Engineer Faces Setbacks With Patience

62 year-old former boilermaker and retired engineer Allan Ostling lives with his wife Jackie in Northern Indiana. The Ostlings live in a house that any child would love to visit. One of the attractions is a porcelain figurine of an "adult" rabbit reading to seven bunnies gathered about. If a household can be said to have a spirit, this artwork would seem to symbolize the highest and best spirit of the Ostling abode. The Ostling enjoy collecting antique books and they have seven grandchildren who love to come over to listen to Grandpa bring to life the fun and adventure of a good storybook.

Most of the stories and the Ostlings' life experiences had been happy, until May 14, 1999, when Jackie underwent surgery for breast cancer. But the most profound, family and life altering blow came on June 9, 1999, when the Ostlings' only son was killed at the age of 35 in a tragic automobile accident. Allan Ostling, III left behind a wife and three children, ages thirteen, twelve and one. With typical stoicism, the Ostlings began planning to help support and raise their grandchildren, even as they dealt with their own unspeakable grief.

Allan grew up tough. His father was an engineer, and the Ostlings moved around a lot, from one boiler job to another, when Allan was a child. He had been to 15 different schools by the time he went to college. Allan, a strapping man known as "Big O", had no trouble making friends. He laughs as he recalls, "I would just pick a fight with the biggest kid in the class and whip him. No trouble at all . . . "

Allan chose the same line of work as his father, as a boilermaker and engineer. His boilermaker work took him into powerhouses and other boiler sites in Illinois and Michigan. After obtaining his engineering degree, he worked at Inland Steel in East Chicago, Indiana for 28 years. Allan threw his boundless energy into his work, often working 48 hours at a stretch. One of Allan's co-workers at Inland Steel was David Johnson, whose wife was diagnosed with peritoneal mesothelioma on July 12, 1999.

After his retirement from Inland Steel in December, 1993, Allan remained very active. He continued to work on his house, in his shop and on his his favorite pasttime, his boat, where he and his wife Jackie spent time with his children and grandchildren. He lifted weights five days a week, and ran an average of three miles, three times a week.

In late July of this year, just a month after the death of his son, Allan began to feel unusually run down and short of breath. He found that he was no longer able to run two miles without stopping. He made an appointment with his family physician in Valparaiso. His doctor detected diminished sounds in his lung and admitted him to Porter Memorial Hospital in Valparaiso, where doctors removed 500 cc's of fluid from the right side of his chest. Two days later, they removed an additional 1600 cc's. When the cytology proved inconclusive, the doctors did a 'punch' biopsy, which also proved inconclusive.

On August 6, Dr. Joseph Venditti performed a lung biopsy of the right pleura. The differential diagnosis included mesothelioma. The specimens were sent to pathologist Dr. John Goeliner at the Mayo Clinic in Rochester, Minnesota. On August 23, the Ostlings learned that Dr. Goeliner had diagnosed malignant mesothelioma of the pleura. The next day, Jackie Ostling, as bright and energetic as her husband, contacted this website.

Their oncologist, Dr. Klein, had suggested a chemotherapy and radiation regimen, but he did not discuss surgery as an option. The Ostlings wanted to do as much research as possible before committing to a treatment. We helped the Ostlings contact Dr. Harvey Pass in Detroit, Michigan, Dr. Scott Swanson in Boston, Dr. Perez-Solar in New York City and Dr. Valerie Rusch in New York City. By September 1, Dr. Pass had e-mailed the Ostlings three times with questions and advice. The Ostlings were pleasantly surprised at Dr. Pass' attention and compassion.

The Ostlings' oncologist, Dr. Mary Klein, told them that they would have a 30 day "window" within which to complete consultations and commence treatment; otherwise, all of the tests Allan had undergone would be outdated, and would have to be repeated. The Ostlings set off on a whirlwind consultation tour, meeting with Dr. Pass in Detroit, Dr. Swanson in Boston and Dr. Rusch in New York City -- all within a three-week span. The Ostlings wanted to make sure that their final decision was based on accurate and reliable information. They also wanted to make sure that the surgeon they chose truly cared about the patient's long term care.

The Ostlings ultimately chose Dr. Pass, who told them that he would try to spare the lung by peeling the tumor off the pleura. Dr. Pass' approach appealed to Allan's sensibilities as an engineer. Why remove the entire lung when the tumor was located around the lung, not inside of it? Allan was concerned that if the entire lung was removed, but the tumor eventually spread to the other lung, he would have no backup, no fallback plan. Allan approached the ultimate question with the serenity of an experienced engineer. If I had a tractor that was not functioning because it was covered with a corrosive rust, yet the engine worked fine, he mused, why would I want to pull out the motor? Just remove the rust . . .

On September 29, 1999, less than a week after the Ostlings informed Dr. Pass of their decision to proceed with him, Dr. Pass began surgery. On inspection of the chest cavity, Dr. Pass saw that the tumor was more advanced than indicated by the CT scans: the tumor had invaded the right lung, and the lymph nodes tested positive for tumor activity. Dr. Pass had no choice but to remove the lung. Additionally, Dr. Pass repaired the diaphragm and a portion of the pericardium. He classified Allan as late stage III.

The Ostlings naturally had hoped for the best. In an intellectual sense, they were prepared for the worse, but the reality proved to be far more unpleasant than they imagined. For a complete narrative of Jackie Ostling's story, please click here . Jackie describes her husband's course after the extra-pleural pneumonectomy below:

The next seven days were the most pain I had ever seen my husband experience. The Dilaudid pain medication caused him to "go crazy"; his eyes were rolling, his feet twitching. The Toradol constipated him severely; his abdomen was grossly swollen. He had a lot of pain from lying on the incision on his back. He was finally released from the hospital in a state of exhaustion on October 6, 1999. Before Allan's release, Dr. Pass advised us that the lymph nodes were "all positive" for tumor activity. Both Allan and I understood at the time that this worsened his prognosis.

Allan was back in the hospital on October 13 and 14, 1999. His hematocrit and hemoglobin counts were low. He required transfusion of four pints of blood. He continued to suffer excruciating back pain, probably from the surgical incision by Dr. Pass. Allan found no relief from this pain until last week, after consultation with a pain management specialist. He has had several nerve blockin an attempt to control his pain.

Last Tuesday, November 2, 1999, Allan started to experience discomfort and bloating in the area of his abdomen. Two days later, Allan underwent an ultrasound ordered by Dr. Pass. The ultrasound detected the presence of fluid in the abdomen. That same day, doctors removed approximately three liters of fluid from Allan's abdomen via paracentesis. The results of cytological testing confirmed that Allan's mesothelioma has moved to the peritoneum (his stomach lining).

On Friday, November 5th, we consulted with Karmanos Cancer Institute oncologist Dr. Michael Kraut, who counselled us on our chemotherapy options. He asked that we return November 10th for a CT scan of the chest, abdomen and pelvic area to attempt to find anything that would qualify Allan for the gemcytabine/cisplatin protocol. At this point, radiation cannot be used, as the cancer is apparently "travelling." As Dr. Kraut said, "Where do we radiate?" Dr. Kraut's plan is to do three cycles of chemotherapy, three weeks on, one week off. If all goes well, it should take eleven weeks. This does not include any week where his blood counts would be too low to do chemotherapy. Dr. Kraut felt that we should have future chemotherapy done locally.

Allan looks terrible. He has lost thirty-one (31) pounds, his color is gray, and he has no appetite. His stomach bothers him and he has nausea most of the time.

Because the tumor had invaded his abdominal lining, with the consequent pain, swelling and weight loss, in early November Allan was in no condition to give testimony in his lawsuit against the asbestos manufacturers, and his deposition had to be cancelled. Each day was a trial in itself -- hospital visits, long waits in doctor waiting rooms, searching for pain doctors, faxing medical records, consulting with specialists.

On November 12, Allan had to have another paracentesis, with another three liters of fluid removed from his abdomen.

On November 17, Allan Ostling rallied. He overcame the pain and delirium to testify clearly and powerfully about his exposure to asbestos over the past few decades. He testified to his concerns about whether his medical bills would be covered by his health insurance; he worried about who was going to provide for his grandchildren. He answered the questions as an engineer would, striving for accuracy. He testified patiently. After the deposition, Allan's exhaustion was certainly apparent. He slept for 44 hours straight!

Parenthetically, we hope that the defense lawyers read this. It is the defense lawyer's modus operandi to first file motions to delay or cancel a deposition because they "are not ready." If that doesn't work, and they actually have to meet the patient face to face, they will prolong the deposition, so that the patient will tire to the point that they can then move to strike the deposition on the ground that they did not get a "fair chance" to cross-examine the plaintiff. In this case, Dr. Pass provided a letter asking that the deposition be limited to three hours because of Mr. Ostling's weight loss, constant pain and metastatic disease. Most courts understand that the human rights of the patient-plaintiff must override the patently technocratic objections of asbestos perpetrator's defense lawyers.

The "Big O" is a remarkable blend of strength and gentility, a man who can bend steelworkers to his will and lead them, and enthrall his grandchildren with bedtime stories. He will tell you that the loss of his son hurt far worse than his mesothelioma. We wish him and Jackie the best as they continue their fight with this insidious disease.

*** POSTED NOVEMBER 24, 1999 ***

An Update -- 3/8/00

When this story was posted on November 24, 1999, the outlook for Allan Ostling was grim. His mesothelioma had apparently moved into his abdomen, as evidenced by the build-up of serous abdominal fluid known as ascites. Dark shadows had developed under his eyes and in the hollows of his cheeks. His testimony at his deposition represented a triumph of a steely will. Allan confided beforehand that if it were not for his scheduled testimony, he might have "given up" to the horrible pain.

But Allan Ostling did not give up -- and neither did his doctor, Dr. Harvey Pass of the Karmanos Cancer Institute of Detroit, Michigan. In an eleventh hour bid to stop the cancer's relentless advance, Dr. Pass counseled the Ostlings to try a promising Gemcytabine and Cisplatin chemotherapy protocol pioneered in Australia.

The results were astonishing, and dramatic. The chemotherapy caused the effusions in Allan's abdomen to recede, then disappear (as interpreted from a CT scan). The swelling in Allan's abdomen went away. Within two months, Allan's color had improved, and he regained some of the weight he lost. He recently felt good enough to go to dinner with his wife Jackie, and even had a couple of beers. Yes!

This is not to say that the chemotherapy has been easy for Allan, as a February 25, 2000 note from his wife Jackie attests:

"Well, we reached another milestone. He made it through another cycle of chemo. Next week is an off week where hopefully, he will be able to rebuild some stamina and then one last cycle.

The end is in sight and that's a good feeling!

However, as of this morning he was physically exhausted, cold, dizzy spells and we knew something was wrong. Off for a blood test that showed Hemoglobin 8.9, Hematocrit 27, Platelets 52 and low magnesium. So as of tomorrow he is back to the hospital for 2 units of blood. Maybe that will pick him up so in a week he can finish the last cycle. (It's only been 5 weeks since his last 3 units of blood).

In any case, with an end in sight, he is fairly tolerant of these side issues. Mostly sick and tired of being sick from chemo and tired all the time."

Finally, on March 7, Jackie writes:

"Today started the 1st treatment of the last cycle of chemo. They already warned Allan he may not be able to make it because his white count is so low. Even after transfusions and a week off, it still went down from 4.4 to 3.3. I went over to the health food store and told them I wanted a jar of everything they had that would build up the immune system. Poor Allan - if he sees one more pill, he may give me the boot."

We wish the Ostlings the best in their continued journey for healing, and hope.

Mr. Allan Ostling passed away on April 30, 2000.