Cancer patient faces death with dignity

It is a 90-degree day in Las Vegas, hotter than that in the cramped apartment, and Ginger Fisher shivers at the memory as she holds her 6-month-old granddaughter in her lap.

"When the surgeon said he found stage 4 ovarian cancer in me that was incurable, I stopped breathing, and I felt so, so cold," the 41-year-old grandmother said, her shoulders shaking.

Grandma's involuntary shudder, more fleeting than the alarm it caused to register in the pretty baby girl's face, is followed by a ticklish hug that makes little Gwendolynn Castro's face transform from near tears to a giggling smile.

"I don't want my granddaughter to remember me as being sick and unhappy all the time," Fisher said, kissing the child.

As it stands right now, Fisher wouldn't mind being dead. The interventions to keep her alive have caused problems that she wishes neither she nor her family had to deal with as she lives out her last days.

She now is doing nothing to stop her cancer from spreading.

That is a position, she said, that should be respected.

"How you live out your life when you're terminally ill is a highly personal decision," she said. "There is no right way."

Fisher phoned the Review-Journal after it recently published a special issue on breast cancer. She wondered whether the paper would do a story on ovarian cancer, which accounts for more deaths than any other cancer of the female reproductive system. And she also wondered whether the paper would do a story on someone who decided that the medical treatment of cancer only reduces the quality of life at the end.

"I was impressed by the women who are fighting so hard for life in your story on breast cancer," Fisher said. "They're doing everything to stay alive, and that is honorable. But I think it is just as honorable that some people, when they weigh the percentages, decide to let nature take its course, who believe the treatment and all that it does is worse than the disease. Those women are out there, too, but you don't hear from them because it's not viewed by society as respectable."

Dr. Karen Milligan, a Nevada Cancer Institute oncologist who treated Fisher until last month, agreed that there are women who decide against medical intervention but added that they are in the distinct minority.

"But I respect their decision," she said. "How someone views their quality of life when they have an incurable disease is important."

The ovarian cancer that is killing Fisher strikes almost 22,000 women a year in the United States. Nearly 14,000 women die from it annually. In recent years, the disease garnered a lot of public attention when "Saturday Night Live" comedian Gilda Radner and Martin Luther King Jr.'s widow, Coretta Scott King, died from it.

The ovaries are the almond-shaped organs on each side of a woman's uterus. They contain eggs and secrete the hormones that control a woman's reproductive cycle.

Fortunately, the risk for a woman acquiring ovarian cancer in her lifetime -- about 1 in 71 -- is far less than the risk of getting breast cancer, which hits about 1 in 8 women. But ovarian cancer is lethal.

"Most women who get it will die of the disease," said Dr. Cheryl Brewer, a gynecologist and oncologist at the Nevada Cancer Institute. "We haven't made any great progress since the 1970s."

The problem is, she said, that only about 20 percent of ovarian cancers are found at an early stage. When the disease is found early at a localized stage, about 94 percent of patients live longer than five years after diagnosis.

"Most women present in stage 3 or stage 4 of the disease, when the cancer is far along," Brewer said.

Unlike breast cancer, where mammograms can detect the disease early, ovarian cancer doesn't have a good screening test. The yearly Pap test that women receive is effective in detecting cervical cancer early, but it is not a test for ovarian cancer. If a Pap test detects ovarian cancer, it is usually at a very advanced stage.

Even a pelvic exam by an experienced physician who feels the ovaries and uterus for size, shape and consistency seldom detects early ovarian tumors.

And Brewer noted that early cancers of the ovaries cause symptoms -- abdominal bloating, feeling full quickly, having to urinate often -- that are more commonly caused by other things. But if such symptoms last very long, then they should be reported to a gynecologist who can carry out an extensive examination.

"Getting this disease early is critical, but it's hard to do," Brewer said. "That's why it has been referred to as the silent killer."

A family history of ovarian cancer, breast cancer or colorectal cancer places a woman at a greater risk of acquiring the disease. Up to 10 percent of ovarian cancers result from an inherited tendency to develop the disease, according to the American Cancer Society.

More and more, Brewer said, physicians are suggesting prophylactic removal of the ovaries to women with a high genetic risk of the cancer, cutting the risk of acquiring the disease by more than 90 percent.

Obesity, not having children, fertility drugs, hormone therapy after menopause, prior breast cancer -- all can increase the risk of ovarian cancer, according to researchers.

And the risk of developing the cancer becomes much higher with age. Rare in women younger than 40, most ovarian cancers develop after menopause, with half of all ovarian cancers found in women over the age of 63.

Ginger Fisher was only 39 when she was diagnosed with the disease.

"I think the fact that I was so young had a lot to do with my being diagnosed so late," she said.

On four different occasions in 2007, she said, she visited either doctors or emergency rooms with pain in her abdomen.

"I honestly thought I had a hernia from helping people move from their apartments," Fisher said. "I had pain from under my breasts to my knees."

In 2007, Fisher, who had worked for several years in financial planning, worked for the company that was relocating people who lived in apartments that were on the property of the already closed Moulin Rouge on West Bonanza Road.

"It wasn't my job to carry or pack things, but I did for some of the older people," she said. "I was just supposed to be doing paperwork."

During one trip to the University Medical Center emergency room, Fisher said, doctors found she had a staph infection in her groin area. In January 2008, she said, she placed the hand of an emergency room doctor at MountainView Hospital on her abdominal area. He felt the growth she had told him about.

Tests found a huge mass in her abdominal area.

Surgery followed at University Medical Center, which included a radical hysterectomy and removal of a portion of her intestine and colon.

So much cancer was found that the surgeon performed a colostomy, a procedure that brings one end of the large intestine out through the abdominal wall. Stools then moving through the intestine drain into a bag attached to the abdomen.

"Not being able to go to the bathroom normally, having to wear a bag -- I just hate it," she said. "It stinks and it leaks. It becomes a chore to get through the day. It's terrible to soil your bed or have an accident in your pants while you're driving down the road. It is embarrassing. If they had told me I would have had to wear a bag, I would have never done the operation."

Frequent infections have required antibiotics. Persistent, gnawing pain from the cancer has meant more drugs.

Even though doctors said her disease was terminal, she agreed to go through chemotherapy that made her ill and lose her hair.

She prayed that a second operation a few months later, which was supposed to allow her to void normally, would be successful. It wasn't.

"They took out more cancer but I still ended up wearing a bag," she said.

Unable to fend for herself, she moved into a tiny apartment with her daughter, Jessica McComas, and boyfriend, Elmer Castro. He works nights as a laborer for a food company. Her daughter recently began work as a medical assistant.

Fisher shares a tiny bedroom with her granddaughter. On this day the family tries to save money by keeping the air conditioning off.

"I can't work anymore, and I get only get a little more than $700 from Medicare," she said. "I feel like such a burden to my daughter and Elmer. They've never said anything mean to me. They couldn't be nicer, but it's just not right. Why should I be sleeping in my deathbed in my granddaughter's nursery taking up space? That just isn't right."

Despite the fact that she has qualified for government medical programs, Fisher regularly receives bills and phone calls from collection agencies for services that doctors and health care facilities say aren't covered.

"It's hard to believe, but I think if you add up all my bills for tests and drugs and surgeons and hospitals my medical bills run close to $1 million," she said.

There is simply no way, Fisher said, that anyone with cancer, who is not heavily insured, can die in dignity and peace in the United States.

"How can you when you're in pain and being harassed for money all the time? I was underinsured just like so many working people are. I put my daughter down as an emergency contact when I went in the hospital so now she gets my collection calls. Why should she have to go through that?"

There are times, Fisher said, when she believes the only reason members of the medical establishment want her to live longer is so they can get whatever money they can from her case.

"They don't act like they care about you," she said. "Money becomes the overriding factor."

That isn't the case, she said, with Milligan at the Nevada Cancer Institute.

"She talks about my having a good quality of life in the time I have left," Fisher said.

Milligan said that statistics show that Fisher has about six months to a year to live if she doesn't take medication that could prolong her life.

"What's so sad is that the Avistan I had her on was helping her," Milligan said.

Fisher said her constant concern over being a burden to her family, coupled with her inability to cope with effects of the colostomy, makes death seem almost welcome.

"Sure I may miss seeing Gwendolynn make her first steps," Fisher said. "But I won't miss the worry and the pain. And I'm hoping some good comes out of my death. Maybe Dr. Milligan and others can study my body and find out why this terrible disease happens. Nobody should have to go through this."

Contact reporter Paul Harasim at
pharasim@reviewjournal.com or 702-387-2908.