17 May 2011

When the cancer specialist gave us his diagnosis it came as no surprise. I like to think that I can read people and I had examined the face and posture of each doctor we visited over the past two months and it was obvious that none of them thought that my wife was curable. Of course, none of them came right out and said that. We heard various comments about the stage of cancer, where it was, if it was operable, why radiation would not work, etc. The bottom line was that we now had an official death sentence. Cathy was diagnosed with terminal cancer of the right lung, chest, neck and numerous lymph nodes. The cancer was inoperable and also not susceptible to radiation. The doctor recommended chemotherapy, 4 hours every three weeks by IV. He wanted a MRI of the brain to see if the cancer was there too. The only good news we got shortly afterwards was that the brain was clear.

On the bright side, Cathy was also prepared. I had been talking to her for weeks, preparing her for the worst. I talked about the various stages of the disease and what might be done as treatment. I told her there was a chance that the cancer might be such that there would be no treatment. My greatest worry was that she would be told to just go home and die. The doctor speculated that Cathy would die in about a year if untreated, or perhaps two to four years with treatment. There was no optimism. I had prepared myself to hear the worst, that she could not be treated, but the doctor was willing to try chemotherapy to slow the advance of cancer, and I was happy for that very minor victory.

Cathy smoked for most of her life. She claims that she smoked about 10 cigarettes a day, but I have a feeling that she was a heavier smoker than that. In 1995, she had a minor stroke due to those cigarettes. Both her carotid arteries were clogged. We got very lucky had found a very talented doctor who had absolutely no bedside manner. His name was Mauser, like the German armaments company, and he lived up to that name. He told Cathy that he didn’t want to waste his time saving the life of a foolish woman who would immediately light up a cigarette after he spend endless hours saving her life. It was tough, brutal love, but it worked. She quit on the spot. She was soon in the operating room and over the next few weeks had two consecutive operations where her arteries were opened up and the plaque removed. She made a full recovery and seemed in good health afterwards.

We saw a family doctor regularly and there was never any sign of a problem. As I write this in May, 2011, with a death sentence hanging over my wife’s head, there is still no pain, no loss of weight, in fact, no symptoms at all. So, how did we discover the cancer? 

Cathy has been coughing for a while. The problem with something as simple and common as a cough is that you can always justify it. When we lived in New York we had an oil burner that created a lot of dust in the winter with the house closed up tightly. She blamed the cough on dust. A few times she told me “I hate this house.”

In June of 2010 we got the opportunity to sell the house in New York and immediately purchased another one in Florida. The climate of course is semi-tropical with lots of pollen. Cathy continued to cough, and I began to get concerned. I must have told her a half-dozen times to get an X-Ray but we both thought it was probably all the pollen in the air. I am an old medic trained by both the Army and the New York City Fire Department and I just didn’t like the sound of that cough. It was hacking and stronger than I would have expected from pollen. I kept insisting that she see a doctor and she finally agreed in April, 2011.

I did not know any local doctors so went on the computer and found one that seemed efficient and was also not too far away. Family Dr. D has a nice personality and seems to know what he is talking about. He will lecture sometimes, but you leave the office knowing exactly what your situation is. He thought it might be acid reflux at first. That would have been like hitting the jackpot. The doctor did not like the sound of that cough so ordered an X-Ray. The X-Ray showed a mass near her right lung.

Since the problem seemed to be in the lung our family doctor recommended pulmonary Doctor F. He immediately asked for a CT scan, and shortly afterwards a bronchoscopy. After the procedure, I watched the doctor carefully for signs of optimism as he explained that he was unable to get far down her right lung because of a blockage. There was no optimism. He then ordered a needle biopsy to get a more definite diagnosis. He also ordered a PET scan to determine if the cancer, if that is what it was, had spread. I wrote at the time:

Cathy is coughing a bit this morning. Before we were blaming pollen and the like and now we know that the lung has an intruder and the cough is probably the body trying to dislodge it. It is awful knowing that there is nothing you can do to stop the cough. It will stay until the intruder is gone. She says she feels pretty good today and that is a relief. We have a full week before we hear the news, good or bad. It is a time of suspended animation. It is hard to get too interested or enthused about anything because the verdict is hanging over our heads. So, I think we shall both just stay in complete denial until we hear the results of the test. The easiest way to put up with a serious problem is to simply ignore it.

I had prepared myself and Cathy for the results of all these tests starting with “it is benign” and ending with “we can’t do a thing about it.” It is a game I play always expecting the worse, and then being pleasantly surprised when things are not quite as bad as you thought they would be. It did not work this time. Things were every bit as bad as I predicted they could be; perhaps even worse. The pulmonary doctor told me that he would not be treating her any further and I told him, “Good, you have given me nothing but bad news you son of a bitch.” Of course, I smiled when I said it. He did wonderful work, but he had to be honest and all he had for us was bad news. I told the kids:

The pulmonary doctor had gone as far as he could with the case so he sent Cathy to a cancer specialist, Doctor Z, to make the final decisions on medical care. In May, 2011, we visited his office and he explained that there was cancer in the lung, above the heart and in numerous lymph nodes. He was drawing a diagram on a blackboard and making all these little circles to show where the cancer was and Cathy told him; “You need a bigger blackboard.”

He said it was too widespread for surgery or to use radiation, but we could take 4 hours of chemotherapy by IV every three weeks and it might slow the growth of the cancer and extend her life. He did not mention a cure, just an extension. He also wanted an MRI of her brain to see if the cancer had spread there. I joked “You know she is Irish, the brain scan won’t show much.”

Cathy was ambivalent about the treatment. She told me very seriously that she was considering just letting the cancer take its course because she was 73 and felt she had lived a long and full life and she had heard terrible things about how the chemotherapy affects your body. She had some general pain from arthritis, the statins she takes for cholesterol and other ills and wondered why she should continue to fight for the right to hurt. She actually had a point, but I told her that she should never give up. I reminded her that son Peter would be getting married soon and both her grandson and granddaughter were engaged. Did she not want to attend those weddings? In order to get her to start treatment I said, “let’s do two treatments and then we can see how it is working. If the drugs have no effect on the cancer perhaps you can make a better decision then.” I was basically stalling for time, but we need to keep her motivated and ready for the fight. I can think of nothing worse than just going home and waiting to die.

As I write this, the first chemotherapy treatment is 8 days away. We picked up two drugs today; the first to help Cathy’s body fight any allergenic reaction to the chemotherapy and the second to fight any nausea and vomiting that might occur. In eight days they will place a needle in her arm and during the next four hours put three different chemicals into her body that are supposed to fight the cancer. I have no idea how bad it will be for her. A friend told me to get some “Sea Sick" wrist bands to help with the nausea. They are just pressure bands designed to help alleviate sea sickness that go on the wrist. I expect nothing from them but they are cheap enough so why not give them an opportunity to surprise me. Of course, I bought them.

Right now the best case scenario is that Cathy will be as sick as a dog for a day or two after chemotherapy and then snap back to normal. The worst case is that she stays sick for a week and is unable to move around or live a normal life. I have no idea what will happen. I hope for the best but expect the worst.