FIGHTING CANCER DURING COVID
Retired cop who battled leukemia while isolated in hospital feared he would die without being able say goodbye to his family
During his worst week with cancer during the pandemic, retired RCMP Supt. Russ Grabb was so immune-compromised that he was separated from his wife and kept in an isolation room inside Lions Gate Hospital, as a deadly outbreak of COVID-19 was spreading through the facility.
“I was most certain I would die without ever being able to say goodbye in person to my family,” said Grabb, who worked for the Mounties for nearly three decades before retiring in 2006. “On Day 4, I cried. And sobbed openly like there was no tomorrow.”
Grabb, once a high-profile RCMP spokesman, was diagnosed with hairy-cell leukemia in late April. He was admitted in grave condition to Lions Gate Hospital on May 10, after he developed a severe infection following five days of chemotherapy.
Having a non-curable form of cancer and enduring a brutal regimen of chemo is always difficult, but so much more so when you have no immune system to fight off a lethal virus running rampant through the province.
Despite that, Grabb offered to share his personal story to thank the medical professionals who cared for him, and to say that he is grateful for the life-saving care he received when so many other patients had surgeries cancelled last spring for procedures involving eyes, hips and knees, urology and other medical conditions, so space could be freed up in hospitals for COVID patients.
“Not a day goes by 10 months later where I'm not racked by profound guilt. I got my chance at swift early treatment and relief from suffering, and so many others didn't,” he said this week.
If people had a cancer diagnosis last spring, most of their treatments and procedures went ahead as planned or have been completed now, said Dr. Kim Nguyen Chi, B.C. Cancer's chief medical officer. There may be a few isolated cases of cancer patients still facing delays, he said, but insisted that is not happening system-wide.
“I feel for those people, and they may be experiencing some sort of COVID-related issue to their individual experience. But as a system, we've tried to maintain (treatment) as much as we can,” Chi said.
Of concern to specialists across Canada, though, is that cancer diagnoses are down five to 10 per cent compared to expectations. New cancer cases would typically grow by a small margin each year, not shrink.
“What that does suggest is that there are people out there that have cancer who have not been diagnosed,” Chi said.
“So if there's a delay in diagnosis of the cancer, when it is diagnosed it may be more advanced, and that's what we're worried about . ... We want to really encourage people if they have concerning symptoms or if they're due for their screening services, that they really should access the system.”
The lower diagnosis numbers could be the result of patients being hesitant to visit medical offices during the pandemic or due to slightly longer waiting times for some screening procedures, Chi said.
Screening for cancers like breast and colon was essentially shut down from March to June last year to free up space in hospitals. The diagnostic services were started again in the summer. Although they still have not returned to 100 per cent of
Not a day goes by 10 months later where I'm not racked by profound guilt.” Russ Grabb
previous capacity, Chi said they “are ramping back up” and that anyone who needs a test will get one.
Grabb got the tests he needed. His cancer story is not a fairy tale. His best-scenario ending is that he is in “qualified remission,” meaning when (not if, but when) the cancerous cells take over his bone marrow again, he will have to endure more chemotherapy, possibly as soon as in three to five years, but ideally not for a decade.
Still, he's alive to tell his story. And he wants to share it to encourage others to get tested and to get treated.
GRATEFUL FOR ANSWERS, FEAR OF THE OUTCOME
On April 2, 2020, Grabb's 63rd birthday, he'd had enough. In addition to his heart condition, cardiomyopathy, he'd also been battling for months some symptoms that doctors couldn't initially explain: exhaustion, cuts that wouldn't heal, giant mysterious bruises, lingering infections, and a crippling pain in his abdomen.
So he walked to the local LifeLabs to get his blood tested.
The next day, his family doctor phoned. He had dangerously low levels of red and white blood cells, platelets and hemoglobin. But it wasn't clear why.
The doctor also warned that elective surgeries were being cancelled because of COVID, and it might take longer to schedule the bone marrow biopsy and spleen ultrasound he needed. He was frustrated. And scared.
But the next day, he got a call from hematologist Dr. Kimberley Ambler's office, and within a week was at Vancouver General Hospital for the procedures.
“I felt like he really should be investigated as quickly as possible,” Ambler said. “The speed of Russ's care was pretty typical of patients in his situation. I don't think in his case there were any significant delays as a result of the pandemic.”
Four days later, he learned that he had a rare form of leukemia known as “hairy cell,” which is not curable but responds well to treatment.
“Having what is essentially cancer of the immune system created no end of worry and fear for both me and my family,” he recalled. “I was grateful that at the very least, I had some answers to explain all my prior agony.”
During the first week of May, he had daily chemotherapy to attack the cancerous cells in his bone marrow, and then was sent home with an immune system that was basically at zero — as the first wave of the coronavirus raged on.
“You know that if you get ... some sort of infection, it most likely would be fatal. You have nothing to fight it with. So because COVID is in the air, it's even more frightening,” said Grabb, who hunkered down in his North Vancouver his wife Marianne. condo with
Doctors warned him to seek help if he started to feel ill after the chemo. Two days after returning home he was weak and had a fever nearing 40 C.
He went to Lions Gate Hospital, where he was diagnosed with malfunctioning kidneys and an infection that had become septic.
It was the last time he would be near his wife for a week as he was whisked into a private room, where he was visited by a wave of specialists and tested for the coronavirus.
Lions Gate was in the midst of a month-long COVID outbreak, during which 16 patients hospitalized for other conditions became infected, including nine who died.
We've done a good job in B.C. of managing our patients with cancer.” Dr. Kim Nguyen Chi
SCARY TIMES
“You know it can't be good when the internist in the daunting haz-mat suit asks how you feel about ventilators and induced comas — especially when nearby patients were dying of COVID,” Grabb said.
He did not have COVID, so was put in an isolated room for protection from the virus and other hospital germs. He tears up when he describes the “earth angels” who looked after him, noting the medical staff had to don and doff full PPE each time they came into his room.
His wife Marianne would walk daily to the hospital and talk to him on the phone from below his fourth-floor room, although he had to wave a white towel from inside so she could figure out which darkened window was his.
“I couldn't really see him because of the tinted windows but he said, `I want to see you,'” Marianne recalled.
“You really feel helpless, and really kind of sidelined, because you've been so on board with everything step by step by step for months and months and months and all of a sudden, because of COVID, you're not allowed to even cross the doorstep of the hospital now.”
She would often go home to cry after those visits from the sidewalk below his window
“So many people were going through so much but you do feel for your own person that you love and you want to be there, and sometimes just holding their hand in the hospital helps them,” she said.
“And when you can't do that, I think that's a big void.”
EMERGING FROM THE DARK DAYS
Grabb tried to keep his spirits up but by the fourth day in isolation, he was feeling very down. His blood levels were still low, his vitals were not good, he had never-ending nausea. “You start to think that, you know, you've lived a good life, you have a great family. Maybe it's just time.”
But by that Saturday, doctors let him go home, where he has stayed in a bubble with Marianne, attending medical appointments and walking to the grocery store. People not wearing masks make him uneasy, though, because of his weakened immune system and he wishes masks were mandatory everywhere.
“Watching people walk around with no masks, it feels like you're soaking in the bathtub with somebody standing beside you with a plugged-in toaster,” he said. “They're just completely unaware that they could be giving you a death sentence.”
Chi echoed Grabb's call for mask wearing and social distancing, but said relatively few cancer patients in B.C. have become infected with COVID.
Last spring, early data suggested that cancer patients were at higher risk of severe complications if they caught the virus, Chi said. Difficult changes were made in B.C. to try to protect them, such as physicians doing most assessments online and patients being prohibited from bringing a support person with them during in-person treatment.
While other jurisdictions had higher infection rates among cancer patients, those in B.C. had about half the infection rate of the general population, said Chi. “So I think there's a bit of good news there — that we've done a good job in B.C. of managing our patients with cancer.”
A bone marrow biopsy in November showed Grabb was in “qualified” remission, but he's still low on certain blood cells required to fully boost his immune system. For now, though, he feels much better.
“I think he did really get excellent response and the disease is in remission right now, and hopefully will be for many years,” Ambler said.
When asked what he would say to other cancer patients right now, Grabb offered encouragement.
“Despite what you're reading about the wait times and cancellations,” he said, “you will get through this.”