‘The worst is yet to come’
Playing a medical waiting game
As the Mars rover Curiosity explores the red planet, 141 million miles away, Nancy Vandermey is one of the team members at the controls.
But the Jet Propulsion Laboratory rocket scientist — who also worked on NASA’s Cassini and Galileo projects — has had very little control over an earthly challenge she’s facing.
Vandermey has breast cancer. Stage two.
She got the diagnosis Feb. 4, and surgery was supposed to be March 19.
But then coronavirus torpedoed normal routines at hospitals and medical clinics. As they prepare for a possible onslaught of patients sick with the virus, some hospitals have curtailed or eliminated socalled non-urgent procedures to conserve beds and medical equipment.
Vandermey followed these developments closely, hoping she wouldn’t get bumped off the surgery
schedule at Kaiser Permanente Los Angeles Medical Center. Having cancer was unnerving enough, but delaying treatment would be doubly scary.
A few days out, Vandermey got the news she had feared. Surgery was being postponed, and one medical staffer told her the schedule change was due to “lack of supplies.”
A couple of days later, Vandermey said, her doctor apologized and told her he thought the surgery would happen in the next couple of weeks. But a day later, another medical staffer had a more worrisome prediction.
“I got an email saying it was more likely to be a couple of months rather than two to three weeks,” said Vandermey.
Vandermey, a wildlife lover and photographer who has traveled the world taking pictures than can be found at wildcatzoo.com, lives in Tujunga, where she has captured images of the big cats who live in the surrounding hills and have wandered up her street and through her yard.
She’s working from home these days, because the virus has altered routines at JPL, and said that “operating a Mars rover from home is new and different, and that’s interesting.” But trying to determine whether Mars has ever sustained life hasn’t entirely gotten her mind off the pandemic that’s sweeping this planet or the medical condition that has disrupted her life.
“It’s been very scary,” Vandermey told me, worrying that the cancer would have a chance to spread during the delay. “I figure the longer surgery doesn’t happen, the more likely it is to be months and months, because hospitals are going to be overwhelmed with virus patients. They currently aren’t, and I was trying to get in there before it happens.”
Vandermey didn’t want her surgery to delay treatment for anyone else and noted that hers is an outpatient procedure, which would tie up resources for only a short time. As someone with an underlying health issue, she might be considered in a high-risk population for severe complications if she gets coronavirus, but Vandermey told me she fears the cancer more than the virus.
After the postponement, she filed an appeal with the Medical Board of California and posted about her predicament on Twitter.
Among those who responded: a woman who said her pacemaker implant is on hold and a man who said his mother’s checkup following cancer surgery has been delayed two months.
And there’s no telling how many more postponements are in the offing. Antelope Valley resident Joyce Macconnell has two knee replacements scheduled, the first in May, but told me she wonders if it will be pushed back.
“Hospitals are being urged to postpone as many elective procedures as they can without causing harm to any individual,” said Jan Emerson-Shea of the California Hospital Association. “California has no hard and fast rules, but basically [the question is], can an individual go two to three months, perhaps, without a procedure, or will that cause any harm?”
Emerson-Shea said she understands these are tough choices for hospitals and doctors, but she added that the term “elective” needs to be clarified.
“It does not mean not medically necessary; it just means it’s not an emergency,” she said.
Emerson-Shea didn’t want to speculate on the best protocol for Vandermey or any other patient. Hospitals are making caseby-case decisions and doing their best, she said, to make tough judgments about which treatments can safely be delayed in order to prepare for “this unprecedented crisis.”
Dr. Robert Cherry, chief medical and quality officer at Ronald Reagan UCLA Medical Center, said each surgical unit is constantly reviewing which operations should go ahead as scheduled and which can be delayed so that beds and medical gear are conserved. That can involve tough calls, because one thing we do know about coronavirus is that it has the potential to spread rapidly.
“We are now [at] anywhere from 35% to 40% of our normal surgical volume,” Cherry said, a slowdown designed in case of a need to accommodate a crush of very sick patients.
But among the procedures going forward as planned, Cherry said, are surgeries for cancer and cardiovascular disease.
When I called Vandermey’s doctor, he said he wasn’t at liberty to speak about her case. A Kaiser Permanente spokesperson sent me a response stating that Kaiser doctors “are clinically evaluating all elective procedures scheduled for the next few weeks to determine those that can be safely postponed. These may include select cancer surgeries.”
The statement went on to say that “national societies are recommending delaying many types of cancer surgery, in part because of evidence of serious complications from COVID-19 after surgery.”
I can understand the hospital’s point of view. Kaiser, like other hospitals and like the general public, is trying to navigate these scary, uncertain times. But I also can’t imagine what it would be like to be in Vandermey’s position, worried about the spread of cancer at a time when so much else is unsettling in the world.
When I drove out to see Vandermey Tuesday afternoon, the rocket scientist was on a break and walked down to the bottom of her driveway to meet with me. We spoke from a virus-safe distance of 15 feet or so. And she had great news. A bit earlier, she had gotten a call from her Kaiser doctor.
Her surgery is now scheduled for Thursday. She expects to be back at work in a couple of weeks, and that’s a good thing. There’s a lot of the universe left to explore.