Dr. Veronica Schimp minced few words in outlining chemotherapy treatments to Florida International softball coach Beth Torina and her mother, Betty Dieter, during a meeting in December 2009.
Wedged against Betty’s spinal column, a four-inch tumor impinged on a vessel branched to her left kidney. Sixty other lymph nodes in her abdominal cavity were affected by malignant cancer cells.
Schimp, the chief surgeon in the gynecological oncology department at Orlando’s MD Anderson Cancer Center, rendered a verdict of ovarian cancer.
Copious research left Beth convinced a relatively new treatment was prime for her then-60-year-old mother. Steely and frank, Beth’s directness is routine, but Betty’s illness catalyzed it into a sturdy presence after moving part-time back into her parents’ one-story house during a rare monthlong break in her schedule.
While her mother awaited surgery, the only child adopted traits more accustomed to the dirt infield scene at LSU’s Tiger Park than the one-story brown house on Hidden Beach Circle. It emerged in small gestures, like buying a talking bear for her mother to clutch as her tumors shrank. And in grand schemes, like a surprise luau in the middle of an FIU road trip.
And the help of a daughter using the tools and the approach of a coach may have properly girded Betty for a year’s worth of treatment once outlined unsparingly. And it has produced a three-year remission and is the genesis for LSU donning teal uniforms in select games to raise awareness of ovarian cancer.
“I’m going to put you in a chair but make you run a 5K that you didn’t prepare for,” Schimp said. “You’re going to think, ‘I’m not ready to run.’ ”
‘What does that mean?’
The starting line was pain near the small of Betty’s back, the kind of knot left after a day of hefting heavy boxes. For a week, it lingered in November 2009. Go see a doctor, chided Stephen Dieter, Betty’s husband.
So the music teacher with three-plus decades in elementary education made an appointment with her internist, Cythina Powell. Two days after a CT scan, Betty snagged a ringing phone on a foreboding date: Friday the 13th.
A cryptic Powell spoke on the other end of the line.
“She just kept saying that she wanted to see me early the next week,” Betty said. “I kept asking, ‘Why don’t you just go ahead and tell me?’ ”
After hanging up, Betty rang her daughter in Miami.
On the FIU campus, the former University of Florida pitcher was only in her third season at a program with a roughly $520,000 budget. Betty called worried from a 230-mile drive four hours north on the Florida Turnpike.
Three days later, Steve and Betty settled into an exam room and were left walloped by Powell.
“Your CT showed lymph nodes on the scan,” Powell said.
“What does that mean?” Betty asked.
“You most likely have cancer,” Powell said.
To reach an ultimate conclusion, Powell ordered a PET scan, where a radioactive tracer is administered via IV and collects to allow radiologists to take another CT scan read by a doctor on the screen. In this case, Schimp, whom Betty admits she chose almost randomly, laid her eyes on results later affirmed by surgery.
“She had it on the surface of her ovaries, the surface of her uterus and the surface of her ovaries,” Schimp said. “She had the most common kind of ovarian cancer.”
‘Don’t wait. Get in there.’
On the fourth floor of the Orlando Regional Medical Center, Schimp laid out her seemingly grisly solution.
“I’m just going to open you up,” Schimp told Betty. “We’ve got to get in there in and move things around. I’ve got to pull out anything you don’t need.”
Not even hearing the prospect of Schimp taking a peek under her small intestine left Betty shuddering.
“Just take out anything you don’t need,” Betty told Schimp. “Anything you don’t think needs to be there, get rid of it.”
As for Beth’s reaction, it was tinged with the same vein of immediacy expressed by Schimp.
“Don’t wait,” Beth said. “Get in there. Get it taken care of.”
Any form of cancer is dreaded, but ovarian cancer is among the worst and ranks as the fourth-highest cause of death in women. This year alone, the National Cancer Institute estimates roughly 26,000 women — many in their 50s and 60s and beyond menopause — will be diagnosed, and roughly 15,000 will die at the hands of a cancer whose cause isn’t known.
Unlike breast cancer, the most common cancer in women, ovarian cancer doesn’t have a consistent screening tool such as a mammogram. For example, a pap smear is only effective 10 percent of the time. For Betty, it meant she fit the profile and was saddled with the macabre reality of her cancer potentially growing undetected for up to year.
Never keen on ticking off grim statistics and metrics, Schimp succinctly stated Betty’s chances at surviving.
“There’s only about a 40-percent chance you’ll still be here in five years,” Schimp said.
‘Get yourself ready’
The calendar granted Beth an opportune window, though, to lean her full weight into tilting statistics in Betty’s favor.
On Dec. 12, 2009, roughly a month after Betty’s first doctor visit, classes dismissed at FIU for winter break. The Golden Panthers, who were coming off a 31-29 season in 2009, left campus. On the recruiting front, it was a quiet period.
“It’s one of those rare down times,” Beth said. “Camps and clinics are the main thing, and those are a little bit more extracurricular for us. It’s not really a requirement.”
Around Thanksgiving, Beth assembled a crack crew to handle holiday affairs around the house that backs up to Lake Crane with a familiar Sunshine State symbol of palm trees in the front yard.
First, there was Nick Torina, her future husband, a former pitcher at Houston and later an analyst on college baseball broadcasts. In tow, too, was assistant coach Lindsay Leftwich, who followed Torina from FIU to LSU.
They cooked, they cleaned and they took Betty shopping on Black Friday before loading up in the car on Sunday for a return to Miami.
Only Beth dropped her bags and stayed.
“It’s the same room I had as a kid,” Beth said. “They always try to get me out of the house, but I always leave a lot of stuff there.”
Up and until her surgery and first round of chemotherapy in January 2010, Betty still taught at Bay Meadow Elementary School, located on a strip of land between Big Sand Lake and Lake Sheen, to children in kindergarten up to fifth grade.
Over the course of four hours, Schimp extracted Betty’s uterus, cervix, fallopian tubes and ovaries.
“I shouldn’t have any little nodules anywhere,” Schimp said.
Ideally, any tumors left behind are residual, measuring less than half an inch.
Ahead of the procedure, though, Betty presumed her day-to-day routine would remain normal. At Bay Meadow, where she has taught since 1989, she allayed fear by telling her students, “I’m going to get this surgery, and then I’ll be back.” The promise was amended after Betty learned her details of chemotherapy.
“I had to line up someone else to take over for me,” Betty said. “Everybody said, ‘Leave now; get yourself ready.’ ”
Swelling in her lymph nodes worsened the pain, but not enough to prevent Betty from running around Orlando for last-minute Christmas shopping.
‘We had an opportunity’
If Beth disavowed researching the cancer dotting her mother’s body, she found a familiar routine in which to direct her energy.
“I did it one time,” Beth said of researching the cancer. “It was really bad, so I just never did it again.”
Instead, she researched treatment options, which had been laid out by Schimp in meetings with Beth, Betty, Steve and Bob Ludwig, Betty’s brother who flew in from his teaching position at the University of California Santa Cruz.
Schimp presented three choices, but Beth was dead set on one: IP chemo plus Avastin, a drug that slows the growth of cancerous blood cells, as part of a clinical trial for study by the Gynecological Oncology Group.
“They were very interested because we had an opportunity to offer something that couldn’t be offered off label,” Schimp said.
In 2006, a study led by Deborah Armstrong from Johns Hopkins University showed IP chemo had a median survival rate of a little more than five years, while IV chemo produced only a median survival period of four years.
Yet the dosage of the drugs, which bind to the DNA of cancerous cells and prevent replication, are absorbed more slowly and require an amount 15 to 20 times greater than IV chemotherapy. The dose of drugs leads to nausea, vomiting, hair loss and vomiting along with low white blood cell counts in bone marrow.
Second, IP produces more discomfort. The drugs are dissolved in a liter of saline before being infused into the flexible tube, followed by another liter to wash them over tissues. After the infusion, patients switch positions every 15 minutes over two hours to distribute the drugs, but the process can lead to bloating. In several studies, less than 40 percent of patients made it past four of six cycles before switching to IV therapy.
Adamant this treatment course was best, Beth pushed for her mother to enroll in the clinical trial. A drawback existed, though: Patients were randomly distributed into different treatment groups, meaning Betty couldn’t simply ask to receive the course of IP and Avastin — the second arm or group of the study — her daughter coveted.
“I pretty much fought these people the whole way,” Beth said. “I told them, ‘We’re getting Arm 2, or I don’t know if we’re doing this clinical trial.’ I fought the randomness of it.”
A talking bear hints at the softer facet of her approach to bolstering Betty.
Fundamentally, Torina coached. She identified a problem, sought a solution and advocated for its implementation. But until Betty called and told her daughter she had, in fact, been selected for the second arm of a clinical trial, Beth’s stock of options to help centered around fostering normalcy.
“You just try to find things to take her mind off of it,” Beth said. “It’s like with anything. We try to have our normal conversations and talk about anything other than her cancer.”
It’s why at Christmas, when Betty’s throbbing back prevented her from decorating the house, Beth went and bought a real tree from a lot. Next came a trip to pick up decorations. While Betty kept on teaching, Beth tacked them up around the house and plucked her mother’s favorite ornaments to adorn the tree.
On the day of her mother’s surgery, Beth was due to speak at a clinic. Arriving late, she heard from Schimp the surgery unfolded smoothly. Over the next week, she and Steve swapped nights sleeping in her hospital room to monitor her progress.
And ahead of chemotherapy, Beth bought her mother a bear that softly uttered “I love you” to carry into her treatments on Mondays, along with another bear adorned in surgical garb given to her by Bay Meadow teachers, and a lei Steve sent back from Hawaii — Betty’s favorite place on earth.
“I was trying to motivate her and keep her positive,” Beth said. “You do that each day. You encourage, and you motivate.”
Even in the first grade, before Betty signed her up for Little League, Beth directed potential energy into kinetic energy. If a teacher handed out an assignment, she’d stroll over to Beth’s group to find the pupil had organized them and doled out tasks.
“That’s just her personality,” Betty said. “She’s just a person that sort of figures things out and everybody else goes along.”
‘She definitely got me’
By April 2010, Betty closed in on the end of chemotherapy, with a string of sessions during which Steve would work on his iPad and wake her every 15 minutes to have her change positions.
Since her mother’s first session that January, as FIU’s season unfolded, a year in which the Golden Panthers notched their first victory in the NCAA tournament, it had been hard for Beth to visit. A month remained in her IP treatments, but Betty’s birthday, which fell on April 22, loomed.
From Miami, Beth hatched a plot, roping in one of Betty’s friends to get her out of the house for an afternoon of shopping. While they perused racks at their favorite clothing stores, Beth and the Golden Panthers arranged a luau at her childhood home.
They hid the bus in a parking lot up the street and crowded into the living room. Betty opened the door to find the vacation to Hawaii she demanded from Bob waiting for her.
“She definitely got me,” Betty said. “It’s the best surprise you can imagine.”