Ruth Ann Angus has her second visit for chemotherapy talks to Cheri Cooper RN during a review of the drugs scheduled for this session. Photo by David Middlecamp 11-19-07
Chemotherapy drugs slowly dripped through a tiny tube inserted just below Ruth Ann Angus’ right biceps.
As the toxic chemicals seeped into her bloodstream to kill the cancer cells threatening her body, Angus reclined in a chair at a San Luis Obispo oncologist’s office and looked out the window at the sun hitting Cerro San Luis.
The 67-year-old Morro Bay woman thought about how she got there and worried about what would come next.
“I’m afraid of getting sick and throwing up,” she said. “I’m afraid of running out of money.”
Though her chances for a full recovery were good, she was afraid of dying.
“You can’t help but think about the possibility,” she said. Since finding a pea-sized lump in her left breast five months earlier, in June, Angus had made many difficult decisions about treating her cancer.
Already by this early November afternoon, she had two surgeries and fought off a nasty infection. But she was far from finished.
At least three more chemo treatments and seven weeks of radiation therapy awaited. In addition, she could look forward to frequent blood, imaging and diagnostic tests. Cancer consumed her. Yet, the single woman with no family nearby still had to deal with life’s other unrelenting demands: rent, medical co-pays, credit card and loan payments, and car repairs.
Angus supplements her monthly $991 Social Security check and $200 pension with freelance writing and photography. She feared being too sick to work.
“If I don’t work, I don’t eat,” she said.
Array of decisions
About 1,400 San Luis Obispo County residents will receive a cancer diagnosis this year. Fortunately, their chances of survival are greater than ever.
Still, cancer is the second leading cause of death nationally after heart disease and will take 500 local lives this year. The majority of those who die will be Angus’ age or older.
After her mammogram showed a suspicious mass, and a biopsy confirmed it was cancer, Angus faced major decisions. Where would she seek treatment? How would she choose a doctor? Did she want a lumpectomy or mastectomy? Would she need chemotherapy? If so, what kind and for how long?
Cancer is a complex disease requiring multiple doctors and a litany of tests and treatments. Making decisions about where to go, who to see and what to do can be overwhelming.
Angus, who naturally takes charge and demands straight answers, began reaching out to her expansive network of friends for help and advice. “I was stunned to find out how many women have had (breast cancer),” she said. “Every time I turn around, there’s someone — and from all age groups.”
Some women advised Angus to seek a second opinion at a university comprehensive cancer center. Others recommended a local oncologist and surgeon.
Angus fortunately had access to doctors and treatment because she is covered by Medicare and a good supplemental insurance plan. She didn’t have the money to drive north or south for treatment, but she expected good local care. She followed her primary care doctor’s advice and went to a local surgeon to remove the lump.
A mastectomy was never an option. Two decades earlier, when Angus had a non-invasive breast tumor and surgeons preferred mastectomies, she fought for a lumpectomy. Current research shows a lumpectomy with radiation is as effective as mastectomy in many cases.
On Aug. 9, the surgeon removed Angus’ tumor. A pathologist confirmed it was invasive ductal carcinoma.
Three weeks later, the surgeon cut under her left armpit and removed 14 lymph nodes. Cancer had spread to two. That meant Angus needed chemotherapy.
A nasty infection
Angus’ face offers a window to her emotions. She rolls her eyes in frustration, sticks her tongue out in disgust, and frequently flashes disarming smiles.
In early September, she was scowling in anger. “Why me?” she screamed.
“One day I just started screaming out loud,” she said. “I was cursing God. Now, I’m probably going to hell, but I had to let it out.”
Debts were looming, and the incision under her arm continued to hurt weeks after the surgery. Pain radiated, she said, from her left ear down to her breast.
“I feel like a rag doll that has been ripped apart, lost some stuffing and been stitched back together too tightly,” she wrote in a journal after the surgery.
In anticipation of a grueling chemotherapy regimen, Angus called county Social Services to inquire about enrolling in welfare and food stamps. She also activated credit protection on some credit cards, knowing she might not make the minimum payment each month during treatment. In late September, she returned to the surgeon, who drained gobs of puss from the operation site. But the pain and swelling remained. Angus grew weak and feverish.
A week later a test confirmed the doctors’ fears. Angus had Methicillin-resistant staphylococcus aureus, or MRSA, a dangerous infection that resists most antibiotics. That same week, MRSA was front-page news after it had killed a Virginia teenager.
The infection complicated Angus’ treatment timeline. She was supposed to have her first chemo treatment within 10 weeks of the lumpectomy. But she had to be rid of the infection first, since chemo weakens the body’s ability to fight infections.
Strong antibiotic pills didn’t kill the infection. Her next defense was intravenous treatments of vancomycin, a last-option antibiotic.
Angus’ medical oncologist, Thomas Spillane, initially wanted her to receive seven IV antibiotic treatments in the hospital. Angus, however, couldn’t afford the $992 deductible that Medicare requires for hospitalizations. Another option was to have a nurse give Angus treatments at home. Medicare wouldn’t pay for that.
Sympathizing with Angus’ financial situation, Spillane persuaded the hospital to give her the treatments on an outpatient basis. By then, she had passed the 10th week after surgery.
The IV antibiotics wiped out the infection but exhausted Angus. Afterward, her morale sunk further, and she began having “second and third thoughts about chemo.”
Choosing chemotherapy
Spillane convinced Angus that chemotherapy was necessary to increase her chances of killing all cancer cells in her body.
Together, Spillane and Angus chose a chemo treatment best for her specific cancer, previous health history and lifestyle.
“When we choose chemotherapy for patients, we base it on the biology of the cancer, how advanced and aggressive the cancer is, and on the person and what’s going on with them,” Spillane said.
For Angus, Spillane chose a combination of two drugs, Taxotere and Cytoxan. She would receive them intravenously four times every three weeks.
Most chemotherapy is now done in the doctor’s office instead of in the hospital, thanks largely to the development of effective anti-nausea drugs. The night before her first treatment, Angus took two anti-nausea pills, an anti-anxiety pill and two anti-allergens. She didn’t sleep well, though, and was uncharacteristically quiet the next day waiting for the doctor.
“I’m about to pump poison into my body,” she said. “I’m a bit nervous.”
She met with Spillane to review the treatment details before an oncology nurse connected the bags of liquid chemo drugs to her catheter, a plastic tube inserted into a vein in Angus’ arm.
“How do we know we zapped everything?” Angus asked Spillane. “That’s the difficult and very important question that we don’t have a very good answer to,” Spillane said. “We call this adjuvant therapy. What we are doing is attempting to mop up the microscopic cancer cells that we can’t see and don’t know are there.
“It’s a type of treatment that we assume we’re doing good, and will know only in the future — in retrospect,” he said. “How long will the side effects last?” Angus asked.
“Everybody is different,” Spillane said. “I’m hoping you don’t have too many. Don’t let yourself get dehydrated. Call us if you don’t feel well.”
Angus hoped that call wouldn’t be necessary.
Staff writer Sarah Arnquist has left The Tribune but can be reached at sarnquist@gmail.com.
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