closes at night to keep predators out.
Predation is probably the number
one issue for most chicken owners. In
fact, the McDonalds’ first venture into
keeping chickens was a total disas-
ter. McDonald didn’t realize she had
to shut the chickens in at night. The
very first night there was a massacre in
her backyard. Raccoons had gotten into
the coop and killed all seven chickens.
“I said, ‘Girls! You better stay inside!’
It took a while before we decided to try
again,” she says. “It was very traumatic.
There were a lot of tears. But we told
the kids, ‘This is the cycle of nature.’
It’s a good lesson.”
Another time, a hawk swooped
down and grabbed one of the chick-
ens as it was pecking around the yard.
Aside from trying to keep predators
from attacking (usually at night), Mc-
Donald says it only takes about five
minutes a day to care for her flock. She
shakes out their food (a mix of milled
grains), makes sure they have water
and lets them walk around for a bit.
Every night, she closes the hatch. A
;;-pound bag of feed (specially or-
dered from a local pet-supply store)
costs about ;;; and lasts two to three
months, she says. In the event of ac-
cidents or non-fatal attacks, wounds
are treated with topical antibiotics.
In winter, McDonald uses an electric
ring—a common farm implement—to
keep the chickens’ water supply from
There can be surprises. The McDonalds’ second batch of chicks inadvertently included a rooster. After several
nights of the young rooster crowing at
all hours—a wild screech from the immature male—they placed the bird in
an animal sanctuary.
McDonald says each chicken has
Jacqueline Mroz is a Montclair-
a unique personality. Some are calm,
some jittery. “They’re not as cuddly as
cats or dogs,” she says, “but they’re a lot
easier to take care of. And they come
running when they see me.”
The McDonald family still eats
chicken for dinner—but they never
butcher their own birds. And when
they’re barbecuing some fowl near their
flock, they make sure to call it beef.
based freelance writer.
the long and winding road
have insurance, we’ll do it.”
That makes a big difference to
D’Agostino, a former Italian teacher,
who is currently unemployed, single and
relies on Medicaid.
But D’Agostino was also drawn to
Theurer, which similarly accepts patients regardless of their ability to pay.
For starters, Theurer looks more like
a five-star European hotel than a New
Jersey hospital. Goy, the hospital director, conscripted Santiago Calatrava—
designer of the World Trade Center’s
Oculus transportation hub—to help with
the plans for the building, which opened
in 2011. The first thing you notice when
you enter is the soaring, four-story lobby
and its gleaming grand piano. Goy is
particularly proud of the rooftop herb
gardens and cooking studio. “This is the
best way to tell a patient that you believe
in their future,” he says.
D’Agostino’s greeting at Theurer was
impressive. She was handed a notebook,
pen and a magnet “with every number
you could need,” and was escorted wherever she needed to go. “It’s like a well-oiled machine,” she says.
It wasn’t the accoutrements, however,
that made it hard to decide where she
would have treatment. It was the science.
Both offered clinical trials for metastatic
triple negative breast cancer.
“My head was spinning,” D’Agostino
“As we get more and more into personal-
says. “It was very daunting at first. I’m
not a science person.”
Elly Cohen, program director of
BreastCancer Trials.org, says that the
complexity of medicine at this level is
extremely hard for patients to navigate.
ized medicine—the biology of your tumor,
what medications are available to you—
it’s going to be very confusing,” she says.
Compounding the problem, says Aisner at the Rutgers Cancer Institute, is
the fact that patients rarely recall more
than 15 percent of what they’re told in
the consulting room. “If there’s another
person in the room, we can double that,”
he says, referring to data from the past
30 years. “The real answer is to have a
Memorial’s trial involved androgen recep-
D’Agostino wound up getting help from
Vicky Carr, a patient advocate and clinical
trial consultant based in Virginia, whom
I’d met at a focus group for triple negative
cancer patients. Carr helped D’Agostino
tease out the differences between the
trials she knew about and also sent her
to check out trials at Memorial Sloan
Kettering and Weill Cornell in Manhat-
tan. D’Agostino couldn’t enter Cornell’s
trial because they didn’t take Medicaid.
tors, and D’Agostino’s tumor, it turned out,
didn’t express androgen.
Both the Rutgers Cancer Institute and
Theurer offered clinical trials involving
checkpoint inhibitors, but in the end,
D’Agostino’s decision came down to trial
phase. Theurer was enrolling patients in
phase III trials, but since these trials are
randomized, D’Agostino knew she might
get a placebo. Rutgers was offering her a
phase II trial in which all the participants
were getting Keytruda.
There was also the human factor.
Hirshfield, at Rutgers, had a bedside
manner so kindly that, if she weren’t
wearing a lab coat and stethoscope, you
might have mistaken her for a nursery
school teacher. She occasionally giggled
during a consult, and at the end of their
first meeting gave D’Agostino a hug.
At a later visit, D’Agostino says, “I was
starting to cry and she came up and held
my hand. When you get people who are
loving and intelligent...oh my God.”
There is no question that, while the
science of cancer seems to be advancing
at almost startling speed, the path for
the cancer patient remains a labyrinth,
blocked at every turn by a patient’s ability to cut through scientific complexity,
insurance and monetary concerns, and
considerations of geography.
Does it help, I wondered, to live in the
state where most of these drug trials
were being initiated?
No, says Dr. Cliff Hudis, CEO of the
American Society of Clinical Oncology. “I personally don’t think there’s any
particular geographic relationship.” After
all, Merck and Squibb are global companies, and their drugs are used in clinical
trials everywhere. “We will seek out top
investigators, regardless of geography,”
says Rubin of Merck.
Yet being in New Jersey does have
an upside, in part because of the talent
the state attracts. Many alumni from
the Rutgers Cancer Institute have gone
to nearby pharmaceutical companies.
86 FEBRUAR Y 2017 NJMON THLY.COM
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