Pain and Suffering

My mother cautioned me to other choices when I mentioned the prospective, now actual, title of this post. But everybody knows that metastatic lung cancer is no cakewalk. It causes the victim pain and suffering—and eventually death. And, if it happens to someone you love, it causes you pain and suffering, if only empathetically.

Notwithstanding the recent, surprising tumor regression, my father has been sickly for a week. Nausea. Lack of appetite. Dizziness. Difficulty climbing stairs. I followed him up to his bedroom this evening, noticing the syncopated rhythm of his footsteps and the cane: step, step, thump. [Pause] Step, step, thump. He had to stop at the first landing where, with his head resting on the banister, he said softly but with a noticeable hint of anger, “Weak as a kitten.” His frustration at his own enfeeblment was wrenching.

It has become hard to attribute his current symptoms to his most recent chemo treatment. My mother and I each wish we could learn the cause, because maybe then we could find a way to mitigate his discomfort. Knowing also would help alleviate our nagging back–of–the–mind apprehensions—the kind which never really leave you when someone you love is terminally ill.

At least he is improving.

In Brief

Hi,

I’m sorry I haven’t been posting regularly. I’ve been fighting a deadline at work. I’ve also been told that—even in the wake of record profits—Wells Fargo is cutting budgets and I and the other consultants on my team are soon to be terminated. So I’ve also been freshening up my resume and pounding the pavement at the same time. But enough about me.

My dad has had a lot of nausea in the wake of his recent (4th) chemotherapy treatment, last Tuesday. He has eaten very little and slept poorly. Having seen this before, in the wake of chemo infusions, we were initially gladdened by recent news that further treatments would be less–affecting oral. Unfortunately, Dr. Canin has since decided that, owing to the unexpected amount of regression of the pulmonary tumor, the primary cancer site, future chemo treatments will not be oral after all, but will continue to be intraveneous. I trust that the suffering my father is experiencing therefrom is worth the hopefully consequent continued prolongation of his life. I’d say so, but that would be my selfishness. In the end, it is solely my dad’s decision.

I have also learned that the bone–hardening infusions my father has been receiving (the most recent being last week, too) are not as I thought iridium, which is an element, but Aredia, which is a trade name drug. It’s basically Fosamax times ten.

More soon.

Four for Four

This week, all at Kaiser Permanente, in Walnut Creek.

Monday: Appointment with Dr. Canin
Tuesday: Chemotherapy Apointment
Wednesday: Post–chemotherapy examination for post-chemotherapy Taxol intravenous infiltration
Thursday: Iridium infusion

Waiting for hours. Driving back and forth between Berkeley and Walnut Creek. My mother must be exhausted but she doesn’t really show it.

At the very least she deserves beatification.

“Considerably Shrunk”

My dad saw Dr. Canin today. The discussion focused around the significantly favorable results of my dad’s latest CAT scan. My parents reviewed the radiographs, which clearly showed considerable regression of the pulmonary tumor. My mother’s stated opinion is the title of this post. (Don’t forget that she was a registered nurse, so her opinion isn’t of the laity.) My dad might be an outlier after all.

Tomorrow will be my dad’s fourth chemotherapy, which as before, will be adminstered intravenously. After which I am sure he will feel tired and probably nauseous for several days. However, succeeding treatments will be oral. Yes, he will simply take a pill, which will be far less toxic, with fewer and lesser side effects. We are all very happy about this.

The news keeps getting better and better, though he is still weak and having frequent bad days. And, it is important to note, there has been no discussion about the metastases. I need to follow up on those....

Inurement

It has been just under two–and–a–half months since I found out my dad has lung cancer. I am emotionally exhausted, as I know my parents, sister and other relatives to be, as well.

At first, everything was new, everything was an unknown, a cause for alarm. Amped by the epinephrine, cortisol and other stress hormones coursing through our veins, our emotions were at a fever pitch. I won’t say we’ve since become blasé, but the shock, anger, fear, anguish and foreignness are dissipating, instead being replaced by understanding, acceptance and growing knowledge. The one constancy is uncertainty. That won’t end till, well, the end.

We’ve learned a lot:

• There will be more chemotherapy (the next round is Tuesday, January 23rd).
  
• There will be unpleasant side–effects.
  
• There will be more mysterious procedures.
  
• There will be more long days.
  
• There will be more—increasingly—bad days.
  
• There will be more good days—relatively few, most likely.
  
• New symptoms will appear.
  
• Old symptoms will recur.
  
• Affordances will be made.
  
• There will be some joy.
  
• There will be frustration.
  
• There will be fear.
  
• There will be lots of pain.
  

It’s going to be like this for a while. Maybe a year or more. (Very unlikely.) Maybe just a few weeks. (Rather unlikely, given the recent regression of his tumor.) Nobody seems to know, or at least be willing to predict.

‘Chemotherapy’ has given way to ‘chemo’. The procedures are becoming familiar. The myriad appointments are all blurring together. The daily phone call to my parents begins with asking my dad how he feels and ends with discussing the latest medical news with my mother. It has become surprisingly routine.

We are living with cancer.

Clarification & Amplification

Since yesterday’s principal post, I’ve received congratulatory messages concerning my father’s improvement. For example:

Let’s hope the trend continues indefinitely! Please give him my best wishes for a speedy recovery.

Those are nice sentiments, and I certainly agree with them in spirit. Unfortunately, reality is frequently in conflict with our wishes. And so it is here. To underscore what I said yesterday: He is not going to get better, not really. He will experience a brief improvement after which he will resume his downhill slide, almost certainly thereafter irreversibly. Well, he could experience spontaneous remission. And I could win the California Lottery.

But why not at least pass on the wishes? Well, my dad is a dispassionate, philosophical, scientific pragmatist—except about Republican politics, a topic on which frequently he raves. He understood clearly when Dr. Canin said “Well, you don’t have that much time left,”, though the statement certainly was abstract. He appreciated the significance of Dr. Canin’s further comment that, for patients like my dad, chemotherapy isn’t a cure; on average it prolongs life by just six to ten weeks. My dad understands that he is going to die. Soon.

Consequently, I think that wishes for a speedy recovery are ill–advised and inappropriate. But I will not edit your hopes and feelings. After reading this post, if you still would like to convey similar hopes/wishes/sentiments to my father, please [removed]. She’ll be able to pass the message on to my father sooner than I would.

Admittedly...

I am happy!

“Very Pleased”

To hear my father tell it, the title of this post is the verbatim summary assessment of his oncologist, Dr. Canin (click to see his Kaiser profile; I’ve been mispelling his name for weeks), concerning the results of my dad’s latest CAT scan. The pulmonary tumor has reduced in size. By how much? I don’t know. And the metastases? Again, I’m in the dark—as is my mother. For unfathomable reasons, my father is being extremely circumspect in his recounting of his discussion today with Dr. Canin. Even my mother had not heard of the “very pleased” declaration until I persisted for details from my father in her presence. (She was very pleased, too.)

Be that as it may, the news is good. Though it does not mean my father will be up and around, going to his office anytime soon. Any celebration should be guarded. The tumor is still there. It has only become smaller. The metastases almost certainly are still there, too. Odds are, he as just gained some time. How much? It’s anybody’s guess. The statistics are still damning: Just over one of three is alive twelve months after original diagnosis; 1 in 20 twenty–four months after. My dad’s original diagnosis was already over two months ago.

So, to what do I attribute his recent spate of ‘bad days’? Who knows? Anyone who has studied statistics is aware that by chance there can be clusters of samples [events] which, when viewed within a localized or constrained context, appear anomalous in their frequency of occurrence. Such is often the case with purported cancer clusters, for example. It could be that next he has two weeks of great days. In the end, it is the average (both the mean and mode, in this case) tendency that is meaningful.

Thus we rejoice a little. We celebrate a little. But for not one minute do we forget, do we become indulgent nor complacent. There is still very little time to waste—if any. Every day, every moment is precious. As they should all be, anyway.

Please keep those fingers and toes crossed.

Morbid Curiosity

He is, to quote my mother “okay, today.” That is, he is on par with yesterday. With the exception of Saturday past, his health has been markedly poorer in the last week contrasted with the week just prior to that. Pensively, I and my parents await Dr. Cainin’s phone call and the results of last Friday’s CAT scan. The stresses of curiosity, uncertainty, and fear clearly are affecting each of us.

Ummmm...

Conceiving a title for today’s post was obviously rather difficult. Not wanting to sound like a broken record (I’ve included the link for anybody under thirty), I finally just gave in and resorted to the onomotopoetic word that kept passing my lips as I thought. But the situation is tantamount to a broken record. “Good day.” “Bad day.” “Good day.” “Bad day.” Though, as of late, the days are more bad than good. Of course we knew that would happen ...eventually.

He is better than yesterday and the day before. But ‘better’ is a comparative; it is relative. He is better, but just a bit. He is still weak. Still tired. Still dying.

We’re still waiting for the results of his second CAT scan. Initially we thought we’d have them today but my parents found out on Friday—and I found out yesterday—that Dr. Canin, my dad’s oncologist, would be out of the office for today’s observance of Rev. Dr. Martin Luther King’s birthday.

And so still we wait. Rather pessimistically.

Merry–go–Round–and–Round

Lest I was vague in my earlier post, today is a very bad day. I don’t think he has arisen from his bed for more than a minute or two. He has eaten nothing yet—though he just asked me to prepare a small amount of soup—and drank little. He is very weak and speaking very slowly. He complains of aches and pains. In the last week there have been more days like this than not. (Yesterday he had quite a good day.) I do perceive a trend. But tomorrow should be will be definitive.

Merry–go–Round

Round and round, up and down. One day he’s good, the next bad. I view it as ominous that the proportion of bad days to good has changed dramatically as of late. But tomorrow (Monday) we’ll get the results of his latest CAT scan, which occurred last Friday, with nary a hitch. Then I’ll know better whether my foreboding is justified.

Stay tuned.

Vacillation

Another bad day, following a very bad night. [Very unpleasant symptoms.] He didn’t crawl out of bed until just before 1PM. I called my parents just after that. While waiting for him to come to the phone, I heard him moan to my mother about how poorly he felt. When we spoke, his speech was tremulous and strained. He said he was—and sounded—very weak but added that he expected to feel better as the day wore on. I hope so. It’s hard to sit at my desk and concentrate knowing he is suffering.

Delta

This coming Friday, my dad finally will have his second CAT scan. The delta (mathematical and statistical for ‘change’) between it and the baseline original scan will allow an estimation of the disease’s progression and timelines. I expect we’ll get the actual results on Monday, after a radiologist has had a chance to review the scan, which will look like this.

To quote myself:

Then we’ll know for sure if his apparent resurgence is in fact because of a diminution of his tumors and/or a reduction in their metastases, or simply the consequences of the palliative effects of the treatments. The odds are vastly for the latter.

Cross your fingers. Cross your toes. Cross anything possible. Well, if you cross your legs you’ll probably fall over. Or if you cross your eyes (and see this), you’ll almost certainly get a headache and walk into walls. (More succinctly and to be paranoically legalistic: please do not hurt yourself on my recommendation.) But anything else is fair game.

I know the uncertainties overshadowing the next few days will be very stressful for both of my parents—indeed for all our family.

Life Time

Time is relative. At least perceptually. Some events happen so fast we don’t even think about their occurence, such as light streaming out from bulb to wall when we flick on a light switch. Other events are so slow as to be imperceptible within human lifetimes. Such as any event that is measured in geologic time, like orogeny.

The watching of analog clocks (bereft of second hands) occupies an interesting place between these poles. It is difficult to perceive the instantaneous moving of the minute hand, yet if we watch it for a while, it becomes clear that the hand has moved.

Lately I’ve been writing that my dad generally has been of surprisingly good health, allowing for the occasional ‘bad day’. But it was only this morning that I realized that he is declining. He is a little slower, a little weaker. It’s impossible to see day–by–day but, in retrospect, enough change has occurred to be undeniable.

Tick. Tick. Tick.

Flop Flip

He had a good day. Especially as compared to yesterday. He felt well enough to spend most of the day downstairs, much of it reading. He also socialized with me, my mother, and some good family friends (who brought much delicious food) over dinner. True, he didn’t eat very much, but it was still a vast improvement overall.

The indeterminancy is maddening.

Flip Flop

He’s having a bad day. A very bad day. He is tired, nauseous. He was out of bed for just about an hour, returning to it midmorning and falling asleep almost immediately. We don’t know why. We hope these symptoms are transitory, that he will be restored tomorrow to his previously relatively good health. We learned early on from friends and relatives that there would be good days and bad (trending towards the latter). And we’s certainly seen that already. But, as I’ve written before, we cannot foretell the future, save in gross abstract. So we just love and watch and tend and soothe and hope and wait.

If You Haven’t Already...

Please add yourself, including your name and your photo to the map! I will be showing the map again to my father tomorrow (Saturday).

Thanks!

I’m Still Here

Unfortunately, I returned from Yosemite to a veritable conflagration at Wells Fargo and my time has been consumed accordingly. In addition, my significant other (egad, what an ungainly term, but ‘girlfriend’ is so innocuous; I’m working on changing the nature of our relationship) came down with a bad case of norovirus—yes, the same thing that has beset San Quentin State Prison (looks kind of pretty in the photograph) and is flaring up around the world. So I’ve been also spending time ministering to her, leaving scant for myself. But things should calm down today.

Anyway, my dad seems generally happy, feisty (as always) and reasonably healthy—within the bounds of what could be expected. He still gets himself up and down the stairs between the floors of his house, with much less effort than a few weeks ago, actually. Last I knew, the oxygen remains untapped. And he still sleeps beside my mother as he has for much of the last fifty–one years (save for the many many months spent alone overseas).

Except for the cane, bathroom fixtures and chapeau, and a pronounced slowing down, it’s almost possible to fantasize that he’s fine, that there aren’t tumors spreading inside him.

I have yet to learn about the value of iridium infusion my dad received in my absence. Also, Kaiser rescheduled a number of appointments so he didn’t meet with his oncologist yesterday and the date of another CAT scan is up–in–the–air. Consequently, timelines are still indeterminate.

In sum, there really isn’t very much to relate right now, as I predicted. But keep checking back here. Because this comparative calm simply can’t last.

Back in the Saddle

It’s 2007 and I’m back after a very nice week in Yosemite. Three days of Nordic skiing, a snowshoe trip to a fabulous overlook near Badger Pass and a hike halfway up Yosemite Falls.

Anyway, to the matter at hand: My dad. I shall be brief because it is rather late.

• Despite being listed as such on the appointment schedule Kaiser provided my father, last Thursday was not a chemotherapy treatment. Instead, my mother says he was given an infusion of iridium. Although I’ve found several references to iridium in the treatment of lung cancer, none seems to apply here. I hope to get more details from my mom tomorrow, after which I will follow up.
  
• My dad did receive a chemotherapeutic treatment earlier today. When I saw him earlier this evening, he seemed and said he was fine, save for a bit of post–treatment nausea; which is not uncommon with chemotherapy. He did add that Kaiser administered an anti-nausea agent for the first time.
  
• Thursday is the next appointment with the oncologist. We’re expecting him to schedule another CAT scan. My thoughts are that it, along with its predecessor, will allow his physicians to assess the rapidity of the cancer growth and maybe—not to be morbid—make a gross prediction as to my dad’s longevity.