The END of our story...

I wanted to tell our story...well, I guess it's really my story because Jeff isn't here to tell it himself or at least contribute. I guess it is unusual to begin a story with the end, but it's important to know that Jeff died August 14, 1989 after a long hard fight...this fight is central to our story.

We knew he was fighting for years but didn't know he was fighting cancer until the autopsy...

Final Pathological Diagnosis:
I. Leptomeningeal malignant melanoma with extensive infiltration of subarachnoid space with perivascular infiltration and direct penetration into brain parenchyma...
A. Post operative status: 1) Right temporal lobectomy, January 1985 (85-MS-1654), 2) Additional resection right temporal lobe, August 1985 (85-MS-20848), 3) Additional resection of hippocampus, April 1989 (89-MS-11041)
B. Acute and chromic leptomeningitis
C. Granular ependymitis
D. Massive cerebral edema
II. Evidence of aspiration pneumonia with secondary endobronchial organization, bilateral
III. Organizing interstitial pneumonitis, mild to moderate, right upper and middle lobes of lung
IV. Atelectastis of left lung with massive left pleural effusion (2000 ml) (history of CSF shunt to left pleural cavity)

Cause of Death:
A. Leptomeningeal malignant melanoma
B. Massive cerebral edema
C. Aspiration pneumonia


Dr. Allen Wyler's comments/history...
This is a 34 year old white male admitted to Baptist Memorial Hospital on June 5 1989. He had a history of seizures following trauma in 1980. In April 1989, he had a right temporal lobectomy for seizure focus. Postoperatively he had severe headaches, nausea and vomiting. He was admitted for problems of poor oral intake, poor hygiene, inability to walk and generalized failure to thrive.

Upon admission, he had a sudden onset of respiratory distress. he was febrile and blood gasses showed a p02 in the 40's. Intubation was performed. A CT scan of the head showed marked communicating hydrocephalus.

He was extubated June 8, and was more responsive but became incoherent on June 10, with increased respiratory distress. Blood gases showed 17.5%methemoglobinemia. He was treated with methylene blue with limited response. A red blood cell exchange was performed June 11.

Following the red blood cell exchange, he had some clinical improvement, but then developed increased rales and rhonchi with worsening respiratory distress which required intubation again on June 12. A ventriculostomy was placed June 12, and then converted to a VP shunt June 14. 

On June 15 he was extubated and clinically improving until June 19 when he became unresponsive. He had decreased oxygen saturation and a right lower love pneumonitis. this was presumed to be due to aspiration, therefore, a tracheostomy was placed June 19. On June 20 he was noted to be responsive and improving.

On July 16, CT scan showed stable ventricular size. On July 20 he had partial proximal obstruction of his shunt. The shunt was revised on July 21 and noted to be clotted with protein. The shunt clotted again and required revision on July 27 (a ventriculo-pleural shunt was placed because of poor absorption in the peritoneal cavity). The shunt removed on July 27 grew Staphylococcus, so he was begun on intrathecal Vancomycin. On August 3, the shunt was externalized until the infection cleared.

On August 6 he was noted to be less responsive with decreased drainage from the ventriculostomy. The ventriculostome was replaced on August 6. On August 7 he was noted to have a generalized seizure.

On August 7 there was noted a definite change in his neurological status in spite of a functioning shunt. His pupils were non-reactive. He had no grits's on the right. Babinski was positive. On August 11 his pupils were fixed and dialated. A CT on August 12 demonstrated hydrocephalus and an abnormality in the right temporal lobe medially.

On August 14 the ventriculostomy became non-functioning. A cT scan was compatible with massive cerebral hemispheric infarcts with obliteration of the left lateral ventricle. Carbon dioxide flow studies were consistent with brain death.

The ventilator was disconnected at 9:02 pm on August 14. The heart stopped and he was pronounced dead at 9:32pm.


The rest of Dr Wyler's comments are technical descriptions of the autopsy & their findings. "Microscopically, the findings were significant for the discovery of leptomeningeal malignant melanoma.....Criteria for the diagnosis of melanoma of the central nervous system have been controversial, but the currently accepted criteria include 1) the absence of a primary tumor anywhere in the body, and 2) the presence of a diffuse melanoblastic infiltration of the soft membranes."

I remember being told in lay terms that the cancer was in the "lining of his brain."

Jeff was 34 when he was admitted. He had his last Father's Day & his 35th birthday in the hospital that he would not walk out of.  He left me, a young 34 year old widow & five beautiful children; Ben who turned 11 while his dad was in the hospital, Jill 9, Cindi 7, Terri 4, & Ty was 2.