Rick wished he had known about his predisposition. If his doctor had known the link between bladder and colon cancer genes, Rick would have been regularly checked for colon cancer after his brother's diagnosis. His colon cancer might have been detected at a much earlier stage.
Didn't his siblings want their children to be spared the advanced cancer he endured? To live longer and better lives? Knowledge was power, the power to alter that future, he told them.
He went with them to NIH in Bethesda on a warm April day in 1997, and he brought with him a well-worn remedy the family used in times of sorrow: laughter. The joking and kidding, even betting on who was going to have the problem gene, filled the time between each sibling's private consultations.
Focus on the future
Secretly, they were nervous. Rick tried to get them to focus on why they were there: for our kids, our kids, our kids. "We will get over this," he counseled.
The middle sister, Dolores Padula, was pretty sure she didn't have the bad gene especially after a check of her colon came up clean. But she put off learning the result for six months - she was so fearful of the possibility that her children might inherit the faulty gene. The gene bypassed her and her sisters.
Rick's younger brother, John, refused to get his test result. If he didn't know, he thought, he could continue to hope he didn't have the gene. When doctors found a polyp on John's colon a year and a half later, he made the decision he had refused to make for months. He got his test results. He, too, carried the faulty gene. But that was as far as he would go.
Rick begged his brother to have the polyp rechecked. Here was a chance to avoid repeating the family history. But by the time John went to a doctor, the polyp had grown into a cancerous tumor. He was 39, slightly younger than Rick at his diagnosis.
Rick was furious. There could be no more stalling; the next generation was at risk. Step by step, he would have to lead, Rick realized. The future of the family depended on it. He would have to take charge, to push the members of his family to a place where they didn't want to go.
Confronting the children
The first step was education.
Among the people he approached about the family's genetic flaw were the children of his late brother Buddy. He took them aside at a graduation party and told them what to expect and advised them to be pro-active.
If they tested positive for the gene, they had an 85 percent chance of getting the disease. They would have to follow a routine medical regimen - Rick gets tested every three months - but they could be treated early and aggressively. They would become like millions of others who handle chronic illnesses in their lives.
And they might be luckier than some; far more people get environmental cancers than hereditary ones, and many of those are discovered too late for treatment. Genetic testing could help them lead normal lives, he argued. Hadn't he run his own business for more than a decade?
With his own young children, Rick was equally direct.
He told them about the genetic side of his cancer in late 1998, when he knew his latest bladder cancer would require a long recovery. He explained they could be tested when they reached adulthood, and if they had the gene, NIH would follow them, too. "Maybe by the time you're 30," he tried to assure them, "you'll be able to take a pill."
Because she had lived with her dad's cancer so long, Rick's oldest child took the news matter-of-factly.
"OK, then, I am going to get tested," Alyse, now 16, said when her father told her. "I am living with a 50 percent chance."
Alyson, 13, the youngest, struggled to comfort herself: "I have my dad's eyes. I have my dad's nose, maybe I have been spared his genes."
Son C. J., 14, was too busy playing football, mowing the lawn, and keeping tabs on his sisters to think about it. If he has it, he has it, he says. He'll handle it the way his father has handled it: He'll deal with it.
The possibility of inheriting this family trait made Rick's kids and his nieces and nephews acutely aware of environmental factors that contribute to cancer - attitude, eating habits, stress. The youngest found themselves eating a second piece of broccoli over the ordinarily more appealing chocolate bar.
The oldest chose considered lives; one married young and became a father. Others joined religions that don't permit drinking or smoking.
And everybody worried about the social and financial fallout of testing positive.
Rick, too, was tired of people privately regarding him as doomed. Yes, he sold his business when bladder cancer returned again, in late 1998, this time in the ureter. His recovery from this fifth cancer was so difficult that his father and stepmother moved into his home to care for him.
But he eventually returned to work, this time for a former competitor.
He faced down his greatest fear - going bald from head to toe.
He got over a breakup with the woman he loved and started dating again.
