James Morse was born and raised in Siren, Wisconsin 65 years ago. When
James was 13, he began working for his father, also a carpenter, digging
trenches for home foundations. During his high school summer breaks, James
worked with his father, building homes in the Siren, Wisconsin area. By
the time he had graduated from high school, when most of us barely have
a clue let alone a skill, James knew how to mix concrete, build forms,
frame houses, tape, drywall, and roof houses.
Mr. Morse had always been a hard worker. As the father of nine children,
James found it necessary to work wherever he could find work. He worked
in Wisconsin, Minnesota, California and Oregon. His only hobby was bowling.
James was an excellent bowler, and in the 1960's was asked to join
the Professional Bowling Association. He refused the offer, however, because
he felt that he needed a stable career in construction to support his family.
In the fall of 1997, while living and working in the Woodburn, Oregon area,
James noticed he was having some difficulty breathing. By November, he
had developed a serious cough. Thinking he had pneumonia, James sought
medical attention at the Canby Clinic in Canby, Oregon. The doctor ordered
chest films, which revealed that his left lung was "clouded over,"
but further tests were needed in order to diagnose the problem.
On December 4, 1997, James went to Willamette Falls Hospital in Oregon
City, Oregon. A thoracentesis (a surgical puncture of the chest wall to
remove fluid) was performed. Two liters of fluid were collected from his
lung and sent to the laboratory for analysis. The test results were inconclusive.
The doctors shrugged it off and prescribed antibiotics.
When the pain and shortness of breath continued, Jame's physician scheduled
a consultation with a thoracic surgeon. During the January 27, 1998 examination,
a CT scan revealed a pleural effusion, calcium deposits on the lining
of the lung, and a possible tumor in the left pleural space. The doctors
recommended surgery to remove the fluid and also to biopsy the suspicious tissue.
On February 17, 1998, James was admitted to Kaiser Permanente Hospital
in Portland for a thoracotomy. During the surgery, biopsies were taken
from several locations in the left chest cavity, and multiple adhesions
were removed from the lung and chest. The surgeons noted that the pleura
was thickened in the lower left lung lobe, so they removed some of the
pleura in order to improve left lung expansion. An air leak was also discovered,
so the lung was deflated and a sterile talc was insufflated (blown) into
the chest cavity, completely covering the lung and chest wall. A pathologist
used staining and immunostaining techniques to analyze the tissue samples.
The pathologists diagnosed malignant mesothelioma.
After surgery, James was in pain. To relieve the pain, he took Vicodin.
On the sixth day following surgery, his chest tube was removed. James
was discharged from the hospital on February 23, 1998.
On March 5, 1998, James had his first visit with an oncologist. The doctor
explained to him that he had mesothelioma and that his prognosis was grim.
The oncologist told him that there was no known cure for mesothelioma,
nor any guarantee that treatment would extend his life. The oncologist
also told him that the usual cancer treatments--chemotherapy and/or radiation--have
been ineffective in battling mesothelioma. The oncologist explained that
he may live just as long if he chose to monitor the cancer and treat the
symptoms of pain. The doctors did not discuss photodynamic therapy, gene
therapy or pleurectomy / decortication.
James was devastated by this news. After recovering from the initial pain
of surgery, he was "ready to play with pain." His chief complaint
was a feeling of constant fullness, followed by an occasional sharp jabbing
pain on the lower left side of his abdomen. Otherwise, his appetite was
fair and he had not lost too much weight. He had even returned to work
After much agonizing, James decided to seek palliative care, treating only
the symptoms as they occurred. He also started a regimen of natural herbs
and supplements, such as Beta-carotene, shark fin cartilage, vitamins,
and yew bark, hoping that these supplements would slow the progression
of the cancer. Throughout the spring and summer of 1998, he continued
to feel good.
In late August or early September, the pain worsened. At first, James thought
he had a kidney stone. The doctors ordered an intravenous pyelogram on
September 8, 1998, but it was negative. James felt the pain increase when
he coughed or sneezed. His oncologist feared that the cancer had spread,
so more chest films were ordered. However, the films did not reveal any
changes or abnormalities from previous films. The oncologist prescribed
15 mg of MS Contrin and morphine orally for the pain. Unfortunately for
James, the pain became constant, and was so excruciating that he could
no longer work.
Concerned that James was not able to handle the pain, his oncologist scheduled
an appointment for him with a pain management consultant. During his appointment
on September 19, 1998, James described his pain as being different from
the tightening of his chest he had experienced just after surgery. The
"new" pain was a constant sharp pain on his left side, which
extended forward to his upper abdomen above his belly button. The pain
intensified when he bent over to tie his shoes or reached above his head.
The morphine no longer provided any relief.
The pain management physician suggested a temporary nerve block. If effective,
James would be a candidate for an intercostal nerve block. The nerve block
procedure consists of cutting the nerves in the intercostal muscles between
and on the outside of the ribs. The intercostal muscles control the volume
of air in the chest when breathing. The theory is that cutting the nerves
will relieve the pain associated with breathing (the expansion and deflation
of the chest/rib cavity). The doctor explained the procedure to James,
including the risks of bleeding, infection and possible nerve damage.
James consented. The temporary procedure was performed at the doctor's
office. Afterwards, the pain had subsided somewhat. James felt only a
slight tenderness while bending or reaching when he returned home.
Two days later, James telephoned the pain management physician to report
that the pain had ceased for a short time, unfortunately, had returned
in full force. James underwent the full intercostal nerve block surgery
on October 30, 1998.
However, the surgery did not improve Mr. Morse's suffering. Even after
the surgery, he was still tormented with pain. After spending two days
in bed, his doctor prescribed 300 mg. of Gabapendine to take in addition
to the codeine that he had been taking.
On November 13, Mr. Morse died at home. His pain had finally ceased. He
is survived by nine children.
POSTED DECEMBER 17, 1998