Posts Tagged ‘radiation treatment’

The Beginning of the End

November 1, 2011

There are pivotal points in life. Life is often compared to an hourglass, our days like the sand dropping one grain at a time until all the sand runs out. Maybe, but the sand does not trickle at a constant rate. Certain events speed things up. Like the pebbles in a rain stick, there is a point where the trickle that sounds like raindrops becomes a flow that sounds like a downpour.

The radiation treatments were coupled with a regimen of steroids. The steroids made Howard a little cranky. Then they made him easily annoyed. Then they gave him the kind of short fuse he’d had twenty years earlier and which he’d gotten over as age and life softened him. At first, I didn’t like the transformation. Then it scared me. He accused me of trying to control him when both of us knew that neither of us could actually control the other. That had been worked out years earlier. When he became instantly angry over something trivial and actually raised his arm, as if to strike, he frightened both of us. He didn’t know what was happening to him. Neither of us was sure it was the steroids, but I suspected as much. He called his doctor and quickly went off them. Within a couple of days, he returned to the kind of equanimity we were both more comfortable with.

In only a couple of weeks, the radiation treatment was complete. In a matter of speaking, Howard was fully cooked and he was weakening before my eyes. I had become proficient at determining when he needed a blood transfusion and I was sure he needed one. For a couple of weeks, I nudged. He wasn’t ready. Then I pushed. He still wasn’t ready. Finally, I asked him what was going on, why he seemed reluctant to call for an appointment to have his blood tested. He’d had blood transfusions when he needed them for months. Why was he dragging his feet now?

Something in my tone, combined with his weakening state, broke through the defenses. He admitted that he was putting off having his blood tested because his radiation doc had told him that if there was a reoccurrence of his symptoms, he should have his wife drive him to the hospital. I was certain that his doctor was referring to the symptoms related to the cancer having spread to the dura—the numbness in his face, for instance—and not the weakness associated with needing a blood transfusion. But it was the word “hospital” that had brought him up short. He feared that all of the doctors were giving up on him and he would now be consigned to hospitalization. And that was the last thing he wanted.

It took him a good minute or two, after dropping this bit of information, to add that he did not want to complicate his life—meaning the hospitals and everything that went with it. He was near tears. I bust out laughing.

“Complicate your life? Do you realize how ridiculous that sounds? Complicate your life? Could it get more complicated than it already is?”

And then I invoked the Gretchen Principle. Gretchen, meaning Gretchen Minney. The Gretchen Principle was a reference to something she had done when her husband, Bill, was dying of a brain tumor and found himself in the hospital. He wanted out. Gretchen understood the implications of doing so, but broke him out anyway. She commandeered a wheelchair and they escaped.

I told Howard that I would not allow anyone to keep him in the hospital against his wishes. I added that I was in agreement with him to stay out of hospitals if at all possible. I promised to break him out, as Gretchen had done for Bill, if necessary. He was relieved and seemed to relax a bit.

It was a good agreement. We would need it soon.

The morning he finally decided he needed that blood test, he slowly made his way from the upper level of the house to the lowest level and took a seat in my office, where I was busy editing.

“I need you to drive me,” he said.

I turned to face him, raised my eyebrows, and told him I would drop what I was doing and take him. “I need you to drive me” was code for a lot of things.

I had been concerned about his driving. His doctor had not forbidden him to drive because he hadn’t had a seizure, but driving seemed risky at best. He’d fallen more than once coming to or going from the truck when he felt particularly weak. He’d made it into Newsland on one occasion, only to fall once inside. An ambulance was called. He was mortified and talked his way out anything but a quick check. That he’d actually told me when he returned home was a surprise because he had been embarrassed and it was exactly the kind of thing he might have kept to himself. Apparently, he had come to the conclusion that he needed a confidant about such things and I had proven myself trustworthy. Not an easy decision for a former Marine and Chief of Police.

When I’d expressed my concerns about his continuing to drive, he had promised me that should the day ever come when he felt he could not drive himself somewhere, he would ask me to drive him. I hadn’t believed him, but he was doing just that—right in front of me. I was not so much surprised by the fact that he was too weak to drive as I was him admitting it.

He was so weak that I’d told him, wryly, that he’d be dead soon if he didn’t go for a transfusion. It was that critical. I had seen him in need of a blood transfusion before but I had never seen him this weak.

Slowly and with care, we got into my car and made our way to the cancer clinic. It was only my second time there. He had insisted on going alone for all the time he’d been treated there. I’d gone with him when we discussed the matter of radiation treatments, less than month earlier. When we arrived, the nurses immediately saw what I had seen. They took a blood sample and assured him that even without seeing the results, they could tell he needed a transfusion. I offered to place a bet with them on the number of units, knowing it would be at least three. That told them pretty much all they needed to know about the wife. They could see that I was neither naïve nor weak spirited. They could also see that I was not going to be placated or assured. I was calm, I wanted answers, and I wanted to know what we needed to do for my husband—right then, right there.

Three was an underestimate. He needed four units. The nurses were very concerned. He was used to having the blood work done one day and the transfusion the next. There wasn’t going to be a delay this time. He was going to get that transfusion as soon as we could get him to the outpatient unit at the hospital and he was going with an oxygen tank in tow. His blood oxygen level was 82-85%. No compromises, no leaving without the tank.

He objected. They persisted. He growled. They were adamant. He did not want to be seen as an invalid. Didn’t matter. They rigged him up with a tank while they made arrangements for the transfusion. Arrangements made, we left the clinic with an oxygen tank trailing us. I got him settled and the tank settled. Just as I was about to drive off, heading for home to grab a few things before continuing on to the hospital, he said, “Be careful,”—meaning that I should take care with my driving.

I left the car in “park,” turned to look at him, and said, “Are you kidding? Be careful? We can’t get into an accident. We have an oxygen tank in the care. If we’re hit, we’ll blow up.”

The absurdity of it was so funny that it was verging on Monty Pythonesque. It wasn’t quite . . . but we would be all the way there shortly.

At the hospital, I swung around to drop him off at the door. He was not going to let me help him in and he was not going to let me get him a wheelchair. The best I could do was drop him off, snag the closest parking spot I could, and sprint back to him. I found a spot very close and was away from him for less than sixty seconds. Too long. As I approached the hospital doors, I could see that he had never made it inside. He was on the ground with a flock of people around him. To make matters worse, the automatic doors kept opening and closing on a woman who was also on the ground. I soon found out that she was a nurse assistant who had been in the wrong place at the wrong time. She was coming in as he was and when he began to go down, she tried to catch him. She was a small woman. Even ill, he was a large man. The doors thwamped and thwamped on her until someone finally stopped the beast.

Howard was on the ground, conscious and annoyed. Doctors and nurses were gathered around him. That part was good. Someone called for a neck brace and a board. That part was also good. But numerous people kept asking him the same questions, over and over. “Are you conscious? How long were you out? Did you lose consciousness? Can you move?” And on and on. One time would have done it as far as Howard was concerned. He wanted to answer the questions and get the heck out of there. He was embarrassed, unhappy at being prone, and becoming increasingly annoyed by the mantra being murmured by the medical staff in the form of questions.

If there was any chance that Howard might get a glimmer of understanding that he had waited just a tad too long to go in for a blood transfusion, it would happen right there as he lay on the cement in front of the hospital doors. It was alarming, but it was so . . . so . . . Howard. There was something just a bit funny about it. The thwamping doors. The fact that I knew some version of “Just shoot me” was being muttered just enough under his breath as to be imperceptible to anyone but me. The surreal quality of it all.

Not funny at all was my internal radar. It was on alert and sirens were going off inside. I knew that this was the beginning of the end.

Copyright 2011 by Melanie Mulhall

Worst Fears

September 26, 2011

What we fear most sometimes ambushes us when we are otherwise preoccupied with challenges we believe are, in themselves, about as much as we can take. My husband had a brilliant (if sometimes perplexing) mind. He was a wordsmith and the keeper, in our household, of obscure words and interesting etymology. He was a deep thinker, though he occasionally proclaimed that if personal depth could be compared to the depth of a pond, his would be revealed as being only ankle deep. I felt it would be measured in fathoms, not inches.

The decline he experienced the summer and early fall of 2010 was mostly a physical decline, not a mental one. He could handle the physical decline, even if he did not like it. His worst fear—and mine for him—wasn’t physical decline, but losing his mind during the downward spiral.

The threat of that ambushed us in mid-October. One of his closest friends, Andy Wilkinson, was visiting from Texas. I had urged Andy to visit because I feared that Howard might die before they had a chance to see one another again and something in my sense of urgency had gotten through to him.

Neither Howard nor I thought much about the MRI scheduled during Andy’s visit. There had been so many scans and tests over the previous three years that I no longer gave them much mental or emotional air time because they almost never revealed anything important or even useful. But the MRI had been scheduled because Howard had reported some rather puzzling symptoms during a checkup. He’d been having a certain numbness on one side of his face that seemed to be present when he was prone and went away once he was out of bed and moving around a bit. He hadn’t been quick to tell me about it and when he had, he hadn’t seemed overly concerned. The fact that he had actually informed me of the symptom should have told me more than his seeming lack of concern about it. But my antennae must have been slightly misaligned that day.

I’d chalked it up to his overall lack of mobility. The blood just wasn’t having a chance to circulate like it should. I had little fear of stroke because it didn’t fit the kind of numbness connected with stroke. He and I had both noticed that words were occasionally failing him, too, but that didn’t alarm me, either. It wasn’t severe and I thought it to be symptomatic of his overall decline.

The MRI was just a minor interruption to an otherwise lovely visit by Andy. In fact, Andy went with him to the appointment.

His doctor called the house before they returned. The cancer had metastasized to the dura—the covering of the brain. There were also a half dozen nodules between the dura and brain, one of them large enough to be putting some pressure on the brain. That was probably what was causing his symptoms.

This was the first time in fifteen years his oncologist had seen this kind of metastasis in one of his prostate cancer patients. The online research I did later suggested that cancer metastasizes to the brain in 1-2% of prostate cancer patients and that this percentage might actually be inaccurately low based on the autopsy results of some men who had died of prostate cancer. It would seem that the cancer might be finding its way to the brains of these men more often than assumed, but when it did, they often died before it was discovered.

As his doctor talked, it seemed to me that the fear I’d never allowed handhold, foothold, or any purchase at all in my mind was standing in front of me and making faces, instead of just climbing around in my head. If the cancer continued to spread in this area, any number of alarming and deadly things could happen, depending on the part of the brain impacted. He could have seizures. His ability to swallow, breathe, see—in other words, his ability to perform one or more bodily functions necessary to live—might be impaired. He could lose his ability to speak . . . or even think. The possibilities were ugly.

I was in tears when he and Andy got home. One look at me, before I said a word, told Howard that something was very wrong. I don’t think he immediately connected it to the MRI because, like me, he hadn’t expected the MRI to tell us much. Andy was an innocent caught in a drama he hadn’t auditioned for. Fortunately, Andy was as good a friend and as strong a man as I had always believed him to be. But he’d come to our home without having seen, first hand, Howard’s decline over the past few months and was now finding himself in something of a B-grade horror movie.

I think Howard’s doctor had been in shock, too. He didn’t hold out much hope for doing anything about this newest development during my initial conversation with him. But by the time we saw him, less than two days later, he had a plan. We could do nothing about this newest development. Or . . . Howard could undergo a round of radiation treatments, not to effect any “cure,” but to mitigate some of the potential consequences of the metastasis. In other words, if we were lucky, Howard might continue his pilgrimage toward death and ultimately die without losing his senses or his mind.

Neither of us was keen to have him undergo radiation treatments, but we were both relieved by the sliver of hope that having them might allow him to maintain some of that keen mental prowess so important to him.

I found myself supporting the idea. Howard had chosen an allopathic, conventional approach to the treatment of his cancer. It was not an approach I liked. It was an approach I doubted I would take if I were diagnosed with cancer. Yet, here I was—the woman who mostly disdained the entire approach to medical “care” in the Western world—not only supporting radiation treatment, but feeling grateful that it was an option.

As for Howard, he never wavered from his stance that Death was going to have to do more than show up and invite him to depart, it was going to have to wrestle him—like the angel who wrestled Jacob through the long night. The poet Rainer Maria Rilke once wrote that it is not winning that tempts the man who would wrestle with such an angel. On the contrary, the man who would undertake a match like this would have the wisdom to know that being defeated by such a powerful being would make him more than he had been before the match.

Perhaps, but Howard wasn’t quite yet ready to surrender in this way. He wanted to hold on to any shred of his physical presence that he could . . . and as much of his mind as could be bargained for in the delicate negotiations between Death, allopathy, and his own considerable will.

Copyright 2011 by Melanie Mulhall