Finally, Life Is Free of Pain for Cancer Victim : Medicine: Estes Park, Colo., townspeople bought Jan Modeland a last chance: a bone-marrow transplant. After surgery and crippling chemotherapy, she is gaining strength.

They were there waiting for her the day Jan Modeland came home from the hospital, as shaky on their tender legs as she was on hers.

The doe and her two newborn fawns had picked a nice family neighborhood in which to spend the summer. It was quiet, with hardly any traffic, big trees and plenty of bushes for cover.

As she lay on the lawn chair, too weak to walk more than a few steps, Jan Modeland watched the fawns and shared their sense of discovery. She was also seeing, feeling, touching life with renewed wonder after believing, in the deepest part of her heart, that she might not have a tomorrow.

Watching the young deer learn to run, feeling the high alpine sunlight on her pale cheeks, smelling the flowers on her own front porch--all of those everyday sensations were thrills to a woman who had spent five years slowly, inexorably, dying of breast cancer.

Now, after frequent medical setbacks--including hospitalization for severe gastritis that caused her to lose a pound a day for nearly three weeks--Jan Modeland believes she will live.

“I’m starting over,” she said. “I have a unique appreciation for life now. I go from window to window and look out and know that I am still part of all of this.”

The disease, which can lurk for as long as 10 years before it is discovered, was found in Jan’s right breast in 1987. She had a modified radical mastectomy, years of chemotherapy and drastic doses of radiation, but by this year, the 38-year-old woman still was critically ill with tumors in her skull, neck, sternum and pelvis.

Her last, best hope was a bone marrow transplant. In April, she was admitted to the transplant unit at Denver’s University Hospital, one of about 30 such centers in the United States.

Jan’s very arrival at the transplant unit was a victory for hundreds of strangers and friends who had raised, nickel by dime by dollar, the $110,000 deposit required to enter the University of Colorado’s Health Sciences Center.

Dozens of hometown fund-raisers, thousands of dollars stuffed one at a time into fruit jars displayed at local businesses and hundreds of donations from strangers who had heard of her, had gotten her into that sterile inner sanctum where transplant patients get their chance.

Next, she had to survive the procedure.

“If it isn’t a cure, it’s the closest thing we have to it right now,” said Dr. Scot Sedlacek, Jan’s primary physician. “Five to 12% of the bone-marrow transplant patients don’t even make it through the procedure. They die of complications. The sicker you go in, the tougher it is going through it, and Jan was very, very sick.”

About 30% of patients survive and are free of cancer three to five years after a bone-marrow transplant, Sedlacek said. Of the first women to undergo the surgery when it started nine years ago, 14% are still living and free of the disease.

Already weak and bald from earlier chemotherapy treatments, taking large doses of painkillers and rapidly losing weight, Jan embarked on a solitary journey she now remembers as a hazy, incomplete picture puzzle.

Isolated in a sterilized cocoon with protective doctors and nurses and visited only by close friends and relatives, she was the focal point of an intensive lifesaving effort.

“The room was about 20 by 20, with a window to the outside and a little window in the door, a chair, and a bed. That was it,” she recalled. “Everyone wore gowns and masks and paper booties on their feet, and I never saw their faces below the eyes. No one could touch me unless they wore gloves.

“It all happened fast. This is what we’d been working towards, so many people had helped get me to that room. It was time to put me to sleep one last time. I’d had seven major surgeries in three years, but this was it, the big one--and I remember thinking, ‘OK, let’s go, let’s do it.’ But I wondered if I would wake up. Every time they put you under you wonder.

“But then I did wake up. The chemotherapy started, and I was out of it.”

Surgeons had extracted two pints of her bone marrow from one hip. Half of the marrow was cleansed of cancer and re-injected into her body; the rest was frozen and held in reserve.

For the next four days, specialists blasted Jan’s immune system with massive doses of three toxic chemicals used together under the term chemotherapy. The side effects can include mouth sores, lung infections and hearing loss. She got them all.

Her closest friends recall that she could not focus her eyes, never initiated conversation and responded in toneless, short sentences. Mostly, she lay motionless in bed, staring at the wall or the ceiling, the passive star of a real-life passion play.

Would she survive? At first, it appeared so. Would she die? Don’t know, things were getting worse.

“She got very sick again very quickly,” Sedlacek said. “Her lungs didn’t work at getting oxygen into her blood.”

Three weeks after the transplant procedure, her vital signs--blood pressure, pulse, respiration rate--crashed.

“I was very weak, emotionally and physically, but I had to let myself go in order to survive, just let myself flow along with whatever was happening,” Jan said. “The only thing I did was pray.”

Desperate for an answer as to why their patient was sinking fast, her doctors wheeled her into surgery for her eighth operation. They decided to open her chest and look, but when her lungs were exposed, they could see no answer. Everything looked normal. So they closed her up and everybody prayed.

“It was like a miracle,” she remembered. “Suddenly, everything turned around for me. They don’t know what happened, but I started to get better.”

Still too weak to read, her eyesight too blurred from the drugs to see a television screen and her hearing so impaired that conversation was difficult, Jan concentrated on a big poster of a Hawaiian beach scene that friends had put up at the foot of her bed. She also stared for hours at a bulletin board decorated with photos of the people she loved the most.

“My priorities changed. I realized how important each day is. And I began to believe that I really was going to make it.”

The first time she walked after the transplant, she was exhausted after taking 20 steps with nurses on each side of her. The next day she took 29 steps; the next, 35.

“Everything became a milestone, a big accomplishment. And I’m still doing that, pushing myself a little bit harder, doing a little bit more than I did yesterday.”

After more than a six weeks in the hospital, doctors let Jan move to a nearby apartment with her mother, but she still had to report to the hospital every day for tests. Finally, on June 15, she was driven the 75 miles from Denver to her home in Estes Park.

About 50 friends greeted her with balloons and banners, gentle hugs and tears as she stood, nearly speechless with emotion, in the center of it all. Haltingly, her voice cracking, she said, over and over: “Thank you.”

A community effort that had begun last January with a flyer announcing, “This week marks the start of our campaign to save a life,” had succeeded as much as any human effort could. The donations and the doctors had made a difference. A woman who was dying had won a reprieve.

Meanwhile, Jan Modeland still struggles, like the neighborhood fawns, to learn how to live. Cancer patients, more than the rest of us, understand that there are no guarantees in life. A bad cold caught on Monday can lead to intensive care by Friday. In Jan’s case, a serious mouth infection triggered by the medication led to the gastritis. Once launched, the biological chain reaction just got worse.

The gastritis caused diarrhea and nausea. There were more mouth sores, which meant she couldn’t eat and her weight plummeted, which weakened her even more. She was admitted again in mid-September to Rose Medical Center in Denver and put on intravenous feeding.

“No one completely sails through a bone-marrow transplant without things going wrong,” said Sedlacek, the physician, “but she’s had more complications than anyone I’ve seen.”

Complications. They have defined Jan Modeland’s life since she became a breast cancer statistic. She takes nothing for granted, not the beauty of the world nor her tenuous hold on it. She knows another hospital stay could be just a bout of gastritis away.

“I am a morning person, and each day I get up and look out at the sunrise, but I can’t hear the birds singing. It hurts me; I miss their songs. But I am learning that it’s enough to know that they’re out there--to know that I’m still here.

“I can go to a movie, I can read again, I’m crocheting and trying new recipes. My chest doesn’t hurt; my hip doesn’t hurt; there is no pain anymore. I can look at my body and not feel like it’s my enemy. Even the peach fuzz on top of my head is turning into real hair.

“For the first time in nearly five years, I am just trying to have fun.”

Although a long-hoped-for camping trip to the Grand Canyon with her roommate had to be postponed because of her recent hospitalization, Jan is looking forward to short car trips and to Christmas, a season she dreaded last year because she thought it might be her last.

Jan hopes to go back to work as a self-employed surveyor in early 1992 to climb out of the huge financial pit, and she tries to be philosophical about medical bills of almost $100,000: “It will all sort itself out. I can fix all this little stuff!”

Except for the gastritis, Sedlacek is pleased with her progress. He has high hopes for many patients who otherwise might have no options left because of the seriousness of their disease--including that 14% who appear to have been “cured” nearly a decade after undergoing the marrow procedure.

“We have to remember that if they had all gone through conventional therapy, all of them would still have cancer and most of them would be dead,” he said.

And, said Sedlacek, there’s a new statistic to apply to Jan Modeland. Because she is recovering from near death, she now has a 5% to 10% chance of developing cancer in her left breast--the other breast--within 10 years.

“But,” said her physician and her friend, “we have the luxury of lots of time to worry about that.”