ASHBURN, Va. -- Before he received his dosage of radiation and underwent chemotherapy, Washington Football Team coach Ron Rivera received a simple but meaningful greeting at the front desk of the Inova Schar Cancer Institute in Fairfax, Virginia.
It was an everyday gesture in a situation that wasn't ordinary.
Linda Carter, who has been at the front desk in the institute's radiology department for 18 years, serves as a de facto aunt for the cancer patients waiting in her lobby. She was part of the community that developed around Rivera as he underwent cancer treatment. Multiple doctors, therapists and nurses were tasked with helping cure the squamous cell cancer in his throat.
But Carter's was the first face he saw each day.
"I'd walk in and Ms. Linda would greet me and always say something positive," Rivera said. "She was great."
She'd ask him if he was getting enough rest and how he was feeling. And usually Rivera would muster the energy to say "OK" before asking how she was doing.
On Sept. 29, Rivera felt OK when he saw Carter. But, by the time he was at Washington's practice facility later that day, he felt sick enough to wonder if he would have to stop coaching.
His wife, Stephanie, drove him home and he went to bed, skipping lunch and dinner. He couldn't move. Stephanie phoned Washington's team doctor, who lectured Rivera about needing to eat. After he hung up the phone, it was his wife's turn.
"She got after me really good," he said.
And then it was his daughter, Courtney's turn.
"I ate and went back to bed," he said. "The next day I felt really good and it made me realize how important it was to eat. That Tuesday, I didn't know if I could keep going."
Five days later, he coached in a game.
Rivera, 58, was hired by Washington on Jan. 1. On Aug. 20, he announced he had been diagnosed with cancer in a lymph node. During his seven weeks of treatments that ended Oct. 26, including three rounds of chemotherapy and proton therapy five days a week, he sat out three practices but never missed a game.
The coach took multiple naps during the day -- sometimes after his treatment; other times after a videoconference with the media. Rivera left the facility often between 5 and 6 p.m. because of fatigue. It took a toll, but he did not stop.
"I was amazed. Usually our patients, halfway in, stop working," said Dr. John Deeken, the medical oncologist and president of the institute. "Most of our patients toward the end of their treatment are very close to needing to be hospitalized because there are so many complications."
Rivera's success was made possible by a strong system of support, but it was the team at the cancer institute that became his new community, helping him get through his new reality -- during the coronavirus pandemic no less. They all played a role, and it started with Carter.
"I'd tell him all the time, If you don't get enough rest I'll come get you," said Carter, 65. "They get tired from the radiation and stuff. But he promised me he was getting rest. He would talk a little more each day, but he was quiet."
The doctors
Because of Fairfax County's proximity to Washington, D.C., the patients at the institute have included high-powered positions such as government officials and Supreme Court justices. Rivera might be high profile, but because of his upbringing on military bases, he has respect for the chain of command. In this chain, he was at the bottom.
"He was a pinnacle of someone who did that really, really, really well," said Dr. Gopal Bajaj, the leader of Rivera's radiation oncologist team. "It was never, 'Hey, this is who I am and this is what I expect.' It was about, 'I'm here; can you help me? I'll do whatever you say.' You'd never know he was someone of such importance to our area or to sports."
Indeed, Dr. Deeken said in his first session with Rivera he painted what he called the worst-case scenario. At the end of a two-hour meeting, Rivera said: "Tell me what I've got to do and we'll do it."
Rivera also consulted with Dr. Patty Lee, who deals with the surgical and medical management of conditions of the head and neck. But Deeken and Bajaj met weekly with Rivera once his treatments began, and both might be seeing him for the next five years for follow-ups.
"You get to know them at what is probably one of the most difficult points in their life," Bajaj said. "You learn a lot about them and you get to see how they face adversity."
Bajaj knew Rivera was nicknamed Riverboat Ron, but needed a co-worker to remind him why. Not that Rivera's fourth-down gambles were ever a topic of conversation. During most of Rivera's treatments, Washington wasn't winning games, so Bajaj steered discussions to travel, restaurants and shopping.
"There's a star-struck awe from the physician's perspective," Bajaj said, "because you think in your mind he has a different life than everyone else. ... I was surprised to hear the normal life he has."
Deeken's dad grew up a Chicago Bears fan, the team Rivera played for as a linebacker from 1984 to 1992. Deeken, though, is a Green Bay Packers fan, so they would sometimes compare notes on their teams. They'd also talk food, focusing on meals cooked by Stephanie or Courtney.
"It was easy to develop with him both a friendly interaction as well as a physician/patient relationship," Deeken said.
After a few minutes, though, it was on to the important stuff. For Deeken, that meant three chemotherapy sessions for Rivera; for Bajaj's group it meant five weekly proton treatments for seven weeks.
"We threw the kitchen sink at it," Deeken said. "It's one of the most intense treatments cancer patients go through."
Rivera took control in other ways. He preplanned every week in terms of his nutrition, when he'd get IV fluids or when he'd take his medication, when he'd meet with the team and when he'd coach.
"Cancer is a loss of control, and Coach kicked cancer's ass," Bajaj said. "He took control by doing everything perfectly, to a T. He was always at his appointments; always on time. He scheduled his cancer around the rest of his life and not the other way around."
Bajaj said Rivera's strong family ties were important to his recovery -- Stephanie or Courtney would attend every appointment and Rivera would talk about his son, Christopher. Rivera also received help from the NFL and Washington's team dietician, trainer and doctors.
"He was able to mobilize all these resources that would usually be reserved for his players," Bajaj said. "He was able to use them to help him get through the treatments successfully."
At the end, Rivera handed Deeken the same thing he did Bajaj: A signed Washington helmet with the No. 59 -- Rivera's number from his playing days with Chicago. He also gave Deeken a card from his playing days.
"My dad would be smiling down on this," Deeken said. "Very meaningful."
Nurse navigator
The trip to his chemotherapy sessions involved numerous turns in the hospital hallway and an elevator ride, followed by more turns. In the elevator, Stephanie shared a story with the nurse navigator, Zenaida Ferguson.
"When it comes to football, he knows everything. He's a genius," Ferguson recalled Stephanie saying. "But when it comes to directions and finding places, he's a little bit of a lost cause. They had been dating a number of years before he had learned how to finally get to her father's house."
Having someone to navigate cancer would be necessary, and Ferguson did that in many ways. She said the best analogy is serving as the gatekeeper, the first person to get in contact with the patient and walk them through the treatment plan.
Ferguson served as the main contact for at least the first month, bridging the gap between the radiation and medical oncology departments. She coordinated Rivera's schedule and made sure it allowed him to continue coaching. If he woke up feeling poorly and needed to push back the treatments, she'd get the call and hustle to get in contact with the proper medical department.
Often, Rivera communicated via text.
She'd schedule his oncological dentist -- invasive dental work would be difficult to perform after his treatments. If he needed any scan work, she'd arrange. She'd warn him of side effects. Sometimes she'd accompany him as he made the five-minute walk to his car. Once, he was too fatigued to walk, so she wheeled him to the parking garage.
And, yes, one time this Washington football fan let her fandom show. She passed him in the hallway the day after Washington had defeated Dallas in Week 7.
"Great game yesterday!" she said. "I couldn't help myself. Beating the Cowboys is my Super Bowl."
Proton therapists
Every day of treatment -- five days a week -- Rivera needed to repeat an uncomfortable task: Lie still on his back with a meshlike mask over his face. The mask is then latched to the table, keeping the head still for the duration of treatments. Any movement would impact the treatment as the lasers aim for a precise spot. He'd lay his head on a cushion; a warm blanket often was placed on him.
The proton therapists do a little of everything, from scheduling his proton treatments to taking X-rays each time before his sessions. In their initial meeting, they explained what Rivera should expect. And every day they'd verify his information -- from his birthday to his treatments -- to make sure they had the right patient and delivered the right dosage for treatments.
More than anything, they helped him stay calm.
"Our job is to make them as comfortable as possible," said Phillip Ihaza, one of Rivera's proton therapists.
They played whatever music Rivera requested. Early on, he asked for contemporary, then moved to today's top hits. Another time, it was country and western. Every so often the proton therapists, sitting in another room, would see his toes tapping. Rivera used the music to pace his sessions; after five songs he knew they were nearing the end. He needed a bite block to prevent movement from swallowing.
The sessions typically lasted about 25 minutes, sometimes taking up to 45.
"It was a very eerie feeling," Rivera said. "If you're claustrophobic, you've got no chance. I didn't have an episode with it until a week later. I couldn't breathe. I had to give the signal and they had to come quick to unlock me."
"Here we go, we're getting after it, let's go. Come on body, let's go. We're gonna kick its ass." Ron Rivera, on hyping himself up for cancer treatments
Every time thereafter he psyched himself up, as if he was about to play a game.
"From that point on," Rivera said, "every time I hear that first lock going into place my first thought was, 'Here we go, we're getting after it, let's go. Come on body, let's go. We're gonna kick its ass.'"
But cancer would punch back.
He lost 36 pounds and weighed 232 at one point -- six pounds under his playing weight with the Bears. He struggled to swallow, a side effect of the treatment. A "crud" builds up in the throat -- imagine a sunburn inside your throat and the burned skin peeling away -- and Rivera needed a spit cup nearby at all times.
"It's a horrible feeling because I couldn't control it," said Rivera, who added it still hurts to swallow. "I had spit cups everywhere."
He needed a mouthwash rinse of eight ounces of water, baking soda and salt to prevent sores from becoming infected. Stephanie, as well as Washington director of football operations Paul Kelly, were always reminding him to rinse. During games, Kelly would constantly hand him water or Gatorade.
"His skin would start to get raw and then not being able to swallow," said Katie Banks, one of the proton therapists. "But it was like pulling teeth to get a complaint out of him."
Anything acidic or spicy would burn his throat.
"For breakfast, I had pancakes and to help swallow, I had what amounted to three cups of syrup on the two pancakes," Rivera said. "Water tasted terrible. The only things I could truly drink were root beer and Mountain Dew. Those tasted normal and helped me eat from that point on. What's crazy is one of the foods that helped me get through this was Taco Bell tacos, for whatever reason."
Four proton therapists worked with Rivera throughout, usually in teams of two. Not all of them knew of him -- Zemenfes Semaie, the lead proton therapist, said he's a basketball fan and figured "OK, cool; a normal, routine patient." But others did, like Ihaza, who grew up in the area and calls himself a lifelong Washington fan.
"That was the hardest part for me," he said. "I had so much excitement of wanting to have conversations about football. I've been a big fan of [running back] Antonio Gibson; I wanted to see how he felt about him."
The therapists limited football talk. Ihaza also faced another dilemma: his fantasy football league, which he has been part of for 15 years. He has Gibson as well as Washington wide receiver Terry McLaurin and tight end Logan Thomas on his fantasy team.
"I was struggling with the moral aspect, 'Am I going to take advantage of this?" Ihaza said. "I believe in karma, so any little thing that could be looked at as cheating could affect me in the long run."
He bit his tongue. So did Banks, another Washington fan. It was especially hard after the 20-19 loss to the New York Giants in Week 6, after which she joked she had "comments" and questions to ask Rivera.
"I have to make sure he's comfortable and feeling well," she said. "He could have been one of those people that walks in and is, me, me, me and talks about his games and all that. But he was never like that. He'd ask me about my weekend and we'd have a normal, everyday conversation."
Thinking of his brother
There were plenty more who helped with Rivera's care, including those who drew his blood -- one of whom was a Cowboys fan, and Rivera said led to a little rivalry between the two.
The coach, who lost his older brother Mickey to pancreatic cancer in 2015, placed his trust in this group. He said he thought of his brother daily.
"You almost feel guilty, because I was fortunate," Rivera said, his voice cracking. "The hardest thing for me during this whole time, other than telling my family, was having to tell my mom [that he had cancer], because she didn't deserve to go through this twice. Hopefully things continue to go well."
Rivera is grateful for the care he received. Multiple times he has mentioned his desire to see health care reform, pointing out that while he had no trouble paying the deductible, others do.
He recalled a telling scene at the clinic, when the workers were learning the Baby Shark song for a pediatric patient who was about to ring the bell to signify the end of his treatments. Rivera joined in the song.
"Their attitude helps you get through this," Rivera said. "These guys are the experts. I have to put my trust in them. I was going to follow the directions and get this eradicated."
And when that happened, and his treatments had ended on Oct. 26, Rivera knew what came next: his bell-ringing ceremony. He walked down the same hallway he used to travel for his proton therapy. This time as he opened a set of double doors, he was greeted by numerous medical personnel, cheering him on and tossing confetti. When he reached the bell, the linebacker in him --- fueled by the emotion of the moment -- took over.
Ihaza said it was "one of the loudest rings that I've experienced."
They understood.
"Most give it a good yank once or twice," Ferguson said. "He did it a good four or five times. I can't blame him. I'd probably keep ringing it."
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