Before August of 2018, Raegena Boggs had spent no time in a hospital other than brief stints for the births of her four children.
Then a bacterial brew burst the bounds of her gut, entered her bloodstream and infected her liver. Boggs, 62, went into sepsis, a massive inflammatory response to the infection. She was on IV antibiotics for weeks, shuttling between the hospital and her home in Highlands Ranch.
The infection eventually cleared and Boggs thought she, too, was in the clear. Then, another shock. The infectious disease specialist who treated her sepsis examined CT scans taken periodically during her illness and saw suspicious nodes in Boggs’ abdominal cavity. He set up a biopsy in late September that revealed she had peritoneal mesothelioma: the lining of her abdominal cavity was riddled with cancerous tumors.
There had been no time to prepare for the news, Boggs said. She’d never noticed a symptom of the cancer.
“I thought I was done with treatment,” she recalled. “The liver infection was cleared up.”
The shock rippled through her family.
“She was fine one day and the next day we thought she was dying,” says daughter Shelbi, 20, a pre-med junior at the University of Colorado-Boulder, who along with her father, Paul, is her Raegena’s primary caregiver.
“I’m basically a nurse,” Shelbi said. In the course of her mother’s septic struggle, she learned to flush PICC lines and administer intravenous treatments, in addition to assisting Raegena with everyday needs like showering, cooking and driving. She did all she could to lighten the load on Paul, who holds a demanding work schedule in addition to supporting Raegena at home.
Meanwhile, Shelbi juggled a rigorous academic schedule. The cancer diagnosis meant Shelbi would shoulder an even greater share of the burden that disease placed on Raegena and Paul.
More on that later. What neither mother nor daughter knew that September was that the cancer diagnosis was just the next phase of a longer struggle. Obstacles lay ahead that tested their wills. But just as seeds sprout from fire-ravaged soil, Raegena and Shelbi endured the physical and emotional devastation of disease and emerged more tightly connected than ever and with renewed purpose.
Surgery, part one
The next chapter of their story opened in early November at UCHealth University of Colorado Hospital on the Anschutz Medical Campus. Dr. Steven Ahrendt, an abdominal cancer surgery specialist with the Department of Surgery at the University of Colorado School of Medicine and director of CU’s rapidly growing Cytoreductive Surgery/HIPEC Program, performed a lengthy, two-part procedure aimed at ridding the cancer scourge from Boggs’ abdominal cavity.
In the cytoreductive surgical portion, which stretched across roughly 10 hours, Ahrendt painstakingly removed all the tumors he could find from the lining of her abdomen. He also took out her gallbladder, appendix and a portion of the large intestine called the sigmoid colon that was twisted and inflamed.
After finishing the surgery, Ahrendt used HIPEC (hypothermic intraperitoneal chemotherapy) to destroy malignant cells that may have escaped the surgery. In HIPEC, the surgical team pumps about 2 liters of chemotherapy drugs through a heat exchanger that raises their temperature to 41 to 42 degrees Celsius (106 to 108 degrees Fahrenheit). The drugs penetrate 1 to 2 millimeters into the tissue and circulate for 90 to 120 minutes. The increased temperature raises the cancer-killing effectiveness of the drugs, Ahrendt said.
“HIPEC provides control of specks of cancer that might be left behind,” Ahrendt said. “But the key part of the surgery is getting the tumors out. HIPEC is an added procedure on top of that.”
Surgery, part two
With the lengthy surgery completed, Boggs rolled off to the intensive care unit, where the considerable stress she already faced increased. The second day after surgery, Boggs’ right side weakened; three fingers of her right hand dangled, unable to move so much as to pick up a tissue. Another round of CT scans showed that her left carotid artery, which feeds the brain, was 90 percent blocked. That had caused a stroke. Further tests showed she had also suffered a mild heart attack.
The stroke and the severity of the blockage meant that yet another surgery – and soon – was mandatory, said Dr. Max Wohlauer, a vascular surgeon at UCH.
“If a patient is having symptoms and the artery is more than 50 percent narrowed, the risk of stroke in the next two years is greater than one in four,” Wohlauer said. Boggs had escaped permanent damage from the episode in ICU, he added, but the odds of being so fortunate again were unacceptably high.
The situation led to difficult discussions, Wohlauer said. “Raegena was mentally ready to do the abdominal operation and recover from it,” he said. “Now I’m walking in telling her that she needs another surgery. I told her, ‘I’m doing this to reduce the risk of stroke. The one you had in the hospital you completely recovered from. The next one could be life-altering and disabling.’”
About a month later, Boggs was in a pre-operative space at UCH, terrified by the surgery that lay ahead. Wohlauer needed to make an incision on the left side of her neck, enter the carotid artery, and scrape away the fatty plaque that clogged it.
The surgery was successful. Boggs spent only one night in the hospital. When she returned a month later for a post-operative exam, ultrasound imaging showed there was no longer narrowing of the artery, Wohlauer said.
A powerful bond
As much as she appreciates Wohlauer’s surgical skill, Boggs remains strongly stirred by his presence before he made a single incision. As she waited for the surgery, he approached her and devoted time to prepared her for what lay ahead.
“Dr. Wohlauer held my hand in pre-op for five to seven minutes, talking to me calmly in a quiet, soothing voice,” Boggs recalled. “I thought, ‘Oh, my God, this guy is amazing.’”
The connection deepened in a different way after the surgery. One day during her winter break from CU, Shelbi accompanied Raegena to her vascular check-up with Wohlauer. He gave Shelbi his card, and three weeks later, when she was back to school, she emailed him to ask about potential “learning opportunities” – a request he quickly filled. In early March, Shelbi shadowed Wohlauer, joining him and his team in the OR for a vascular surgery and accompanying him to an appointment with a patient. Three weeks later, she was in the OR again, watching Wohlauer enter and clear the carotid artery of a patient, just as he had done with her mother.
The experience has provided Shelbi a much-needed spur to stick with academically challenging coursework that is complicated by helping to care for Raegena, whose chemotherapy drained her energy, produced painful mouth blisters and wrecked her appetite.
She is also still recovering from the pain of the abdominal cancer surgery, which is made more difficult by isolation. Raegena cannot work and spends hours in her bedroom alone while Paul and Shelbi are away.
“Being scared and knowing that you have a rare cancer is a tough one – and so is being encased in your home while you are that sick,” Raegena said. “The anxiety and depression, I sometimes think, is worse than the surgery itself.”
When loneliness threatens to overwhelm her mother, Shelbi sets aside her school work and the sutures she’s taught herself to sew since watching Wohlauer in the OR in favor of simple companionship.
“I sometimes have to come in and say, ‘You’re getting in the car. You have to get in the car with me to drive or sit in a restaurant, something to get out,’” Shelbi said.
She admits the responsibilities of caregiving and school sometimes conflict. She’s had to miss more classes than she’d like, which creates more pressure than ever to do well on tests. But her time at the hospital with Wohlauer has been a boon, she added.
“It’s nice to see a physician who loves what he is doing,” Shelbi said. “That is really inspirational and makes me want to work harder.”
For his part, Wohlauer, who regularly extends shadowing opportunities to med school students, sees in Shelbi the right stuff for a career in medicine.
“She’s a go-getter,” he said. “She’s smart and compassionate. She is also very mature and understands health and sickness on multiple levels, through her coursework and taking care of her mom. She’s very close to [Raegena] and has been instrumental in her recovery.”
Raegena now looks forward to regaining the appetite and physical stamina ravaged by her disease, surgeries and chemotherapy.
“Once I get a grip on this whole thing and get better, I’ll be able to exercise and go to the rec center and get out of my home,” Raegena said. Pending the outcome of scans to show the effectiveness of her chemotherapy, she said she plans to join the University of Colorado Cancer Center’s BFitBWell program, which provides exercise regimens for patients going through cancer treatment and those who have recently completed treatment.
She’s leaned heavily on Shelbi to make that happen, but Raegena said her daughter is just doing what comes naturally. Shelbi is an accomplished competitive figure skater who also dedicated her skills to coaching Colorado Special Olympics skaters at the University of Denver.
“She spent hundreds of hours every year in the program,” Raegena said. “She dearly loved the kids, and the adults she coached as well.”
That’s the way circles close, said Shelbi, who entered the world three weeks prematurely when Raegena was 42. Shelbi spent the first three weeks of her life in a neonatal ICU, her life threatened by respiratory syncytial virus (RSV). She knows she couldn’t have made it out on her own.
“I wanted to go into medicine because I wanted to give back to the people who kept me alive,” Shelbi said as Raegena looked on with pride. “I wanted to give back to the babies that are sick and wanted to do neonatal.”
She paused. “Watching Dr. Wohlauer has made me like vascular surgery.”