A Kind and Generous Heart

By Matias Travieso-Diaz

In the Summer of 2021, my wife Fran started feeling sick. She developed constipation and her bowel movements were accompanied by great discomfort and pain. She visited her gastroenterologist, who ordered a CT scan of her lower abdomen. The scan identified the existence of “a large complex cystic and solid mass deep within the pelvis.” The mass was pressing on her ureters and blocking her colon.

Fran had undergone a hysterectomy in 1981 and was aware of the potential cancerous implications of such an operation, even twenty years after the fact. She immediately consulted a leading gynecologic oncologist at one of the leading hospitals in Washington, D.C. The oncologist examined her and diagnosed her as suffering from stage IIIB primary ovarian carcinosarcoma (a rare, and very serious form of ovarian cancer) and scheduled her for surgery, which took place on an emergency basis on November 4, 2021.

The surgery was scheduled to take three hours. However, Fran was in the operating room for over seven. The operation went smoothly but took much longer than anticipated because the tumor (over six inches long) attached itself to a portion of the intestine, which had to be cut off and the ends reattached. Also, the tumor was putting pressure on one of the ureters and a stent had to be inserted, to be left in place for a few days. The surgeon told us that she had removed as much of the tumor as she could see, but given its size and location she was sure that cancerous cells remained in Fran’s abdomen that would require further treatment.

Fran had to be taken to the hospital’s intensive care unit after the operation because her blood pressure was dangerously low. She had to remain in the ICU for an entire week, during which period she experienced anxiety, boredom, and frustration but handled the situation bravely.

She was finally released from the hospital on November 13, 2021, nine days after the operation, and taken to a rehab facility near our home. She did not fare well there. The care she received at the rehab facility was indifferent and sometimes inadequate, but she suffered through it all without complaints. Although she was there to receive physical therapy, this was largely prevented because she developed large blisters on her right foot that, although not infected, prevented her from being ambulatory. We later learned that water retention in the extremities was a byproduct of the disease that would bedevil her from that moment on.

She went home from the rehab facility just before Christmas and we encountered a couple of problems. First, Fran was unsteady on her feet and fell several times, particularly going up and down stairs. Second, she could not sleep lying in bed because she had trouble getting in and out, and because fluid began building in her abdomen again as the cancerous cells multiplied.

Her relatives came down from New York right after Christmas and left on Sunday, December 27, the day before her first chemotherapy session. The family was to return for visits in May and July, which were greatly appreciated by Fran, our daughter Anastasia (“Nastya”), and me. Fran livened up in the presence of her kin and did all she could to look good for them. The chemotherapy had made her lose her hair, so she purchased and wore several wigs. She never lost her vanity, and our daughter took excellent care of all her needs and her desire to remain as attractive as possible.

The first chemotherapy session took place at the hospital’s “infusion center” of the oncology department on December 28. It did not go well. Her blood pressure dropped drastically and all her vital signs went awry, so the session had to be terminated. The attending doctors decided that she could not receive the chemotherapy doses as an outpatient but needed to be hospitalized so she could be monitored and given the necessary drugs while the injection of chemicals (which lasted up to three hours) was in progress.

Thus, a cumbersome routine was put in place. Fran would need to be admitted to the hospital the night before the chemotherapy and would be released the following day after the chemicals had been administered. An added complication developed at the same time: her abdomen continued to fill with fluid released by the cancerous cells, so in advance of the chemotherapy she would have to undergo a paracentesis, a procedure in which a port would be installed in her abdomen and the fluid drawn out in significant amounts.

All these ordeals would have discouraged a less resolute person, but Fran soldiered on. The head oncologist suggested that, instead of continuing to treat her cancer, they provide “comfort care” to alleviate the side effects of the disease, an approach that would lead to her death within three months. She insisted that the chemotherapy treatment continue. She wanted to stay alive, not for herself, but for me and – mostly – for her daughter.

We did the best we could to alleviate her pain. We installed a stair glider that eliminated the need for her to climb stairs. We got her a recliner, which she found too uncomfortable so she spent most of her time sitting on a large chair. Likewise, we got a stool for her to rest her feet on, but doing this caused her pain. She never made much of her suffering, which was constant and considerable. She had shortness of breath, constipation, and swelling of the ankles.

The worst side effect developed them. The chemicals in the infusion that was administered to her caused her to develop severe neuropathy on the nerves of her feet. The neuropathy gave rise to constant pain, which she sought – without much success – to alleviate through various medications. As the winter of 2022 led into spring, she accumulated an array of medicines, which were often ineffective. She has multiple health problems, including atrial fibrillation of her heart (a congenital condition), low blood pressure, tachycardia, and bouts of anxiety.

I foolishly tried to put a positive spin on things and continued to predict that we would soon see the positive effect of the chemotherapy. Our daughter, more realistically, insisted that Fran was dying and that my trying to downplay the gravity of the situation was not helping matters. She was right, of course. Love makes us blind.

On her May 24, 2022 treatment visit Fran reported having severe neuropathy on her feet, swollen ankles, and lower extremity edema up her knees and above. The doctors decided to discontinue the treatment she was receiving because the cancer had become resistant to those drugs. Her treatment was switched to another drug, less effective but potentially more suitable in her case.

The second chemical proved more benign than the first in that it did not aggravate the adverse side effects of chemotherapy. However, it proved ineffective in treating the cancer, which continued to advance, filling her abdomen with fluid, and causing other conditions to worsen.

On Sunday, July 24, 2022, we took Fran to the hospital to treat a fever that had developed and get her ready for the chemotherapy treatment to be administered the following day. Overnight, she fell on her way to the restroom. She did not sustain any serious injuries, but because of the concerns about her lack of stability, they moved Fran to a regular bed, where she would be safer but less comfortable than sitting on a recliner.

We met Monday afternoon with the assistant to the lead oncologist and we concluded, and Fran agreed, that whether chemotherapy would be continued would depend on the results of an abdominal CT scan to be performed prior to the treatment. Because of her fall and her lack of mobility, it was uncertain whether or when she would be released from the hospital and whether she would be able to walk and move around on her own afterward.

Fran was shaken by this development. She refused to become and invalid and stated that she would rather die than be unable to move by herself.

Nastya and I were unpleasantly surprised Tuesday morning when we arrived at the hospital. Fran’s condition had drastically deteriorated overnight: she was hardly awake, had trouble breathing and swallowing, was incoherent (although lucid) and could not move on the bed where she had been placed after her fall.

We stayed at the hospital until the scheduled CT scan was performed that afternoon, and the results showed that the existing cancerous tumors had grown and there were new ones in her abdomen. The chemotherapy had been ineffective and there was no hope for recovery. Later, we confirmed this conclusion with the oncologist who attended her. She told us that, based on her observation, Fran had only a few days left to live. I sent word to the family, who drove down the next day to be with us.

The last part of the week became a death watch. Fran was unable to speak, though the nurses told us she was conscious and could hear us, but could not respond. She was maintained in a hospice routine in which no efforts were being made to keep her alive. She was not fed or given fluids or medications, except morphine to dull any pain. We took turns visiting with her; now the full immediate family was there, including her brother, her sister-in-law, and their two daughters with their three children. Her brother sang to her and we continuously let her know our sadness and reiterated our love for her. I want to believe she heard us.

Thursday, July 28, the family left to return to New York. Nastya and I returned to the hospital the following day, Friday, July 29, and spent the day with Fran. We went home at seven p.m. when visiting hours were over. A little after eight that night, I received a call from the hospital advising she had passed away from heart failure, apparently feeling no pain.

Fran was buried on August 3, 2022, in the same cemetery where her parents are buried. I delivered the following remarks at the graveside internment ceremony. They summarize the life of my courageous wife and express, as much as my words can convey my appreciation for her and her love, and the immeasurable magnitude of our grief over losing her:

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“I met Fran when we both were in our late thirties. It happened in Cape May, one enchanted evening during the 1979 Labor Day weekend. Then, I saw a stranger across a crowded room and I knew then and there that I had found my true love. I laboriously pursued her – she was not easy to get – and finally won her.

“We were married for forty years. Over time, I came to realize that it was not her beauty, her intelligence, or the strength of her character that was her most outstanding feature: it was her heart. Physically, due to a birth defect, her heart was weak and required multiple treatments and constant care. Spiritually, however, her heart was a priceless, golden jewel.

“From an early age, she felt an urge to help those less fortunate than herself. Her childhood dream was to become a nurse. In fact, she became a social worker, assisting underprivileged children with foster care, protective services, and adoptions. Years ago, I met her supervisor during the early nineteen seventies, who related to me Fran’s tireless and passionate efforts to help the children in the community. She would drive hours, day and night, over two-lane country roads, to secure the placement of a child at risk in a suitable home. She would go at all hours to unsafe neighborhoods, sometimes even before the police arrived, to rescue an abused or neglected child. In a few years, she became a hero in the eyes of the social worker community and her clients.

“She continued her formal education and in 1973 received a Master’s Degree in Social Work from the Catholic University of America. Her new degree, her experience, and the enthusiastic endorsement of those who knew her professionally led to her appointment in 1975 as the Child Protective Services Supervisor for the city of Alexandria, Virginia, a job that entailed leading a team that provided services to families whose children were in need of protective supervision. She held that job for seven years; she was still doing it when we first met.

Our own wedding had to be postponed for a few days because she had to testify in court, as she often did, in a case involving the welfare of one of the children under her care.

“I witnessed how hard she worked for the clients and how disappointed she became when funds were cut significantly so that the agency became paralyzed. Ultimately, she quit government work in frustration in 1982 and went into private practice, where she had a successful career spanning over thirty years.

“Again, she was regarded by her colleagues as among the best and most skilled social work practitioners, applying the highest standards of practice to the care of adolescents, single adults, families, and couples. Some of her former clients still contacted her for comfort and advice many years after her retirement in 2015. One of them reached out to her for help only a couple of months ago.

“But there was always room in her heart to give out love. In 1999, we adopted Nastya, an eleven-year-old girl from Russia. For the following twenty-odd years, Fran showered our own child with boundless care, firm guidance, and affection, helping her navigate the storms of adolescence until Nastya became the lovely young woman she is today. Fran and I were both touched and awed by the love and attention that Nastya provided her mother throughout the course of Fran’s illness.

The beauty of Fran’s heart was displayed outside the family as well. She had many friends at all levels of life, both on account of her community activities and arising from her numerous interests, from jewelry making to flower arranging, which she pursued with unfailing skill and good taste. In the last five days, I have received a deluge of messages of condolence with words like these: from Bolivia: “My children and I are very sorry for your loss, she was a great and lovely person, and our prayers are with her;” from Virginia, “She was a great gift to all of us. She will be missed” and from California, “She was an exceptional person who will be missed.”

“I can truly say that Fran was a loving wife, mother, daughter, sister, aunt, and friend to many people, known and beloved for her kindness, empathy, and generosity. Nastya and I will hopefully manage to live through our terrible loss, but Fran will never leave us. As my favorite song says: Once you have found a person with such a beautiful, exceptional heart, you never let her go. And we will not.”

END

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Born in Cuba, Matias Travieso-Diaz migrated to the United States as a young man. He became an engineer and lawyer and practiced for nearly fifty years. After retirement, he took up creative writing. Over one hundred of his short stories have been published or accepted for publication in anthologies and paying magazines, blogs, audiobooks, and podcasts. Some of his unpublished works have also received "honorable mentions" from a number of paying publications. The first collection of his stories, “The Satchel and Other Terrors” was released in February 2023 and is available through Amazon and other retailers.