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To
grasp the Power of Kate's travail, it
is helpful to realize that Kate Verdon
Spisak is a Saint.
My meanderings now are intended to depict
Kate's course after being informed,
alone in a strange (new) doctor's office
on December 8,1997, that the biopsy
results of a small recently discovered
lesion on her right thigh revealed a
dreaded malignant melanoma. This date
coincided with my (her always adoring
Dad) 58th Birthday. Kate called me at
the office. Given that Katie never wished
to intrude on others, my office staff
thankfully followed my mandate to promptly
transmit all calls from my children
to me.
After first wishing me a Happy Birthday,
Kate fumblingly apologized for advising
me of the 'scary news'. Aware that I
am a perpetual worrier, she had not
wished to burden me about the discovery
and biopsy 2 weeks prior. She and Craig,
her husband to be, had been awaiting
the results for that lengthy time -
inexcusable as was much of her care
until through a tortuous course she
was seen in Consultation , now Stage
IV, in March of 1999 at the National
Cance rInstitute, by Melanoma and Renal
Cell Carcinoma guru- Dr.
Steven Rosenberg, Director.
Talking with Kate, informed that Craig
was out of town on business, I realized
that Kate was confronted with this diagnosis
alone. Kate had not asked any of her
multitude of friends to accompany her
to the Dermatologist's office. She had
placed her birthday call to me from
that setting.
Kate was promptly directed to see a
young oncologist in Fairfax ,VA - a
Washington DC suburb where she resided.
I spoke via phone with the Dermatologic
Surgeon, a well trained young Doc who
had performed the exciscional Biopsy.
He informed that the depth of lesion
was 1.4 mm in thickness - miniscule
- which meant absolutely nothing to
me at that time. The subsequent pathology
report actually described a 1.5 mm depth.
Further, I was told that thebest predictor
of long term survival in absence of
even regional lymph node spread was
depth. Less than 0.75 mm thickness excellent
prognosis. Kate's depth suggested a
95% 5-year survival.
Kate's Mom promptly sojourned to Fairfax,
attended with Kate the consultation
with the Oncologist. I had been advised
by Kate that she "had no palpable nodes"
when in fact she did have shotty, bilateral,
inguinal nodes.
The only sharp words I ever had with
Kate about her illness revolved about
this point. Kate, after graduating from
Wheaton College in 1989, in her need
to serve the unwashed, returned to Johns
Hopkins where she earned her BSN. At
the time of diagnosis Kate was serving
the poor at a women's clinic in the
District of Columbia - she dismissed
these findings (the shotty nodes) as
manifestations of pelvic inflammatory
disease, which may have been accurate.
Kate was offered the option of exploratory
dissection of her groin with the attendant
possible complication of lymphedemain
her leg. Sadly, Kate was not offered
the opportunity of Sentinel Node Bx.
Since my specialty is Psychiatry, I
was not aware that the approach was
cutting edge, and now is standard of
care in early evaluation of a melanoma
of any depth. Although I have been told
by the Docs at NIH/NCI that my self
castigation for not urging the same
is inappropriate, I do fault myself
for not pressing the point when I became
aware - 2 months later - that such was
indeed available.
Being a vain, beautiful woman, Kate
rejected the extensive complete inguinal
node dissection. Given the subsequent
clinical course, it is most probable
that Sentinel Node Bx would have been
positive (an oxymoron), leading to at
least earlier contact with Dr.
Rosenberg.
For 10 months Kate did well, doing vigorous
self exams, visiting her dermatologist
every 3 months and oncologist every
6 months. Initial work ups included
standard CBC, liver function studies
and Chest Radiograph--- all interpreted
as WNL.
Again, most annoying was a 2 week delay
in obtaining the results of the Baseline
Chest X- Ray - which still makes my
blood boil. The Medical profession woefully
fails both patients and families in
these "anxious waiting" times.
Then in Oct 1998, Kate felt a lump in
her right groin which led to a complete
dissection by a caring surgeon of her
inguinal nodes. Of the 21 nodes taken,
2 were grossly dirty (black), 2 showed
melanoma cells upon microscopic examination.
This placed Kate in Stage III. I discovered
through my brief reading that the prognosis
was extremely grave (more than 2 positive
nodes.)
The point of this obsessive recounting
- be aggressive in your approach from
the get go with this unpredictable disease.
Care not if your doctor is "low key".
Our Family Internist, J. Putnam Brodsky
MD in Rumson, advised me at the time
of original diagnosis - speaking from
his own experience with his Dad - "Jack,
make sure you are aggressive". Sadly
we were not.
Instead of being directed to a higher
level of care, Kate began on a course
of Pegylated alpha Interferon, weekly
- she had been randomized to same at
a Community Hospital in Fairfax - absurd
considering that NIH/NCI-Dr.
Rosenberg is in Bethesda, 30 minutes
away.
Again, I did not intervene except to
express my wish that Kate receive a
consultation at Jefferson University
Medical Center in Philadelphia where
an oncologist had been treating patients
with some dramatic success with a vaccine
prepared against patients melanoma.
Unfortunately Kate's oncologist with
whom she had rapport and "utter" confidence,
flatly asserted this doctor only treated
Stage IV patients - absolutely false!
Kate's WBC count plummeted on Peg Interferon
- such treatment was suspended.
Of happy note - Craig and Kate were
formulating plans for their wedding.
Both thought it would be 'neat' to be
wed in the year 2000. Kate expressed
a wish to married in Dahlgren Chapel,
Georgetown University, where I had graduated
Medical School. Through the efforts
of Kate's aunt Pat, my sister who had
a close friendship with the then President
of Georgetown, Leo O'Donovan, S.J.,
such was arranged.
I relate these events to portray Kate's
philosophy - she would live her life
to its fullest. This was not a manifestation
of denial, but a steadfast pursuit of
life. Neither she nor Craig would cower
before her cancer.
Sadly still no referral.
Equally distressing was when Kate planned
to return to work, serving the Poor
at Planned Parenthood in DC (she had
been elevated to Director of Nursing
at a Clinic that provided GYN care to
the uninsured). She requested to delay
her return from a 3 month Disability
by one week to accompany Craig on a
skiing vacation that had been planned
for more than a year. She was denied.
Wisely, Kate resigned that position,
and was promptly was engaged by a charming
young woman doctor OB-GYN who was starting
a private practice in Georgetown. For
2 months Kate served in that office.
She could make her own schedule and
"loved the work".
Wedding plans were moving apace, but
in March I received a call from Kate
as I was departing for the office. She
felt a lump under her left arm.
Kate discovered every single lesion
she had. Removal of same revealed the
first of myriad subcutaneous nodules
- not nodal - but reflected the hematogenous
spread of this aggressive melanoma.
I picked up the phone, contacting two
loyal medical school friends of mine
which resulted in prompt appointment
with Dr. Rosenberg's Group at NCI.
Kate was still feeling well. Functioning
at her always "super level". At long
last Kate was in good hands. Extensive
CT SCAN et al shockingly showed definite
mass in Right Basal Ganglia region in
Temporal Lobe.
Kate flew on her own to Houston and
rented a car at Houston Airport for
consultation at the renown University
of Texas - MD Anderson Cancer Center,
where the bedside manner of the physicians
she encountered left much to be desired.
After consultation back at NCI with
Rosenberg's team, she learned that the
'immune approach' at NCI could not be
done with active Brain Metastasis-even
solitary-because dexamethasone (steroid)
would suppress the immune response and
Interleukin would cause Brain edema.
Upon review with the NCI NeuroSurgeons,
Kate was directed to a renowned Neurosurgeon
at University of Virginia who was a
pioneer in Gamma Knife, a then quasi-experimental
radiosurgical approach..
At this juncture I implored Kate to
cease her allegiance to her oncologist
in Fairfax who frankly did not have
a clue. At the end of my rope, I advised
him that Kate's immediate treatment
must be directed by doctors who were
pursuing "cure" and life which
was Kate's goal - not palliative care.
The initial gamma knife response was
excellent.
Wedding plans were finalized as Kate
began her NIH experience. In May 1999,
Kate gave me a tour of the Reception
Hall in Washington- a glorious spot
- where a grand wedding reception was
celebrated on January 22, 2000, following
Mass at Dahlgren Chapel. Kate also mentioned,
"I have another nodule", which was to
be just one of many that continued to
"pop up" all over the place.
In August 1999, CT SCAN demonstrated
clear shrinkage of the basal ganglia
mass. We were ecstatic - no signs of
other spread and no new nodules. Alas,
early Dec 1999, routine SCANS (Kate
received vigorous monitoring) suggested
possible recurrent lesion which was
confirmed on PET SCAN- even in face
of at least 2 toxic Interleukin courses.
A vaccine had been planted which was
specific to Kate's Melanoma. Kate was
scheduled to be the2nd patient to receive
infusion of her own cells which had
been harvested with anti melanoma powers.
This approach had to be put on hold.
Kate underwent a complete resection
of brain lesion by the first of NCI's
mastermagician surgeons. Most miraculous
- no post op residual. Kate was worried
she might "limp down the aisle". Not
only no limp, we danced the night away
at the reception 6 weeks later. A glorious
night this Dad will always remember
with profound gratitude.
Kate and Craig deferred their Honeymoon
trip.
Kate entered NIH on January 24th for
the infusion of her harvested cells
and more Interleukin, which she tolerated
for the first time without problems.
In April, however, the gas began to
run out. "Routine" testing - Kate, still
feeling quite well (that's what she
told me), noted marked elevation for
the first time of Alkaline Phospatase
and modest bilirubin rise. Fearing the
worst (hepatic metastases), work up
suggested bile duct obstruction. Enter
Magician NCI Surgeon II, a Liver Surgeon
who removed a large retroperitoneal
lymph node that was obstructing the
common bile duct. Metastases also coated
but did not invade the pancreas - these
were "scrapped of".
The situation was more than grave, but
Kat's will was strong. Her brother Michael
was to be married June 23rd, and her
"baby" sister, Renee on September 30th.
Then came the complications of "shingles".
We breathed a sigh of relief because
before the cutaneous eruption, Kate
experienced intense belly pain suggesting
a bile leak. Fortunately not so but
from that juncture on, life became a
daily struggle.
In obvious distress from the ever enlarging
SubQ nodules, Kate attended Mike's wedding
in Ohio.Typical of Kate, during the
Mass, Kate turned to me "Daddy, do I
have to genuflect?"
As I approach the finish line of this
journey, my heart becomes heavy.
Renee's wedding was scheduled for September
30, 2000, at the Jersey Shore where
Kate was raised. She was to serve as
Matron of Honor. In mid September, Kate
developed left leg weakness and a Seroma
in her left thigh. CT revealed new brain
lesion. Placed on Decadron.
Kate stayed with me the week prior to
Renee's wedding. I saw her pain daily.
Medications only made her "dopey" -
which she could not accept.
Kate refused to go quietly to the grave.
On September 27,2000, Kate's 33rd birthday,
I had the great honor to dine with her
privately at the Jersey Shore restaurant
Il Picolo Forno, a favorite of her brother
Mike, who had entered his first year
in medical school a great distance from
home. We finished with an ice cream
at Wilson's in Long Branch-marred only
by Kate's frustration at her Left Foot
"dragging a bit."
Three days later, September 30th, Kate
elegantly strolled down the aisle of
Holy Cross Church in front of her sister
Renee, attending her in style.
Three days later Kate experienced massive
bilateral lower extremity edema caused
by "sudden" inferior vena cava obstruction.
Kate shortly thereafter experienced
her first convulsion. She was promptly
admitted to NCI and Dr. Rosenberg, where
she was treated with dignity until she
went to the Lord on October 28, 2000,
4 weeks after attending her sister.
Five weeks to the day of Renee's wedding
at Holy Cross, I delivered Kate's eulogy
at that same church, without a note--guided
by Kate as I am now. I noted then and
again now, Vita Mutatur, Non Tollitur--Life
is changed Not Ended.
Kathleen Mary Verdon Spisak sits at
the right hand of her patron Saint,
The Blessed Virgin Mary.
Her devoted, yet still devastated Dad
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