Showing posts with label diagnosis. Show all posts
Showing posts with label diagnosis. Show all posts
02 April 2012
26 March 2012
It
This is "it". The piece of flesh growing inside mum's bowels. The view is from the endoscope conducted around twelve days ago. I saw this in that split second when I had a glimpse at the screen, and remember I said I just had a bad feeling. Something intuitively told me it is bad. And "it" is bad...Visible is a lump on the wall of the intestines. This is about the middle section, and actually the tumour is not growing from inside the intestines, as I imagined, but growing from outside in. It came from elsewhere, and I suspect it originated from the ascending colon, where mum was first diagnosed with Stage III colon cancer. Over the years, despite a section of the colon being cut off, despite dozens of chemo treatments, the cancer came back, with a vengeance so to speak. A lymph node in that section of the body has been known to be infected for at least one year or so. And once a lymph is infected, it does not take much For cancerous cells to be spread around the body through the blood vessels that connect to the node.
The black and white MRI image, as the doctor explained, shows an abnormal lump to the centre right of the image (in military positioning, Located between twelve o'clock and one o'clock.) That is not supposed to be there. Whereas the wall of the duodenum (small intestines) are supposed to be only a thin squiggly black line (centre right corner, between two and three o'clock), the lump shows that the walls in that region have become abnormally fat. The tumour is compressing on part of the horizontal colon, compressing on the exit of the stomach to the duodenum, and is dangerously close to the pancreas and spleen. Dangerously close, because though the doctor did not confirm whether there is spreading to the latter two organs, the chances are with time, and it does not take much time, that is bound to happen.
"Treatment... Is it possible?" I knew the answer, but I needed to hear it again, from the third doctor I have spoken to in recent weeks about mum's condition. And the answer was clear.
Mum did not accompany me into the consultation room when the doctor I requested to speak to came to pick me up. "The past few weeks have been a rise and fall of emotions. I had hope before, but now I have really fallen to the bottom of the valley" A local saying for being or feeling the lowest of the lowest. I have rarely heard mum describe her feelings so articulately, even though I know from the expression on her face, from the way she stares into empty space, I can feel she is deeply disappointed, deeply disillusioned.
Yes, there was so much hope before. We thought once the spinal tumour had been removed, then we could stop all treatment and she could rehabilitate and eventually regain her health so she can live out her life as she wants to... But who would have known, who could have imagined that within a month or so of doing so well at rehab and returning home, the complications with eating kicked in. And for so long we were so fooled into believing it was all just due to steroids and the sideeffects of too many pills she has been taking in. Who would have thought as we were dealing with a large lump in the spine, a devious cousin of that lump managed to incubate and start growing and getting stronger and angrier under our noses without us realising it...
Mum did not want to know or see the full extent of the "damage" inside. She more or less knows, I guess, for it is her own body, her own discomfort and her own intestines that is often gargling so loudly as if they were trying to tell us, warn us something is amiss there.
I came face to face with the cancer, and it did not look so menacing to the untrained eye. It is part of the body, part of the same system and feeds off of all the nutrients that healthy, "necessary" cells need to sustain themselves. Cancer, like all sorts of lifeforms, need oxygen and nutrients. Like all cells, its purpose is to multiply and grow and spread. Its life is
[half way writing this next to mum's bed, mum suddenly woke up from her sleep, grabbed a bag and began vomiting, again and again until the see through plastic bag was almost half full... I hugged mum as I helped her up... Again I felt how thin she has become, how much thinner she is getting from the day I saw her when I returned home almost three months ago... My heart ached and felt so sorry. I could not do anything! I could only hug her and stroke her hand... Pat her back... Damn you, cancer... Damn you...]
Its life is killing, killing healthy cells bit by bit by bit until whole organs fail, until whole systems become dysfunctional, until the entire body can no longer sustain life itself... and dies.
I thanked the doctor, and knew what I needed to know. I confirmed what I needed to confirm, and that is mum's condition is truly beyond treatment. Why even attempt to treat something that cannot be treated, and is even less likely to be treated with mum's declining health and inability to eat properly?
Now I realise, after seeing the images, after the doctor explained to me mum's condition, after hearing perhaps the loudest and clearest expression of despair and hopelessness coming from mum, I must be prepared...
Before I still thought perhaps there is hope yet, but now I know, perhaps I have known for a while, that we must accept and face the realities, however painful, however torturous they may be.
16 March 2012
Decision
16032012.1543
Mum and I pleaded with the surgeon. He came highly recommended, a well regarded specialist in colon and rectal surgery, who even operated on a former president. Earlier this week the same surgeon operated on mum's brother to remove a lump in his colon.
Mum waited almost two weeks to be seen by this surgeon, and she was not easily going to give up.
The surgeon explained, confirming the oncologist's diagnosis, that the cancer had spread to the duodenum and was blocking food from leaving the stomach and entering the small intestines. The vomiting is a "naturally" (it's far from natural... But it's what happens when there's a severe blockage.) reflex of the stomach to eject everything out the way it came in; through the mouth thus. It's very serious, and the doctor said it must be operated on. Either to remove the blockage, or as is very likely the case, to put in a bypass duct to redirect the flow of flood past the tumour.
At least we knew and confirmed the cause of the vomiting, even though it was very hard and difficult news to... (literally, pun intended, if it's not too crude...) digest.
Then came the bad news.
"You can go see the surgeon who operates on you before. I have too many patients..." the surgeon said, referring to the surgeon who performed the operation to remove the original colon cancer back in May 2006, on Mother's Day of all days. Mum's face turned when she heard that the surgeon did not want to treat her. She looked so small and sad slumped away in the chair, even smaller and sadder now that she lost so much weight...
But mum has not seen that surgeon for almost six years, on account of his poor attitude and lack of compassion toward her. Mum was assigned to him by the ER ward after a routine checkup (arranged by my dad, who pushed mum to get checked...) revealed the Stage III tumour there. She did not choose him, and did not look around for a surgeon she was confident with or trusted (which is often done here... Patients can choose and pick their doctors). On a return visit after the surgery, mum complained that she was feeling very tired and drained of all energy. That surgeon replied: "Tired?! Can civil servants ever be as tired as doctors?" No need to explain why mum never went back to see him.
Mum narrated the experience to the new colo-rectal surgeon, who is the head of the department at the hospital and well respected. He was unmoved for a while, and kept on saying he simply had too many patients to deal with, and that he was simply overwhelmed with work. But mum and I persisted and tried to persuade him to change his mind. For a while, mum just sat there, and it was a tense moment, and I was half expecting, half fearing the surgeon would throw us out of his consultation room. I felt like crying.
The surgeon sat there and was quiet as mum continued to plead her case. "I've not been able to eat for three weeks, and I've waited so long to see you." The surgeon said he could not take her, for he would not be there the following week to assess mum's case, and that this would endanger mum's health. But mum pleaded more, and my aunt (who was with us, and whose husband was operated by the surgeon a few days earlier...) added a few words too. "Please doctor, we know you a good doctor, please don't refuse us..."
But something moved the surgeon eventually. When he heard mum's complaint about his colleague he finally said that there are some doctors who will only take "good patients", ie patients who have a good chance of recovery and surviving. He never mentioned mum's surgeon six years ago by name, but from his words and tone, and from the way he was forcing a smile, it was as if he was implying his colleague was one of these doctors.
Eventually, after listening to us for almost ten minutes, the surgeon finally said: "You're really willing to wait? I won't be able to do anything until the week after." The surgeon was somehow moved, and despite his initial resistance to taking the case, he relented and said he could make time and make sure a bed is freed up for mum.
And mum quickly agreed to wait. There was a look of relief on her face, as if half her worries have gone.
"You can go to ER and get some care and treatment before the surgery. Or you can go home till we call you." the nurse told us. Mum chose, of course, the latter. Home meant better sleep quality, better comfort, less noise, even if mum has not been able to sleep much and any good anywhere...
We returned home, i wondered how long it would be before we were called in, and how long it would be before mum receives some kind of treatment.
But at least we have some hope yet.
Mum and I pleaded with the surgeon. He came highly recommended, a well regarded specialist in colon and rectal surgery, who even operated on a former president. Earlier this week the same surgeon operated on mum's brother to remove a lump in his colon.
Mum waited almost two weeks to be seen by this surgeon, and she was not easily going to give up.
The surgeon explained, confirming the oncologist's diagnosis, that the cancer had spread to the duodenum and was blocking food from leaving the stomach and entering the small intestines. The vomiting is a "naturally" (it's far from natural... But it's what happens when there's a severe blockage.) reflex of the stomach to eject everything out the way it came in; through the mouth thus. It's very serious, and the doctor said it must be operated on. Either to remove the blockage, or as is very likely the case, to put in a bypass duct to redirect the flow of flood past the tumour.
At least we knew and confirmed the cause of the vomiting, even though it was very hard and difficult news to... (literally, pun intended, if it's not too crude...) digest.
Then came the bad news.
"You can go see the surgeon who operates on you before. I have too many patients..." the surgeon said, referring to the surgeon who performed the operation to remove the original colon cancer back in May 2006, on Mother's Day of all days. Mum's face turned when she heard that the surgeon did not want to treat her. She looked so small and sad slumped away in the chair, even smaller and sadder now that she lost so much weight...
But mum has not seen that surgeon for almost six years, on account of his poor attitude and lack of compassion toward her. Mum was assigned to him by the ER ward after a routine checkup (arranged by my dad, who pushed mum to get checked...) revealed the Stage III tumour there. She did not choose him, and did not look around for a surgeon she was confident with or trusted (which is often done here... Patients can choose and pick their doctors). On a return visit after the surgery, mum complained that she was feeling very tired and drained of all energy. That surgeon replied: "Tired?! Can civil servants ever be as tired as doctors?" No need to explain why mum never went back to see him.
Mum narrated the experience to the new colo-rectal surgeon, who is the head of the department at the hospital and well respected. He was unmoved for a while, and kept on saying he simply had too many patients to deal with, and that he was simply overwhelmed with work. But mum and I persisted and tried to persuade him to change his mind. For a while, mum just sat there, and it was a tense moment, and I was half expecting, half fearing the surgeon would throw us out of his consultation room. I felt like crying.
The surgeon sat there and was quiet as mum continued to plead her case. "I've not been able to eat for three weeks, and I've waited so long to see you." The surgeon said he could not take her, for he would not be there the following week to assess mum's case, and that this would endanger mum's health. But mum pleaded more, and my aunt (who was with us, and whose husband was operated by the surgeon a few days earlier...) added a few words too. "Please doctor, we know you a good doctor, please don't refuse us..."
But something moved the surgeon eventually. When he heard mum's complaint about his colleague he finally said that there are some doctors who will only take "good patients", ie patients who have a good chance of recovery and surviving. He never mentioned mum's surgeon six years ago by name, but from his words and tone, and from the way he was forcing a smile, it was as if he was implying his colleague was one of these doctors.
Eventually, after listening to us for almost ten minutes, the surgeon finally said: "You're really willing to wait? I won't be able to do anything until the week after." The surgeon was somehow moved, and despite his initial resistance to taking the case, he relented and said he could make time and make sure a bed is freed up for mum.
And mum quickly agreed to wait. There was a look of relief on her face, as if half her worries have gone.
"You can go to ER and get some care and treatment before the surgery. Or you can go home till we call you." the nurse told us. Mum chose, of course, the latter. Home meant better sleep quality, better comfort, less noise, even if mum has not been able to sleep much and any good anywhere...
We returned home, i wondered how long it would be before we were called in, and how long it would be before mum receives some kind of treatment.
But at least we have some hope yet.
15 March 2012
The verdict
The new oncologist is a patient man, who was very willing to listen to mum describe her history and conditions. He is the kind of doctor mum needs in preparation for the final leg of her journey, the kind i hope can give her assurance and confidence, no matter what happens from now. In the final leg of life, is not assurance and confidence what we need, along side love and companionship? He is the kind of doctor I have been hoping will listen and advise, and will be Frank with mum. Because secrets and the unsaid can do so much more damage.
The MRI scan that was conducted at the beginning of the month revealed a blockage in the front section of the duodenum leading from the stomach. What is for certain but almost relatively clear, pending confirmation from a biopsy that was taken during yesterday's endoscop, is that the blockage is due to a tumour growing there. Whether it is a new instance of cancer or something that spread from the original site of mum's cancer in the colon is uncertain. It doesn't really matter.
What matters is that with the blockage into the duodenum mum simply cannot eat and simply cannot digest anything, which means she is not getting any vital nutrients to sustain her bodily functions... and what happens when you cannot eat or drink properly? You weaken and you die.
Surgery is the only wat to deal with the problem, either by removing the blockage or by creating a bypass duct to allow food to circumvent the blockage enter the duodenum. The feasibility of the operation and how deeply the surgery can remove the problem epends on an assessment of mum's health condition (which terrible...) and on whether it is worth conducting such an invasive surgery. This can only be assessed by the gastroenterologist, and there is an appointment planned for tomorrow.
The oncologist was very frank with mum after looking at her medical records and noting the treatments she has undergone. She has really done every type of treatment there is, but the cancer keeps on returning and more aggressive. Without solving the eating problem, everything else, including possible followup treatment to contain mum's cancer, is not even worth mentioning or discussing at this point.
I was extremely disheartened, even to the point of being able to hear my heart break deep down inside... mum has gone through so much, so much already, but there is now even more ordeal to overcome? What is wrong with the universe to throw so much at mum, and indirectly at me...? I looked at mum's face as she walked slowly away from the consultation room. We were silent on the entire journey home. It was a journey we have taken before together. The long, long journey home after receiving a warning sentence on your life and happiness.
How does one face all this without flinching? How does one receive such news without being affected or dragged down to the depths of despair?
We got home and I closed the door behind us.
I gave mum a long overdue hug.
A hug to help both of us calm down. A hug to help us both face a new reality we did not foresee and could not prepare for. A hug, filled with unspoken love and care to receive mum I will be with through this and a whirling more.
Diagnosis
Sometimes you hear something but it doesn't register until later because you were temporarily numbed.
Is it a way for your body and mind to process news you fear and dont't want to hear?
Numb.
Numb.
Numb.
09 March 2012
Followup
Seized with fear and dread, I could feel my emotions and tears threaten to emerge.
More treatment, more chemo... How much more can mum take? How much more...?
I
More treatment, more chemo... How much more can mum take? How much more...?
I
Subscribe to:
Posts (Atom)