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A Family Moment Nearly Lost to Cancer

Health: Despite doctors' predictions, ex-smoker lives to greet new grandchild.


BOWIE, Md. — Claire Chasles-Kelly reaches out for the warm bundle in a fleecy red jumpsuit, a girl, 2 days old, her first grandchild.

She strokes the tiny cheek, soft as butter. "Are you going to open your eyes?" she whispers. Then she chuckles: "You're going to open your eyes, look up at me and say: 'Who's that bald-headed person holding me?' "

Everyone laughs, because Claire's scalp is only now showing the peach-fuzz return of hair. The baby has more hair than her grandmother.

Claire has endured much to get to this single, life-affirming moment.

She has spent most of the last year waging a struggle against advanced lung cancer, brought on by 25 years of smoking dating back to her teens. Claire, now 43, has survived a life-threatening infection, debilitating depression and the ravages of six months of chemotherapy.

Her doctors have told her she cannot be cured. But for now, her disease is stable. She is recovering from six rounds of powerful chemotherapy, a harrowing regimen that caused all of her hair to fall out and left her gaunt and fatigued. Although she is plagued by a nagging cough that leaves her short of breath, her energy is slowly returning. Her appetite has returned too, and she has begun to regain some weight.

The chemotherapy, despite its horrific side effects, seems to have bought her some time.

The life span of most people after a diagnosis of advanced lung cancer is often measured in months rather than years. Claire's cancer recurred last November, 18 months after it was first discovered and treated with surgery and radiation. In many ways, she has already defied the odds.

Poignant moments like this--a seriously ill patient meeting her infant granddaughter for the first time--typically do not factor into the ongoing national debate about curbing health care costs and rationing treatments for life-threatening diseases.

Indeed, in recent years, the question has been raised over and over again: How aggressively should physicians treat desperately ill patients, especially when the treatments are expensive, the side effects sometimes unbearable and the outcome uncertain?

"I think there's a tendency by those who look from a distance at the cost of treatment and the burden on the patient to say, 'This can't possibly be worth it,' " said medical ethicist Art Caplan. "And if you're a bean-counter for a health insurance company, or a bureaucrat in an HMO [health maintenance organization], it must be indefensible.

"But, from the point of view of the person who lives to see a grandchild born, makes it to a family reunion, enjoys one more Christmas--or simply has a chance to say goodbye--you cannot put a price tag on the value of these events."

Katy Swanson, case manager for lung cancer patients at Georgetown University Medical Center's Lombardi Cancer Center, where Claire is a patient, doesn't know the cost of Claire's chemotherapy. Experts say chemotherapy can range from tens to hundreds of thousands of dollars, especially if a patient must be admitted to the hospital to receive it. This was the case with Claire, who experienced an adverse reaction to one of the drugs during her first session.

The cost of treatment is irrelevant to Swanson; it is not her job to make the wrenching decisions about who should or should not be treated. And she has little patience with those who hold that smokers don't deserve treatment because they brought their illness upon themselves.

"We don't have the kind of a health care system in this country that makes those kinds of judgments, so I don't let myself think about these issues," Swanson said.

"We need to give people a chance," she added. "And people need the option to say when they've had enough. I ask that of my patients, when the chemo becomes difficult. Most of the time, they say, 'Katy, what's the alternative?' And I say, 'Well, you know. . . .' Most of the time they say, 'Katy, I'm not ready to give it up yet.' "

Claire had a rocky time with chemotherapy, as many do. She lost her appetite, her energy, her hair and, more seriously, her blood counts plunged on several occasions, requiring transfusions.

But she never thought of calling it quits, even during the worst of it. "I'm glad I did it, but I'm also glad it's over," she said.

On this day, cradling Paige--the firstborn of her 22-year-old daughter, Christine--Claire's eyes are moist. But her voice is strong.

"It was worth it," she said. "I hope I'll be around long enough to spoil her and see different things happen for her in her lifetime. But if not, at least I've had a chance to see her and to hold her."

Strong Bonds

Christine Schulze, Claire's only child, is very close to her mother. She has suffered along with Claire throughout the older woman's illness. Christine--like her mother and Claire's mother before her--is a smoker who also began during her teen years.

She was motivated to quit upon becoming pregnant, and after watching her mother deteriorate. But her addiction to nicotine has proved too strong.

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