The morning of the surgery to remove my thyroid and lymph nodes, they handed me two gowns to cover myself and we prepared for the procedure. As you may know, these gowns only cover half of your body. With everything going through my head as we prepped, I didn’t think much of it. Then they had me walk myself into the operating room, which was its own kind of surreal. I remember being so detached from my physical reality that saying goodbye to my parents was easier than when I moved out for college. And then you arrive and walk into an ice box with production level lighting. It felt like the worst kind of Friday night lights.

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Game time had arrived. As I was psyching myself up (didn’t want to go into this with a bad mindset), one of the lovely nurses asked me to take the back gown off.

I froze. That gown was the only thing standing between the entire surgical team and my bare (and very pale) ass. Surely they would all go blind from the intense light reflecting off the whitest cheeks on this side of the Mississippi.

The nurses caught the hesitation and one of them, without any hesitation, told me not to worry with some laughter, mine was “a lot better than what they’re used to seeing.” The contrast caused the whole room to erupt in laughter – guess they’ve seen some ugly ass asses. And there we all were, on the verge of beginning a very serious procedure, finding a way to giggle through the intensity and make the situation easier for a very scared 23 year old.

There were real risks on the table going into the procedure, so the laughing was not because it was funny the way a joke is funny. It was funny the way things get funny when you are standing right on the edge of something that could end you. The lightness only meant something because of the fear underneath it. Sunshine is nothing without the rain. Laughing through cancer is nothing without the part where you are terrified.

A couple of other things I did in there, for the record.

I made them confirm my surgeon’s name. Then I made them confirm it again, and again one more time… He is a brilliant and capable doctor with a generic name, and I had memorized his full name (middle name included) so I could verify that the right guy was about to cut my neck open. If you have ever worked with me in a professional setting, you will be unsurprised by this detail. The instinct to triple-check the one critical detail does not switch off just because they are about to knock you the f out. My poor surgeon got a live preview of what my business partners deal with daily.

And when they asked if I had any last questions before putting me under, I asked if I could keep my thyroid after they took it out.

He looked at me like I was a complete moron. Guess it’s a good thing that my surgeon was not in a giggly mood.

I was messing with him, mostly. But also, if something went sideways in there, if I did not wake up or could never speak again, I wanted the last thing I did to be a joke. That felt more like me than my overwhelming sense of fear.

I woke up (separate story on this one coming). I kept my voice. I did not, for the record, get to keep my thyroid.

But I walked out of that hospital reminded that you can be scared for your life and still make a room full of people laugh, and doing it does not make the fear fake. It makes it survivable. It adds some meaning to the suffering and energizes the hell out of you to keep fighting.

That is a big part of what we are building. As much as we can, we want to laugh our way through the intense stuff, not because it is not serious, but because staring into the void is so impossibly serious for any individual to take on. And the void hates giggles.

If you are about to walk yourself into your own cold, bright room: crack the joke. Make the nurse smile. Be scared and be bold anyway. Both are allowed, and together they carry you further than either one alone.

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The loneliest part came after, when the checkpoints ran out and there was nothing left to do but think and process what the hell was actually going on. That is when the reality of it hit, and that is when everyone around me seemed to decide I was fine.

My 24th birthday was about one month after I was diagnosed, and the party was one of the most isolating experiences of my life. A room full of people who love me, and I have never felt further away from anyone. I’ll never forget forcing a lame ass smile as everyone sang happy birthday, as if I wasn’t concerned that I might not have another one. It was not their fault. Not one of them (thankfully) could understand the reality of where I was. I found myself looking for reasons to sit alone, because sitting alone was easier than managing everyone else’s comfort while quietly drowning in my own head. At least when I was alone, I did not have to protect anyone from the truth of how I was doing.

That was the exhausting part nobody tells you about. The mask. I wore one at work, where I kept showing up through treatment. I wore one around friends, trying to be normal and social so I could have a life outside of cancer. If I had been the parent of a kid going through this, I would have worn one there too, God knows. I got very good at responding “I’m doing well all things considered.”

The loneliness had specific hot spots. Waiting rooms. Rooms full of people talking about dumb shit like last night’s Yankees game, as if I was supposed to give a crap about that. And, strangely, the subway home from treatment. Something about sitting on that train with a hospital wristband still on my arm, slugging it back into normal life like nothing had happened, hit harder than anything that happened in the actual hospital.

People said things. Well-meaning, most of them, and some of them unforgettable for the wrong reasons. My personal favorite: “well, if you had to pick a cancer to get, thyroid’s the one to pick.” A little effort would have told them that some subtypes are imminently fatal, and that a man my age getting it at all is rare enough that there was barely data to tell me what my odds even were. But that is the thing about those lines. They are not really for you. They are for the person saying them, so they can set the fear down and move on. I remember thinking that I wish I had that option.

What I needed was embarrassingly small. I needed someone to ask how I was doing and genuinely want the real answer, not the “bumpy road but I’ll be fine” version everyone was interested in hearing. And I could not bring myself to ask for even that. It was too sad to me that I would have to. So I said “fine,” and I waited to see who would push past it on their own.

Thank God for the ones that did. One friend was walking his own hard road at the same time, and the two of us built something deep out of trying to keep each other upright. We spoke frequently about how we will get to the end of the tunnel and become such better people as a result, and we both did. He stayed on the phone with me while I was quarantining for radiation, just to keep me company through it. I will never forget that.

My manager at the time drove all the way from Battery Park City to Columbia Hospital to visit me after my operation. He gave me a line his mother used to share with him: the fastest cars are modified. The toy Lamborghini he gave me as a representation of that is on my desk right now. That level of support was so rare, and God bless him for sustaining that while I worked at that company.

The ones who helped the most mentally, they let me finish a God damn sentence. If I said I was afraid of dying, they did not fix it. They would say something like, “that must be terrifying, I can’t even imagine,” and then they just sat there in it with me. That is the whole skill. Not advice. Not a silver lining. Not discounting my experience. The willingness to let it be as heavy as it was and not run from the weight. While it sounds simple, it is very hard to actually do. I am grateful for those who did.

There is one more piece, and it is the hardest to admit. Part of getting better was letting go of an addiction to my own suffering. Inside my extended network, being the sick one had made me an awful kind of ‘celebrity,’ and there was a pull to that I had to fight my way out of. So on top of everyone assuming I was okay, I had this private work no one could see: actually getting the hell away from cancer, even the parts of it that had quietly started to feel like identity. This might have been the scariest and most challenging part of post-treatment.

I am telling you all of this because if you are in it right now, I want you to know the after can be the loneliest stretch, and that does not mean something is wrong with you. And if you love someone who is going through this, you do not need the perfect thing to say. You need to ask the real question, and then let them finish their thoughts.

That is the whole reason this foundation exists, and why we do not disappear when treatment ends. No one should face this on an island, least of all in the part where everyone else has already gone home.

If that is you, please reach out.

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You could hear her at my baseball games from anywhere in the park, or three zip codes away. A base hit got the same reaction as a walk-off home run or a groundout. So did a decent report card, or simply managing to breathe. She had one setting for the people she loved, and it was cranked to max volume. Everything I did was immaculate to her regardless of the outcome.

She and my grandfather would drive whenever they could if it meant they could see any of their grandchildren. New York to New Jersey, or wherever we happened to be, and their effort absolutely did not require an occasion, just needed to be a day that ended in ‘y.’

She made sure that Sundays smelled like sauce. Her meatballs have never been matched (sorry, love you Mom), and nobody on this earth has made pastina the way she made pastina. If she was around that would have cured my own cancer! She was not picky about what she fed you, only about whether you were full, and she asked more than once to be sure. My grandfather was the same. The two of them would have my dad’s friends over like it was assumed, like extra chairs were always going to be needed, because in their house they were.

The cooking came from the Italian side, my grandfather’s enormous family, or her sisters that also couldn’t resist that Italian culture, and she took to it like she had been born into it. Her and my grandfather then taught my mother, who has become an incredible cook, and my mother taught me. One day I hope to teach my wife and kids, and none of them will know that the recipe started with a goofy Irish woman who decided to learn.

Because she was Irish, proudly, she always wanted me to go to Notre Dame with a persistence I found funny at the time, and even funnier now since I went to Boston College (a rival). She held both of those things at once, the Irish pride and the Italian kitchen, and saw no conflict in it, which tells you most of what you need to know about her.

She was also a prankster. When I was young I had a blood vessel in my nose cauterized (nothing serious). The doctor had to numb my face, and she convinced me my nose was falling off. She really sold it. That was the joy in her, always looking for the opening, always laughing before the punchline landed. And if that wasn’t enough, she was also comically addicted to video games. We all maintain that there is still no human in history who could play Super Mario better than her.

The memory that first pops into my mind when thinking about her is so simple, maybe because I miss how simple life was in these moments. After school, if I did not have practice (extremely rare), we vegged out and watched Judge Judy together. That is it. Two people on a couch, doing nothing, no occasion, laughing at how silly people can be. I can’t remember ever not having a full schedule, and those minutes of nothing were the rarest thing I had. I didn’t even know it.

We lost her to cancer when I was entering high school, which was way too soon. Even close to the end she would fight like hell through the pain to laugh with us and crack jokes, staying bright for everyone in the room, because being the reason other people felt okay was simply who she was.

When I received my Confirmation, I took her name Katherine as mine in the eyes of the Church. The bishop actually called me over and prepared to give me a hard time about not taking the sacrament seriously, until I told him the background about the devout Catholic woman who inspired me.

I did not think of that as foreshadowing. It was just true. Her name was the one I wanted attached to mine, and I knew she wanted more than anything to be a part of my Sacrament.

And now she is attached to this. The Katherine Paleno Foundation exists because young adults facing cancer should receive the support that empowers them to take on this massive challenge as best they can. Ideally as well as my grandmother took it on. At the very least, no one should end up on an island. Everyone should have someone to show up, sit down, and stay a while when there is no occasion at all. Just like she did countless times for her grandchildren.

She was the loudest voice in the stands, and I want to be that for other people. Maybe you.

Cancer support tends to come in two shapes. One is built for children: child life specialists, bright hospital wings, programs designed around a young kid and their parents. The other is built for older adults, with support groups full of people many decades into their lives. Both serve people who need them, and those people deserve the support. The trouble is that young adults don’t quite fit into either, and end up landing in the gap between.

More than 85,000 people between the ages of 15 and 39 receive this life changing news in the United States every year, close to five percent of all cancer diagnoses. The National Cancer Institute treats this group as a distinct adolescent and young adult population, with needs the system has not caught up to. They are old enough that the pediatric world does not fit, and young enough that the rooms full of older patients do not either. So they sit in waiting rooms and support groups feeling like the only person their age who has ever been there. This is something I can personally attest to.

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The gap is not only about which room you belong in. A diagnosis in your twenties or early thirties lands in the middle of building a career, finding a partner, sorting out money, deciding whether to have kids. Treatment can put all of it on hold or take some of it off the table. Fertility, dating, a first real job, a sense of who you are becoming. At this age, despite support networks doing their best, almost none can actually help these patients juggle these massive undertakings during treatment.

Then treatment ends, and a second, larger gap opens. Everyone around you exhales and moves on, sure the ‘hard’ part is over. For a lot of young survivors, the quiet that follows is the hardest stretch of all. The schedule that ran your life disappears. The team that checked on you every week is gone. The energy allocated to fighting for your life needs to be reassigned. You are left to make sense of a body and a future that both feel changed, with no one beside you. More specifically, make sense of a body that could feel like it betrayed you.

This is the gap the Katherine Paleno Foundation exists to close. We match young adults with a real person who has been there, during treatment and through the long stretch after. We leave the medical advice to the doctors. What we add is connection, navigation, and a hand to hold through the loneliest version of a hard season.

If you are a young adult facing cancer, or you love someone who is, reach out. You do not have to do this alone.

If you are a survivor who wants to be the person you wish you had, we are looking for you.

And if you want to follow the work as it grows, subscribe. I will keep you close to it.

Figures based on National Cancer Institute SEER data available as of 2025.

The treatment was extremely difficult. I expected that part. What I did not expect was how alone it all made me feel, especially after treatments were complete.

My family loved me through every second of it, and they were also (understandably) terrified, holding themselves together so they could hold me together. My friends wanted to help and (also understandably) did not have the words to express what they wanted, so a lot of them went quiet. There is no instruction manual for this, but the result was that I was surrounded by people who cared about me, and I still felt like I was stranded on an island, watching everyone I loved cheer me on from a shore they could not reach. While I no longer blame any of them, there I was left to take my reality head on.

Thank God that over time I was able to find specific individuals who either “got it” or were able to sit with the discomfort of my experiences. These people did as much for me as any surgery or radiation therapy, especially because all of the support groups at the time seemed to be either for very young patients or older patients, both of which are more than deserving of support and care. Nonetheless I seemed to fall between the cracks, and that feeling is why I am building this foundation.

Katherine

I named this foundation after my grandmother. Her name was Katherine, and she was the warmest person I have ever known.

She cheered unabashedly loud for me from the stands at every game, loud enough to embarrass me and make me proud at the same time. She may have been proudly Irish, but she cooked like a native Italian. If love was something you could put on a plate and hand to someone, she mastered that art. She was proudest of her children and her grandchildren, and she made sure we knew it. We lost her to cancer, and even toward the end she did her best to stay cheery and full of energy, because that was simply who she was.

We could not save her. I think about that a lot. But I can take the thing she did better than anyone, showing up with warmth for the people who needed it, and point it at other young people who are facing what I faced.

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What We Are Building

The Katherine Paleno Foundation supports young adults between the ages of 18 and 30 with cancer, during treatment and through the long stretch after it ends. We do it for free, and we aim to provide this support nationally.

The heart of it is simple. We match a young patient with a real person who walks beside them. Someone who checks in, listens, and helps them find their way through the parts no one prepares you for. We will leave medical advice to licensed professionals, but can also provide some tips to help you or someone you know through the process. Just connection, and a hand to hold through the loneliest version of a challenging time.

We also stay after treatment ends, which is the part a lot of programs skip. Remission is not a finish line, and we are left dealing with a whirlwind of physical and mental challenges that fundamentally alter the way we look at life going forward. For a lot of survivors, the quiet after is when it gets hard. We do not disappear then, and (once again, understandably) a lot of the support network moves on once they think you are “safe.”

If This is You, Or Someone You Love

I am building this in the open, and I would like you here for it.

If you are a young adult facing cancer right now, or you love someone who is, reach out. You do not have to do this alone.

If you are a survivor and you want to be the person you wish you had, we are looking for your help as well.

And if you just want to follow along as this grows, subscribe. I will keep you close to the work.

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