In honor of National Asbestos Awareness Week, April 1 to 7, 2013, Robert Shuttlesworth, a senior attorney at Shrader & Associates, engaged in the following Q&A hosted interview to educate the public about the impact of asbestos-related illnesses on victims and their caregivers.
The following is a transcript of the podcast:
Gail: Hi, this is host Gail. I’m interviewing today Attorney Robert Shuttlesworth, a senior attorney at Shrader and Associates, who’s going to talk with us today about National Asbestos Awareness Week. Before we begin the interview, Robert is going to give us an overview of the terms associated with the asbestos‑related illnesses. Robert, could you clarify, in layman’s terms, the different stages of the disease?
Robert Shuttlesworth: Certainly, be happy to do so. Asbestos exposure can cause a number of different ailments or diseases in the body. One that’s most often associated with asbestos exposure is what they call asbestosis. Asbestosis is an interstitial lung disease, which is just a fancy way of saying you’re having a hard time breathing. It’s restrictive, which means you can’t breathe in enough air to have oxygen enter the bloodstream. The asbestos fibers lodge in the lung. It inflames the tissue there, because the body can’t remove it because it’s too small. If this happens enough over an extended period of time, that little lung tissue effectively dies, and if enough of the lung tissue dies, then you’re having a hard time breathing. Because it’s caused by asbestos exposure, they label it asbestosis as opposed to another type of interstitial lung disease.
Asbestos can also cause a number of different cancers. One of the most common cancers it can cause is lung cancer. Generally, it’s a non‑small‑cell carcinoma or an adenocarcinoma. Essentially, a lung cancer is a cancer that forms on the inside of the lung. The chemical process for it is a little more complex than we may need to get into, but a lung cancer can be caused by a number of different things, such as cigarette smoking or different types of gases.
Asbestos, it lodges in the lungs. It irritates the skin. It can cause damage to the DNA in the cell, and every time there’s damage to a cell, in the DNA, there can be a mutation, which can then result in a cancer.
Most commonly, it’s a lung cancer. A very rare form of cancer that asbestos can cause is called mesothelioma. Mesothelioma is extremely rare, and it’s only caused by asbestos exposure. There’s nothing else that can cause it.
What happens is a fiber on the microscopic level is breathed in. It works its way through the lung tissue, or if it’s swallowed it works its way through the esophagus or the digestive tract, and makes it into the internal cavity. There’s a lining around all our different organs, be it the pleura around the lung or the pericardial around the heart or the peritoneal around the stomach. Every time that the fiber pokes at that lining, it’s doing damage to a cell. If it pokes it enough, it’ll mutate the DNA.
They don’t really know why it does it, but it can cause a mutation. A mutation can then lead to a cancer, and that cancer’s called mesothelioma. Be it lung cancer or asbestosis, it takes, generally, a long time of exposure, but with mesothelioma, it really only takes the one fiber making its way into the body cavity and causing damage to that lining of the lung.
Gail: Thank you. Excellent. All of these descriptions are all related to National Asbestos Awareness Week. It’s just different stages of the disease, correct?
Robert: They’re different diseases. They have different processes of how they’ve been developed, but they’re all diseases that are caused by asbestos exposure, so yes.
Gail: Thank you. In further introducing you, Robert, you’ve been with Shrader and Associates for five years. You’ve practiced law in this area for 12 years, and you’ve represented thousands of asbestos‑related victims and have personally met with and counseled more than 50 mesothelioma families. Before we begin talking about the significance of this being National Asbestos Awareness Week, can you tell us a bit about your background as a cancer research scientist prior to becoming a lawyer, and, specifically, how does your scientific background and knowledge impact the way you relate to your clients and their caregivers?
Robert: Certainly. When I was in undergrad, I had ideas about maybe wanting to go to medical school, so I did all my background work in biology and physics and organic chemistry. As I proceeded through school, I came to realize that I really didn’t want to go into medicine. I had more of a passion for the law. I took all my science and decided to pursue more of a science career when I got out and then thought about going to law school later.
I took a job with MD Anderson Cancer Center in Houston, Texas, and I was quickly moved into the lab, and we started doing research in a number of different areas. At that time, we were still mapping the human genome, so most of my initial work went into that, until I happened to meet a cancer victim in the hospital who had mesothelioma and got to talking with him and his family and decided that it was a rare cancer.
There was a legal outlet for that particular type of cancer because it’s only caused by one thing and that’s asbestos exposure. Spent some more time in the lab and then decided that it was time to go to law school. With my experience in the lab and my experience meeting that man in the hospital, I decided to pursue this more as a career.
I take the science background that I have. One of the things in law that people tend to overlook is you have to prove causation. In any particular lawsuit ‑‑ doesn’t matter if it’s a car wreck, all the way up to extreme toxic tort ‑‑ you have to prove that the person has a disease and what it was caused by. That’s all science‑driven, be it on the federal level, like “Daubert” or “Frye.” Different states have different names for it ‑‑ in Texas, for example, it’s called “Havner/Robinson.”
You have to prove, in legal terms, that scientifically what happened is a result of the exposure. Law and science are interesting bedfellows, but they go hand‑in‑hand in the courtroom, especially in a case that’s involving a toxic exposure.
Gail: Also, in your early science career, you were touched by the human element, which I think is important. You were exposed to someone who had been exposed to cancer in your research, early stages, before you branched into law. Is that correct?
Gail: This week, the US Surgeon General, Dr. Regina Benjamin, issued a statement on Monday about National Asbestos Awareness Week which, as you know, runs from April 1 to April 7 this year. In that statement, she says, “The greater the exposure to asbestos, the greater the chance of developing harmful side effects.” Those of special concern of risk to asbestos exposure include construction, insulation, and demolition workers, pipe‑fitters, boilermakers, as well as some handymen, first responders, and community volunteers. Many of these workers’ family lives are totally altered when an asbestos‑related diagnosis is given. What is the first piece of advice you would give to a caregiver or a family member upon hearing of a diagnosis?
Robert: That would depend a little bit on what the diagnosis is. If someone has been diagnosed with mesothelioma, there’s just not any really good treatment options available. Most people who are diagnosed have anywhere between six months and three years to live, so advice to that person’s going to be a little bit different than somebody who has an asbestosis diagnosis, which is more of a difficulty breathing. There’s different stages of asbestosis, for sure, but someone who comes back with you have some asbestosis, that’s going to have a different piece of advice. Same with lung cancer, where there’s some different treatment options available.
Generally speaking, what my advice is, what I typically do with our clients is I explain to them that there’s three teams that they need. They’re going to need their family or their spiritual side working for them. They’re going to need the medicine side, which is their doctors. Then, the lawyers who get involved, their job’s to figure out how to pay for all that.
Depending on what the clients need from me, I can counsel them in all three areas or I’ll stick to my legal area. From a family perspective, I generally try to explain to them that, if things need to be said or things need to be done, now’s the time to do it. There’s no reason to wait around. On the medicine side, I highly encourage them to ask questions. You have to be your own best advocate, even with a doctor you like.
If you’re not asking the right questions, you’re not getting all the information. On the legal side, most of the lawyers can do that, but you want to be engaged in what they’re doing and asking the right questions.
Essentially, the squeaky wheel gets the grease, and you have to be the squeaky wheel. You have to ask the questions, and you have to demand the treatment. There’s treatment options available for all different types of asbestos‑related diseases. Whether or not the person’s a candidate is something that the doctors will come up with, but you have to maintain a positive attitude. You have to eat well. These are things I would tell a family.
To the extent that there’s legal issues that need to be resolved, be it probate matters or things of that nature, I would counsel them on that. For a caregiver, you need to be patient. You need to be responsive. More than anything, you need to listen. That would be what I would tell a caregiver.
Gail: In addition to your legal expertise, when someone first comes to you, even though your legal expertise is your specialty, you are able to offer some level of comfort to the families, because you do have the ability to talk at a spiritual level or a medical level, at least for referrals, if need be, correct?
Robert: Exactly. Each family’s different. I’ve met many people over the years, and sometimes they want to hear about treatment options, and we’ll talk about that. Sometimes they want to hear about end‑of‑life issues, and we’ll talk about that. Sometimes the best thing to do is completely distract them from what’s been told to them. Just because you have a diagnosis of cancer does not mean your life’s over that day. If you’re feeling well and you can do things, then let’s get out and go do them, because you may not be feeling well six months or a year from now.
Gail: As you know, my father was a construction worker who had a milder case of what you’ve talked about, asbestosis. I have three memories of my father that stand out. One, he was a very gentle, humble man who was always smiling. Secondly, he loved his work in the construction trade as a way to provide for his family. Thirdly, he spent the last 10 years of his life continually coughing, which was incredibly sad to see in a man who walked miles a day on a construction site. Having a phone conversation with him became increasingly difficult. I know, for the hundreds of asbestos‑related cases you have witnessed, you have seen victims and their families suffer through much more anguish, through surgery, chemotherapy, and post‑surgery care. Can you share how, as a lawyer and scientist, you find the balance between advocating for your clients and being emotionally supportive to the caregivers and their families?
Robert: It’s a difficult thing to do. I do my best, as a husband and father, to try to leave it at the office when I go home to be with my family, but I’d be lying if I say I don’t wear my clients, really, in my heart, as I go around. One of the most touching families I ever came across was some people in Lufkin. He was an extremely young man to get a type of cancer that’s typically found in older individuals. We investigated that case, found that it was the asbestos that caused the cancer. I went to see him as much as I could ‑‑ he had a young wife and a young son ‑‑ and became extremely good friends with them.
He passed away, and I was at his funeral and was a pallbearer. His wife still calls here. It’s been five, six years since he passed away. I was happy to know that the money that we were able to recover for his family was used to send the son to college, and he should be graduating the spring of next year.
The best thing I can do is listen, as a lawyer. A lot of times lawyers like to talk, and they just talk to hear themselves talk. You can see it in a courtroom if you ever go watch it. I’ve always found it more effective to listen, more than anything, offer advice as needed, and always remember that the first part of being a lawyer is being a counselor.
That means you counsel on everything you feel comfortable talking about, be it the law, be it relationships, be it spirituality, religion. I’m happy to discuss any number of things with people, but I pick it up from them. If they want to talk, then I’ll talk. Otherwise, I try my best to offer comfort and support and explain what’s happening, as best I can, from the legal angle and the medical angle and the familial angle.
That’s how I approach everybody. Over the years, I’ve become very good friends with almost all of my clients.
Gail: It’s a significant relationship you build through this process of litigating for a client. It’s ongoing and extends beyond the settlement, often.
Robert: It really does. One of my favorite clients knitted me a quilt. That was what she liked to do. I got that for a Christmas present this last year.
Gail: It’s been rewarding.
Robert: It’s very rewarding. I tell people, especially the very first time I’m calling ‑‑ maybe they’ve been diagnosed, and they’re talking to different law firms. I always tell them, you have to approach hiring a lawyer more like finding a new church. You’ve got to hear the choir. You’ve got to see what the Sunday luncheon’s about, hear the preacher preach. It’s not like going to find a new dentist. If you go to a dentist and you don’t like that dentist, it’s real easy to find another dentist, and six months later, you go to a different one. When you hire a lawyer, you’re basically inviting somebody into your family to know all the intimate details about your lives. That’s something that you have to earn that trust, and that’s what I try to do with each one of my clients.
Gail: You mentioned previously the family that got the money for the college education for the child. Unbeknownst to me, a class‑action lawsuit was filed on my father’s behalf, along with several others who worked in the Quincy Shipyard in Quincy, Mass, where it was alleged he was exposed to asbestos. A few years after his death, I received some settlement money, and initially those checks meant nothing to me, for as we all know, nothing can really replace the loss of someone we love. But then, after my, “delayed reaction,” I realized that the money meant a lot more than I thought, because what it really meant was closure.
It validated my father’s struggles with breathing and coughing and added dignity to his death, by acknowledging that this hardworking man was exposed to a dangerous substance without his knowing. I was grateful, years later, to apply that money to my own children’s education, which was a small trade‑off for them never getting to know their grandfather.
Can you elaborate on ways you’ve seen other caregivers gain some sense of closure or dignity through your work with them?
Robert: A couple of quick stories. It’s interesting. Somebody like your dad in a case if he’s healthy enough, he would have had his deposition taken. And so, another client, let’s just maybe focus on that. Another client who had similar work history, worked in the shipyards, or the steel mills or something, he’ll have a deposition taken. In a deposition, we go through his entire life story; places he worked, when he was married, the number of kids. Things of this nature all work into a deposition and it becomes almost a book of the person’s life. There’s been some closure in families where the person passed away and he left behind essentially his novel. That’s always given families some closure, to be able to know things about dad or great granddad that just don’t come up in regular conversations with a grandparent.
Certainly, one of the things we do in my firm that I’m very proud of is we move as quickly as we can to get the case through the court system and finalized so that it’s not lingering on for 5 or 10 years after somebody passes away so that it is closed within a reasonable amount of time. Usually two to three years.
There are different schools of thought, but I’ve always been of the opinion that sometimes the best thing is to be able to close the book and not have to keep picking it back up and reading it. If a case is still lingering and those memories, that pain is still sometimes fresh. It’s good to be able to finish a case and have all of the settlements collected and not just have it lingering out there.
Certainly knowing that there’s other people that suffered the same fate and that something is being done about it both from a litigation point of view and from a political point of view can help bring some closure that the person didn’t suffer in vain. These would be examples that I’ve seen over my career of closure.
Gail: Thank you. So often I’m looking at these asbestos victim’s struggles. Society does not quite understand the enormous physical and emotion stressors placed on the caregivers of those victims. Can you please share with us some of the heroic stories of everyday people – the families that loved those victims – that you’ve witnessed? Is there a gem of wisdom they shared or deed they did that stands out?
Robert: I’ve had clients that in addition to things like being able to pay for grandkid’s or kid’s college, it’s simple as being able to afford a nice burial with a nice headstone or plot or being able to finally pay off the mortgage on a house, things of that nature. I don’t know. The way I always explain this to, especially to the person who has the cancer or the disease, is that what we’re going to be doing in terms of gathering resources or financial compensation is the legacy you’re going to leave to your family. That usually brings some peace to the person who may be dying.
In terms of the caregivers, there are a number of families that I’ve known over the years. One quick example is a lady in Oregon who was a deeply religious person. Her husband was deeply religious. They approached his disease and his death from that Christian perspective. We did very well in his case and he passed away and we gave her the money.
She took that and opened up her own ministry. Not like a church or anything, but what she does with that money is she helps elderly people in her community by having a place that they can have a garden and have a little coop. That’s brought her a lot of peace. If ever I feel like I’m not on the right page spiritually or something with a client, I usually call her and ask her for advice. She’s very insightful with that and she calls up the memories she has as the caregiver for her husband.
Another example is I had a client that was extremely active politically after her husband passed away and with her permission, we would use her name and she got called to testify in front of the Texas legislature once on some asbestos litigation that was pending there.
Everybody has got a little bit different thing that they do. Some people like to be left alone and not really think about it again but for the most part if they had closure and they’ve been able to move on, that’s the best thing that can happen.
But in terms of just gems of wisdom, the people who come down with these diseases are often some of the nicest people you’ve ever met. They’re from that generation that just gets overlooked in my opinion because they’re the guys that came out of World War II and either fought in the war or were born shortly thereafter and helped build the country.
To one of them, none of them complained. It’s the most remarkable thing. They literally have a cancer that’s going to kill them. They may be in extreme pain, but I’ve just never really come across one that complained about it.
Gail: My grandfather was a World War II veteran and he didn’t want to complain of his illness until the day he died, any of his pain.
Robert: That’s not uncommon.
Gail: I just want to go back, too, to the point when you had these relationships and the gems you shared with these people. For some of these people, they were able to create something of meaning as a result of the closure and stayed in touch with you so they could do that. That’s quite beautiful. Robert, in honor of National Asbestos Awareness Week and on behalf of Shrader & Associates, would you please share some tips for caregivers of asbestos victims?
Robert: You’re going to want to be their best advocate, so I would go with them to their appointments with the doctors. If they’re seeing a pulmonologist, ask about different treatments, breathing options, if they need to be on oxygen, things of this nature. With the oncologist, you need to ask the right questions, whether or not chemo is working or if they’re doing radiation. With mesothelioma, I would in addition to going to the doctor’s meetings with your husband or dad, you’re going to want to probably have kind of a private meeting be it with hospice or somebody who is going to provide the end of life care to know what to expect. People who are suffering from cancers such as that always do better when they’re back at home, when they’re around their familiar areas. If you can get the person into the home, that’s probably the best thing.
You want to remain positive. Certainly you want to remain loving. There are a number of different foods that help people fight cancer. Certainly some research even on the Internet, certain foods are very good for cancer victims. More than anything, you want to listen. This may be the last several months of somebody’s life and now is the time to say the things that needs to be said. That would be my advice.
Gail: How about a support group? Do you recommend that those caregivers get into a support group?
Robert: If that’s something that’s otherwise beneficial for that caregiver. Some people like discussing things in groups and some people don’t. There’s certainly nothing wrong with doing a support group. Lots of different tips and things can be learned there from people who recently did the same thing. In fact, I actually had a client once that her husband was dying of a cancer and she went to a support group. This was a non‑asbestos related cancer, but she went to a support group and met a man who was going through the same thing only with his wife. The two of them became very good friends and watched and helped each other get through watching their loved one pass away.
A year or so after the deaths of both of their spouses, they had become such good friends that they decided to get married themselves. The families were extremely happy because they knew that they had watched each other put up with the trials and tribulations of watching some with cancer and they found comfort with each other and they’re still doing very well today.
Gail: What a lovely story. Another part of, I would think, the caregivers would be the stress their carrying, stress and anxiety being an ever present fact when dealing with a terminal illness. Might you also suggest they meditate, pray or exercise, or take a walk, or do something physically active?
Robert: Absolutely. Any way you normally deal with stress is a healthy thing, certainly exercise. If you’re a spiritual person, certainly praying. There’s a number of different ways to deal with the anger and the stress that comes from watching a loved one pass away from cancer and there’s lots of different healthy ways to go about that. If a person likes to take their walks, then certainly you’ve got to schedule that in. See if you can get a friend to come sit with whomever for a little bit while you get some things done. You’ve got to maintain your own life in addition to providing the care and so, certainly, those are all healthy suggestions.
Gail: That’s a great point to encourage them to maintain their own life while supporting another person because they have to stay strong to nurture another.
Gail: Robert, legally what does a caregiver have to know or do as far as financial planning, end of life issues? Can you list a couple of key items that legally they need to take care of for their loved ones or help their loved one take care of?
Robert: There are so many that it would be kind of hard to list. In terms of end of life especially if this is someone you’re related to, you’re going to need to know those things. If you’re a spouse who never really took care of the finances, you need to start practicing while their sick because you’re going to be doing it after he passes away. In terms of probate, each state is a little bit different in whether or not you’ll pay the bill but that’s a conversation that needs to be had probably with a lawyer. Having an initial conversation with somebody about probate issues is not generally very expensive. My clients, I tend to do it for them in terms of if they need a will or something like that. I’ll just get them something together.
If somebody is alive and can help…When somebody passes away, you’ve got to go through the final bills. You have to do all these different things. If you can have those conversations before, it’s much easier. If you’ve never really talked about end of life things, burials, cremations, things of that nature, tributes, these are all conversations you can have now which makes the ending a little more tolerable if you do these things now.
Gail: Thank you. Another resource that might be helpful to share with the listeners here is the Family Caregivers Alliance, which is www.caregiver.org. There’s a lot of resources on there for caregivers and statistics about the number of people that are caregiving now and support groups. I just wanted to share that with your listeners.
Robert: Very good, thank you.
Gail: Robert, are there any other comments you would like to share about this being National Asbestos Week? Anything related to the ongoing cry to ban asbestos in the US or words of comfort for caregivers?
Robert: Absolutely. Asbestos has been used in this country since roughly the early 1900s. It has, thankfully, started to be regulated over time, and the use of it has gone substantially down. It’s still used in a number of different products, and they keep finding it in different things. Part of the problem and one of the reasons I’m glad we’re having this week is that people think that asbestos is not used anymore ‑‑ it was banned by OSHA ‑‑ when, in fact, it’s still very much present in our environment. People are still coming down with a disease related to exposure, and they didn’t work in the chemical plants or the refineries or the shipyards.
It’s still present. It can be present in houses, and you need to know enough about it to not be exposed to it. The only way not to get an asbestos‑related disease is to not be exposed to asbestos. It’s important that we keep this together.
Unfortunately, even though in our country we’ve seen a little bit of the light on banning its use in certain areas, there’s a number of developing countries that are actually importing and using asbestos currently, and it’s important to not, just because it’s a cheap fiber to be used in other countries, because there’s no difference between us coming down with a cancer or a foreign country coming down with a cancer. It’s an epidemic if it’s used, and so, the more we can retard its usage, the better we all are.
Gail: According to the World Health Organization ‑‑ these are recent stats ‑‑ about 125 million people in the world are exposed to asbestos at the workplace, and more than 107,000 people die each year from asbestos‑related lung cancers from occupational exposure. Do you have any closing words you’d like to share, comforting words for caregivers, having been so intimately involved with so many cases over the past 12 years?
Robert: Certainly. My advice would be, it’s not over. The diagnosis, nobody knows what’s going to happen. The doctors, the lawyers, the family ‑‑ nobody knows what’s going to happen. If you’re your own best advocate, you can make the most of the time that’s available. You have to have your three teams. You have to have your medical people helping out, you have to have your family and your spiritual people helping out, and the lawyers are there to answer questions and point you in the right direction and hopefully find some compensation to help pay for the treatments and the things that happen and to leave a legacy if asbestos causes the end of someone’s life.
Gail: Thank you, Robert. This was very helpful.
Robert: You’re welcome.