Delia Ephron Writes Her Way Through Cancer to a Happy Ending

The story behind Delia Ephron’s latest book, “Left on Tenth: A Second Chance at Life,” began sweetly, like the romantic comedies Ephron wrote with her sister, Nora Ephron, the beloved author, director and screenwriter of “You’ve Got Mail” and “Sleepless in Seattle.”

But the delay that drew out Ephron’s happy ending — the sine qua non of the narrative trope that is the Marriage Plot — was so catastrophic that if she had pitched the story to a studio executive, they would have turned it down as being too much, too over the top. Even for one of the four daughters of Phoebe and Henry Ephron, the tart-tongued screenwriting couple behind “Carousel and “Desk Set.”

The backdrop was terrible loss. In 2012, Nora Ephron died of leukemia, a death that shocked the world because she had kept her long illness a secret from everyone except a few friends and family members. Three years later, Delia Ephron’s husband of more than three decades, Jerome Kass, a theater, film and television writer, died of prostate cancer. Nearly a year after that, Ephron wrote an essay for The New York Times about what happened when she disconnected his landline. It was a piquant sketch of contemporary life and widowhood involving hapless encounters with operators at telephone company call centers and the eye-crossing rage that wrestling with technology can elicit.

The essay touched a nerve with many people, including Peter Rutter, a widower from San Francisco, who wrote an email to Ephron. He was a Jungian psychiatrist; he, too, had tilted with a phone company after his spouse’s death and, he added, he and Delia had met before. They had gone on a few dates a half-century earlier. Nora Ephron had fixed them up, he said, though Delia Ephron had no memory of their (chaste) encounters. In this way, email by email, Rutter wooed Ephron, and after a few weeks of potent correspondence, they met in person and their epistolary romance blossomed into the real thing.

Four months later, Ephron was diagnosed with leukemia. The couple married at NewYork-Presbyterian/Weill Cornell Medical Center, the same hospital where Nora Ephron had died, because by then Ephron had begun her treatment — a violent course of chemotherapy, and then more chemotherapy, and finally a stem cell transplant — all of which would nearly kill her. Jessie Nelson, the screenwriter and director, officiated, one of the few friends Ephron allowed to share her ordeal.

“You’ve Got Mail” had careened into “Love Story.” But unlike the doomed Ali McGraw character in that limp 1970s weepy, Ephron had no intention of drifting quietly away. She fought like crazy to stay alive, and “Left on Tenth,” out April 12 from Little, Brown, is her account of that terrifying experience. It’s a medical thriller, a cancer memoir woven through with a love story, and it’s a hero’s journey to boot, to borrow a phrase from her husband the Jungian. Except there were two heroes: Ephron, who passed through the gates of death, and Rutter, her steadfast champion, who accompanied her.

“So many extraordinary things happened,” Ephron said, “and there’s no logic to explain them. Yet they happened to me and I’m actually rather ordinary.”

On a bright afternoon in mid-March, Ephron was at home in her sunny apartment on East 10th Street. (The book’s title, “Left on Tenth” is how she would direct visitors to the duplex.) Now 77 and two years cancer-free, she looked vibrant and Manhattan-stylish in sleek black pants and a black top. She was Ephron-slim, but not cancer-skeletal, as she had been for so many months. And quite strong, as she demonstrated, popping up from the pale blue sofa. For months after she returned home from the hospital, she had been too weak to move without a walker. Just standing up, she said, was beyond her.

To write the book, Ephron had to report on her lost year, she said, because she remembered so little of it. She pored over her emails and her medical records, which the hospital delivered at her request and totaled 6,000 pages. She interviewed the female friends who had been her support group.

“I think for everybody who has had as traumatic an experience as I had,” Ephron said, “or even half as traumatic, if you can paint it, knit it, dance it, it will be better. For me, I could take this thing and I could write it.”

She was surprised and pleased to learn she had unleashed a torrent of profanity during an early stint in the ICU, because it was completely out of character.

“Meredith thought it was my inner voice” — Meredith White, one of the women who gathered to help, spelling Rutter so he might catch a few hours sleep — “but Peter, who is a doctor, said it was steroid overload.”

“Left on Tenth” is rendered in fragments, a structure that mimics Ephron’s experience of her illness and treatment, which she recalled in flashes. One chapter is a scant paragraph describing the exchange with the doctor who each day appeared at Ephron’s hospital room door to ask if she had eaten anything. No, she would invariably reply. One day, she added, despairingly, “This is rough.” The doctor looked at her intently. “This is war,” he said.

Ephron had been diagnosed during a routine checkup; since her sister’s illness, she had twice-yearly tests for the disease. In the years since Nora Ephron’s death, treatment for leukemia had evolved, and Delia Ephron’s first chemotherapy was an experimental drug called CPX-351. It worked, for a time. When her cancer returned after six months, her only hope was a stem cell transplant. As with the chemo, the treatment in that department had progressed. But because Ephron was in her 70s, her chances for surviving were very low.

The ghost of Nora Ephron hovered.

“You are not your sister,” doctors would tell Delia Ephron, over and over. “You can have a different outcome.”

This was a complicated mantra for survival. To Ephron, it felt like a betrayal of the sisters’ long, symbiotic relationship. They shared half a brain, Nora Ephron liked to tell people when they began writing scripts together. One of Delia Ephron’s first memories is of her sister biting into a tomato and the juice squirting into her eye.

“As a child, I simply tried to do everything she did,” Ephron writes, “although she was going around the track so fast I couldn’t keep up.”

In the Ephron household, the family religion was language, and you had to be on your toes. The family secret was alcoholism. “I hope you never tell anyone what happens here,” Ephron’s mother once instructed her, in a sober moment. Phoebe Ephron was 57 when she died of cirrhosis, when she famously told Nora Ephron, “Take notes.”

But to Delia Ephron, the second child, the peacemaker, who was then working on a how-to guide of crocheting, a project not exactly in the family tradition, she delivered a different death bed zinger: “I hated crocheting.”

Patients have to be cancer-free before a stem cell transplant, so Ephron underwent another round of CPX-351. The treatment worked, and she was cleared for her transplant, which also worked. But Ephron’s body revolted. She could keep no food down, and soon could not breathe on her own. “Failure to thrive” was the official diagnosis.

“She was so angry that she was still alive,” Nelson recalled during a phone interview. “I remember her saying, Let me die! with such fury, as if I were the one doing it to her. When we talked about it later, she didn’t remember. Thank God for that.”

Nelson had also steered Ephron into her relationship with Rutter. After their first electric meeting, Ephron had balked. She was terrified. She phoned Nelson: “I can’t see him again, he has a backpack.”

“Everyone in Northern California has a backpack,” Nelson retorted. “Even Mark Ruffalo has a backpack.”

“There was so much luck and so many odd coincidences that I really began to wonder about things like miracles,” Ephron said. “Because there is no question that there was only one person that could have taken me through this journey and it was Peter.”

Rutter, silver haired but schoolboy youthful in a button-down shirt and a sweater, has the quiet intensity of all good therapists. He spoke of his beloved’s ordeal in Jungian terms.

A stem cell transplant is a profound identity shift, he said. “The miracle, and the trauma, in crossing over from death to life is of equal stature to a heart transplant. The simplest way to explain it is Delia was restored to herself, but she had to go through the gates of death to do it. It deepens anybody who has been close to that.”

Ephron shrugged. “You end up in the situation, and you just do what you do.”

Rutter said gently, “Actually Delia, that is the essence of being heroic. You persist even if it seems impossible.”