Cycling icon Lance Armstrong was slipping back in the pack: The cocky, brash Texan, normally so full of steam, had wilted in the 220-kilometre road race during the 1996 Summer Games at Atlanta.
"Armstrong," as one reporter described it, "was cooked." Nicknamed the Texas Bull for his impulsive, confrontational riding style, he seemed "pooped."
What no one realized -- least of all the athlete himself -- was that cancer was galloping through his body. The surprise wasn't that he finished 12th in the race, it was that he finished at all.
A diagnosis of late-stage testicular cancer at the age of 25 threatened to put him out of the game for good. The odds were stacked against him: He faced a 40 per cent chance of survival.
And yet last week the same Lance Armstrong learned that he will lead the five-man U.S. road team to race for gold at the Sydney Olympics. If that isn't enough, two weeks ago he also won the Tour de France.
Mr. Armstrong proved to his critics that he's the ultimate comeback man -- and to the rest of the world that there is life after cancer.
But even his cancer specialist, Dr. Craig Nichols, is astonished.
"It's spectacular," he said, sitting amid photos of his famous patient that compete with stacks of papers and books in his tiny, cramped office at Oregon Health Sciences University where he is the chief of hematology and medical oncology.
"I can't think of another sports story of someone who has come back from where he was."
Without Dr. Nichols and others, it might never have happened.
By the time Mr. Armstrong had gone to a Texas doctor complaining of severe headaches and spewing up blood on Oct. 2, 1996, two months after the Olympics, he was on the brink of death. "He would not have survived [another]three to eight weeks," Dr. Nichols said.
The type of cancer cell that attacked Mr. Armstrong's body, medically referred to as non-seminoma, was astonishingly aggressive, leaving massive tumours in his lungs and one in his abdomen.
But that wouldn't be the end of it.
Doctors in Texas surgically removed the cancerous lump in his testicle and started him on his first round of chemotherapy, using the standard protocol of BEP. That cocktail is a mixture of three drugs -- bleomycin, etoposide, and cisplatin, the last of which is the most important because its use has turned testicular cancer into a highly curable disease.
It was then that Mr. Armstrong received a letter in the mail from another cancer doctor, Dr. Steven Wolff, who just happened to be an ardent cycling fan. He urged the athlete to get a second opinion from testicular cancer guru Dr. Lawrence Einhorn, who could treat the disease and minimize possible side effects that could compromise Mr. Armstrong's racing capabilities.
That was heartening news to Mr. Armstrong, who assumed his sports career was over. In a subsequent telephone call, Dr. Wolff also questioned Mr. Armstrong about his level of HCG, the endocrine protein that stimulates women's ovaries.
It was a telling blood marker because it shouldn't be present in the bodies of healthy men. Mr. Armstrong shuffled through his medical file and found his level was 109,000 -- way too much HCG, suggesting the cancer had spread to the brain.
An MRI on the athlete immediately revealed the cause of the high HCG level: There were two grape-sized spots of cancer on the surface of his brain.
Mr. Armstrong went to Houston for another opinion and eventually settled on two cancer super-specialists in Indianapolis, Dr. Einhorn, a distinguished professor of medicine at Indiana University, and his colleague, Dr. Nichols, who has since moved to Portland.
"To be perfectly honest, when we got the referral, I didn't know anything about cycling and the name Lance Armstrong at that time was like John Smith, it just didn't have any connotation," Dr. Einhorn said in a telephone interview.
When he arrived, Mr. Armstrong certainly made an impression. Hard as steel, the tough-talking Texan fired off dozens of questions about the disease and treatment, questioning doctors about his prognosis and about their abilities.
All told, there were more than a dozen tumours in his lungs, some the size of golf balls, and another mass in his abdomen. The cancer, which first sprouted in his testicle and swelled to the size of a lemon, had probably been in his body for only six months or so.
Mr. Armstrong's cancer was very advanced. Dr. Nichols, who has treated roughly 1,000 cases of testicular cancer, rated the cyclist in the "top 50 in terms of worseness" of his patients.
But there was some reason for hope. Even though the cancer had spread massively through parts of the athlete's body, it was a type that is highly treatable and typically boasts a 95-per-cent cure rate if caught early.
Still, since the cancer was so advanced, Mr. Armstrong was in the worst prognosis category, and his odds of survival were even poorer.
Testicular cancer is a relatively rare disease. In Canada, 820 cases are expected to be diagnosed this year and 40 men will die of the disease, said Dr. Mary Gospodarowicz, a Toronto radiation oncologist who is an expert in testicular cancer and lymphoma.
"Testicular cancer is very different from other cancers," Dr. Einhorn said. "When you have breast cancer, or bowel cancer or lung cancer and it has spread to the brain and the lungs and the abdomen, there's a zero cure rate. But testicular cancer is unique. It's a highly treatable and highly curable disease."
Had Mr. Armstrong developed testicular cancer in the early 1970s, he most certainly would have died. What would make the difference was the use of cisplatin, a form of platinum, which was pioneered more than two decades ago by Dr. Einhorn in Indianapolis.
"Why this cancer is much more sensitive to chemotherapy than breast-cancer cells or prostate-cancer cells, no one knows," Dr. Einhorn said. "If you could figure that out, you'd probably be claiming the Nobel Prize."
Mr. Armstrong's advanced cancer didn't deter Dr. Nichols from deviating from the traditional treatment protocol and making two important recommendations that would put the racer back in the saddle.
First, Dr. Nichols recommended that the athlete undergo surgery to remove the tumours, instead of radiation treatment. With surgery, there would be less risk of co-ordination loss -- and Mr. Armstrong needed his co-ordination if he were ever to bike through the Alps again.
The second step was to substitute ifosfamide in the chemotherapy cocktail for the more commonly used bleomycin, a drug that has the side effect of slightly reducing lung function.
For most men with testicular cancer, bleomycin would not be a serious issue. "A 5- to 10-per-cent loss of lung function isn't going to change our daily life," Dr. Nichols explained. "But to a professional athlete, it would be crippling as far as his career goes."
Still, with the drug switch, Mr. Armstrong experienced short-term side effects of more severe nausea, vomiting and loss of appetite.
The chemotherapy left the cyclist in a fetal position, retching around the clock. He endured four rounds of platinum-based chemotherapy.
"On the really bad days, I would lie on my side in bed, wrapped in blankets, fighting the noxious roiling in my stomach and the fever raging under my skin," Mr. Armstrong wrote in his autobiography. "I'd peek out from under the blankets and just grunt."
He could stand the rigours of chemotherapy due to his physical stamina, but it was his "mental toughness and his positive outlook" that made the difference, Dr. Einhorn said.
Mr. Armstrong would receive chemotherapy for one week, then have two weeks off. Despite the weakness and loss of hair, including even his eyelashes, there were days he would cycle 50 to 80 kilometres.
"Chemo had made the worst climb in the Alps seem flat," he wrote in his autobiography, It's Not About the Bike: My Journey Back to Life.
By the end of his treatment regimen, though, the cyclist was more easily fatigued. He didn't recognize how much until he was out riding one day and a woman who appeared to be in her 50s whizzed by him effortlessly on a heavy mountain bike.
"You fool yourself. You fool yourself into thinking you might be riding faster and feeling better than you really are," he wrote. "Then a middle-aged woman on a mountain bike passes you, and you know exactly where you stand. I had to admit I was in bad shape."
Almost four years later, Mr. Armstrong's chance of recurrence is pegged at 1 per cent, but he still has six-month checkups with Dr. Nichols just to make certain the disease doesn't creep back.
"He went from being bald and with scars on his head from cancer, to riding down the Champs Elyseé in front of a half million people," Dr. Nichols said. "It was incredible."
Today, the 28-year-old sports genius not only has a smashing career, but he is giving back with the Lance Armstrong Foundation, and has a happy family life with his wife, former public-relations account executive Kristin Richard, and their baby son, Luke.
"I think he'd tell you that he wouldn't have accomplished all that had he not had cancer," Dr. Nichols said. "In some ways, cancer is the best thing that happened to him."
It's difficult to believe anyone could describe cancer as something that has a good side, but Mr. Armstrong himself is among those who believes that is the case.
"From a therapeutic point, is it a miracle? No, it isn't," Dr. Nichols said, answering his own question. "What is a miracle is that he went back to a spectacular life and it changed his life to focus on doing good."
But it's also a lesson for cancer patients: It underlines how important it is to find an expert in treating the disease. Says Dr. Gospodarowicz of Toronto's Princess Margaret Hospital: "There is no doubt that being treated by an expert is associated with a better outcome.
"There's a tendency to say that everyone gets equal treatment. [But]the more expertise you have, the more likely the expert will think of new answers in the presentation or new answers in treatment."
Without that tailored treatment, Mr. Armstrong might have battled back to life, but he almost certainly would not be the champion he is today.
Adversity, it seems, has been life's fuel for Mr. Armstrong. The son of a teenaged mother, he has not only survived but thrived from a disease that threatens to break the mind, if not the body.
He has become almost as famous for his cancer as for his cycling, and in doing so has set up the Armstrong foundation, which gives out research grants and encourages patients to learn about their disease, including the need for second opinions. It also focuses on getting patients back on their feet after cancer, offering advice on everything from finances to how to deal with colleagues at work.
"These life-after-cancer programs were in large part his [Mr. Armstrong's]idea and designed around his view about what people need," Karl Haussman, the foundation's executive director, said in a telephone interview from Austin, Tex.
"When we started doing research on survivorship, we found there are no programs for people to get their lives back."
In his book, Mr. Armstrong wrote that the life he battled back to is far better after cancer. Cancer, chemotherapy, and brain surgery taught him patience and perspective.
He has settled into a grand house on a cliff above downtown Nice, a pastel city of the French Riviera that slopes toward the pebbled beach on one side and crawls up a mountain on the other.
Though he is a grand célèbre in Europe -- in the league of a Wayne Gretzky in North America -- few residents in his Nice neighbourhood appear to know that residing in their midst is the latest back-to-back winner of the Tour de France.
You can hardly see the cyclist's white home behind the wall. But its large picture windows offer a panoramic view of old, jam-packed Nice and the ocean. Mr. Armstrong has chosen his adopted home in order to train in southern France. He bikes up to seven hours a day, and comes home to his wife and 10-month-old Luke.