Ex-Smoker Battling Cancer Encounters Rocky Ground

It is 1:30 a.m. and Claire Chasles sits up, abruptly awakened from a deep sleep, gasping for air. Even though she is tethered to a plastic tube that delivers oxygen through her nostrils, she can’t breathe.

She panics as a wave of heat, almost like a classic hot flash, sweeps across her face, neck and chest. She is sweating and struggling for air.

“It is the scariest thing you can imagine,” she says later, describing the episodes that have been occurring two or three times a night.

“I feel like I’m on fire. And I can’t breathe. It takes me about 15 or 20 minutes to catch my breath.”

When Claire started smoking as a teenager 25 years ago, lighting up made her feel sophisticated. Now, at 42, it has given her lung cancer.

In the prime of her life, she is a woman fighting to survive.

She wants desperately to get better, and insists that she will. But lately she has had a rocky time of it.

After a month in Georgetown University Medical Center, battling a persistent infection, she is home--sleeping on a hospital bed in the middle of her living room because she is too weak to climb the stairs to her bedroom.

“I don’t go upstairs anymore,” she said. “If I need anything, someone brings it down to me.”

Her fiance, Joe Kelly, sleeps nearby on the sofa.

Recently, during another such middle-of-the-night incident when Claire wasn’t able to recover quickly, Joe called 911 and paramedics took her back to the hospital. Doctors feared she had developed fluid in the sac surrounding her heart, a potentially fatal condition if left untreated.

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Claire says the doctors believe that her impaired breathing is caused by the tumor growing at the base of her windpipe. “There’s mucous and stuff down there, and when I try to clear it out, my air is just blocked,” she said, adding in frustration: “I want to breathe normally again, like everybody else.”

Since her cancer returned last fall, 18 months after it was first diagnosed, Claire has lost more than 30 pounds and must take medication to maintain her appetite.

She also takes painkillers to ease the discomfort from surgery associated with the infection, a procedure that cost her three ribs. The incision remains open, to allow the infection to clear, and a visiting nurse comes to the house every day to clean the wound and change the bandages.

This routine hurts, so the nurse telephones about 30 minutes before she is due to arrive. Claire then takes a painkiller, so that its numbing effects will be working by the time the nurse gets there.

Because she cannot get the dressing wet, Claire takes sponge baths. She longs for a long, hot shower. But now, in her tired state, even that would hardly be like the old days--she would have to take it sitting in a chair.

Her feet are swollen, probably because she hasn’t been moving around much, and she doesn’t have the strength to get dressed, drive her car or clean her house. A family member is with her constantly. “Even going to the bathroom is a chore,” she said.

“I hate being stuck, not being able to get up and move around like a normal person,” she said. “But they say it’s supposed to get better, that I won’t always be like this.”

Much of the fatigue likely is a side effect of chemotherapy, which began recently. Claire was scheduled to undergo the chemotherapy on an outpatient basis--the drugs are given intravenously in one daylong session every three weeks--but she experienced an allergic reaction to taxol, one of the two drugs in the regimen. Now they must be administered in the hospital, more slowly--over two days.

Recently, she got her hair cut very short, knowing that the chemotherapy will cause it all to fall out. It is one way for her to maintain some sense of control. She also ordered a wig from a place that designs them especially for cancer patients; it is dark brown, short and feathered--and looks exactly like her new hairdo.

She remains hopeful and feisty, refusing to consider the possibility that she could lose the battle.

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“If there is any fear, I just deal with it when it surfaces,” she said. “But I try not to let it surface.”

She is motivated by coming life-cycle events, which can be powerful therapy for the seriously ill: the birth of her first grandchild, due in the fall, and her own wedding, probably in early summer.

Claire’s 21-year-old daughter, Christine Schulze--who also is addicted to cigarettes--recently felt the baby move.

“It was three weeks ago, I was at the bowling alley,” Christine recalled, clearly taken with the memory. “I didn’t know what it was--I remember thinking, what is this? Now I get days where I feel it once or twice, and days--like today--when it’s going crazy. I’ve always got my hand down there feeling it. And now I’ve got this little potbelly. I think it’s neat.”

She and Brady, her fiance, already have names picked out--Susan Marie and Tristian Joseph. Christine yearns for a girl--but, overall, cares only that the baby is healthy.

Claire can’t wait. “I want to be a grandma,” she said.

And she also wants to be a bride.

After hesitating for months, she has decided to get married.

“He’s sticking around,” she said of Joe, explaining why she finally agreed to marry him.

When Claire’s cancer came back, she says she told him: “You can leave if you want.”

Hearing that made him angry, she says.

“ ‘I stuck around the last time, why would I leave you now?’ ” she recalled Joe saying.

“He’s still here, and I don’t know what I’d do without him,” she said. “I just love him to death. He is such a caring and loyal man. He keeps saying he wants to get married and take care of me. I didn’t want him to have to deal with this. But he says he wants to take care of me. He’s always there for me. Always.”

Joe, who has a 12-year-old daughter, Jessica, from a previous relationship, has never been married. They are planning a small ceremony at their home in June or July for family members and a few close friends.

Claire, who has been married twice, wants it to be special for him because he has never had a wedding.

“This is his first marriage,” she said. “I want him to have the cake. I want him to have the pictures with family and friends. I want something nice and simple, something for him to remember. We’re going to do it right out back, outside. We’ll hang some flowers, nothing too fancy.”

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Claire no longer smokes. But despite her ordeal, almost everyone else in the family does: Joe, Christine, Brady and Kerri Ann Chasles, 20, the daughter of Claire’s second husband. Only Jessica does not.

Everyone must smoke outside now because the oxygen that Claire uses to aid her breathing is highly flammable.

Christine is trying to limit her smoking to no more than four cigarettes a day. But it is a constant tug of war between her good sense and her addiction.

She worries about the impact of her smoking on her unborn child. Smoking during pregnancy has been linked to low birth weight, infant mortality, lower intelligence in children and mental retardation.

But she is hooked. And the roller-coaster stress of her mother’s illness has made it all the more difficult to stop, or even cut down.

“The last six weeks have been hell,” Christine said. “It’s been so hard, dealing with everything Mom’s had to go through. I don’t like to see her that way.

“It’s an up-and-down process,” Christine said. “You never know what’s going to happen next with her. Her main complaint today is that she feels weak. I tell her she’s going to have days like that--you’re not going to have every day that you feel great.”

Claire makes the point often--to Joe, to Christine, to anyone in the family who will listen--to pay attention to the harsh reality of what is happening to her. Stop smoking now, before it happens to you, she says.

“I don’t want you to go through what I’m going through,” she said, over and over.

Christine agrees, intellectually. But physically, her body will not let go of its need for nicotine.

“It’s a chemical dependency,” she said. “It has to be. It’s the habit of holding one in my hand. You do that so many times in the day that you don’t even think about it. Believe me, there’s no other reason why I can’t stop. I’m trying.”

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Claire is blessed with a large, extended family--many of whom either live with her, or live nearby, and take turns staying with her.

On this warm spring afternoon, Kerri Ann is keeping her company. Kerri Ann has no relationship with her biological mother; she was a toddler when Claire married her father, and Claire raised her. She calls Claire “Mom,” and considers Christine her sister.

Kerri Ann, who works nights in a casino, is a volunteer firefighter. She has seen her share of medical emergencies, but she says Claire’s illness has shaken her in a way unlike anything she has ever confronted.

“God, yes, it scares me,” she said. “This is different. This is family. This is my mom. She may not have been my birth mom, but she’s my real mom.”

Kerri Ann has asthma. She smokes two packs a day.

“I’m a chimney stack,” she said. “I was 18 when I started. I took that first puff, and kept on going.”

Wrapped in a blanket on the sofa while Claire, in a robe, watches TV nearby, Kerri Ann shakes her head.

“Do you know the first thing we firefighters do when we come out of a burning building?” she asked. “We take off our breathing equipment and light a cigarette.”

Kerri Ann goes outside to take the dogs for a walk--and to smoke--while Claire remains inside with a visitor. She hopes to sit outside in the sunshine a little later.

Claire does not dwell on what-ifs. She is still feeling combative toward her cancer. But she’s thinking about a living will--and organ donation.

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“With my cancer, I don’t know if I could donate organs, although I’d like to help somebody else out,” she said. “I don’t know what’s going to happen. I don’t want to have my life prolonged with heroics. Family members are going to suffer a lot anyway.”

In the rare moments when she allows herself to think about death, she remembers her aunt, who recently died in a hospice at age 94.

Claire was hospitalized and couldn’t go to Philadelphia for the funeral. But Christine went, and came back with photographs of her aunt in her casket. Claire says she found the images comforting, particularly in the way they conveyed positive messages about hospice care.

“They let her go with dignity,” Claire said. “There was no shame in the way she died. They kept her as comfortable as possible. She looked very much at peace.”