Flower power

Can Nature Help Make Chemo Easier to Endure?

A new garden lifts the spirits of cancer patients at Houston Methodist.

By Gwendolyn Knapp April 1, 2020 Published in the April 2020 issue of Houstonia Magazine

The Horizon's Hope garden at the Houston Methodist Outpatient Building. 

Brad WHITE WAS DIAGNOSED WITH STAGE IV COLON CANCER last September, but it wasn’t until November that the fear really swept over him. That’s when the 55-year-old native Houstonian got off the elevator on the 21st floor of the Houston Methodist Outpatient Building for the first time ever, his wife and mother at his side, for chemo. “It was so creepy,” he says now. “You have no idea what’s about to take place. You’re naïve to everything.”

But the staff understood—they see the same looks on people’s faces every day. White’s dietician, Renee Stubbins, stuck her head in the treatment room to say hello while his infusion nurse, Ashley Verzwyvelt, chatted him up— then asked him if he’d like to participate in a brand-new clinical trial to study the effects of nature on cancer patients. 

“Then all of a sudden, I had a room next to this garden,” he says. “I could look outside and let my mind wander.”

That garden—four long beds of Texas wildflowers spread across a downtown-facing section of the hospital’s rooftop and surrounded by a colorful floral mural by famed Houston street artist Gonzo247— was actually created by Stubbins and Verzwyvelt as a means to bring nature, and a tranquil setting, to their stressed-out patients, who named it Horizon’s Hope.

Stubbins and Verzwyvelt work on the front lines at the center, where patients go to receive chemotherapy infusions—harsh chemicals that are used to kill cancer but can also make people very sick. For many, says Stubbins, “the first day of treatment here is the scariest day of their life.”

There’s a lot of waiting around. They’re poked with needles. They could have a reaction to medication. They have nurses accessing IV ports that run through their chests. Many are in pain. “And there’s always the anxiety,” Verzwyvelt says. “‘Am I going to lose my hair? Will I get sick? Will I be very tired? Will I be throwing up all night? Am I going to be eating?’ A lot of them have taste changes. It’s a lot.”

It was an old sign on the wall that had pointed to a nonexistent “Rooftop Garden” for as long as anyone here can remember—something perhaps planned but never implemented—that got Stubbins and Verzwyvelt thinking.

“That was the root—no pun intended—of what inspired us to start it,” says Stubbins.

In 2018 the newly launched Center for Health & Nature, a partnership between Houston Methodist, Texas A&M, and the nonprofit Texan by Nature, put out a call for project proposals involving the impact of nature on health care—the center’s area of scientific interest. Stubbins and Verzwyvelt pitched turning the unused space that formed a balcony outside of two patient room windows into a garden, and were selected as finalists in November 2018. The Center for Health & Nature also connected them with two Texas A&M doctors who wanted to study the effects of nature via virtual reality, and the clinical trial was born. The purpose? To see if exposure to that or the garden could improve stress levels, and even pain, in those enduring chemo.

Building the garden proved a bigger challenge. The women’s meager $25,000 budget—mere peanuts in the worlds of landscape architecture and Med Center projects alike—sent them searching for folks willing to help pro bono. Luckily, there were many.

Peter Caldwell, a landscape architect at Asakura Robinson, designed the garden free of charge, while Gonzo247 painted the lush, colorful mural. Volunteers helped install the garden’s support structure and plants in late October before the clinical trial began the next month.

White was the fourth patient to participate. From late November to early February, he was randomly assigned to one of three different rooms during each of his infusion visits: A control room; a virtual reality room where he’d wear VR goggles and escape into outer space, the desert or deep-sea settings; and then a garden-view room. “I’d call to my mom, ‘Come look! Ashley is out there weeding,’” he says.

When Verzwyvelt wasn’t tending the garden on break, she’d assess White’s pain, distress, blood pressure, heart rate, and saliva cortisol—a hormone the body produces when it’s stressed out—at the beginning and end of each visit in order to measure his condition.

It’s too early for any conclusions, but Verzwyvelt believes that among the seven patients to complete the trial (there will be 36 total by the time it ends), she’s already seen a pattern of decreased saliva cortisol thanks to the garden—and the VR goggles, too, by the way. For White, the greenery made an immediate impact.

“It makes you feel better on a sunny day to see all the plants,” he says. “It makes me want to go weed my own yard.”

Of course, he currently can't do that. Since September he’s dropped more than 50 pounds. His medication gives him muscle spasms and night sweats, and he’ll likely need abdominal surgery to help shrink his cancer in the near future, too. But he is surrounded by family—two of his three grown daughters live in Houston—and his longtime employer, Landry’s, has been extremely supportive, so he stays as positive as possible. “There’s no alternative,” he says.

Now, when he arrives for infusion treatments—as of late February, he was on his fifth round—he knows the drill. He wears comfortable clothes, brings a magazine, and “gets in line,” as he calls it, to receive his chemo. He’s often still offered one of the garden rooms, and when the center’s music therapist plays him a song, he’ll listen while looking out the window at the flowers.

Long term, Verzwyvelt and Stubbins want to expand the garden and make it accessible for all patients one day. They envision a peaceful retreat where patients could go to meditate, do yoga, grow produce, or even play in a drum circle. To transform the entire space into a walkable garden enclosed by glass siding in place of the current railing will take a projected $1.5 million, including $500,000 for a new support structure. But with the push in recent years to integrate nature with health care, the women believe their plan could be possible, especially if rolled out in phases. “We’re open to partnerships,” they say, only half joking.

For now they’re hoping a Houston Garden Club grant will be approved so that they can add a fruit tree, and they’re applying with Johnson & Johnson and the American Cancer Society for more funding to extend their research and explore whether exposure to nature can help with pain management.

As it stands, for patients like White, arriving for chemo to find butterflies flitting outside the window or a favorite nurse tending her garden, means some of the terror of battling cancer is taken away. The flowers waving outside the window are indeed a horizon of hope. “It’s almost like being at the park in a weird way,” White says. “Only 21 stories up.”

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