The face of grace and courage

By Katherine Grant
For NewsNow

Ida Guarascia sits at her kitchen table, her head tilted to one side as she tries to study her long red fingernails – not an easy task as she struggles with her vision.

“I tried to fix the polish up for you,” she says to her husband, Randy.

He gently takes one hand in his and looks it over carefully. “You did pretty good. I will take care of that for you later.”

It is a moment that may best define the relationship between the Beamsville couple.

They take care of each other – for better or worse.

To say it has been a difficult year is a huge understatement but this story really begins well over a decade ago.

In 1998, Ida had a troublesome sore on her nose which simply wouldn’t heal. The diagnosis was skin cancer, basal cell carcinoma. Ida underwent surgery and a flap of her own skin was used to repair the damage done by the removal of the small patch of skin cancer and the surrounding tissue.

“I was told it was all clear, all gone,” she recalls noting there was never any follow up.

So life went on.

The single mom of two now-grown daughters met Randy, they fell in love and the pair began a life together about 15 years ago.

It hasn’t always been an easy existence – but it hasn’t been so bad either they are both quick to note.

Randy has a serious and

debilitating back problem which has required surgery. He is also blind in his left eye as a result of a cataract with which he was born and cannot be corrected. His disabilities aren’t something he allows to interfere with his enjoyment of life. He has lived in the Beamsville area since 1999 and has coached hockey and soccer when his back condition allowed.

Ida has health issues of her own.

About a year before the skin cancer surgery in the late 90s, she was hit by a car while walking through a parking lot and suffered a heart attack as a result. She has lived with a heart condition since then.

Being both positive and practical, the couple has always made the best of it. They live in a modest rented home on Cosby Road in Beamsville. They have a pair of dogs to keep them company and a stray cat recently took up residence a well.

Unable to hold down full-time jobs, they live on disability pensions.

And until now, they have managed.

Late last fall, Ida once again had a sore which wouldn’t go away and her right eye was watering incessantly. Without a family doctor there were a few missteps but when Ida was finally assessed, the news was dire – a cancer diagnosis was confirmed.

“From that day on it never stopped,” said Randy referring to the whirlwind of scans and other diagnostic tests which came into play.

It soon became apparent that basal-cell skin cancer had now worked its way into and around Ida’s right eye and inside the tear duct.

Basal cell carcinoma is the most common form of cancer. It rarely metastasizes or kills but can cause significant destruction and disfigurement by invading surrounding tissues.

About three-in-10 people will develop a basal-cell cancer in their lifetime with about 80 per cent of those cancers developing on the head and neck.

For Ida, a team of specialists was assembled including those in the fields of head and neck, eye, ear, nose and throat, a plastic surgeon, and a neurologist in case the cancer had spread to her brain. Surgery was scheduled for March 20 at St. Joseph’s Hospital in Hamilton.

At first it appeared Ida faced the horrifying prospect of losing both eyes.

“The plastic surgeon said, ‘I will save your left eye’,” recalled Ida.

The couple was given an estimate of 24-27 hours for the surgery and were told it might be necessary to go in and place a mesh patch over the brain to protect it.

“I will remember that day forever,” says Randy. The plan – for what he calls the “A” team of doctors tending to his wife – was for one of them to come give him an update about eight hours into the procedure.

So late on the Thursday afternoon, one of the surgeons left the operating room to tell him there was no cancer in Ida’s brain so the mesh patch was unnecessary. But then an unexpected blow: Ida had lost not just her right eye but also her nose. The cancer had spread and destroyed more tissue than they had been able to determine from tests.

The surgery became far more invasive.

A large patch of skin with the muscle attached was been removed from the left side of Ida’s upper back and was used to fill the open wound in her face with the muscle sewn into place in the empty eye socket.

A second patch of skin was then removed from her back to enclose the area where the muscle was removed. In order for the graft on her face to survive, a vein was attached through an incision in her neck to ensure a healthy blood supply.

Ida wouldn’t know the extent of the surgery for nearly a week as she was sedated and had a breathing tube in place. On Wednesday she heard the grim news.

“My first instinct was, it is what it is; we will deal with it,” said Ida.

The hardest part, she added quietly, were the things she “didn’t sign up for.”

“I have no sense of taste, no sense of smell and I will never smile again.”

It has been hard not to despair and she admits she has her moments.

The skin graft, which will form the foundation for her new face, is pink and healthy although the edges where it is attached are still raw and red. At first cold and hugely swollen, it has taken well. A second surgery was necessary when a portion of the graft at her forehead opened and didn’t close on its own.

During the surgery, more skin cancer was found and clipped away near her eye and in a few other areas. She is undergoing five weeks of radiation as insurance against it coming back.

Although surgeons were able to save her left eye, the eyelid is being pulled down gradually closing her eye, obscuring her vision as the large pouch of skin covering much of her face, shrinks and heals.

To see, she must tug up on the eyelid with her finger to open it.

In addition to the disfigurement, Ida is struggling with the loss of her independence. She can no longer drive or cook or even tend to her own grooming but Randy has been there every step of the way.

“He really has gone above and beyond,” says Ida of her husband.

“Hey, you were there for me, carrying me to the car when I couldn’t walk, helping me to the bathroom when I could only crawl,” he told her.

Randy is trying to do the gardening, cut the grass and do the housework, laundry and cooking, and they are clearly worn out from dealing with the ordeal of the last several months. Their children (Randy has two grown sons), have helped out but don’t live nearby. The day-to-day tasks are still a struggle.

Ida will undergo surgery this fall where her new face will be sculpted to allow for a facial prosthesis to be put in place. A pair of eyeglasses will be fitted to hold the prosthetics, an eye and nose, in place. The cost will be about $5,000 to $8,000.

For now, their financial needs are of a more pressing nature. They have received some financial support to partially cover the cost of her medication but her five-week hospital stay took its toll on their already strained budget with the cost of travel and parking.

The couple has nothing but high praise for the expert care Ida received at St. Joseph’s.

“They were fabulous, just fabulous,” said Ida. “The care has been unbelievable.”

For now, she is resting, healing and trying not to stress about finances. It has been an emotional rollercoaster.

“When I pass people on the street I hear them say, ‘that poor woman,” says Ida sadly. But worse for her, “children are terrified of me.”

Randy is quick to reassure her that people care and this is a chance for parents to teach their children compassion – she shouldn’t feel she should stay in her own home.

When Ida’s young grandson came to visit recently there was some trepidation on her part. Concerned about how he might react, she tried to prepare herself. But he saw past her changed appearance, she is still the grandmother he knows and loves.

And that is as it should be.