Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, December 25, 1993 TAG: 9312260024
SECTION: VIRGINIA PAGE: B4 EDITION: HOLIDAY
SOURCE: JIM SPENCER NEWPORT NEWS DAILY PRESS
DATELINE: LENGTH: Long
It was Mother's Day. Gena Silver celebrated it by helping her 21-year-old daughter plan her own funeral.
Julie called all the pallbearers personally to invite them to carry her casket. She wanted to be buried in her Easter dress, the one with the bright flowers and the big white collar. She wanted her survivors to sing five hymns - "Because He Lives," "Trust and Obey," "Victory in Jesus," "Sweet, Sweet Spirit" and "Our God Is an Awesome God."
The fungus inside Julie's head was out of control. Trying to stop it, surgeons at the Medical College of Virginia had cut away her nose piece by piece. All that remained of the center of a face that once had glowed from the pages of a high school yearbook was a cavity between the eyes. The next operation stood to take one of those.
"There's nothing else we can do," a doctor told Julie's father.
"I'm not going to watch you pick my daughter apart," Donnie Silver replied. "How long does she have?"
"Twenty-four hours to two weeks."
Seven and a half months later, Julie Silver's funeral plans are on hold. The fungal infection and the acute lymphoblastic leukemia that made her susceptible to it have retreated.
For no earthly reason.
"My own academic and intellectual background tells me that science had something to do with it," said Mark Ellis, Julie's cancer doctor. "But I think there's something else more powerful happening in this girl.
"This looks like a miracle. That's what I'd call it."
Julie and her parents call it an act of God. They say they have the proof. Early in this 4 1/2-year struggle with leukemia and its complications, Donnie Silver stopped taking his cues from doctors. He started taking them instead from a commanding voice inside his head that he believes was the voice of God. At a critical point in her illness Julie believes she saw Jesus reaching out to her from outside the fifth-floor window of her hospital room. Years later, Julie's sister, Mary Jo, and her grandmother saw what they believe was a bedside healing by a stranger the family decided was a guardian angel.
They felt chills and tingling sensations, then they made important choices. They believe in the power of prayer to literally save a life. They talk about out-of-body experiences like they talk about what's for dinner. And they care not a whit for cynics who dismiss their claims as religious hocus-pocus.
If you read the medical textbooks, Julie Silver should be dead or, at best, badly brain-damaged. Instead, she studies at Christopher Newport University near her home in Newport News. She drives a car and dates. She has survived seizures, a stroke, a coma, two deadly fungal infections, three emergency operations, three bouts of chemotherapy and the loss of several toes and a nose.
She's an inspiration. You can't talk to Julie Silver without feeling something special. Saul Yanovich, the MCV cancer specialist who has followed Julie's case since her diagnosis in April 1989, is uncomfortable talking about miracles, especially the religious kind. But even he admitted, "Julie taught us how to be humble. I don't know the reason she survived."
Bill Wigg, a head and neck surgeon at MCV, is more direct. "Medically," he said, "there's no explanation for her."
How do you explain Julie Silver?
"I used to be pretty dogmatic about cancer quackery," Ellis said. "But the more you hear the testimonials of patients, the more you realize that there are things that can't be explained scientifically.
"In the Silvers' minds their faith and prayers have been answered. They think this is a test of faith, and I guess I agree."
\ A swift illness
Ellis remembers what Julie looked like the first time he saw her in August 1989 after months of chemotherapy. She weighed 82 pounds. She had no hair. She was curled up in a fetal position. A stroke brought on by a blood clot in her brain had left her paralyzed on her right side.
It was tough to imagine her playing field hockey less than a year before, when she was a senior at Denbigh High School. But that's the way it is with acute lymphoblastic leukemia. It crashes into you. One month you're running effortlessly on an athletic field. Three months later you're winded going up a flight of steps at school. Two months after that you're dying.
Julie knew something was up. Along with fatigue came colds, earaches and bladder infections. She went back and forth to the doctor for a month early in the spring of 1989. On April 29 her mother demanded a blood test.
"My hemoglobin count was 3," Julie said. "The normal range for a woman is 10 to 15. They thought the machine was broken. They shipped my blood to Mary Immaculate hospital for a retest."
There was no mistake.
A nurse took Julie and her mom into a room. The doctor came in. "My suspicions are you might have leukemia," he said. "Do you know what that is?"
"It's cancer," Julie answered.
It was, more specifically, acute leukemia, which replaces normal cells in the bone marrow with cancerous cells so quickly that it can kill within three or four months.
When Donnie Silver arrived at the doctor's office, he didn't want to be in the same room with his daughter. Just being there would tear him apart. The owner of a steel fabrication business, he was used to being in control. Now he felt helpless.
"To me," he said, "the word `leukemia' meant nothing but cancer, and cancer meant nothing but death. All the way to Richmond, every time I looked in my rear-view mirror at those beautiful brown eyes, I just broke down. Inside, I was praying, `Lord, my daughter doesn't have cancer.' "
She did. Julie had one of the lowest hemoglobin counts of any patient to enter MCV under her own power. And the first round of chemotherapy couldn't get all the cancer.
"My senior prom was the 29th of May," Julie said. "The doctor told me there was a chance I might be able to go. But on that day they did a bone marrow biopsy and discovered that only 40 percent of the cancer cells were gone."
She spent prom night in the hospital with her boyfriend, "eating hot dogs and pulling out my hair in clumps."
She set her sights on graduation in mid-June. By then she was into a second round of chemotherapy. She was bald. She was weak. Her immune system was virtually destroyed. An IV tube hung perpetually from her arm. Shortly before graduation, she asked her sister Mary Jo, then 13, to march in her place.
"I stayed at MCV," Julie said. "But I didn't want to be alone, so Mom and my brother Brandon stayed with me, and my dad went with Mary Jo and videotaped graduation." When Julie's name was called, the class of '89 stood and clapped. One of Julie's friends laid a long-stemmed pink carnation in Julie's empty seat.
\ From bad to worse
Two weeks later she nearly died.
"Heck Week," Donnie Silver likes to call it. It ran from July 4 to 10.
Julie's blood pressure went haywire. It soared to 210 over 140, nearly twice normal for a person her age. At 1 a.m. on the Fourth of July, Julie had a seizure. A nurse happened to be in her room in the north wing of the 10th floor at MCV. The nurse grabbed "Buddy bear," the stuffed toy named after Julie's boyfriend, and crammed it into Julie's mouth to keep her from biting off her tongue.
Summoned in the middle of the night from the Ronald McDonald House, where relatives of sick children stay, Julie's parents weren't sure what was going on.
"A CAT scan of her brain found a mass," Gena said. "They didn't know if it was a tumor or a clot."
At 3 a.m. the Silvers confronted cancer doctor Chris Desch.
"Is my daughter going to die?" Gena asked him.
"We're in trouble," he answered.
The tears filling Desch's eyes told the Silvers just how much trouble.
Julie had a second seizure, and her blood pressure wouldn't stabilize. Donnie Silver made a decision. He surrendered his daughter to God. He called Mike Felton, a deacon at Warwick Baptist Church who had lost a son to cancer the year before. Felton gathered up some other deacons and headed for Richmond. They placed their hands on Julie and prayed over her like a spiritual trauma team.
The doctors moved Julie to the intensive care unit. She needed the attention. Donnie and Gena Silver's firstborn child, once a beautiful 17-year-old with thick brown hair and big brown eyes, looked like a monster. Her face was swollen. Her eyes bulged grotesquely from her head.
On July 5 Julie stopped breathing and slipped into a coma. Her father had returned to Newport News to check on his machine shop. Gena called from the hospital. "The doctors have told me to get you up here," she said.
Donnie picked up Julie's boyfriend, Buddy, and raced for Richmond. "Lord," he prayed silently, "if you're calling my daughter to eternal home, I pray that you give me the strength to accept it and to help my family."
"I'm not calling your daughter to eternal home."
It wasn't like the burning bush talking to Moses. But Donnie immediately recognized the voice of God.
Sitting next to him in the car, Buddy heard nothing.
The words were coming from inside Donnie's head, but they repeated themselves over and over, slowly and calmly.
"I'm not calling your daughter home."
When he saw his child in a coma, wrapped in the medical machinery that was keeping her alive, he wasn't sure he could believe the voice.
"Lord," he prayed, as he stood near the respirator that was breathing for Julie, "are you sure you're not calling my daughter to eternal home?"
He felt a tingling. It started in his scalp and went all the way down to his feet. Inside his head, the voice came again. "I'm not taking her to eternal home," it told him.
Another CAT scan showed a 2 1/2-inch blood clot on the left side of Julie's brain. The doctors said an operation to remove it would probably kill her or at least cause some brain damage. But without an operation she would surely die.
"Lord," Donnie prayed, "whatever you give me of my daughter, I'll accept."
"She's coming back," the voice told him. "The old Julie is coming back."
Julie made it through brain surgery, but she remained in a coma. Her first 72 hours off the operating table were critical. Either her brain would continue to swell and she'd die, or the swelling would subside and she'd wake up.
"They put her in a private room with a big window," Gena said. "Every day I'd go to the window and tell her what the day looked like. I'd read her her mail and unwrap graduation gifts and say who they were from, just like she was awake. I'd tell her, `Julie, I know you're there. You have to keep fighting.' "
On July 7 Julie began breathing for herself. On July 8 she started to rub her sheet. Then her kidneys failed, forcing her into dialysis. Two steps forward, one step back. On July 10 Julie woke up and spoke.
She knew her name but little else. She was in what doctors called "brain trauma." During the next two months she cussed like a sailor, tore her clothes off, threw mashed potatoes at her grandmother and put her dad in a headlock.
A stroke had paralyzed her right side. She would need months of physical therapy to learn to walk and write. Another clot, this one in her right foot, had cut off the blood supply to her toes. Eventually, they would have to be amputated.
But as far as Gena was concerned, God had answered the prayers of hundreds of people and made good on his promise to her husband. Julie was not just alive; the cancer cells in her bone marrow had stopped reproducing.
In August Julie moved from MCV to Riverside Regional Medical Center in Newport News.
Nearly two months after brain surgery, Julie Silver was going nowhere fast.
When Mark Ross, the director of Riverside's Rehabilitation Institute, evaluated her on Sept. 9 to see about moving her to his facility, she barely spoke. She couldn't tell left from right or hold up a prescribed number of fingers.
It was as if she needed something more than therapy. Three nights later, on the evening of an hourlong prayer vigil at Warwick Baptist Church, she got it.
\ A figure says her name
Julie awoke at 4 a.m., not sure what had roused her. She looked toward the window of her fifth-floor hospital room. There was a white stuffed toy sitting on the window sill, but she's quite certain that's not what she saw. What she remembers is a man standing outside the window, a man in a white robe with sleeves that hung down like angel's wings.
Huge palms extended toward her from the sleeves. She especially remembers how big those palms looked, bigger than human hands. As bright a light as she'd ever seen obliterated the man's face, but she could make out his goatee.
The figure spoke a single word:
"Julie."
At 4:30 a nurse found Julie sitting on the floor beside her bed crying. No one could figure out how she got there. Her left hand had been tied to the bed so she wouldn't pull out any tubes. Her right side was paralyzed. The bed rails were up.
Yet there she sat, free of her restraint.
The nurses, worried that she had hurt herself in a fall, summoned a doctor. He found nothing wrong. The X-rays he ordered showed no injury. The tears, it turned out, weren't tears of pain. Julie wasn't hurt. She had seen Jesus and wanted to call her dad.
"They asked if I knew my phone number," she said. "I hadn't known it since my operation, but I rambled it off. They went to check, and it was right."
Then, she did something else she hadn't done since her operation. She dialed a telephone. A few days later, Ross checked Julie.
"He told Donnie and me that this was not the same woman he had evaluated the first time," Gena said. "He didn't know what had happened. But the next week Julie was transferred to the rehab hospital."
Her stay lasted exactly one week. Complaining of pain in her right side, she was brought back to Riverside where doctors discovered a fungal infection had formed abscesses on her liver.
Pat Haggerty, an infectious disease specialist, rescued Julie's liver by feeding an anti-fungal antibiotic called Amphotericin B into her bloodstream.
Nothing could save the toes on her right foot.
"When I looked at my toes, they were black," said Julie. "I told people I'd been to the beach and gotten tar on them."
In fact, she had gangrene.
On Sept. 29, exactly five months after she was diagnosed with leukemia, Julie got to visit her home. She used an eight-hour pass to eat Dino's pizza and celebrate Brandon's birthday. A month later, she arrived for her Halloween doctor's visit with Haggerty in a clown suit. Afterward she was wheeled around her neighborhood trick-or-treating. Three days after that, on Nov. 3, she came home to live.
"I still had to go back to the rehab institute for therapy three days a week," she said. "But it sure felt good to sleep in my own bed and eat home-cooked food and be with my family."
It felt even better to beat the odds. Her father taught her to drive again. She drove to therapy on the day the folks at the rehab told her that her license would probably be revoked because she'd lost her peripheral vision. Later, she proved them wrong by passing a vision test at the Division of Motor Vehicles.
On Valentine's Day 1990 she walked again.
\ A few steps forward
"I came home from rehab," Julie said. "I had already gone from a wheelchair to a walker to a four-pronged cane. I waited for my dad to get home. Then I said, `Mom and Dad, I have something to show you,' and took four steps from the archway of the dining room to the kitchen door."
Soon, she was moving all over the house, then the mall. May 5, 1990, Julie celebrated her release from the rehab institute by cooking pizza for her physical therapist, occupational therapist and speech therapist.
In August 1990 came a critical decision. Ellis wanted to start a round of chemotherapy to sustain her remission from leukemia. There was no earthly reason not to, but Julie, who felt as if she had just gotten her life back, asked for two weeks to decide.
"I went to sing at an old folks home with people from church," she said. "I requested several hymns. I asked God for a signal if I didn't need any more chemotherapy. When we sang `Trust and Obey,' I got a chill."
Instead of starting chemotherapy, she started college. She went part time at Christopher Newport University, taking English and math. She struggled. The stroke had damaged her short-term memory, so it was hard to listen and take notes at the same time. She couldn't remember whole thoughts long enough to write them down.
"I found out at the end of the school year that there was assistance for people with my problem - tutors, extra time to take tests, taping lectures," she said.
With that help Julie tried a full courseload in the fall semester of 1991. She took the spring semester off to work three days a week as a volunteer at the Leukemia Society and did a good enough job handling the Pennies from Heaven and Adopt-a-Patient programs that in June 1992, the local chapter named her volunteer of the year.
Back at Christopher Newport she enrolled in college studies, psychology, biology and a biology lab in the fall semester of 1992.
In August of that year her great-grandmother died. In September her father's father passed away. In October her aunt's mother, who had chronic leukemia, died of heart problems. In November, she broke up with her boyfriend. The grief weighed her down. But it was nothing like the abyss of her relapse into cancer.
People who have been seriously ill have an instinct. They know intuitively when something is wrong with their bodies. Last January, Julie Silver "didn't feel right." She went to the doctor for a blood test. Her white count was a little low, but not abnormal. Two weeks later, not much had changed.
Following up, Ellis performed a bone marrow biopsy Thursday, March 18. "Go home and have a good weekend," he told her.
She intended to. After school on Friday she grabbed a cheeseburger to take home for lunch. She hadn't had a bite when Ellis called.
"This best be good news," she warned him.
"Julie," he said simply, "you're out of remission."
Old feelings and fears flooded over her like the tidal surge of a hurricane. She wept. Her father was stunned.
"She didn't look sick," he said. "She looked totally healthy."
\ A time to pray
The next night Jim White, the preacher at First Baptist Church, came to Julie's house. A deacon from his church who knew the Silvers had asked him to stop by. White was familiar with the Silvers. They had visited his sanctuary a few times, church shopping.
"We just began to pray," White said. "I don't know how long. It was an encounter with the power of the Lord. There was a sense of the presence of God there. It's something that's wonderful, but you can't manufacture it."
Julie needed the send-off. She arrived at MCV on March 22 with the bone marrow samples Ellis had taken. Yanovich confirmed Ellis' diagnosis. Now, Julie knew for sure she would have to be shot full of the poison that would make her sick and bald until the cancer retreated.
Julie stayed in the hospital for weeks waiting for her "good cells" to come back. They didn't. They were being consumed by an infection taking root in the tip of her nose.
Mucormycosis is what doctors call an "opportunistic infection." It usually attacks diabetics who are in poor health or leukemia patients whose resistance to germs is weak.
"In all the patients we've seen, it is almost universally fatal," said MCV surgeon Bill Wigg. The medical college only sees two to four cases of mucormycosis a year, he said.
The only way to treat the fungus was to cut away the infected tissue and blast Julie's system with Amphotericin B, the antifungal antibiotic that Julie had taken nearly four years earlier for the abscesses on her liver.
"Before the surgery we called Dr. White," Julie said. "He came with some people from First Baptist. I said, `I'd like for each and every one of us to say a prayer out loud.' We did. I prayed that God would give me the strength to handle whatever happened. My parents walked with me to the surgery floor. I said, `See you later,' because I don't like to say goodbye."
She was scared. Nobody talked to her. So she prayed.
Julie stabilized quickly after surgery. Donnie left Richmond, visited his mother who was hospitalized in Sentara Hampton General. Then he flew to North Carolina to finish up a construction job at Camp LeJeune.
On May 5 he called his wife at MCV.
"They had to do emergency surgery on Julie because the fungus came back," Gena reported. "And your mother died this morning."
On May 8, Julie suffered a seizure.
The fungus had invaded her sinuses and was heading for her brain.
\ `Stay focused'
This time as he drove to Richmond Donnie didn't hear God. He was coming from his mother's funeral. What ran through his mind were the words "death and a casket." At MCV Donnie watched a doctor stick a huge needle into his daughter's right sinus cavity and draw out some tissue. Tests showed that the fungus was growing rampantly. With or without more surgery, the doctor told him, Julie would almost surely die. The fungus would claim her vision, then her hearing, then her life.
Julie's father walked into her hospital room to tell her she was going to die.
When they finished crying, they were both exhausted.
"Let's get some sleep," Donnie Silver told his daughter. "We've got a lot of planning to do. You're God's tool, Julie. Stay focused."
The Silvers planned Julie's funeral the next day. Nelson Hinson, a deacon at First Baptist and a family friend, came to Richmond and led a communion service around Julie's bed.
"I didn't want to be left alone in my room at night," Julie said. "Mary Jo stayed with me. We had devotions before bed, said prayers holding hands and went to sleep. I never thought I wasn't going to die."
"My biggest fear," said her sister, "was that she would die and I would have to call Mom and Dad and tell them."
A week passed. On the Sunday after she had planned her funeral, Julie's guardian angel showed up. He wore a protective mask to keep from breathing his germs into the air in Julie's room, but he had it on upside down.
"I'm Julie's grandmother," Joyce Pizzeck said, introducing herself to the plump, brown-haired stranger. "I don't know who you are."
"I have been drawn here today to pray for Julie," said the man. "I don't have much time."
"Yes, but who are you?" Pizzeck pressed him.
"I'm Jeff from Virginia Beach. I have been drawn here today to pray over Julie." The man knelt by the bed, where Julie was asleep. He put his hand on Julie's left forearm and commanded the leukemia and fungal infection to be lifted from Julie's body in the name of Jesus.
When he took away his hand, Pizzeck said, Julie's eyes popped open.
"I woke up to a voice," Julie recalled. "I was nauseous and tingling. The cavity where my nose had been ached."
Jeff disappeared down the hall.
Gena Silver wasn't sure what to make of the guardian angel story. But she had turned her daughter over to God, and she thought she could see her getting better. Her husband counted days. When two weeks passed he felt better. But he balked at taking Julie home.
Although Yanovich and others at the hospital spoke of "quality of life," Julie's leukemia had not retreated. Her bone marrow still had cancer cells. So the "quality of life" the medical staff was talking about was the most comfortable place to die.
She arrived home June 1. Seven hundred yards of yellow ribbon greeted her. It was swathed around every branch of every tree in her front yard.
In the months since then, Julie and her family have proven there is indeed no place like home.
"Quality of life," explained her father, "is just that. Let's live."
She talked to Jeff. He turned out to be the ex-husband of a Leukemia Society staff member who had heard about Julie. He had felt compelled for reasons he couldn't explain to go to her room at MCV.
In July her cancer finally went into remission.
"If I had to answer a question about her prognosis on a medical boards exam, I'd have to say poor," Ellis confessed. "But she's so far off the curve already that you throw out the statistics and take it one day at a time."
And each of those days, said her father, "is one more gift from God."
by CNB