Mesothelioma Robs 23 Year Old Child Prodigy Of Beautiful Life
In the words of her father, Elizabeth Clancy was "beautiful inside and out." She took gymnastics from the time she was three years old until she was eleven. She earned a black belt in tae kwan do and became an instructor. She finished third in her high school class with a 4.0 average. She attended Colorado State University on scholarship and graduated in 1997 with a business degree. She worked 80-hour work weeks at a Houston investment banking firm; she was being groomed "to go places." Tremendous physical stamina fueled her accomplishments.
On October 30, 1997, Elizabeth was 22 years old. On that evening in Houston, on her way home from her investment banking job, her car was rear-ended by a truck. She experienced pain in her neck and right rib area, but did not seek medical attention until the next day, when she saw Dr. Eileen Duncan, a family practitioner at the Kelsey Seybold Clinic in Houston. X-rays of the neck showed some muscle spasm.
Six days later, on November 6, 1997, Elizabeth returned to Dr. Duncan complaining of increasing right lower rib pain. Dr. Duncan felt this pain was the result of trauma from the steering wheel or seat belt in the accident.
On February 17, 1998, Elizabeth returned to Kelsey Seybold, where she was seen by Dr. Dickinson, an internal medicine specialist. She complained of pain on breathing and turning. Chest films showed a right-sided effusion. Dr. Dickinson scheduled a thoracentesis, which was conducted the next day at Kelsey Seybold. Ultrasound-guided thoracentesis removed 500 ccs of lemon-yellow fluid from a well-defined pocket in the right pleural space. Dr. Neil B. Longley saw "no pulmonary abnormality" which would account for the fluid in the chest.
A week later, on February 24, 1998, Dr. Jeffrey P. McGovern, a Kelsey Seybold pulmonologist, consulted with Elizabeth regarding the thoracentesis. Cytological testing revealed the presence of abnormal mesothelial cells. He noted that Elizabeth still had pleuritic pain with moderately labored breathing, with only minimal relief from Advil. She could walk only one flight of stairs before developing labored breathing, which as Dr. McGovern observed, was "markedly impaired since three months ago." (Elizabeth had won world competitions as a black belt in tae kwan do.). Chest films taken the same day showed a moderate-sized right pleural effusion, with a mass-like consolidation in the right lower lobe mostly obscured by effusion. Elizabeth's doctors felt she was suffering from pneumonia.
On the late evening of March 7, 1998, Elizabeth sought emergency medical attention for pain on breathing and fever at the Emergency Room of St. Luke's Episcopal Hospital in Houston. She was admitted just after midnight. Chest films from early the next morning showed irregular thickening of the pleura. A second set of films taken later that same morning showed "a lacy network of abnormal increased density" at the right lung base, which could represent post-hemorrhagic or post-inflammatory scarring, or a tumor. However, Elizabeth's doctors did not tell her parents that cancer was a possibility. In fact, Elizabeth's father, a lawyer, asked her doctors directly about this possibility and they assured him cancer was not a concern.
The next day, March 9, 1998, Elizabeth and her parents Diana and Dan Clancy consulted with a cardiovascular surgeon at St. Luke's Episcopal, Dr. Jack Williams. Dr. Williams believed that there was scar tissue covering Elizabeth's lung (extent unknown). The tissue needed to be peeled from the lung in a "decortization" procedure, which Dr. Williams analogized to peeling the rind from an orange. The CAT scan showed a fractured rib which could have caused internal bleeding inside Elizabeth's chest cavity. Dr. Williams surmised that the internal hemmorhaging caused a web-like covering of scar tissue over the right lung.
Dr. Williams believed that there was evidence of fluid around the lung which needed to be removed. He explained to the Clancys that the surgery would last approximately two hours, and there would be a one to two-week hospital stay and a six-week recovery period. He said that the lung would be healthy and good as new after the procedure. There was no mention of the possibility of cancer.
Thirty minutes into surgery the next day, Dr. Williams emerged from the operating room and told Elizabeth's mother Diana that there was a problem, that he had opened Elizabeth's chest and had taken a sample of tissue and sent it to the laboratory for analysis. He said that the lab notified him that frozen section analysis showed a rare form of cancer known as mesothelioma. He told Diana in a rush that he would have to remove Elizabeth's lung (Elizabeth was anesthetized and did not consent to the radical procedure).
The Clancys' horror mounted in the recovery room when, contrary to their expressed wishes, one of the medical staff told Elizabeth that her lung had been removed. The family had to be called into the recovery room to be with Elizabeth because she was hysterical. Dr. Williams told the family that he had left three to five percent of the tumor, which he could see but not remove. One site of residual tumor which Dr. Williams saw but could not remove was where the tumor had penetrated through the diaphragm and grown onto the liver.
Elizabeth was discharged from St. Luke's Episcopal on March 18, 1998, eleven days after she sought emergency care there. The diagnosis was confirmed through pathology at M.D. Anderson. In an effort to treat her mesothelioma, Elizabeth consulted with The Stehlin Foundation, Texas Oncology, M.D. Anderson, and the Kelsey Seybold Clinic. The Stehlin Foundation had no clinical trials for mesothelioma. She was told at Texas Oncology that chemotherapy and radiation therapy would not cure the disease, but only possibly control the symptoms. Dr. Dong Moon Shin at M.D. Anderson told her that the tumor would grow and return without treatment, but chemotherapy would probably have no effect on the tumor. Dr. Edward Soo at Kelsey Seybold advised that there were no protocols which promised a cure for mesothelioma. Dr. Soo suggested that Elizabeth might want to wait and see what happened, rather than to begin any treatment at this time.
In the spring of 1998, Elizabeth went to Jackson, Tennessee so that her parents could help care for her. She always intended to return to her job and life in Houston, Texas.
A repeat CAT scan on September 14, 1998 showed no signs of disease. Another CAT scan on December 14, 1998 showed thickening of the pleura, but a follow-up needle biopsy of fluid and tissue showed that the tissue was scar tissue and the fluid showed no signs of disease. A February, 1999 CAT showed an abnormal-looking liver.
On March 5, 1999, Elizabeth was admitted emergently to Jackson-Madison County Hospital with abdominal swelling, difficulty urinating, and lack of bowel movement. An abdominal CAT scan showed an enlarged liver with a branching, low density lesion, pleural thickening in the right hemidiaphragm, right lateral thickening of the peritoneum, and a small to moderate amount of ascites.
On March 17, an MRI showed the chambers on the right side of the heart enlarged, and thickening around the area of the heart and pericardium.
On May 30, Elizabeth was admitted to the Emergency Room at Vanderbilt University Hospital in Nashville, Tennessee with complaints of severe back pain and swelling. She weighed 100 pounds, 25 pounds less than at the time of her accident. On her discharge from Vanderbilt seven days later, Elizabeth weighed 90 pounds.
On June 29, 1999, Elizabeth underwent a paracentesis in which two liters of fluid were removed from her abdomen. Vanderbilt tested the fluid, which was positive for malignant cells, consistent with mesothelioma. Slides were sent to Brigham & Women's Hospital, which confirmed the diagnosis.
Thereafter, from July 14 to September 8, 1999, Elizabeth underwent eight paracenteses at Vanderbilt University Medical Center in Nashville. The paracenteses produced fluids ranging from three to five and one-half liters in volume. Elizabeth's last visit to Vanderbilt was on September 18, 1999. She received a morphine shot and fluids intravenously to rehydrate. The next day, September 19, 1999, Elizabeth passed away.
Elizabeth and her parents searched for hope, for effective treatment, and found none. Elizabeth tried to work, to fight her disease, but even her indomitable spirit was not enough. She died in her parents' home at the age of 23. She leaves her loved ones with unspeakable anguish. Hers is the picture of senseless loss, and our determination that such loss should never recur.
*** POSTED DECEMBER 14, 1999 ***