1932 / Class of '01 / Dx at Stage III-B / Died 1-6-02
(Submitted by her daughter, Denise Mauriello, Dmauriello@adelphia.net)
My mother, Darla Collette, passed away on January 6, 2002 from the complications of MM after only a six-week battle. She was born Darla Chesshir on March 22,1932 in Ashland, Ohio. As a child, her family moved to California in search of work after losing a lumber business in the great depression. They settled in San Bernardino, California in 1940 and Darla flourished there, married my dad in 1952, and began having kids in 1954. She and my dad moved us to Upland, California in 1960, a nice suburban city east of Los Angeles.
She stayed home with us children until around 1977, when she returned to school for college courses and re-entered the workforce as a systems analyst. With the exception of being a heavy smoker and having an asymptomatic mitral valve prolapse, she was a very healthy woman up until November of 2000, when she returned from a vacation in Japan with a flu, which turned, into pneumonia. She was treated with IV fluids and IV antibiotics at home, per her request. She was afraid of the hospital.
She was very ill; I remember that her speech was slurred during this time, she had high fevers, was very weak, and it took her two months to shake it off and return to work. Even after returning to work, her endurance was quite compromised. She kept saying that it was tough to get old and that at 68-69 years old, getting up for work at 4 oíclock a.m. wasnít as easy as it used to be. She refused to retire; she loved her work and the people she worked with. In June and July, my family stayed at her home for several weeks and I could see how much she had slowed down. She struggled to eat, stating she had no appetite. She would fall asleep at the dinner table, in a chair, in the car. She bruised and tore her skin very easily but always explained away her problems, attributing them to her age.
In August, she had a bone density test that uncovered severe osteoporosis for which she was given Fosamax. The medication caused nausea and vomiting, and she was very thirsty, craving water and coffee.
The week before Thanksgiving, 2001, mom had a flu shot and developed cold symptoms soon afterwards. Those symptoms rapidly progressed to dizziness, slurred speech, loss of equilibrium, and her chest was now involved by the weekend of November 17-18. On Monday, November 19, she left work around noon and came home saying she was too sick to work and that she thought sheíd take off the following week, also. (This was a red flagómy mom never planned ahead to miss work.)
She visited her doctor, labs were drawn and a chest x-ray done. She was so ill that when my dad came to pick her up to take her back home she thought that her blood had not yet been drawn. I later found out that besides right middle lobe ďpneumoniaĒ, her HgB was 8.8 and WBCS were 28,000. She didnít want to be admitted to the hospital. She went home to be on oral antibiotics and respiratory therapy with O2 and nebulizer treatments. She didnít improve, so the eve before Thanksgiving, her internist made a house call and declared that she seemed no worse.
The day after Thanksgiving, I received a disturbing phone call from my dad saying that Darla was a lot weaker and could hardly move off the couch. I insisted that he call the doctor, which he did, and we finally insisted that she admit herself to Pomona Valley Hospital Medical Center.
Hydration and diagnosis of underlying cause of illness were first on the list after admission. Her physician said he had been waiting for the opportunity to find cancer in mom because of her heavy smoking. Immediately, she needed two units of packed cells, as HgB was now 7.7. Her WBCS were 28,000, platelets okay and her chem. panel indicated some kidney failure with elevated BUN, creatinine, and her serum calcium was 12.8.
A Gastroenterologist did a colonoscopy and EGD and a pulmonary specialist did a bronchoscopy with washings after a CT of chest didnít show a specific tumor. Darla still had that area of her right middle lobe that appeared to be pneumonia. A hematologist/oncologist, Dr. Latif, was called in also to consult. The bottom line was that she went through three weeks of grueling testing, including a bone marrow biopsy, surgery to place a groshon catheter, several units of blood and a few units of platelets. Her strength and mental sharpness deteriorated from about the third day after admission. She complained of rib and pelvic pain frequently, taking only an occasional Vicodin. She was unable to get up to the commode even after five days with her increasing shortness of breath so I begged for a Foley to be placed and that made a huge difference in attempting to help her conserve her strength.
Her HgB kept dropping into the high 7 range and platelets dropped to as low as 14,000. Full body x-rays showed no lytic lesions. She was unable to eat and began on TPN just prior to the day when Dr. Latif announced the definitive diagnosis of MM, stage III-B.
Chemotherapy of VAD was started over a four-day infusion (this was to be my momís only round of IV chemo). However, she was showing worsening signs of renal failure. As soon as I asked how long do we wait before a Nephrologist consults, magically one appeared. He was a wonderful man, Dr. Kahn. CT of the kidneys showed ďcystsĒ and although he kept trying to cause diuresis in my mom with hydration, lasix, and a change in IV fluids, her BUN ended up at 171 and creatinine was 3.1. A Quinton catheter was finally placed and hemodialysis started. After two rounds of dialysis, momís mental status cleared and her confusion was gone. She was still having a very hard time talking, due to shortness of breath. The O2 remained n all the time and nebulizer treatment continued. Her lung function was not what it had been prior to hospitalization.
Her kidneys continued to be unstable and she still needed blood and platelet transfusions the week before Christmas. She was still able to make urine but the BUN and creatinine continued to creep up. Talk started at this point about a gastrostomy tube because Darla could not take in an adequate diet. On December 21, however, her right arm swelled up, fingertips to shoulder. It was elevated on a pillow and shrugged off as fluid leaking from an IV line, although the only line for fluids at that point was the groshon catheter. Over the next two to three days the other arm swelled as well. Her IV fluid rate continued at a total of about 180ccís/hour. By December 24, she was very short of breath and uncomfortable. Two more units of blood were given. Her arms remained edematous and WBCS were 9.2, HGB 8.2, platelets were holding a 74, but her differential was off.
On Christmas morning came the dreaded phone call: Darlaís respiratory rate was 44/min, O2 saturation 77, arms grotesquely edematous, and not really able to respond to verbal stimuli. She was rushed to ICU and under the care of a pulmonologist, Dr. Sandhu, placed on a ventilator, dialyzed, and chest film showed pulmonary edema. Three and a half liters of fluid were removed through dialysis; the first time fluid was ever removed during the procedure. Her axillary temperature was 103.2F, she had a heart rate in the 130ís, and now they said she lacked albumin to hold fluids inside the veins. She had more blood and albumin was also given. They decided she was septic; all lines were removed and replaced over the next couple days. Her blood culture came back candida, a very common fungus that we all have on and in her body. She was put on Cardiezm, a heart med to control rate. Daily chest films showed improvement in the fluid in the lungs. The gastrostomy tube was placed because she still lacked protein in her blood and besides through albumin, they could give her a nutritional liquid with protein. The fear was that because her lungs were compromised (she still had that area showing up in her right middle lobe) largely from years of smoking, she should not be left on the ventilator a minute longer than necessary for fear that she would not come off it.
After three days on the ventilator, Darla was weaned to just a mask for oxygen. She looked great, still having respiratory difficulty but giving us the thumbs up sign. I fully expected to see her moved out of the ICU when I returned the next morning. Imagine the shock I felt when I rounded the corner in ICU to see her gasping for breath, lungs full of fluid again, wearing a Bi-pap mask and machine. Her nurse felt that if they could get her through dialysis and take off several liters of fluid, that this respiratory device could help keep her off the ventilator. In no uncertain terms, this nurse informed me that if mom went back on the vent, we would never get her off.
For another three long days, we sat vigil, watching momís respiratory rate and O2 saturation. Dr. Sandhu felt that if we didnít want her back o the ventilator, we had to give her time to regain her strength. I cried and told my mom that when the mask came off on January 1, she would have to work hard of take deep breaths if she wanted to stay off the ventilator. She was able to indicate that she didnít want to go back on the vent. When the time came to take off the Bi-pap, she did okay and they weaned her off slowly then put a special mask on her that gave a stronger flow of oxygen.
January 2 came and I was geared up for thinking she was really going to make it. I mean, they didnít think she could go without the ventilator and she proved them wrong. However, I got another one of those phone calls that told the unimaginable: Darla had a 30% pneumothorax and Dr. Sandhu wanted to put chest tubes in and place her back on the vent. The hardest thing I have ever done was to go talk softly in my motherís ear, crying, and explain to her that her doctors had never told us how bad the MM was, how compromised her body was. I told her that her lungs were shot, that her kidneys had by now completely failed, and that if she went back on the ventilator, she would never come off. Her WBCS were back up 30,000. They felt she was septic again. I told her that it was okay to quit fighting, that we loved her and would miss her but that we would see her again in heaven. She then indicated that she wanted no more done.
She was moved out of ICU that night and placed on a morphine drip for her rib pain and to help keep her respiratory rate under control. The oxygen, tube feeding, antibiotics, and comfort measures continued, but dialysis was stopped. By Friday, January 4, she seemed to be breathing so comfortably that when she began getting very restless, sitting herself up in bed with a strength I hadnít seen in weeks, the nurse gave her Ativan and she went to sleep, never to wake or rouse again. We sat vigil, until January 6, 2002 at 12:32 a.m. when she was finally at rest, and went home to be with the Jesus.
My heart breaks because we couldnít make her better when she wanted to fight the disease. She was just to malnourished going into this and her smoking caught up with her. MM is a terrible disease and if my mom had to suffer so greatly from it, I guess I must thank the Lord that her suffering was for a relatively short time. My regret was that I didnít get her transferred to a cancer center that had physicians who specialized in MM. I never had the chance; we were going to discuss that when she got out of the hospital.
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