Life Ends Half-Lived for Defiant Ex-Smoker

She did not go without a fight, but in the end that was not enough.

On a cold, bright day in the nation’s capital, Claire Chasles-Kelly lost her three-year battle against lung cancer. She died with Joe, her husband of four months, by her bedside--stroking her hand, telling her he loved her, saying that it was OK to let go.

For Claire, the final process of dying was a metaphor for the way she had confronted the disease and the smoking that killed her. She never--at least not consciously--accepted that she would die. And as a teenager and an adult, she turned aside the warnings and the evidence of danger; she never thought smoking would catch up to her, she often said--the young just don’t think that far ahead.

In the face of the cancer’s recurrence a year ago, she was defiant and combative. And she continued to fight for nearly 24 hours after her family decided, after much agonizing, to wean her from the ventilator that had taken over her breathing.

She was heavily sedated by then, comfortable, not in pain. Her heart pumped on, her blood pressure was strong. Every few seconds, she would take an isolated, heaving breath on her own. But her lungs, destroyed by the effects of 25 years of smoking, could not sustain her.

On Nov. 15, a few minutes before noon, she stopped breathing. At that moment, she became one of the nearly 500,000 Americans who are killed every year by tobacco.

She was not one of lung cancer’s well-known victims. She was not a public figure, like former First Lady Pat Nixon, a secret smoker. She was not a movie star like Yul Brynner, who before his death denounced his smoking addiction and begged Americans to quit.

Claire was more like the rest of us. At the age of 43, she was a wife, a mother and a grandmother. She liked to sew and made her own clothes. She was bilingual, speaking English and the native language of her French-Canadian parents. She had a job she enjoyed, as an accounting clerk at the University of Maryland. She had a close-knit extended family and a pair of Maltese dogs.

After two disappointing marriages, she had found Joe, a friend rediscovered after nearly 20 years. They were wed in July, while Claire was undergoing chemotherapy. And last month her daughter, Christine, 22, gave birth to Claire’s first grandchild, Paige Elizabeth. Claire’s spirit kept her going long enough to hold the baby.

She died not of any lack of determination in confronting her disease but of a seemingly inconsequential decision made decades earlier--at a time when the possibilities of life and her own strength seemed boundless. It was a fatal illusion.

Because, much as her family loved her and will cherish her memory, the overwhelming reality of Claire Chasles-Kelly’s life is what did not happen in it and never will. That’s how it is when you die before you have lived not much more than half a normal life. What you missed bulks very large in the balance.

For one thing, although Joe Kelly turned out to be the great love of Claire’s life, they never got to live out a life together. They never even got a honeymoon; Claire was far too sick for that.

In the years ahead, they will not have quarrels and make up. Or help Joe’s 13-year-old daughter, Jessica, do her homework or supervise her first date. There will be no asking the neighbors over for a barbecue or celebrating anniversaries and birthdays. Claire and Joe will not pay off the mortgage, retire and travel. Claire lived to see her daughter’s baby, but Paige will never know her grandmother.

Claire did not even get her deepest, final wish--that those closest to her would learn from her terrible ordeal: As she lay dying, her family maintained a vigil by her bedside. Every once in a while, Joe, Christine, even Claire’s 68-year-old mother would feel the need to take a break. They were never gone very long.

Just long enough to smoke a cigarette.

Couldn’t Get Any Air

The cardiac intensive-care unit at Georgetown University Medical Center can be a noisy place. Doctors, nurses and other staffers move about, chatting and laughing. Sophisticated machines beep in steady cadence.

Claire is in Room 4201 following surgery to drain fluid that had built up around her heart.

Only two weeks earlier, she had cradled her granddaughter for the first time and finally seemed to be regaining some strength after the chemotherapy. Then, with bewildering suddenness, her breathing started to deteriorate. She couldn’t seem to get any air.

Back when the cancer had first been detected in her right lung, she had undergone surgery and radiation. For 18 months after that, there was no sign of the disease. But it returned a year ago. Six rounds of chemotherapy took a terrible toll: Once a pretty and robust brunet, Claire became so thin and exhausted, so ravaged by pain, that she could barely move around the house. Her hair fell out. It had only just recently begun to return, in a gray fuzz.

Even as she entered the hospital for the last time, she was asking the doctors about other possible treatments. Lung cancer at such a late stage cannot be cured. Claire and her family had been told as much, months before, but she refused to accept defeat.

Now she lies tethered to the respirator. The oxygen tube prevents her from speaking. Her hands are tied to the sides of the bed to keep her from pulling out the tube, as many patients try to do. She is connected to a heart monitor. And a pulse oximeter measures the level of oxygen in her blood; its sensor is wrapped around the tip of her finger.

Her right lung is gone, and her left lung is failing. But she is conscious. A nurse asks if she is in pain. She shakes her head no. Is she comfortable? She nods yes.

Christine has brought the baby to the hospital because she and other family members are convinced that Claire hung on as long as she did to be here for the birth.

Doctors have warned that the baby could carry germs to her grandmother, so Christine holds Paige up to the glass outside her mother’s room.

“There’s Grandma,” Christine says, swallowing back tears. “Tell Grandma she’s got to get better.”

Claire turns her head toward the window and opens her eyes wide at the vision of the baby.

The nurse in the room says to Claire, “She’s gorgeous,” and Claire nods.

Claire’s mother, also named Claire, has flown in from Canada, where she has left Claire’s father hospitalized with heart problems.

A lifelong smoker who survived breast cancer, Claire Bernard struggles with the fact that her daughter is dying. It is almost unbearable, this prospect of outliving your child, and she cannot stop weeping. She holds Claire’s hand, speaking almost inaudibly in French.

Carole O’Malley, Claire’s younger sister, is also there. More than the others, she is angry.

She is not angry at the doctors, or at Claire. She is angry over the waste of a life, ruined by an addiction to nicotine. She stopped smoking in 1988, had a brief relapse, then quit again in 1993 after her sister’s cancer was diagnosed. She is the only member of Claire’s family who does not smoke.

“When they told me the cancer had spread, I started to shake. I felt: I gotta have a cigarette,” Carole says. “Do you believe it? I quit smoking eight years ago, but the urge never goes away. The tobacco company executives should come up here and see what this looks like.

“She’s too young to die. Those damn cancer sticks got her. It’s not fair. It’s just not fair.”

She chokes back tears. “It’s so rough. She’s my only sister.” She turns to Christine, who holds the baby in her arms.

“You’ve got to stop smoking,” Carole says. “You don’t want her [the baby] to be standing outside an ICU 20 years from now the way you are today. Do it for her.”

Refused to Give Up

Claire’s pervasive denial about the inevitable outcome of her illness almost certainly enhanced the quality of her final months. It enabled her, at least on an emotional level, to cope with the roller-coaster effects of the disease and to cling to future plans.

She got married, talked about a honeymoon in a Delaware beach cottage and dreamed of a trip to Switzerland. She could hardly wait for the birth of Christine’s baby.

So great was her refusal to consider defeat, Carole says, that “I couldn’t even talk to her about doing a will. I’d say: ‘Claire, have you done a will?’ and she’d say: ‘I am not dying. I’m not doing one.’

In the final hours, her unwillingness to face even the possibility of dying has created a painful problem for the people around her. They sense what still remains unsaid, and they find it excruciating to consider the decision forced on them about the respirator. They have been unable to ask Claire what she wants, how she feels.

“Now we have to play God--how can we do that?” Carole asked. “We have to make this decision for her. What if it’s not what she wants? What if we take her off the respirator and she starts crying and says: ‘I don’t want to die.’ What do we do then?”

They are sitting in a conference room near the ICU with Claire’s oncologist, Dr. Naiyer Rizvi. “She is dependent on the ventilator,” Rizvi says. “I don’t think she can make it on her own.”

Carole raises the possibility of decreasing Claire’s sedation so they can ask her what she wants them to do. Rizvi gently tries to dissuade her from this idea.

“I don’t think we’d be doing her any favor by waking her up and asking her,” he says. “In fact, I think that would be almost cruel. I think the best thing to do is to wean her off the ventilator, keep her comfortable--and if she goes, she goes.”

“Don’t wake her up,” Claire’s mother says. “Don’t make it any worse.”

Joe, who ultimately must make the decision, agrees. “I don’t want her to suffer. If she can only live on a ventilator--that’s not a life.”

“It’s not going to happen quickly,” Rizvi assures them. There will be time to say goodbye.

The family gathers. Father James Denn, a Catholic priest affiliated with the hospital, anoints Claire with oil and prays over her.

No longer worried about the possibility of infection, the nurse allows Christine to bring the baby into Claire’s room. She holds her near her mother’s arm. Claire turns to the baby. She takes her hand, momentarily released, and places it on Paige’s tummy.

“Say hi to Grandma,” Christine says, adding: “I love you, Mom. I love you.”

Kerri Ann Chasles, Claire’s stepdaughter, arrives. Her eyes are red. She is the daughter of Claire’s second husband, but Claire raised her from childhood.

“Hi Mom,” she says.

Others arrive: Christine’s fiance and the baby’s father, Brady Greene. Joe’s mother and one of his sisters. They form a half-circle around Claire’s bed, crying quietly and reciting the Lord’s Prayer.

“Rest in peace, Claire,” Carole says. “Rest in peace.”

At 1:13 p.m. the nurse starts to put Claire into a deeper sleep using Fentanyl, a drug 10 times stronger than morphine. She begins to shut down the machine. Claire will be in a coma-like state, without pain, anxiety or awareness.

As Claire begins to experience the effect of the drugs, Carole removes a tiny photo of Paige that had been tacked to the bulletin board near the bed. She places it in Claire’s right hand.

Joe has not left Claire’s side. But when it becomes apparent that the process may go slowly, Carole offers to relieve him.

“I’ll be back in a few minutes,” he tells her. “I’m gonna catch a smoke.”

Somehow, Claire continues her labored breathing late into the night. Joe sends the family home.

The next morning, he gives permission for the final step, removing the tube from Claire’s throat that had been delivering enough oxygen to keep her comfortable and to keep her airway open. Less than 15 minutes after the tube is removed, Claire’s chest stops moving. She grows still.

Dr. Kara Beckner, an intern serving a rotation in the ICU, enters, feels for a pulse and listens for a heartbeat. There are none.

“She’s gone,” Joe says.

“Yes, she is,” Beckner replies.

A Smoking Culture

Claire’s final resting place is to be St. Ephrem, the French-Canadian town in the province of Quebec where she was born. She will be buried in the family plot, the photo of Paige still in her hand.

First, however, funeral services are held at St. Mark’s Catholic Church in suburban Washington. Friends and family arrive early. They stand in the cold sunshine outside the church, sharing memories and trying to comfort one another.

Christine lights a cigarette, then is struck by what she has done.

She can’t quit, she says, unless Brady quits. Theirs is a smoking culture, the practice passed down from generation to generation.

They hope they can break the long cycle with Paige.

“I know that stopping this would be the greatest gift to Mom’s memory,” Christine says. “Maybe with Mom’s help, I can do it. I know she’s up there watching me.”