ASHBURN, Va. -- The biannual checkups for cancer continue to provide positive results. That doesn't prevent Washington Commanders coach Ron Rivera from playing the what-if game before every visit.
It's been two years since he was diagnosed with squamous cell carcinoma during his first training camp with Washington. That means it's been only two years since he had to deliver the news to his mom, who was still coping with the death of Rivera's brother, Mickey, to pancreatic cancer five years earlier. And only two years since undergoing seven weeks of treatment that altered Rivera's life.
So when he goes in for a checkup, as he did in March and will do so again in September ...
"I always hold my breath," Rivera said.
"There's always trepidation," his wife, Stephanie, said.
Rivera once asked Dr. John Marshall, the chief of the division of hematology/oncology at Georgetown University Hospital, Lombardi Comprehensive Cancer Center, "When do you stop feeling this way, this fear that it's going to come back?"
That fear accompanied him when he underwent his one-year biopsy.
"You're on pins and needles," Rivera said. "All of a sudden the call comes and you see that number and for that brief second you're thinking ... then when the doctor says it came up negative and everything you're doing is great, that's a huge relief."
Rivera's cancer diagnosis in August 2020 changed him. It made him appreciate the details of life and alter his schedule to do things he might not have previously. He's become an advocate for proton therapy and befriended others going through cancer treatments, providing guidance and becoming a de facto cheerleader -- as others were for him.
It also took quite a mental toll, from Rivera's own experience as well as from losing his brother in 2015.
Rivera says he feels much better as he enters his third year with Washington -- the best he has felt before a season during his coaching tenure in D.C. He was undergoing cancer treatments in Year 1; the residual effects bothered him more in Year 2 than they do now.
But he's still dealing with the aftereffects -- he remains partially deaf in his left ear, his stamina hasn't fully returned, he can't yell without it hurting his voice and his taste buds remain altered. He no longer orders red wine with dinner because, he said, "It's a waste. I can't taste it." He did feel good about having a dish of non-dairy vanilla ice cream recently. That was a minor victory, even though he couldn't fully taste it like he once did.
This is how cancer has touched Rivera's life.
'I have to be really careful'
The changes remain subtle, perhaps more visible to Rivera himself than to others.
"Coach is always very even-keeled," said Washington offensive coordinator Scott Turner, who has spent six years coaching with Rivera. "That first year was really hard on him. [Now] sometimes he's tired, but he does a good job hiding it from the rest of the guys, but I see him as himself."
Considering most players only know him from Washington, it's hard for them to compare how he was pre-cancer. But they do see a change from two years ago to now. If Rivera gets tired, as Turner said, he shields it well from his players.
"You can tell a [difference from 2020] just in how he is around the guys, how active he is," defensive tackle Jonathan Allen said. "This is the Coach Rivera we knew he was, and it's exciting to have him back. Just how engaged he is with every position group."
But the impact of chemotherapy from 2020 continues. Rivera used to run from one drill to another and be more hands-on with position groups; he would be visible in meetings. His goal this summer was to get back to that point. He has to some degree, although there are times he has to duck out to close his eyes. And he would like to yell a bit more.
Now, if he yells early in practice it could cause him to stay much quieter the rest of the day. After one training camp practice earlier this month, Rivera was upset. He gathered his players, had them take a knee and chewed them out. He paid the price later as it made his larynx sore. He also knows his doctor won't be happy.
"That was hard on me," he said. "I woke up and it was sore so I had to drink more water and use throat lozenges."
He's regaining his stamina -- Rivera estimates it's between 80 and 90% of what it was pre-cancer. During a summer trip to Ireland with Stephanie, he walked seven rounds of golf in 12 days. He also lost eight pounds after that excursion.
He used to run 2 or 2 1/2 miles twice a week, in addition to walking twice a week for 40 minutes. Now, he's running once every two weeks with the goal of hitting 2 miles in 30 minutes.
"If I get active during practice, the late afternoon is hard, it's hard to stay awake in [some] meetings," Rivera said. "Every now and then I get a dull headache and I have to close my eyes."
Those 30-minute power naps in his office recliner get him through the rest of the day.
"I'll hit a really good REM," he said.
"If I get active during practice the late afternoon is hard, it's hard to stay awake in [some] meetings. Every now and then I get a dull headache and I have to close my eyes." Commanders coach Ron Rivera
When he gets tired, especially after the long days of training camp, the neuropathy -- a nerve condition that can cause muscle weakness, numbness, pain or swelling -- in his feet worsens. He still deals with brain fog, another byproduct of chemotherapy, though it's not as severe as it was a year or two ago when he'd look at a play script and couldn't "make sense of what I was looking at." Now it mostly causes fatigue.
And then there's the vertigo, which bothers him when he turns sharply to his left. One time, when he first started chemo two years ago, a security guard said goodbye to him. Rivera turned sharply to his left to return the goodbye. As he continued to walk to his car he started feeling dizzy and broke out in a cold sweat, so he laid on the grass for a few minutes until it subsided. He'll still occasionally get vertigo, though not that severe. If he sleeps on his left side he sometimes wakes up groggy. But, he hasn't had an episode in two months.
He can't eat like he used to at the Commanders' facility, with meals designed for pro athletes -- steaks, veal chops, even eggs. In some cases the meals are too heavy or require too much chewing, are hard to swallow, or are simply not good for his digestive system.
Rivera also lathers up with sunscreen on his arms, throat and neck and wears long-sleeved shirts in practice.
"I have to be really careful," he said.
'Nothing is guaranteed'
Reaching a certain age -- Rivera turned 60 in January -- leads to more introspection. For Rivera, that's increased because of how cancer has affected him and his family.
"Now we're thinking we have to enjoy the moment," Stephanie said, "because nothing is guaranteed. When you get in the grind you're thinking just about the work, but in the offseason now it's, 'Let's enjoy this offseason because we work so hard. I want to enjoy the time we do have off.' With family or friends, it's making sure to take that time.
"With family [gatherings] he says, 'I know we have this going on, but let's see if we can work it out.' Before he would say, 'No we can't do that.' Now, if there's a chance, we do it."
Rivera said he's become more sentimental in the last two years and admits to appreciating the "little things." In a football sense, that could mean a win or certain players. He'll soak in moments, even processing how a player warms up before practice. As an example, he mentioned Jeremy Reaves, a smaller safety who has yo-yoed between Washington's active roster and the practice squad since 2018.
"I watch players do the little things before they get to the big things," Rivera said. "I appreciate it. I appreciate guys taking time to do things right, to warm up right, to make sure everything is ready to go properly."
"For example, I watch a guy like Jeremy Reaves who works hard and does things the right way and is always ready just in case. I've come to appreciate that kind of young man even more."
'He's just a genuine, kind-hearted person'
Last November, Turner mentioned to Rivera that a friend of his had a neighbor, James Hill, who had been diagnosed with the same form of cancer. Hill, who turned 50 in May and said he's been a Washington fan since he was a kid, was starting treatments at the same cancer institute Rivera went to in Northern Virginia.
Rivera did what he's done with a number of cancer patients the past two years: He texted Hill and said he'd love to talk. Hill said he could talk anytime. Then, while at his son's basketball practice, Hill received a call.
"I pick up the phone and he said, 'Hey James this is Coach Ron; you've got this,'" Hill said. "He launched into what he went through and the support network around him and how his brothers would call him every morning and how important that was to him, and he shared stories how others [reached out] to him and said, 'I've had this.' He said, 'You're going to deal with it, you've got it.'"
Rivera detailed what to expect after radiation treatments, how it becomes difficult to swallow and how he'll lose his taste -- and the taste he will have is metallic. He told Hill how he loved eating pancakes with butter and lots of syrup to help it go down smoothly. He let him know the one beverage he could actually taste: root beer.
"Root beer is literally one of the few things you can taste that tastes like itself," Hill said.
Hill needed a blood transfusion several weeks after his treatments ended. Doctors removed his thyroid in May after discovering a nodule. Through it all, Rivera remained in contact via texts or calls. Hill is friends with former Cleveland Browns coach Freddie Kitchens, so he understands a coach's life.
"They have no time," Hill said. "For him to take the time out to call -- and I'm not the only one. He reached out. And it was always genuine. I didn't know the guy other than being a football fan; he's just a genuine, kind-hearted person. It was amazing.
"The emotions are high because you bury all that stuff. Ron told me to focus on what's important, not what's interesting. When you talk to someone who went through it, you're on a different mindset because you've both been through a lot of s---. It bubbles up. Talking to him brings tears to your eyes."
Hill texted Rivera a photo when he rang the bell at the hospital, signaling the end of his treatments.
Not every encounter ends as well. One of Rivera's former high school teachers, who was also a football coach, told Rivera about an acquaintance who had cancer. Rivera reached out, and he and the woman texted back and forth.
"It is emotional because certain things bring you back to where I've been. It's a stark reality." Commanders coach Ron Rivera
One day, his former coach texted him and said she had taken a turn for the worse. Rivera said he texted her every other day for two weeks, without a response.
"Then I got a call from her number and it was her husband and he wanted to let me know she had passed and to thank me for lifting her spirits," Rivera said. "That was ..."
His voice trailed off.
"It is emotional," Rivera said of these exchanges, "because certain things bring you back to where I've been. It's a stark reality."
His wife said they affect him "tremendously." Stephanie also said she didn't realize how many people he's talked to, until they get a letter or note or email thanking him. Rivera estimates he's reached out to between 20 to 25 people in all.
"Any person that reaches out, he'll give a call or give words of encouragement," Stephanie said. "When you're going through cancer treatments it's so important to have that positive karma."
'He's excited about the season'
Another woman he talked to, Denise Durgin, wrote a book titled "Prescription for Proton Radiation: Real Patient Stories, Expert Physician Input on a Highly Precise Form of Radiation Therapy." She included a chapter on Rivera's experience.
Shortly after his diagnosis, Rivera harped on affordable health care, something he's continued to mention. But, boiled down, he's also pushing to make proton therapy -- which doctors used to treat him -- more common for cancer patients.
Proton therapy, if covered by insurance, is at least as much as three to four times the cost but is less invasive than the more traditional photon therapy. Proton therapy better targets the location of the cancer, which kills more cancer cells and less surrounding healthy tissue than other radiation treatments. But the cost involved has limited its use.
"It didn't wipe me out," Rivera said. "If I had gotten photon therapy the likelihood of me being hospitalized was high. But proton therapy limited the collateral damage, and I was able to continue to work."
Rivera shared his proton therapy experience with members of President Biden's Cancer Moonshot initiative. He also was the guest of honor an online gala run in part by Marshall's wife, Liza, a breast cancer survivor who befriended Rivera through her support and their shared interest in cancer care and health care. Rivera spoke for 20 minutes about his experience.
But Rivera's main job is coaching football. And after two years he does feel closer to his old self entering the season. The Commanders have gone 14-19 with one NFC East title in his first two seasons.
"He feels really good about where we are," Stephanie said. "[For him] it's just more about making sure I take care of myself because I want to be part of this. He's excited about this season. What the cancer taught him is [life] can be taken away."