Posts under ‘cancer’

Cancer insidiously spreads itself into remote corners of the body, with greedy fingers reaching out where it is most unwanted. With unmatched stealth, it manages to send pieces of itself to distant organs through avenues of lymph or blood. And strangely enough, even if the cancer originated in the lungs, any distant metastasis will always show microscopic signs of its organ of origin if a scientist or doctor cares to check. So, if a brain cancer eventually lodges itself into the femur or spine, there are cellular markers that will actually brand that metastasis as originating in the brain. It’s like a postmark by the cancer post office which delivers nauseating information of its original port of entry.

As the cancer nudges its way into various body systems and organs, it chokes off blood supply lines, interrupts normal metabolic activity, and insinuates itself in places where it is wholly unwelcome. Once it invades an area, the tumor will then begin to grow its own blood vessels, co-opting a nourishing blood supply for its own devices. Deprived of adequate circulation of blood, important organs or tissues become compromised and begin to malfunction or die. Chain reactions of metabolic chaos are set off, and delicate biological balances begin to be altered. At a certain point, there is no turning back, and the body begins an inexorable decline.

If treatment is chosen, the damage done by both chemotherapy and radiation can often exacerbate previous symptoms or create new ones. Radiation can permanently damage certain tissues which happen to be in the way of the treatment, and chemotherapy is wholly nonselective in which cells it destroys. For this reason, hair and other fast-growing cells are killed, including the lining of the gastrointestinal tract. Many cancer patients will say that the effects of the treatment are worse than the disease. An ironic reality.

When a patient comes to hospice, no further treatments are planned, and the disease is left to run its natural course. Left to its own devices, cancer spreads its wings and lodges in brain, bone, liver, lung—almost anywhere. And while certain cancers have a predilection for metastasizing to certain distant lands, it will also simply begin to work its way into locally adjacent sites, pushing through tissue, breaking down walls, filling up cavities, destroying connective tissue. If the cancer is in a visceral organ like the pancreas, it will choke off vital blood vessels and take up more and more space in a crowded abdominal cavity. Back pain, nausea, and radiation of pain to the flank will only add insult to injury as the cancer slowly takes over more and more bodily real estate. Running amok, symptom management and alleviation of suffering become the only goal.

As the patient nears the end, all medications are stopped which do not directly treat specific symptoms related to the cancer or its effects. Eventually, much to a family’s dismay, medications for underlying chronic disorders (like thyroid diseases or diabetes, for instance) will simply be discontinued. Just as the cancer is allowed to run its course, other underlying conditions are allowed to simply coexist with the cancer, and the management of symptoms and the alleviation of pain and suffering hold sway as the laser beam focus of care.

As a clinician or a family member, this decline of the body as it is taken over by unwanted forces is difficult to witness. Family members and friends may face denial, anger, or any number of reactions as their loved one declines before their eyes. With any luck, skilled clinicians can provide the emotional, psychological and spiritual support which is so needed at this pivotal time. Clergy and other members of the care team can also provide additional support as the situation spirals inexorably towards death.

Countless patients and families experience this series of battles and maddening losses when cancer moves to a stage beyond treatment or cure. With physical illness comes loss of independence, mental decline, spiritual questioning, and psycho-emotional changes. When hope of a cure has vanished, then hope for peace and freedom from suffering become the focus, and a thoughtful hospice team will treat the family as skilfully as it treats the dying patient.

Many of us have walked this road with a loved one or known someone who has. Cancer somehow seems to touch a majority of families, either by direct experience or at least by association. In my own family, every man on my father’s and mother’s side seems to have died from cancer, and my step-father succumbed to pancreatic cancer less than five months ago.

I have known cancer intimately in my personal life and my professional life, and while it is an acquaintance I don’t covet, it is one which has brought me deeper knowledge of the human condition beyond anything I could ever have imagined. Without a doubt, even more learning will ensue as I work in a hospice setting, but also simply from being a human being in relation to other human beings who are facing illness and the certainty of death.

To anyone who has lived through the loss of a loved one to cancer, I offer my sincerest condolences, my prayers for your healing, my prayers for your loved one’s soul, and my hopes that your life and family will be further spared unnecessary suffering. In the face of loss and death, we all must face our own mortality and spiritual pain, and I wish you, dear Reader, strength and peace in your own travels down this often turbulent and troubling path of human existence. Namaste.

Foremost on my mind today is the cancer which is growing daily in my step-father’s abdomen. Resistant to radiation and chemotherapy, the mass has reached its tentacles of new blood vessels beyond the pancreas, encapsulating crucial abdominal blood vessels, siphoning off his very lifeblood for its own parasitic purposes. Cancer is truly cell growth gone beserk, and the cells just keep multiplying as he becomes less and less comfortable, and more and more fatigued.

Now, a clinical trial is on the horizon, with the promise of an experimental drug to stop the tumor’s growth of new blood vessels, also known as “angiogenesis”. These clinical trials are often the last stop in terms of known therapies for patients still looking for cure or treatment, and we have illusions that it will buy us much more than few months. But who knows? Miracles do indeed happen.

As the “family nurse”, it’s a challenge to know when to turn off my “nurseness” and simply be a son. I am constantly wondering about treatment options, resuscitation status, hospice referrals, funeral arrangements, symptom management. The son in me worries most for my mother, her future as a widow, where she will go and what she will do after these thirty years of marriage. I have walked many families through this journey. Now I’m on the other side of the equation and it is testing my mettle.

It is all excellent fodder for therapy, and some very coarse grist for the proverbial mill. They say that God (or The Universe, if you will) never gives us more than we can handle at any given time. If that’s so, I want to say to whoever makes that determination that I have plenty of grist right now, thank you. My mental mill is working overtime, and no additional stressors are welcome at this time. Will my request for a reprieve be heeded? Only time will tell.

He left six months ago for his homeland of Puerto Rico, certain that he wanted to die there. Five years of a professional yet intimate relationship were behind us: AIDS, cancer, remission, diabetes, wasting, cancer relapse, colostomy, and a downhill slide from there on.

When hospice at home failed, and wet sheets, untaken meds, and benign neglect demonstrated that being alone in his own apartment was not working, his family whisked him away to Puerto Rico, where he could come to rest surrounded by the smells and sounds of his motherland. I was sad to see him go, but happy for his reception into the welcoming bosom of family, and honestly relieved that my years of urgent calls and emergencies were over.

I had considered going to Puerto Rico to say goodbye, to visit him in his native land, but our financial situation and my responsibilities here stayed my hand. I also was just not sure that my appearing at his bedside would be truly beneficial to him, or only painfully remind him of all that he left behind, perhaps giving rise to unnecessary remorse and regrets that would have otherwise have remained blessedly subterranean. If I had gone, it would surely have been for me, not him, and I just wasn’t convinced that it would be for the best. Instead, I erred on the side of caution, following the ages old adage, “Don’t just do something, sit there.”

We did have one telephone conversation about four weeks after his departure. I called the home where he was staying in Puerto Rico and we chatted for a while. I told him that I loved him, and that God would bless him and his family. He blessed me as well, and we hung up. Although I had planned to call again, the number on a sticky note by my desk, it just didn’t happen.

Another goodbye, another letting go, another opportunity to say “I did enough”. And I can say it truthfully. I did enough. No room for regrets. It’s simply goodbye.

My step-father begins radiation this morning at 8:30, perhaps at this very moment. He will also take oral chemotherapy for the first six weeks and then perhaps change to intravenous therapy thereafter. The only cure for pancreatic cancer is surgery, and this is not a possibility for him, at least for now, and perhaps never. These are the times when living five hours away from one’s aging parents is a painful and isolating experience.

Life-altering illness offers many lessons and will push one to the edge and beyond. Change is the only constant here, and there are so many with which one must cope. It is not only change which holds one in its grip, but the spectre of loss visits in guises both small and large. One might lose one’s hair from chemotherapy. The ability to drive, to eat whatever and whenever one wants, the ability to control one’s bodily functions may all be lost at any time in this complicated game. For every step forward, there can often be several steps back, a new aspect of loss appearing at any moment.

I would assume that the most devastating losses come in the form of the loss of independence and of dignity. Retaining independence becomes a major challenge as the body gives way, as symptoms preclude even the most basic of daily activities. And with the loss of independence, one may begin to feel a loss of dignity, of the self, of one’s place in the world. When the individual becomes weak, incontinent, unable to toilet him- or herself, unable to bathe independently, these are the losses in which the person begins to lose quality of life and a true sense of self, or at least a sense of the self as one has known it.

Anticipatory loss is another aspect of illness. As a form of grieving, this manifests as one faces losses which are only around the corner. Depending on the form of disease, one can anticipate further deprivation and change. In progressive neurological disease, even the most simple function may be on the docket. The powers of speech, swallowing, hearing, touch, sexual function—these too can be taken away and remain but a memory.

The most devastating of all losses may be the knowledge that one will eventually leave one’s loved ones behind. The worries and concerns may mount: Will s/he be OK? Will they be financially solvent? Did I do enough to prepare? Are my affairs in order? How much will my illness cost them, both emotionally and economically? Will my loved one be able to continue on without me? Who will care for them when they are sick or needy? Did I accomplish all that I wanted to accomplish?

Finally, beyond loss, one begins to look toward the future, one’s future beyond this world. One examines the spiritual questions on the table, reflects on one’s life, hopefully makes peace with the choices that have been made, and considers what will happen when the curtain closes on this earthly existence. The beliefs that have grown in the psyche and mind over the decades now come to bear. One’s faith—or lack thereof—makes itself known. They say there are no atheists in foxholes, and the existential begins to take on more and more importance as the material world recedes. This is the time when the outer losses lose the crucial impact which they once carried, and the mind turns inwards towards matters of spirit, of faith, of making peace with both life and death.

I have watched a number of individuals enter, travel through, and complete this process. For those who lost function of outward communication and became demented or aphasic, their inner peacemaking was just that—inward—and I have not been privy to their process. For those who retained their mental capacities and ability to communicate until the end, the observer and loved one can glean much more from the experience and in some ways share more in that journey.

When the individual entering this phase of life and letting go is an intimate loved one (like a parent) rather than a patient, that is where the poignancy of this process takes wing, and also where the pain can become more visceral. This is the place where my mind and heart now dwell, and it’s now my turn to walk this road as I have watched so many others travel with me as advocate and guide. The loss may be swift, it may be slow, but it is real, it is intimate, and its reality cannot be denied. I feel for my mother as she faces this gradual deneoument of her life as she has known it, and while I fear for her security and stability, I also must care for my own. This is no place for codependence and loss of one’s center. This is a time for groundedness, thoughtfulness, spiritual insight, sensitivity, and compassion for myself as well as others.

As a family, we have crossed that threshold of loss and letting go, and the path which we will follow together has been trod for millenia. May we do it well, with grace and humility, and come through the other side stronger and more healed, and may my step-dad’s losses and eventual passing be peaceful and as painless as possible, with suffering kept to a minimum. This is my wish for us and for all families who are on any portion of this universal journey of life, love, and death.

So be it.