Hans G. Engel, MD, wrote about the amazing Valerie in September 1994. “When Val suffered, I visited repeatedly,” he writes, “and I remember dashing up the hospital stairs every time she ‘died.'” An early and frequent contributor to Cortlandt Forum, Dr. Engel is now retired and lives in Mission Hills, Calif.
Valerie was the sickest woman I ever cared for. She had been a New York hoofer in her teens and came out to Hollywood hoping to get into the movies. But all she did was marry a bit player and get TB. After four years in the sanitarium, she ended her career.
Arthur and Valerie squeaked by. They never became rich and they never worked again, but they kept themselves going by selling shares of valuable stock that Valerie's mother had left them.
Valerie's medical problems started in childhood with rheumatic fever; later, she came down with pernicious anemia, which resulted in combined system disease, a degeneration of the spinal cord, leaving her legs weak and unsteady. From then on, she spent most of her life on the sofa.
A failed pregnancy led to a hysterectomy. Soon after, Valerie developed severe psoriasis. Oral steroids seemed to work, but after three weeks of treatment, Valerie was vomiting blood.
But those were minor.
Valerie, who never weighed over 110 lb, suddenly started to vomit after meals and lose weight. After a diagnosis of linitis plastica, she had a gastrectomy and barely survived the blood loss. But after six pints of whole blood, she made a fine recovery. Transfusion hepatitis followed, then turned into chronic active hepatitis. Next came bouts with fevers, arthritis, and lupus erythematosus (LE).
Maybe it was the LE or her rheumatic heart, but she would go into congestive failure every so often. Twice-weekly injections of meralluride would clear the fluid, but soon renal function would deteriorate and urine output would almost come to a halt. It was a juggling act all the way.
And every so often, Valerie would die—of acute pulmonary edema, of blood loss—or she just would stop breathing for minutes to annoy us. After the first period of prolonged apnea, she developed seizures, which would recur unpredictably. Then there was the breast lump. Valerie and Arthur absolutely refused surgery. She was 74, had too many problems, and did not expect to live much longer.
At age 81, she came down with the flu, followed by pneumonia. It was an interesting film: classic pulmonary edema, tuberculous scarring, bronchopneumonia, and the silver dollar-sized coin lesion. Valerie survived the first night in the hospital. And the second. By the third day, she seemed better. On the sixth day, I wrote the discharge order.
Several hours later, I got a call. While waiting for Arthur to take her home, Valerie was found dead in bed. A postmortem exam revealed the cause of death: Valerie had choked to death on a breakfast roll.