zumba is five different types of dancing, so it takes a lot to learn it. Choreography is complicated. We didn't think it'd be that huge, but she was giggling about it because the girls in the classes were phenomenal, and our mouths were on the floor. She stayed with it and loved it. She didn't think her body could move that way. She picked it up and ran with it. She kept going and had a little cult following.
"The thing about Pam is that she always would be encouraging. She was one of the strongest women there. If someone could not do something, she'd always get with them, dance or ride with them, motivate them. Even if they were screwing it up to no end, she kept them pumped.
"One thing I learned from her is to 'look someone in the face and remember their name.' I've been teaching for 20-odd years, and it's hard to remember names and faces," says Tammy. "She and I had a point in our careers where we had different ways of learning people's names. We'd come up with fun stuff in class — a fist bump or something — and when you call people out, and you know their names — maybe they're overwhelmed or dealing with illness. It makes a difference when you take the time."
Pam continued to emanate her inspirado as she developed more and more of a following at the gym, at work, and in life. Medical Broadcasting Company became part of Digitas Health, a Publicis company. Pam led a significant office buildout and company move in Philadelphia, overseeing the work of architects and contractors to create a dynamic work environment that would serve 400 employees. When staff walked through the front entrance, Pam greeted them with her lighting-up-a-thousand-cities smile. "Hello, beautiful people!" It was infectious.
She wanted to give back and help others. "Pam used the gym as an outlet in a big way," Tammy says. "She also rallied people to do all kinds of giving. She'd have Zumba parties — not just about breast cancer, but about pets and all kinds of causes. We had an animal drive. She knew that was my passion, too. Whatever charity it was, we made it part of our fitness drive."
In the spring of 2013, things shifted. Pam began having difficulty with her vision. After some diagnostic testing, she and her family learned that the cancer had come back in her brain and spine. She disclosed to some people; she didn't tell everyone. Her family rallied around her.
That summer, she underwent radiation and began a new chemo regimen. But she didn't quit working out or teaching. She kept going to work, and she kept teaching Zumba. She wanted people to know she was still herself. "This doesn't mean I'm any different than I was before," she said to me. "It's just a thing that happened. I just have to manage it. It's a condition." She fought against the stigma of metastatic breast cancer, determined to exist as her authentic self, making her own choices and continuing to be in charge of her life.
"She was so into keeping physically fit," says Diane. "I think that was her way of taking some kind of control over what was happening to her body. She believed that if she could be physically fit, that would help. Her husband would tell her to slow down, but she didn't. Eating well, healthy foods, exercise. And trying to do what she could to fight the disease with reading tons of research. She was always involved."
In the summer of 2014, Pam got certified to teach a fitness program for women who were undergoing breast cancer treatment or were recovering from it. She wanted to develop a class to help the physical recovery process. "She was passionate about helping these women," says Diane.
"Pam was never afraid to share her story, and for me, that is huge. 'If I can battle this, you can overcome things, too,'" Tammy says.
In September 2014, the cancer was in her liver. Still, Pam met me for breakfast at IHOP. She was beaming. "Isn't this great? I'm so excited. I'm getting the pancake special." It was not warm in the restaurant, but it felt warm being with her. She told me she was smoking medical marijuana from the dispensary, and explained all the flavors. "I have something called Cherry-licious, and it's awesome!" We couldn't stop laughing.
That October, I interviewed Pam to get her thoughts about Breast Cancer Awareness Month. "When you put a breast cancer awareness banner in front of someone, and they have cancer in their kidneys, liver, and bones, they're not connecting with the messaging that's going on out there. Like me — I'm not connected with a lot of it because I'm fighting a different battle than people with early-stage breast cancer — it's totally different, like night and day. Understanding that it's still breast cancer is the hard part. They think, 'She beat it once; she'll beat it again. In 6 months she'll be fine.' But because it's not isolated to one area, it never goes away, and you're always fighting."
She wanted to know about the latest treatment breakthroughs and clinical trials. And she kept teaching Zumba when she could, staying motivated to go to the gym after work. Tammy says, "There were certain times when she was really sick when she told me 'life is too short, you know?' We told her we wouldn't let the group forget what we've accomplished."
There were ups and downs as she continued her chemo regimen that fall. She researched. She got tired. She stayed in bed and then she got out of bed. She had some emergency room crises, and she got through them.
"Besides being one of the most courageous people I've ever known, she was so out there to fight this disease and do everything she could to keep herself as healthy as she could. She always came across as 'I'm gonna beat this no matter how grim the diagnosis and course of treatment,'" says Diane. "She always approached it not complaining. She approached it with determination. I don't know where she got the time to do all that. She was a role model. That smile that could light up a room."
In December 2014, after much rallying (and ordering of eggs over easy), we lost Pam. Although we were somewhat prepared, it was still an enormous suckerpunch to the gut.
I've faced death a few times. Tentatively, I can say I've mostly come to terms with it. We're sometimes called to come to terms with it over and over, though. Four weeks before Pam passed away, I had been hit by a car and was nursing a broken leg. It was almost absurd. I had developed some acceptance that maybe there was a reason I had to go through these things and remain on the earth. I stopped questioning it. But Pam having to go was kind of a short-circuit in the mind. And because I was temporarily stuck with an injury, I was not able to say goodbye in person. I don't usually get angry about cancer. But the rage that came up that night was primal and unfathomable.
Music had been a big part of Pam's Zumba classes. "Some days she'd play heavy metal, sometimes disco," Tammy says. "But she always had the Stones. That was her music. Joe found some CDs in her car and asked if I wanted to use them for a spin ride. I listened to three of them, and each mix featured the Stones' 'Miss You.'"
It felt like a sign. The morning of her service, I loaded up Exile on Main Street and made it loud.
We're hard-wired to expect certain things. We believe that people who exude so much joy, love, and full-on aliveness are going to be here for the duration. How could they not? When they leave earlier than seems right, it simply makes no sense. And sometimes, it results in intense anger. As time passes, the anger can eventually dissolve into a kind of bittersweetness.
In early January I was in Boulder, Colorado doing work with our technology team at Foraker Labs. At 5 a.m., I awoke suddenly in my hotel room.
In the dream, I'd been walking around in the museum area of Philadelphia. I paused on the steps outside the Franklin Institute, when Pam appeared. She was wearing a green shirt she'd been wearing when I photographed her at a party in 2007. She looked slightly disoriented, as though she wasn't quite sure where she was. But as soon as she saw me, out burst the dazzling, face-breaking smile. I was bewildered, unsure of what was real and what wasn't.
"What's wrong?" she said.
"I don't know," I said. The day was beautiful and sun-drenched. Stunning. We didn't need jackets. We watched for a minute as people moved up and down the sidewalk.
Confidently reaching for a known reference point, she looked at me. "Well come on. Let's go get some pancakes."
Tags: metastatic cancer
Claire Nixon
Claire Nixon, Editorial Director — Claire directs a team of writers, researchers, content managers, and physicians through the creation of high-integrity web content. She brings 20 years of experience in health communications and journalism to the Breastcancer.org team, as well as the lens of the patient – she was treated for breast cancer in 1998 and again in 2012. In her off-time, Claire enjoys creative writing, independent films, meditation, and the ocean.
Frazoo says:
Hello Claire,
The story of Pam's journey, and yours, moved me to tears. My dear sister, Lisa, was very much like Pam and fought the good and noble fight against this horrid disease with determination and lots of humor. I miss her each and every day.
Journey718 says:
Hi Claire,
I'm so sorry for the loss of such a vibrant, beautiful person in your life. I'm glad she was able to be there for you and wish you continued blessings & good health. Seems like Pam left an amazing legacy for everyone she touched. Fortunately that means she will continue to touch others every day.
I saw you said Adriamycin & Cytoxin. By any chance was the breast cancer TNBC? Triple Negative? TNBC is a monster of a different land. I have a loved one on that very cocktail now, so I'm hoping you can let me know. My prayers to you & yours … Journey
Claire Nixon says:
Hi Journey!
Thank you for the kind words! Neither Pam nor I had breast cancer that was triple-negative, but you can learn more about triple-negative breast cancer and current treatments here: http://www.breastcancer.org/symptoms/diagnosis/trip_neg
Wishing you and your loved one all the best!
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