Captain Albert Carpenter: Tough Battle for a Brave Naval Officer. Bethesda, MA

After thirty years of faithful service in the United States Navy, Captain Albert Carpenter retired on July 1, 1973. During his thirty years of service, Capt. Carpenter fought in and survived three wars. As a trained soldier, he was prepared for many battles and he learned to never retreat. His military training had instilled in him the discipline to solve problems and calmly face hardships head-on. Unfortunately, three decades of sacrifice and exemplary service could not prepare Capt. Carpenter for an extended battle with mesothelioma.

In September of 1997, at the age of 77, Capt. Carpenter began to feel increasingly tired. He also noticed a slight pain in his chest and progressive shortness of breath. His voice became hoarse and he felt like he was suffocating. Over the next two months, his shortness of breath grew worse.

Albert Carpenter finally went to the emergency room at the National Naval Medical Center in Bethesda, Maryland for treatment of his symptoms. A chest film showed a large left pleural effusion. On November 8, 1997, Capt. Carpenter was admitted to the Naval Medical Center and underwent a thoracentesis which resulted in the removal of 1500 cc's of fluid. The fluid was sent to the pathology lab for cytological testing. The fluid tested positive for mesothelioma. A CT scan of the chest revealed pleural based nodules in his left chest cavity with minimal mediastinal adenopathy (swelling and morbid change in the lymph nodes).

Capt. Carpenter was then referred to a cardiothoracic surgeon for a biopsy. On November 21, 1997, Dr. John S. Thurber performed a left chest thoracoscopy with pleural nodule biopsy and a talc pleurodesis (a procedure in which sterile talc is introduced into the chest to produce adhesions to prevent pneumothorax [the collection of air or gas] and effusions). Dr. Thurber saw multiple nodules on the visceral and parietal pleura and also on the left hemidiaphragm. The nodules were diffuse and widespread throughout the left chest. Dr. Thurber also found a large amount of bloody serosanguineous fluid (containing serum and blood) which he suctioned and sent to cytology and microbiology for examination. The pathologists examined the biopsy tissue and diagnosed malignant pleural mesothelioma, epithelial subtype.

To conclude the surgery, the doctors suctioned off Capt. Carpenter's chest and inserted a talc slurry poudrage (application of an irritating, but otherwise nontoxic, powder to the pleural space of the lung in order to produce pleural adhesions). About five grams of talc were insufflated into Capt. Carpenter's chest.

The tissue and the evacuated fluid were then evaluated and the pathologists at the Armed Forces Institute in Bethesda confirmed the diagnosis of malignant pleural mesothelioma. Capt. Carpenter was discharged on the sixth post-operative day and referred to oncology services for evaluation and future treatment options.

The doctors classified Capt. Carpenter's tumor at Stage II. They did not recommend radiation therapy or any surgical options, such as a radical pneumonectomy. Capt. Carpenter decided to undergo experimental treatments at the Lombardi Cancer Clinic in Washington, D.C. These treatments included Gemzar (gemcitabine HCL) and Taxotere. He was later enrolled in a clinical program using CPT 11.

The doctors at Lombardi were very straightforward with the Carpenters. The Carpenters understood that there was no magic cure. Chemotherapy drugs, although state of the art, were experimental. They also understood that the natural course for untreated mesothelioma patients was dismal. By this time, Capt. Carpenter had lost nearly thirty-five (35) pounds from his six-foot three-inch frame. He now weighed a slight 145 pounds. When Capt. Carpenter was released home, he rigorously complied with his chemotherapy treatment schedule for five weeks. A CT scan taken on February 9, 1998 showed that the tumor had increased in size around the lung and there was a pulmonary embolism (obstruction of the pulmonary artery) in the right pulmonary artery. Capt. Carpenter returned to the Naval Hospital in Bethesda where he was treated for the embolism.

On March 17, 1998, Capt. Carpenter began experimental chemotherapy using CPT 11. Prior to administering the chemotherapy, Capt. Carpenter had extensive testing to evaluate the condition of his kidneys and bladder, which were found to be healthy. At the Naval Hospital, Capt. Carpenter began an infusion regimen which involved the insertion of a port near his clavicle. He wore a cassette containing the CPT 11 around his waist which was connected by an IV line to the port. The CPT 11 was slowly infused over a twenty-four (24) hour period. Every day, Monday through Friday, Capt. Carpenter went to the Naval Hospital to have the cassette refilled.

One month after beginning the CPT 11 chemotherapy, a CT scan was taken which showed that the tumors were neither smaller nor larger. Unfortunately, six weeks later another CT scan showed that the tumors had indeed grown and that the tumor or "rind", as it was described, had completely encased the left lung and large airway. The doctors at the Naval Hospital recommended the termination of the CPT 11 regimen. At that time, Capt. Carpenter was having difficulty breathing. The doctors recommended two (2) weeks of radiation therapy in hopes of reducing the tumor and enhancing Capt. Carpenter's breathing. The Carpenters agreed. Capt. Carpenter received twelve (12) treatments of radiation therapy which helped his breathing.

A short time later, in late May early June of 1998, Capt. Carpenter learned of another experimental treatment that was being offered at the National Cancer Institute. The treatment was to be Taxol by infusion cassette and PSC 8-33 by pill. He scheduled an evaluation on August 22, 1998. Unfortunately, Capt. Carpenter passed away on August 20, 1998, just days prior to his appointment.

Throughout Capt. Carpenter's illness he attempted to maintain his daily routine, just as he did when he was in the Navy. Each morning he arose at 5:00 a.m., ate breakfast, read the paper and attended to personal and business matters. He ate lunch at noon, and filled his afternoons with exercise, doctors appointments, reading and/or gardening as time and weather allowed. Before his illness, Capt. Carpenter often performed volunteer work in the afternoon. Dinner was promptly at 7:00 p.m., followed by social activities or quiet time with Renee. He would retire each evening at 10:30 p.m. Capt. Carpenter followed this rigid schedule until the day before he passed away.

His widow, Renee Carpenter, is deeply proud of the way her husband marshaled all of his resources to fight for his life. Renee states, "My husband was, I thought, incredibly brave in the way he faced his illness. He never complained, he never gave up hope, and he fought to the end."

Capt. Carpenter served his country in the Navy from 1943 to 1973. As an experienced soldier he fought many battles, but the toughest one may have been his battle with malignant mesothelioma. According to Renee, in his final days, Albert's main concern was for the welfare of his wife and children. This is not surprising, as his entire life was dedicated to serving others. He always put his country and family first.

** POSTED OCTOBER 15, 1998 **