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20 SOONER MAGAZINE THE ORDEAL OF SEAN Marsee By MARGARET FRENCH

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Page 1: Digital Collections - THEORDEAL OF SEANMarsee · 2002-08-08 · cigarette smokingthathe optedfora "safer"alternative. Instead, likemany in his peer group, he "dipped" snuff, ... Theyjoinedtheeffortto

20

SOONER MAGAZINE

THE ORDEALOF

SEAN MarseeBy MARGARET FRENCH

Page 2: Digital Collections - THEORDEAL OF SEANMarsee · 2002-08-08 · cigarette smokingthathe optedfora "safer"alternative. Instead, likemany in his peer group, he "dipped" snuff, ... Theyjoinedtheeffortto

An alarming message is going out to dippersand chewers from a Sooner physician who can't forget

the young athlete whose life he couldn't save.

Sean Marsee, an 18-year-old Tali-hina, Oklahoma, high schoolstudent, was so respectful of the

health hazards associated withcigarette smoking that he opted for a"safer" alternative . Instead, like manyin his peer group, he "dipped" snuff,the smokeless tobacco which has beensupplanting cigarettes as the fastest-growing tobacco habit nationwide .Snuff is a moist, fine-cut tobacco

usually held securely between thecheek and gum for long periods oftime . The other smokeless product,chewing tobacco, is the dry, leafy to-bacco that is chewed and producesmore juice.However, Sean's Ada physician, Dr.

Carl T Hook, a 1970 graduate of theUniversity of Oklahoma School ofMedicine, believes the smokeless to-bacco Sean used killed the young man.Sean succumbed to a battle with oralcancer that took less than one year-from diagnosis to death-to claim hislife .A track athlete, Sean first sawHook

in April 1983, one month before hishigh school graduation . He exhibiteda sore on the right side of his tongue .Even at first glance the physician feltthe tumor was malignant.

"It was very difficult to just tell ayoung man I had never seen beforethat he had cancer of the mouth, butI believed that the moment I saw him,"Hook remembers. He prescribedmedicine for Sean to decrease the in-flammation and soreness, and in-structed him to discontinue use of thesnuff. When Sean returned two weekslater, Hook recommended surgery."He requested that we wait until

after an upcoming track meet andgraduation, and I agreed," Hook says ."I thought back to when I was a seniorin high school and what I would havedone if someone had told me I was

going to have an operation to cut outpart of my tongue, that my mouth andtongue would be so sore and swollen Iwouldn't be able to talk or eat for aweek . So he ran in the meet, graduatedon Friday and had surgery Monday."The lesson was malignant, as I

feared it would be . We removed approx-imately one-third of his tongue at thattime, and after a week's hospital stay,he went home . In two weeks, after thestitches came out and the tissues hadheated, he was to begin daily radiationtherapy in Oklahoma City. Because hewas so young, we wanted to pursueextremely aggressive treatment -even though there was no evidence ofany other cancer at thetime- but youhave to be suspicious, and you worrythat there might be."When Sean arrived for radiation

treatments, an examination of hisneck revealed a suspicious lump. Thisnecessitated a second operation calleda radical neck dissection . Amuch moreextensive operation had been recom-mended, one which would have re-moved hisjawbone. Sean had refused."He was 18," Hook says . "He had

just graduated from high school withplans to enter the Rangers, a highlyskilled Army carps. He would not con-sent to that operation."The lymph nodes were removed sur-

gically from the right side of his neck .Eight of them were malignant, foretel-ling an ominous and surprising prog-nosis, the physician recalls ."The day he checked into the hospi-

tal for the second time I was able tofeel one node that. I thought could bemalignant, and it was-but therewere seven others that could not befelt . They were tucked up under thefloor ofhis mouth, under thejawbone."That operation was followed by radi-

ation therapy, which made Sean ill . Inaddition, oral radiation makes the

mouth sore, dries out the saliva glandsand diminishes the taste buds, not atall conducive to eating and drinking .Halfway through the therapy programin July, dehydrated and losing weightrapidly, Sean was admitted to the hos-pital with pneumonia and had to behydrated with intravenous fluids .By late September he was doingbet-

ter, but in November he returned toHook with another small nodule onthe right side of his neck. When biop-sied, it too proved malignant, a verybad sign in an area already treatedwith radiation and surgery. Additionaltomography-CAT scans-then re-vealed a mass that appeared to be arecurrent tumor, separate from thesmall nodule that had just been re-moved.With no other recourse, Sean had

another operation in December, aheroic surgical effort to save his life .In an eight-to-nine-hour procedure,the doctors at Oklahoma MemorialHospital removed his right jawbone,more ofthe tongue, the floor and otherparts of the mouth, leaving such a de-fect that a skin graft. from his chestwas required to close his neck .From then on, Sean breathed

through a tracheostomy tube, was fedthrough a tube in his nose and re-quired intravenous fluids to maintainhydration. Just in time for Christmas,he was discharged and returned home .By January, he had obvious residualdisease, and his condition worsened .On February 25, 1984, Sean Marsee

died ."The family's pain did not stop

then," Hook says, "but the immediatemisery of seeing him suffer was gone .They were relieved that he did nothave to suffer any longer.

"In April 1983, 1 first saw a 150-pound youth . In February 1984, heweighed less than 90 pounds . He un-

1986 SPRING 21

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derwent three large, major operations,one small biopsy and a full course ofradiation therapy and was gone-allin about nine and a half months."

It wasn't that Sean had ignored hissymptoms over a long period of time.Before he consulted Hook, a specialistin head and neck problems, a routinephysical examination in January 1983showed a small patch described asleukoplakia . a pre-cancerous area onhis tongue, but the patch went unde-tected in a February Army physical . InApril, when Sean first asked hismother, a registered nurse, if it couldhe a slow-healing canker sore, she im-mediately sought medical advice ."What surprises and distresses you

is to see the cancer spread that fast,"Hook explains . "And yet we know thatcancer in young people can be moreaggressive than cancer in olderpeople ."Hook was accustomed to seeing oral,

throat and lung cancer in older peoplewho had dipped snuff all their lives .It was common for them to developcancer of the mouth. But seeing aninvasive, aggressive cancer in such ayoung person took Hook by surprise .

2 2

SOONER MAGAZINE

In the high school graduation photo on. Page 20, handsome young Sean Marseelookedforward to life .Pictured above at age 19. he had less than a month to live .

"He was, by far, the youngest patientI had ever seen with this problem,"the Ada physician says .The battle for Sean's life lost, Sean's

mother, Betty Marsee, felt honor-bound to tell Sean's story in hope ofsparing others similar problems . Sheasked Hook to assist her in combatingthe popularity of smokeless tobacco,especially among young people .Theyjoined the effort to obtain legis-

lation making it illegal to sell smoke-less tobacco products to persons under18 . That goal has been realized . Statelaw introduced by Oklahoma legis-lator Billie Floyd now prohibits mer-chants from selling any smoking orsmokeless tobacco product to a minor.Strong support for the measure alsocame from legislators and parents allover Oklahoma .Mrs. Marsee was called to

Washington, D.C ., to testify before theU.S . Congress . Subsequent federallegislation signed into law by Presi-dent Reagan February 27 nowrequireswarnings that users risk mouthcancer, gum disease and tooth loss .Reagan also approved a ban effectiveAugust 28, 1986, on broadcast adver-

tising of smokeless tobacco products .Government mandated warninglabels on cigarettes and the 1971 banon broadcast cigarette advertising hadomitted smokeless tobacco products .Curiously, television advertising forsnuff products such as the one Seanused first appeared in 1972 .Hook is convinced of the importance

of warning labels . Particularly be-cause he was an athlete, Sean washealth-conscious . He chose not tosmoke cigarettes but defended hissmokeless tobacco habit by pointingto the absence of warnings ."He told me, `It says right on the

package that cigarettes are harmfulto your health,"' Hook recalls, "but hedidn't believe he was doing anythingwrong by using the smokeless to-bacco."Hook contends that the deadly

chemicals in smokeless tobacco are ab-sorbed directly into the bloodstreamfrom the mouth, and it contains largeamounts of nicotine . Hook cites a re-cent study in an Oklahoma college inwhich 10 snuffdippers and 10 smokerswere asked to quit, and success wasgreater among the smokers.Equally important, he warns, is con-

vincing people that the smokeless to-bacco should not be used as a substi-tute for any other tobacco product."As recently as five years ago, some

parents were encouraging their chil-dren to use this product as a safe alter-native to cigarettes . It is not."

In perhaps the strongest confirma-tion ofHook's beliefs, Surgeon GeneralC. Everett Koop reported in Marchthat scientific evidence indicates thatsnuff and chewing tobacco are not safealternatives to smoking. Further,Koop cautioned that longtime snuffdippers may be 50 times more likelyto contract cancer ofthe cheek or gumthan persons who do not use tobacco.

Koop summed up his warning suc-cinctly: "If you chew, quit . And if youdon't, don't start."Hook, at the suggestion of numer-

ous school officials, has taken the mes-sage about the perils of smokeless to-bacco to Oklahoma classrooms . He isjoined there by dentists and other con-cerned health care and education per-sonnel eager to help .After his visit to one high school, he

was asked to return for presentations

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at the junior high and elementaryschools in that district . A screeningprogram in the community referred 10percent of 169 fifth graders to a dentistor doctor with tobacco-inducedchanges in their mouths .

Thankfully, Hook believes aware-ness of the severity of the problem ison the upswing. He thinks Sean's his-tory and other information includinghis battery of graphic photos havehelped to warn and perhaps frightensome young people into giving upsmokeless tobacco.An ABC television crew, in Okla-

homa recently to interview Hook andthe local principal, among others,failed to find any snuff dippers at theAda high school ; they had to go to arural school nine miles away. Hook be-lieves that the school children in hisarea have quit the smokeless tobaccobecause they are getting the messagethat it is dangerous. Now, he says, thechallenge remains to reach those whohave not yet started."You have got to teach these kids

when they are elementary and middleschool age about the hazards of dip-ping snuff and keep them from everstarting it," Hook insists . "It's toughstopping after you're addicted ."Sean was raised in a rural southeast-

ern Oklahoma town where use ofsmokeless tobacco was widespread ;most ofhis classmates, includingsomefemales, used it, partly in response topeer pressure . Recent studies indicatefemales definitely are among the reg-ular users. In Oregon, for example, Faypercent. of all high school studentshave used snuff at one time, which in-dicates users of both sexes.When the CBS television show "60

Minutes" aired a segment on smoke-less tobacco, students at OklahomaCity's Putnam City High School wereinterviewed, and girls with snuff in-side their lower lips were readily avail-able . Many rationalize their use ofsnuff, saying they cannot find boys intheir class who do not use it, so theysimply partake with them .

In "World Smoking and Health," anAmerican Cancer Society publication,a recent survey of 5,894 students in72 colleges and universities showedthat 12 percent use smokeless tobaccoand another 8 percent plan to use itin the future .

Dr. Carl Hook left, and KTOK radio host Dr. Howard Hagglund take call-insmokeless tobacco questions during a remote broadcast from. a shopping mall .

In appealing to youngsters, Hookuses the least obvious but most effec-tive tactic . Realizing young people can-not envision their own mortality, heinforms them of a more immediate,guaranteed penalty.

"1 show them photographs ofmouths-teeth, gums and tongues ofsnuff users-and I tell them that in100 percent of the cases, people havechanges in their teeth and gums, andnot good changes. Teeth becomestained, and gums pull away from theteeth, some far enough that they be-come loose. They are prone to cavities,and after a while, those teeth fall out.Youngsters don't like to think aboutfalse teeth."Hook also enumerates for the una-

ware the extraneous ingredients thatmost often accompany packaged to-bacco.

"I ask them if they would eat fer-tilizer or drink insecticide or pes-ticides, because they are probablyright there in the snuff, and they can-not be completely removed. Also, dirtand sand are present, not to mentionseven different chemicals - nitro-somines - carcinogenic elements wehave identified so far, each of whichcan cause cancer."The thing is, this is a preventable

cancer, a preventable, life-threateningdisease of the body, as opposed tocancer of the breast or some other partof the body that we don't yet have con-trol over."Sean began usingsnuff'when he was

12 after receiving free samples ofSkoal and Copenhagen at a localrodeo, supporting Hook's contentionthat the product's advertising cam-paign has appealed especially to

1986 SPRING 2 3

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younger people. An entire family ofthese products is available; for exam-ple, Copenhagen is a strong variety,Skoal is milder, sweeter and therefore,easier to use, and finally, Happy Days,the lightest brand . Sean had"graduated" to Copenhagen .The product appears to conjure up

a certain "image" with which mostpeople can identify-macho, active,exciting-like athletes or cowboys.Hook emphasizes the point thatsmokeless tobacco is so irresistablyhandy."Ranching and farming seem to go

hand in hand with the use of smoke-less tobacco," he says . "Many of thepeople advertising on television pro-

ject that connotation-riding and rop-ing or still able to compete in athleticevents with the snuff in your mouth."Mrs. Marsee has filed a $37 million

lawsuit against U.S. Tobacco, makersof90 percent of all moist snuff, includ-ing Copenhagen, Skoal and HappyDays---- a $600 million market with abonus of a nearly 20 percent net profitmargin . In fact, 75 percent of the cor-porate giant's revenues are derivedfrom such products .

Lately, however, the picture hasbeen clouded for the firm, in view ofother problems in addition to the suitstemming from Sean's death. GregoryN, Con nolly, a Harvard-trained publichealth administrator who directs theMassachusetts Dental Health Depart-ment, fought nationwide for the warn-ing labels and advertising restric-tions. Now, he promises to follow U. S.Tobacco abroad, and in fact, has al-ready begun lobbying foreign healthofficials in advance ofU.S.T.s attemptto expand in those markets.An independent owner of a tobacco

shop located in Greenwich, Connec-ticut, near U.S.T. headquarters, re-fuses to stock mainstays Copenhagenor Skoal, because he says that 15-year-olds are the only ones who ask forthem .Oneconcession U.S.T. has made vol-

untarily is the removal ofactive sportsfigures from their stable ofadvertisingspokespersons. Some prominentsports figures are showing signs ofwaffling in their endorsements and/oruse of the product, and one who pub-licly has taken astand against smoke-less tobacco is the highly popular Kan-

24 SOONER MAGAZINE

sas City Royals third baseman GeorgeBrett.Formerly featured in a television

commercial for smokeless tobacco,Brett said although it was "not easy,"he was making an "honest effort" toquit his chewing tobacco habit, due inpart to the 1,000 letters he receivesannually asking him to quit becauseit is a bad example . The All-Starswitched to bubble gum, explaining hehad seen enough of the films warningof mouth cancer from smokeless to-bacco.Plenty of other big names, however,

are willing to make the financially lu-crative sales pitches. Walt Garrison,Oklahoma State University and Dal-las Cowboys alumnus, is the premierspokesman in this part of the country.In the East, it is Oklahoma nativeBobby Mercer, formerly a New YorkYankee outfielder and presently aradio announcer for the club, whosings a song, "I'm a Skoal-Dippin'Man ." Another sports figure, NickBuoniconti, formerly of the MiamiDolphins and nowpresident of U.S . To-bacco, stated on "d0 Minutes" that thelink between cancer and smokeless to-bacco has never been scientifically es-tablished, which is his company's patdefense.

"Fortunately," Hook counters, "mostphysicians who treat these patientsare satisfied that snuff causes cancer,and when the Marsee case goes totrial, I think the facts will be broughtforward."The American Cancer Society went

on record in March calling for theelimination of all cigarette and smoke-less tobacco advertising, along with aban of tobacco company sponsorshipof events that attract young audiences.The new proposal is similar to thoseendorsed by the American Medical As-sociation and the American Lung As-sociation.Hook has discovered - through

other physicians and contacts withSean's family - several young indi-viduals who have developed cancer ofthe tongue and mouth. They all weresnuff users.

"It has become an issue for them(U.S . Tobacco) to completely deny thatthis can be a problem. It is so irritatingthat it makes you kind of stubborn,but Mrs. Marsee's attorneys are not

going to give up . U. S. Tobacco thinksBetty Marsee will go away," Hookspeculates, "but she will still bethere."Thecase was to be tried in November

1985, but the company obtained a post-ponement until May, when the trial isscheduled to proceed over U.S . To-bacco's protests and requests foranother stay . The company has lawfirms in Oklahoma City, Little Rockand New York City fighting the law-suit .

Marsee's object, Hook says, is not alarge monetary settlement, althoughif that happens, she has said she willestablish a foundation to aid cancervictims. Her main goal is to make cer-tain that the dangers of smokeless to-bacco become widely known and fullyappreciated - and that is beingrealized .For himself, Hook is answering

another calling that parallels his Adapractice in otorhinolaryngology,which includes diseases and problemsinvolving tonsils, ears, vocal chords,larynx and mouth. The hours awayfrom his wife Sandra, daughter Cori,17, and son Kevin, 15, are mountingas travel time increases, but he simplycould not end his involvement withSean's death."Experiencing the slow death of an

18-year-old youngster-he turned 19before he died-from a preventabledisease, watching him die, is an emo-tional thing. He died a miserable,painful, slow death. Then to see howprevalent the use of this tobacco prod-uct was in my locale-kids were usingit everywhere, how prevalent the tele-vision advertising was to endurepeople to use it, especially youngpeople-I felt it was my obligation toeducate some people ."Sean wanted to do this himself,"

Hook continues. "He wanted to go outand speak to people . He was planningto go with me, if he had lived and beenable to . He was going to show themwhat had happened to his body in anattempt to rid him of the cancer. Hewas going to show them how hard itwas to talk and how difficult it was tohe seen with your face and head andneck so disfigured . He wanted to edu-cate young people . He didn't make it,and I feel like I owe it to him to con-tinue."