Relentless Assaults Erode Cancer Patient’s Resolve

All Claire Chasles wants to do is have a good cry. But the unforgiving nature of her disease has denied her even this.

“I start to cry, and I can’t stop,” she says, her voice breaking. “And then I can’t catch my breath. I can’t breathe. So what good does it do?”

Claire, 42, a smoker since age 16, has advanced lung cancer. Since the disease recurred last fall, she has been fighting it with all the defiance she can muster. But her resolve has started to crumble in the presence of an overwhelming feeling of sadness.

Some might say she has good reason to weep. After two cycles of powerful, toxic chemotherapy, she is extremely weak and gaunt, and she has lost almost all of her hair. The physical assaults have taken their toll, and she is depressed.

“When I was 16 and lighting up, I felt very, very glamorous,” she said. “Now I’m crying all the time and losing weight, and my hair’s falling out piece by piece in huge clumps. You think that’s glamorous?”

Her physicians had been hoping the chemotherapy would delay her advancing tumor and give her some quality time. Claire has been counting on this, but the treatment has been as ravaging as the illness.

In February, she appeared robust and healthy. But despite a remarkably positive attitude, she then began a precipitous slide. And now her spirits have followed.

“It’s not unusual for very sick patients to get depressed when they finally start to see evidence of the disease in their lives,” said Dr. Paul Lanken, a bioethicist and medical director of the intensive care unit at the University of Pennsylvania.

“It’s hard for people to accept a bad prognosis when they’re feeling fine,” Lanken added. “But then the disease catches up to them, and it becomes real.”

Doctor Concerned

Claire met Thursday with her oncologist, Dr. Naiyer Rizvi of Georgetown University Medical Center’s Lombardi Cancer Center, and Katy Swanson, a registered nurse who is the case manager for lung cancer patients. They are concerned about Claire’s emotional outlook and her deteriorating physical condition.

“I’m sorry this has been happening,” Rizvi says.

“I just want to get it [the chemotherapy] over with, and be on my merry way,” Claire replies.

Rizvi takes a deep breath.

“I think the odds are stacked against you, frankly, at this point,” he responds, not unkindly. “I think the fact that you are weaker and losing weight is concerning.

“I would be deceiving you if I thought the chances were excellent for you to make a recovery and get back to where you were before. It’s the reality.”

“OK,” Claire says very slowly.

Rizvi leaves for a few minutes, and Swanson sits down, pulling her chair next to Claire’s wheelchair.

“This is the most down I’ve seen you,” Swanson says. “I think you’re now realizing how sick you are, and you’re thinking about the future and whether you’re getting better. And we can’t make any guarantees.

“It’s tough to know what to do. That’s what affects everybody with lung cancer. They start to think: ‘Is it worth it?’

“This is something we know we can’t cure, but maybe we can give you some quality time. Some beat it, but most don’t. And I think that’s starting to hit you.

“Start thinking of short-term goals,” Swanson says gently. “Not six months or a year in the future.”

“I’m not,” Claire insists. “I just want today.”

“You should be thinking today or tomorrow and the next day,” Swanson says.

Swanson pauses.

“Do you want to give up the chemo?” she asks. “That’s what you need to be thinking about.”

“No,” Claire says. “I’m going to finish it.”

Rizvi decides, however, to postpone by one week the third chemo session, which would have marked the halfway point in the treatment. In the meantime, he hopes Claire will regain some strength, and he will do a series of tests to see what’s happening with the tumor.

“Are you somebody who has thoughts of God? Are you religious? Is there anything that keeps you going?” Swanson asks.

“Just my friends and my family,” Claire says.

Swanson and Rizvi leave the room.

“I don’t know what they were trying to say,” Claire says. “But I know they’re not saying: ‘Give up.’ ”

Bout of Depression

Claire’s depression had begun in earnest several weeks earlier.

She began crying over little things and complained that she didn’t know why she was feeling so sad. Maybe it was her appearance and the crushing fatigue that had made minor tasks nearly impossible, she said. She had started to use a walker because her legs buckle when she gets up.

“I can’t do anything. I feel so helpless and lifeless,” she said. “I have no energy to do anything. I don’t take pride in myself the way I used to. The pride’s there somewhere. But I just can’t get to it.”

Joe Kelly, her live-in fiance, wants to get married. And a grandchild is due this fall. Claire wants to plan for these happy events. But, understandably, it is difficult now.

“I want to be able to run around. Play with my grandchild. Be a wife to my husband,” she said. “But I’ve got to get better. Maybe I’m scared that I won’t, that it will get worse.”

That’s the closest she comes to acknowledging fear. If she is frightened about where her illness is heading, she doesn’t talk about it. She repeatedly insists, even through the tears: “I’m not licked yet.”

She talks about getting married and having a delayed honeymoon. “I’ve always wanted to go to Switzerland,” she said.

Claire’s 21-year-old daughter, Christine--five months pregnant and herself unable to quit smoking--has been trying to stay upbeat. But both women feel the strain: Claire because she hates being stuck in an armchair, unable to do anything but watch television, and Christine because she has had to assume so much of her mother’s care.

“I should be doing things for her, spoiling her, taking her shopping,” Claire said.

Christine works part time as a waitress in 12-hour shifts. he also fetches whatever Claire needs, fixes her meals and coaxes her to eat. Claire has lost more than 60 pounds since last fall, most of it during the last three months.

“It’s stressful, but it’s not Mom’s fault,” Christine said. “She can’t do anything for herself. She took care of me. Now it’s my turn to help her.”

She teases her mother gently. “I think you look so cute, just like a baby,” she says of the fine wisps of hair still on Claire’s head.

And, as Claire gets up and slowly makes her way across the room, Christine jokes about her mother’s skinny legs. “She looks like a stork,” she says, as Claire chuckles. Despite the humor, it is clear Claire is frustrated.

“I’ve been so sick since Valentine’s Day, I’ve been in bed constantly,” she said. “Now I just want to feel halfway decent. I’d just like to have one week where I feel good, then maybe I can handle the next dose of chemo. I want to get my strength back so I can play with that baby when it comes.”

Reasons to Not Smoke

She wants something positive to come from her ordeal.

Indeed, she wishes that every young person preparing to light that next cigarette could see her sunken cheeks and balding head.

“I don’t want kids to ever start,” she said as she coughed. “I don’t want them to ever go through the torture and the pain and the scariness and everything that’s associated with this disease. Believe me, there’s a lot of it.”

New statistics about teenage smoking, however, show a sharp jump in recent years. And the news has been especially ominous for women. Lung cancer now kills more women than any other kind of cancer.

The Clinton administration has proposed regulations to keep teens from buying cigarettes and to shield them from tobacco ads. But the industry has filed legal challenges.

Claire doesn’t understand why the proposed regulations are so controversial. She wishes something, anything, had kept her from starting to smoke. She doesn’t smoke anymore.

“Is this what the kids want--what’s happening to me?” she asked. “I’m sitting here and crying and taking all of these medications and watching my hair fall out.”

Christine watches, and not without mixed emotions. Her pregnancy is progressing well--she has gained 25 pounds--and she is delighting in thoughts of her impending motherhood, hoping for a girl.

But she smokes. When Christine first learned she was pregnant, she swore she would stop. She felt she had to for the sake of the baby.

Christine also started smoking as a teenager, seeing her parents and grandparents all smoke. Today, the best she can do is try to cut down. On some days, she smokes only a handful of cigarettes. On other days, she goes through a pack. Her fiance, Brady, and Claire’s fiance, Joe, also smoke.

“I keep telling Brady we have to do this [stop smoking] together,” Christine said. “But he says he doesn’t think I can stay with it.”

They are all witnessing Claire’s struggle. And still they smoke.

“It’s so damn hard,” Christine said. “I want to stop. I have to stop. But just try to tell that to my mind and my body when it wants that nicotine.”

She looks at her mother in the next room.

“Now that you can really tell she’s sick, I do think about it, more now than I did before,” she said. “When I didn’t see it, it didn’t bother me. If only I could’ve seen this before I started smoking.”

Seeking Counseling

Last month while undergoing her chemotherapy, Claire met with Dr. George Uy, a Georgetown staff psychiatrist. She was hoping that some counseling would help.

With two intravenous lines hooked to her left wrist, she answers his questions.

“What do you think is one of the reasons you feel down?” Uy asks.

Claire blames a still-unhealed wound in her side, where surgery to reinflate her lung was performed several months ago, the site of a subsequent infection.

He takes notes.

“Any hopelessness?”

She nods her head.

“How’s your concentration?”

Her answer is peculiar: “I used to love to read the obituaries. I can’t read them anymore. They upset me.”

“Any thoughts about wanting to end your life?”

“No, I haven’t come to that.”

Uy asks about her family, and she tells him about the coming grandchild--”That’s another reason I want to live--I want to spoil that baby”--and her plans to get married, possibly this summer.

“Do you know what your prognosis is?” he asks.

“It’s probably not good, but I’m going to fight it. You never know. I talk to friends who say: ‘I know someone with only one lung and he’s gone on for five, six, seven years.’ So you never know.”

Christine and other family members are worried about Claire’s attitude, and they persist in urging her to fight on.

“If she can keep her spirits up and kick ass, she’ll be OK,” Christine said. “She’s not gonna live forever. But she’s not gonna die tomorrow either.”

Of herself, Christine says: “I don’t have time to feel sad. I don’t like seeing her like this. But I’ve got to make sure she stays happy, so she doesn’t give up.”