In the fall of 2022, Robin Clough and Dr. Gene Dorio their lives as they had for years, serving older adults in the Santa Clarita Valley. Clough, meanwhile, was busy with her work as an administrator at the local senior center Dorioa geriatrician on a house call, crossed the valley to visit his patients.
In November that year, Clough noticed a lump in her neck and had it examined. The first indication was that she had papillary thyroid cancer.
“I was a little concerned,” Clough said, but not overly so, because she knew this type of cancer was treatable and highly survivable. “So in the back of my mind I thought, 'Oh, I'm so lucky. …It's the easiest cancer to take care of. ''
California is about to be hit by an aging wave, and Steve Lopez is in on it. His column focuses on the blessings and burdens of growing older – and how some people are challenging the stigma associated with older adults.
Then things took a sharp turn. “I noticed it was growing a lot,” Clough, 70, said of the lump. “I had trouble speaking.”
An operation was planned. Dorio, 72, said it was expected to take about three hours to remove the tumor and half of Clough's thyroid gland. But the procedure dragged on. When the surgeon notified Dorio nine hours later, the news was grim. The tumor had spread through the thyroid gland, to the carotid artery and to the tracheal rings.
“He told me it was everywhere,” Dorio said.
Tests revealed that Clough had anaplastic thyroid cancer, a much more aggressive form than papillary cancer.
We all know that our fortunes can change without much warning, especially as we get older and the odds turn against us, increasing the threat of our bodies gradually failing and our minds fading. But in just a few weeks, Clough and Dorio had gone from cruising through life to confronting death.
Dr. Gene Dorio kisses Robin Clough in the kitchen of their house. Dorio, a home visiting geriatrician, spends much of his time caring for Clough.
(Genaro Molina/Los Angeles Times)
With her type of cancer, life expectancy is often measured in months instead of years. “It was so hard to process, and I think my mind kept me from processing it because it was just too overwhelming,” Clough said.
They had fallen for each other about twenty years ago, after they had all gotten married and divorced. Dorio has a daughter named Janene. Clough has two daughters, Catie and Amy. Dorio-Clough's relationship and the blending of the two families began when he gave her a flu shot at her senior center; then he had her on his local radio show 'The Senior Hour'.
They never married and still don't see the need.
“We are compatible and we love each other… and have the same interests: fighting for people's rights,” said Dorio, who works with Clough pushed for legislation – signed by Governor Gavin Newsom – giving families more power to make medical decisions for loved ones, even in the absence of an advance directive. Dorio had also served on the LA County Commission for Older Adults.
Robin Clough remembers how difficult the weeks of cancer treatment were.
(Genaro Molina/Los Angeles Times)
Faced with her grim diagnosis, Clough and Dorio leaned on each other and on Janene, Catie, Amy and their godparents, Susan and Tony. There were weekly Zoom meetings to strengthen minds and share information about emerging therapies.
I had gotten to know Dorio a little over the years on his home visits, so I was copied from the periodic updates on Clough's status that he emailed to friends and family. She exceeded the three- to six-month forecast, and in July 2023, Dorio wrote that she was better, “but still has a long way to go.”
By then, she had undergone seven consecutive weeks of chemotherapy and radiation, the latter of which left her with burns to her neck. A metastatic lesion was surgically removed from her leg. Dorio took Clough to MD Anderson Cancer Center in Houston at the recommendation of Cedars-Sinai.
“To all our friends and family,” Dorio wrote in the July update, “seeking a second opinion and being persistent in researching and asking questions of your medical team is very important, regardless of the diagnosis. It's a rollercoaster physically and emotionally. But we have had tremendous support from our family and many of you in the community. If you need it, we will provide you with help and guidance in the future.”
In Houston, medical staff questioned Clough about her family history. “This cancer is usually caused by radiation exposure,” Clough said, “and one of the first things they asked me… was where did you grow up?”
Her answer was Arizona, downwind of nuclear weapons testing in nearby Nevada in the 1940s and 1950s, contaminating water, soil and food sources for years.
I asked Clough if she had seen the Oscar-winning film “Oppenheimer,” about the creation of the first nuclear weapons.
“I'm not going to watch it,” she said firmly.
It's impossible to directly link Clough's cancer to gun testing, but the federal Centers for Disease Control and Prevention reports that people exposed to radiation fallout“Particularly during childhood, they may be at increased risk for thyroid disease, including thyroid cancer many years later.”
Oncologists Alain Mita of Cedars-Sinai and Maria Cabanillas of MD Anderson, who had previously worked together on patients with anaplastic thyroid cancer, determined that Clough's cancer warranted treatment with Keytruda, a drug that boosts the immune system.
But after a few months of treatment that showed some promise, the cancer grew again. In late December, Clough's doctors switched to a drug called Retevmo, a targeted therapy that blocks the engine of tumor growth.
Dr. Gene Dorio postpones hip surgery to care for his partner, Robin Clough, and uses a cane for support.
(Genaro Molina/Los Angeles Times)
A hopeful Dorio remembered that in a Blog post from 2017, he had written that “genetic engineering research is on the verge of finding the DNA stop button” for cancer cell growth. He added: “Hopefully one day our great-grandchildren will ask… 'What was cancer?'”
After a month of Retevmo medication, Clough had to stop due to adverse side effects on her liver. But a new scan revealed what seemed like a miracle to her.
The cancer was gone.
Two months later she underwent another test.
No cancer.
“Her cancer is currently undetectable and in remission. For anaplastic cancer that is very unusual,” said Dr. Mita me.
That doesn't mean the cancer won't return, he said. But for now there is reason for optimism.
Mita said he couldn't have predicted this level of success against such an aggressive cancer a decade ago, and he hopes medical science will make more progress in the coming years. For some cancers, he said, doctors can now skip chemotherapy and radiation in favor of drugs like those used to treat Clough.
Cabanillas shared his optimism, saying that survival rates at MD Anderson have improved in some forms of anaplastic thyroid cancer using “immunotherapy in combination with targeted therapy.”
In her kitchen a few days ago, with the girls' college diplomas and family photos on the wall, Clough said it was all overwhelming at times, and Dorio chimed in with his own concerns and determination to stay strong for her sake. Clough's life was consumed by doctor visits, surgical procedures, persistent unpleasant side effects from treatment and the constant anxiety of waiting for the next test results.
“I never felt like it was too much,” Clough said. “There are times when I think: I'm so tired of this. But it's never been too much, and I think that's because of my loved ones.”
Dorio has since closed his practice to focus on the house visiting patient who lives in his own home. He has also postponed hip replacement surgery and uses a cane.
It's more than a little helpful, Clough said, if, in the midst of a life-threatening medical crisis, the person you live with is a doctor. She said she never felt she could beat cancer completely, “but I could keep it under control. And I still have that hope.” Every day, she said, is a bonus.
Clough shed a few tears as she told her story, but also flashed a bright smile.
'I should have left, but I won't. So every day is “Wow,” you know? I see my daughters and in the meantime I had my first grandchild.”
The boy is now 11 months old.
His name is Robin.
steve.lopez@latimes.com
