At 18, life is pretty predictable. Embracing your last year in high school, applying to colleges, planning for the prom and preparing to walk at graduation.
It’s a different world for Carissa Outen.
The North Central High School senior is coming to terms with her second battle with cancer, struggling with exhaustion from the disease and scheduling school around chemotherapy and doctor appointments.
With 83 days left to graduation, Carissa is racing against time until the chemotherapy saps her strength, but she desperately wants to finish her senior year as normally as her classmates.
“We’re trying to take this one thing at a time,” Carissa said.
“There is never a good time for cancer, but this is pretty poor timing,” said her mother, Gwen Ashcraft. “I told her that we will take hands and work through this.” Carissa was diagnosed in July 2008 with follicular lymphoma – extremely rare for those younger than 19 – after she’d gone to see a doctor about a swollen elbow.
Doctors decided to treat the cancer with chemotherapy. The cells disappeared after six months, and she was told to expect the cancer to be in remission for at least seven years.
But on Feb. 19, doctors told Carissa and her family the cancer was back. It showed up in a mass of lymph nodes near her stomach. It’s stage four, the most severe, because it returned so quickly, doctors said. “Truly looking back (at the first diagnosis), it was almost surreal,” a tearful Ashcraft said during an interview where she was joined by two North Central teachers and a counselor to talk about Carissa’s journey with cancer.
Teacher Joanne Candelaria added: “It was world-crashing when we got the phone call.”
When the teen’s supporters learned the news the cancer had reappeared, “We are all angry and hostile,” said Joey Morton, a North Central teacher.
Yet, “There has never been any thought of her dying through all of this,” Carissa’s mother said. “Is it a reality? Yes. Will we accept it? No. Will Carissa? Absolutely not.”
‘I don’t know weak’
Carissa has already proved she’s tougher than cancer and stronger than chemotherapy.
She says her perseverance comes from having been raised by a single mother and watching her older sisters, Heather Maynard and Britnee Outen, go through their own struggles.
“I don’t know weak,” Carissa said.
The day the teen first learned she had cancer she was at Sacred Heart Children’s Hospital, where she’d been through a battery of tests to uncover why she was sick.
Dr. Angela Torbaugh-Lotrario, a pediatric oncologist, gave Carissa the diagnosis and said she wanted to do more tests before sending her home that day.
Carissa looked at her watch and asked the doctor: “Will I be done in time to go to work? I have to work tonight.” The shocked doctor repeated the bad news, and Carissa said: “I know. Do I need to call work and let them know I’ll be late?”
That attitude has stayed with Carissa, her oncologist said.
“She doesn’t seem to let anything slow her down,” Torbaugh-Lotrario said.
Follicular lymphoma attacks lymph nodes and tends to grow in a circular pattern. While it is common in men 60 to 80 years old, it’s rare in women and extremely rare in the young. There are only 100 known cases worldwide among young people, according to two recently released medical reviews. Carissa’s case is being studied by oncologists at Seattle Cancer Care Alliance, a treatment center that’s a collaboration of Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Children’s Hospital.
Despite suffering the debilitating side effects of chemotherapy that summer, Carissa went to marching band camp. She kept her job and returned to high school in late August 2008.
Medical professionals at Sacred Heart said it was unusual for a cancer patient to attend school during treatment. A nurse went to North Central and spoke to students and staff about the disease and Carissa’s needs, including being as germ-free as possible.
The teen, who has dreamed of going to Gonzaga University since fourth grade, stayed in her Advanced Placement classes and maintained a grade-point average between 3.2 and 3.4.
Probably the hardest part for Carissa, emotionally, was when she lost her hair, her mother said. The teen’s response to the situation: She shaved her head.
“I got more compliments with my head bald than when I had hair,” Carissa said.
Still, she admits she faced some challenges.
Physically, “I had no oomph to do anything,” she said.
The treatments also made her memory spotty, which she called “chemo brain,” forcing her to record class lectures and relearn information she’d once mastered. “She did it with grace, and the kind of strength I’ve not even seen from an adult,” said Morton, the North Central business and marketing teacher.
“She is the strongest person I know,” said friend Ciara Mielke. “On the rare occasion that she needs someone to vent to, I consider that my job, and physically being there for her when she needs it, at the hospital or wherever.”
Cancer taking unusual course
Carissa’s family traveled last weekend to Seattle to learn more about the disease’s resurgence and what comes next.
“This follicular lymphoma isn’t acting like any lymphoma they’ve ever seen,” Ashcraft said. “It’s growing faster than they expected and it’s adhering to the bones.”
As a mother, “ ‘This is making me scratch my head’ is not something you want to hear from the doctor,” Ashcraft added. “A pathologist is looking further to figure out why the cancer cells are acting this way.”
Meanwhile, medical professionals have determined a new course of treatment.
“Lymphoma often returns after treatment,” Torbaugh-Lotrario said. “What we hope is that with more aggressive treatment, it will make it stay away for longer.”
Even though Carissa is unsure what the future holds, she knows she may want children someday, so she’ll undergo fertility treatment before starting cancer treatment.
The first chemo session should be in mid- to late April. Carissa will receive those treatments in Western Washington, two three-day sessions, 21 days apart.
She plans to work and attend school throughout.
But she’s hoping the chemo’s effects hold off long enough that she can go to the prom on April 24 with her sandy-blond hair still intact.
“Because it’s a slow-growing lymphoma, we can probably make that happen,” her oncologist said.
Once the chemo knocks out the cancer, she’ll have a stem-cell transplant and spend three months in isolation.
Carissa’s mother will take a leave from her job at the Spokane County Jail and temporarily relocate to Seattle to be with her daughter. Lodging alone could cost between $6,000 and $15,000, Ashcraft said. That doesn’t include food or any other expenses.
“I know there are money issues. I know there are work issues,” Ashcraft said. “But I can’t worry about it. It’s minute by minute.”
A lime-green dress
While Carissa talks about the prom as if it’s no big deal, her friends say that’s just self-preservation.
“I can’t imagine someone telling me I wouldn’t be able to do that (go to the prom),” said Mielke. “We’re similar people, and that would kill me.”
When pressed, Carissa admits she has some ideas for the formal dance. After all, she was on the prom committee and helped plan the event.
The dress she likes is lime green. “I’d like something bright like my personality.” She’s lined up a date, a guy friend. She’d like to go to the Melting Pot restaurant for dinner. And she’d be joining several other friends.
“I’d have my dress, a date and my hair – I’d be set,” Carissa said.
But her friends know it’s a wait-and-see situation with the disease and its impact on her health. “Everything’s up in the air,” said Kirsten Arnold, a friend since kindergarten. “Whatever she wants, we’ll be there for her. If she can’t go to prom, I won’t go.”
The one event she hasn’t wavered on is graduation.
At one point last weekend, after doctors left the room, Carissa told her mom: “They don’t get it. I’m OK with going to graduation without hair. I’m just going to graduation.”
She told Arnold, “I worked my butt off through the last chemo. I’m going to walk across that stage.”
Her friends said they are willing to carry her across the stage on their shoulders if that’s what it takes.
One concession Carissa had to make is to shelve plans to go straight into a four-year university. She’s making plans to go to Spokane Falls Community College while she recovers from the chemotherapy and stem-cell transplant.
“The only way I can explain her … she’s my hero,” Heather Maynard, Carissa’s eldest sister, said as her eyes welled with tears. “She’s crazy. … I’ve been through some stuff, but … we all get our strength from her.”
Said Carissa: “I learned so much about myself and my world. I became more confident in myself and realized I am a very lucky person.”