Melissa McCutcheon was diagnosed with cervical cancer in 2002 after she had gone almost five years without a Pap smear in an effort to save money. The cancer, which has a high cure rate when caught early, was advanced at the time of discovery, and McCutcheon had been bedridden for most of the past four years.
In a last-gasp effort to fight off the disease, she had a hemicorporectomy in late March at the University of Alabama at Birmingham (UAB) medical center. The procedure involves amputation of the lower half of the body, including removal of the legs, genitals, pelvic bones, urinary system, rectum, and base of the spine.
McCutcheon, who lived in Lacey's Spring near Huntsville, never recovered from the radical surgery and died last Tuesday morning in a UAB intensive-care unit.
McCutcheon worked as an administrative manager for Lowe's before being disabled from her disease. After she was unable to withstand more radiation or chemotherapy, she proposed the hemicorporectomy to her oncologist.
The surgery was developed in the 1950s, based on advances from treating battlefield injuries in World War II. Only about 45 people worldwide have had the surgery since it was first performed successfully in 1961.
One online article describes hemicorporectomy as "probably the most mutilating operation ever to be described in surgical literature." The article outlines the possible complications from the procedure:
Hemicorporectomy results in a reduction of body weight by about 50%. The reduction in total vascular area reduces the ability to compensate for changes in circulating blood volume. Small losses may produce shock and intravenous transfusions can easily produce pulmonary oedema. The loss of normal abdominal wall function results in a reduction of lung vital capacity and functional residual capacity and a ventilation-perfusion mismatch with tidal volume diverted more to the lung apices.
News accounts of the McCutcheon story have focused on the human-interest angle. Numerous ethical, procedural, philosophical, and financial questions have gone unanswered. For example:
* Who at UAB made the decision to proceed with the surgery?
* Did any oversight body review the decision?
* Who were the doctors that made up the surgical team?
* How much did the procedure, and postoperative care, cost?
* Did McCutcheon's insurance cover the entire cost? If not, who covered the rest?
* Did UAB stand to benefit from performing the procedure, from publicity and perhaps opportunities to publish articles in medical journals?
Perhaps the biggest question is this: Was performing a hemicorporectomy on Melissa McCutcheon a wise use of our health-care dollars? And are decisions to go forward with high-risk/low-reward procedures one reason America's health-care system leaves so many citizens with no coverage at all?
How did our system work in the McCutcheon case? It provided a radical surgery at the end stage of her disease, when the chances of success were slim. But it failed in providing the simple, inexpensive test that probably would have helped cure the disease early on.
As for McCutcheon herself, it appears that she was a good-hearted, well-intentioned person who simply wanted to live in order to help raise her two teenage daughters. She was not the type to think only of herself, and she clearly thought about the bigger world around her.
Most cases of cervical cancer are caused by the human papillomavirus (HPV), which can be transmitted during sex. In a 2006 interview with the Decatur Daily, McCutcheon said she contracted HPV from a sexual encounter in her youth, and she became committed to helping girls learn from her experience:
Her face beams with joy, knowing she has outlived the few remaining days that doctors gave her in February 2005 and that she's using her time to help other girls avoid her mistakes. "I had no idea you could get cancer from a virus," McCutcheon said of human papillomavirus. "And if I would have gone to the doctors years earlier, we would have caught it, and it wouldn't have been a big problem." McCutcheon's big problem briefly describes about four years of repeated surgeries, radiation and chemotherapy treatments that resulted in a radical hysterectomy, removal of most of her colon and bladder, the loss of a kidney, and nerve damage that has left her unable to walk. A month after she lost 27 units of blood in January 2005, doctors gave her three days to live.
McCutcheon tried to use her remaining days wisely:
Though understandably scared, McCutcheon wasn't ready to give up hope. "That's when I decided if I'm going to stay, I need to be effective. There needs to be a reason why I'm here," McCutcheon said. "I asked God to at least let me be here till my youngest graduates high school." Her daughters, ages, 11 and 12, need her to stay active in their lives, she said, so they don't fall into the same lifestyle McCutcheon grew up in the small community of Woodville, between Huntsville and Scottsboro. The town offered teens little to do but get in trouble, she said, and sex was viewed as an easy diversion. Until she became a Christian in her mid-20s, she said, she, like all her friends, followed the view, "If you have a relationship, you have sex." And she added that she waited longer than most of her friends, losing her virginity as a high school senior. "The average age for most of my friends was 12 to 14," McCutcheon said. That's the age range of girls she wants to warn about the dangers of premarital sex, as well as the need to get vaccinated against HPV. "There's still going to be consequences. Maybe not a disease or pregnancy, but emotional ones," she said. Aided by a computer slide show, McCutcheon has spoken to girls at her church, Brindley Mountain Baptist, as well as a church in Hampton Cove. She tells them postponing sex till marriage is worth it so they'll have something special to share with their husbands for the first time. "You've probably already told someone that you love them or kissed them or gone to second base with them," she said. "You really want to have something that's special just between you and your husband." Her pastor, the Rev. Ken Galyean, said he was amazed at her effectiveness. "My daughter said it was the most holy time she had ever spent, and she just sensed the presence of God in a sweet and powerful way as Melissa humbly shared in open honesty of how she got cervical cancer from a promiscuous lifestyle."