With Grace and Good Humor

Fifteen years ago, Nancy Raasch was diagnosed with metastatic breast cancer. Then, in 2009, came multiple myeloma. Despite these malignancies, she refuses to let cancer define her.

With Grace and Good Humor click to enlarge Ralph and Nancy Raasch in the front yard of their home in Carrboro. Nancy views her seventeen-year cancer journey as an opportunity that has allowed her to meet people she wouldn't have met and gain perspectives she otherwise wouldn't have. Ralph, a retir
With Grace and Good Humor click to enlarge Six years ago, after 35 years as a graphic designer, Nancy Raasch reinvented herself during her recovery from an autologous stem cell transplant. Now she designs and makes jewerly using mulberry paper and water.

by Zach Read - zachary.read@unchealth.unc.edu  Photos by Max Englund - max.englund@unchealth.unc.edu

Nancy and Ralph Raasch, of Carrboro, were high school sweethearts in the Bay Area. Nancy’s interests were in the arts, Ralph’s in the sciences.

“We were the perfect balance,” says Nancy, a jewelry designer who spent 35 years in graphic design.

Ralph went on to receive his PharmD at the University of California, San Francisco, and in the late 1970s accepted a faculty position at the School of Pharmacy at UNC.

“At first, North Carolina felt far from home,” Nancy says, “but it became our home when our daughter was born.”

While at the School of Pharmacy, Ralph collaborated with physicians at UNC Hospitals, primarily in infectious disease research but also, occasionally, in cancer research. Then, in 1998, when Nancy was in her late 40s, she noticed that she was losing weight. It was confirmed soon after: she had breast cancer. Within two years, her cancer spread. The news was difficult for them to process: the cancer was treatable but not curable. But no matter how Nancy felt, she never let her worries consume her. 

“I had a choice to dwell on it and feel sorry for myself or be positive,” she says. “I’ve always been positive, and that’s how I’ve tried to approach this.”

The Ideal Patient

From the beginning, Nancy leaned on Ralph, whose clinical experience helped them understand what to watch for in the various drugs and treatments she received.

“He researches everything,” she says. “He knows the ins and outs of all the drugs. Not only has he been supportive in the way you’d hope of your spouse, but he’s also been a valuable resource.”

Nancy’s care at UNC – first at the Gravely Building and now at the North Carolina Cancer Hospital – has lasted seventeen years, through two malignancies: metastatic breast cancer and, six years ago, multiple myeloma, a cancer of a type of blood cell called a plasma cell. Ralph, now retired, has been at her side throughout.

“I’ve tried to support her educationally, emotionally, and physically, and serve her needs as best I can,” he says. “I spent a lot of time in the hospital environment working in collaborative ways with physicians, and we were part of some very difficult cases. But I also saw the positive ones, and I’ve tried to take the optimism and strength I experienced in those patient interactions, combine them with Nancy’s very strong internal strength and perseverance, and simply support her.”

Dr. Lisa Carey has been Nancy’s breast cancer doctor since Nancy’s diagnosis in 1998.

“She’s the ideal patient,” says Dr. Carey, Richardson and Marilyn Jacobs Preyer Distinguished Professor in Breast Cancer Research at UNC Lineberger Comprehensive Cancer Center. “She has had the same grace and good humor for seventeen years.”

She’s been my patient with metastatic disease for fifteen years now, which is an amazing thing by itself. But when you look at all she’s done during this time, it’s even more amazing. She’s been a contributor as a patient advocate, and she’s not only been instructive to other patients, but also to my students. --Dr. Lisa Carey, physician-in-chief, North Carolina Cancer Hospital

It wasn’t always easy. Fifteen years ago, Nancy relapsed: her breast cancer became metastatic, reaching the lungs, liver, and other areas. A few years later, she had a brain metastasis removed by Dr. Matthew Ewend, chair of the Department of Neurosurgery and Van L. Weatherspoon, Jr. Eminent Distinguished Professor at the UNC School of Medicine. But Nancy was fortunate that new drugs had been developed and approved that could control her specific type of cancer for a longer period of time. Her positive response to the drugs and therapies encouraged an even greater do-no-harm approach from her providers, who wanted Nancy to feel well while living with chronic disease.

“She is what we hope for in a patient,” says Dr. Carey, director of the UNC Breast Center and physician-in-chief of the North Carolina Cancer Hospital. “In the long term, we want to cure all cancers, but if patients have to have metastatic cancer, then she is the example of how we try to treat it – with minimum side effects, with the patient as engaged as she is in her own care.”

The longer Nancy received treatments, the greater the chance that she would develop a disease such as multiple myeloma. Dr. Peter Voorhees, associate professor at the UNC School of Medicine and researcher in the Leukemia, Lymphoma, and Myeloma Program at UNC Lineberger Comprehensive Cancer Center, serves as her myeloma physician.

“Of all my patients, she’s the one that could be most accurately described as a medical miracle,” says Dr. Voorhees. “That’s not something I throw around lightly.”

Dr. Voorhees credits Nancy and the work of Dr. Carey for helping Nancy become a good candidate for her autologous stem cell transplant, which she received in 2009, despite having metastatic breast cancer.

“Someone with both metastatic breast cancer and multiple myeloma ordinarily wouldn’t do well with the transplant,” says Dr. Voorhees. “But there was no evidence of breast cancer progression in Nancy as a result of her excellent response to treatment, we were able to get her myeloma under control, and her positive attitude and willingness to have the transplant made it possible. After transplant, she enjoyed almost three years off all myeloma therapy.”

Nancy has paid back her care team by being engaged in her own care and in the care of other patients, serving as a model for them.

“She’s been my patient with metastatic disease for fifteen years now, which is an amazing thing by itself,” says Dr. Carey. “But when you look at all she’s done during this time, it’s even more amazing. She’s been a contributor as a patient advocate, and she’s not only been instructive to other patients, but also to my students.”

Reinventing Herself

Six years ago, as Nancy was recovering from her autologous stem cell transplant, she found herself at a professional crossroads. She was too tired to continue working with her graphic design clients during recovery. 

“It was devastating,” remembers Nancy, who valued the professional and creative services she’d been providing clients for so long. “I had to reinvent myself, and I wasn’t sure exactly how I’d do it.”

As she recovered, she didn’t lose interest in creative arts. One day, while reading American Craft magazine, she discovered joomchi, an ancient Korean craft that uses mulberry paper and water to form objects. She was immediately drawn to the textured look of the pieces and the vast possibilities that existed within the form. To her surprise, the medium hadn’t been oversaturated by artists and craftspeople in the U.S.

“As a graphic designer and print specialist, I’ve always liked paper,” she says. “I thought, ‘Man, this is cool.’ You use layers of tissue-thin mulberry paper and water. The mulberry paper has long fibers, and it becomes stronger and fuses together as you agitate it. I could see myself doing this. My recovery became an opportunity.”

Nancy began working in the field, designing and making elaborate jewelry. Today, she sells her jewelry through her website, Raasch Design, and is a member of the Carolina Designer Craftsmen Guild, Orange County Artist Guild, American Craft Council, and the Society of North American Goldsmiths.

“It takes about three half-hour segments on the Food Network to produce a piece,” she says with a smile.

In February, Nancy took her jewelry to Baltimore for the 2015 American Craft Festival, the largest crafts show in the nation, where she was juried-in based on a selection of her work submitted as slides. She was stunned by the reception she received.

“To be accepted into the show by the American Craft Council was an incredible honor,” she says. “I’d only been doing this for a few years. Then, to receive interest from galleries and to have them ordering my work, that was simply awesome.”

Opportunity through Cancer

“During one of her weekly Friday visits for treatment years ago, I remember Nancy telling me, ‘I only have cancer for half a day on Friday, and the rest of the time I forget about you people,’” Dr. Carey says, laughing. “I thought it was brilliant. She’s fully engaged in what she needs to do to be a partner in her treatment of cancer, but she doesn’t obsess about her cancer and she isn’t defined by it.”

Nancy’s myeloma has relapsed, as it does with every patient, but it is under good control today. These days, Nancy only has cancer on Tuesdays and Wednesdays, when she receives her myeloma treatment in the Outpatient Infusion Center at the Cancer Hospital.

“Like Gravely before it, the Infusion Center is such a warm place,” Nancy says. “It’s lively – it’s a place for the living. I look forward to getting my coffee and sitting in my chair, among friends.”

Pat Decator, a nurse in the Infusion Center, is one of those friends. Pat has been caring for patients with cancer for more than three decades. She arrived at UNC at the time Nancy was first diagnosed and has cared for her since then. She remembers Nancy’s trademark grace and good humor during her brain metastasis.

“She was able to laugh at herself even then,” Pat says.

The two talk to each other about the milestones in their lives, swapping stories about their families and the weddings of their daughters.

“I have learned so much from Nancy,” Pat explains. “She serves as a model for people working here and for other patients. If she sees a patient come in and knows he or she is struggling with a port, she encourages the patient not to be afraid of it, to embrace it. I have been so impressed with her, and I try to live my own life like her. Whatever challenges are out there, you get through them and don’t drag them on your back all the time.”  

Dr. Voorhees notes that Nancy is a favorite of the staff in the Infusion Center, not only because of the length of time she’s been seeing them, but also because of her outlook.

“People are astonished that she’s been able to be so positive over so many years,” says Dr. Voorhees.

Today, Nancy views her cancer not as a battle, but as a journey, one that has influenced her in ways she isn’t even aware of. And although she would never choose to have cancer if she had the option, she appreciates what cancer has brought into her life.

“I wouldn’t have met some of these wonderful people and characters like the patients and providers I’ve come to love,” she says. “As a patient, you see many of the people here more than you see your friends outside the hospital. But I view it as an opportunity to know them, and with that opportunity, I’ve learned that the group of people at UNC is the most caring you could ask for – each individual. And as a whole you can’t get any better.”