Sunday, January 25 through Friday, January 30
Mom and I had discovered a unique breakfast spot in Emory Village. While she and Dad packed and prepared for the trip home, I drove there to pick up carry-out. I hauled a box along in case I needed it for beverages.
Sitting on a bar stool at the counter eating area near the rear entrance, I placed our order. As usual, the Rise and Dine was crowded with hungry patrons enjoying the unique omelets and specialty coffees. As the exotic beauty placed two beverage trays and two carryout bags on the bar, a college student sitting nearby made an offer.
"I'll help you carry that out to your car."
I gratefully accepted and placed the beverages in the box. He had done his good deed for the day, I told him.
On the return trip, I watched wistfully as families crossed the road to the cream-colored church, small children in tow and toddlers in arms. I'd forgotten it was Sunday. At home, I'd be on my way to Sunday School and would sing in the choir. It gave me a good feeling, though, to see so many people eager to worship God.
Gathered around the desk-table, we enjoyed breakfast together in the room. By noon we were on the road with all our belongings, Mom ensconced in the back seat and Dad reclined in the front seat. She slept longer than he did, and a bit of Dad's conversation was enough to keep me alert.
We unloaded the car at their house, then I said goodbye and headed home. All of us agreed, talking by phone, that it would be great to sleep in our own beds.
Every day I talked to Mom, but the first few days, Dad didn't want to talk on the phone. On Thursday he answered the phone. His voice was hoarse and rather toneless, but other than that he sounded fine. He seemed disappointed his appetite wasn't better and he still needed pain medication. I encouraged him to give it time.
Ben Haden called me. He hadn't been able to reach either of my parents and wanted a report on Dad's progress. We talked several minutes, a pleasant conversation, and I assured him I'd give them his love.
Mom told me today Dad called work and told the girls in the office he'd be back in two or three weeks. She was skeptical about two weeks. I'm just glad he was talking positively. He's been somewhat listless and isolated, by his own choice, this week. Recovery is more than a physical process. It's also psychological, emotional, and spiritual. I'm praying he will continue to improve in each of those ways.
Friday, January 30, 2009
Sunday, January 25, 2009
Chapter Thirteen: Better News
Saturday, January 24
After catching breakfast at Evans', we gathered up Dad's things he might need, valet parked near the front of the hospital, and I wheeled Mom up to his room.
Dr. Sarmiento had already made rounds. Dad asked him how many Whipples he did in a year. Last year he had done 75. Dad told me Johns-Hopkins and Massachusetts General had each done about 150 Whipples per year, but using around six surgeons. Dad, Gary, and John Galloway believe Dr. Sarmiento is in the top three as far as how many of these operations an individual surgeon performs.
In past times the surgeons only took out 4-5 nodes for the pathologist to dissect from the block of tissue extracted. Dad had 29 nodes removed. Only one was positive for cancer cells. Dr. Sarmiento asked how Dad was doing. He admitted to the surgeon he was down, feeling discouraged. Dr. Sarmiento said he shouldn't be discouraged. Virtually all the people he operate on have cancer of the pancreas. The pathologist who works closely with the surgeon is an expert on cancer which originates from IPMN--introductal papillary mucosin neoplasm--which is the type first identified on Dad, in the mucinous cyst seen by MRI and CT, before his scope in South Carolina. He told Dad this was just about the smallest cancer he has seen.
Dad shared with Mom and me the two most encouraging signs from Dr. S.:
1) the very small cancer was a significant prognostic indicator
2) Dr. S. and his pathologist say this cancer is almost certainly not a typical pancreatic cancer.
The IPMN-generated behave differently. For those who don't have IPMN and have pancreatic cancer originating in the ducts, the five-year survival rate is less than 15%. If the cancer started as IPMN, which apparently was the consensus at Emory, Dad has better than a 50% chance of surviving five years. In the broad spectrum of patients, those with "garden-variety" pancreatic cancer have a 10% chance of survival.
Mom, Gary, and I all asked, how can you be sure the tumor was IPMN-originated, just because it was near the other tumor found in the node? Good question, Dad agreed. He plans to follow up on the path report, which didn't give the details on why those involved in the pathology study had drawn the conclusions they did.
Part of their reasoning may have been because the original tumor and the node tumor were smack together--too much to be a coincidence? Was there some kind of transition? It's unlikely two different types of tumors were that close to each other.
Dad explained to us that his tumor was considered a T-3, because it was 2.2 centimeters, but it was elongated, like a flattened, misshapen pancake. In some places it measured 1.5. The outcomes are poorer for a T-3 as opposed to a T-1 or T-2.
N-0 would indicate no nodes with cancerous cells. Dad was barely N-1, which means lower risk. Most of the data is applied to a different type of tumor, so it may not be accurate applied to his case.
The positive node found in Dad's tissue was near the original tumor. Samples were taken of different groups of nodes further from the specimen. Several node groups beyond the positive tumor were clear. When Dad described this to Gary on the phone, he said, "I'm in a class by myself." Mom and I heartily concurred.
John Galloway stopped by and stayed awhile. He said, "As a physician, with the circumstances of your cancer, I might say you didn't really need to take the chemo.
"But as a patient, having experienced near-fatal cancer myself, I would do it. When I heard the chemo and bone marrow transplant would only increase my chances of long-term survival about 10 %, I wondered whether it would be worth it. But I realized I didn't want to look back and regret not doing all I could to live my life to the optimum."
He pointed out that perhaps Dad had a higher likelihood at age 79, nearly 80, of dying from something else other than pancreatic cancer, but he encouraged Dad to take the chemo.
As for Dad's questions about the origin of the cancer, to John it appeared it was contiguous with the IPMN, so it is probably the same type of cancer. John agreed that the moderate nuclear grade (not fast-growing or wild) and the small size were also good signs.
John, a myloleukemia survivor who experienced several close brushes with death, said wryly, "Dr. Hixson , your chances for survival are probably a lot better than mine."
Dad finished his lunch as Mom packed his things. The nurse removed his IV line for the last time. The tech brought his huge plastic chariot/cart, and we loaded him and all his belongings. As we followed him down the hall, me pushing Mom's wheelchair, Elaine the tech and Jean the nurse were there to tell us all goodbye. I got tears in my eyes as I thanked and hugged them. They took such good care of my dad at Emory.
Dad enjoyed resting in the hotel room, Mom as well, while I tracked down his over-the-counter meds and pain medication. The CVS at Emory Village gave me directions to a nearby CVS in Druid Hills where I was able to get his pain prescription filled. After resting, I got us all a carryout from Evans.
We were just finishing dinner when Gary surprised us with a visit. It was a fun family evening.
After catching breakfast at Evans', we gathered up Dad's things he might need, valet parked near the front of the hospital, and I wheeled Mom up to his room.
Dr. Sarmiento had already made rounds. Dad asked him how many Whipples he did in a year. Last year he had done 75. Dad told me Johns-Hopkins and Massachusetts General had each done about 150 Whipples per year, but using around six surgeons. Dad, Gary, and John Galloway believe Dr. Sarmiento is in the top three as far as how many of these operations an individual surgeon performs.
In past times the surgeons only took out 4-5 nodes for the pathologist to dissect from the block of tissue extracted. Dad had 29 nodes removed. Only one was positive for cancer cells. Dr. Sarmiento asked how Dad was doing. He admitted to the surgeon he was down, feeling discouraged. Dr. Sarmiento said he shouldn't be discouraged. Virtually all the people he operate on have cancer of the pancreas. The pathologist who works closely with the surgeon is an expert on cancer which originates from IPMN--introductal papillary mucosin neoplasm--which is the type first identified on Dad, in the mucinous cyst seen by MRI and CT, before his scope in South Carolina. He told Dad this was just about the smallest cancer he has seen.
Dad shared with Mom and me the two most encouraging signs from Dr. S.:
1) the very small cancer was a significant prognostic indicator
2) Dr. S. and his pathologist say this cancer is almost certainly not a typical pancreatic cancer.
The IPMN-generated behave differently. For those who don't have IPMN and have pancreatic cancer originating in the ducts, the five-year survival rate is less than 15%. If the cancer started as IPMN, which apparently was the consensus at Emory, Dad has better than a 50% chance of surviving five years. In the broad spectrum of patients, those with "garden-variety" pancreatic cancer have a 10% chance of survival.
Mom, Gary, and I all asked, how can you be sure the tumor was IPMN-originated, just because it was near the other tumor found in the node? Good question, Dad agreed. He plans to follow up on the path report, which didn't give the details on why those involved in the pathology study had drawn the conclusions they did.
Part of their reasoning may have been because the original tumor and the node tumor were smack together--too much to be a coincidence? Was there some kind of transition? It's unlikely two different types of tumors were that close to each other.
Dad explained to us that his tumor was considered a T-3, because it was 2.2 centimeters, but it was elongated, like a flattened, misshapen pancake. In some places it measured 1.5. The outcomes are poorer for a T-3 as opposed to a T-1 or T-2.
N-0 would indicate no nodes with cancerous cells. Dad was barely N-1, which means lower risk. Most of the data is applied to a different type of tumor, so it may not be accurate applied to his case.
The positive node found in Dad's tissue was near the original tumor. Samples were taken of different groups of nodes further from the specimen. Several node groups beyond the positive tumor were clear. When Dad described this to Gary on the phone, he said, "I'm in a class by myself." Mom and I heartily concurred.
John Galloway stopped by and stayed awhile. He said, "As a physician, with the circumstances of your cancer, I might say you didn't really need to take the chemo.
"But as a patient, having experienced near-fatal cancer myself, I would do it. When I heard the chemo and bone marrow transplant would only increase my chances of long-term survival about 10 %, I wondered whether it would be worth it. But I realized I didn't want to look back and regret not doing all I could to live my life to the optimum."
He pointed out that perhaps Dad had a higher likelihood at age 79, nearly 80, of dying from something else other than pancreatic cancer, but he encouraged Dad to take the chemo.
As for Dad's questions about the origin of the cancer, to John it appeared it was contiguous with the IPMN, so it is probably the same type of cancer. John agreed that the moderate nuclear grade (not fast-growing or wild) and the small size were also good signs.
John, a myloleukemia survivor who experienced several close brushes with death, said wryly, "Dr. Hixson , your chances for survival are probably a lot better than mine."
Dad finished his lunch as Mom packed his things. The nurse removed his IV line for the last time. The tech brought his huge plastic chariot/cart, and we loaded him and all his belongings. As we followed him down the hall, me pushing Mom's wheelchair, Elaine the tech and Jean the nurse were there to tell us all goodbye. I got tears in my eyes as I thanked and hugged them. They took such good care of my dad at Emory.
Dad enjoyed resting in the hotel room, Mom as well, while I tracked down his over-the-counter meds and pain medication. The CVS at Emory Village gave me directions to a nearby CVS in Druid Hills where I was able to get his pain prescription filled. After resting, I got us all a carryout from Evans.
We were just finishing dinner when Gary surprised us with a visit. It was a fun family evening.
Friday, January 23, 2009
Chapter Twelve: How to Be Realistic and Optimistic--at the Same Time
Friday, January 23
After another great breakfast at the trendy little Emory Village restaurant, Rise and Dine, Mom and I entered Dad's room in time to meet Dr. Kauh (pronounced "Ko"). He is a hematologist/oncologist at Emory. In Dad's recap to the doctor, I heard for the first time that the original tumor targeted by the surgery was actually larger than the scope showed. It was longer, 2.2 cm.
Dr. Kauh agreed that the node with the tumor being close to the first tumor was good. He said radiation is controversial. Europeans don't believe in it. They chose to do their trials with chemotherapy, Gemsar, alone. The German study, which included hundreds of patients, made much more sense, however, than an American study which only used 43 patients, due to the doctors' bias against enrollment.
Chemo and radiation had been standard care until the last three years. In 2003, patients treated with chemo only did best. Chemo plus radiation was 2nd to last. Dr. Kauh's inclination with clean margins like Dad's is to shy away from radiation.
The regimen he uses--standard with most oncologists currently--is Gemcitabine (produced by Eli Lilly as Gemzar) . Most patients respond with few side effects. Normally they experience flu-like symptoms for two or three days after treatment. The protocol is once weekly for three weeks in a row, then one week off. Blood counts are taken to ensure the patient remains healthy.
This goes on for six months, with a total of 18 treatments. The window after surgery is 4-8 weeks, depending on the individual's progress.
The doctor told Dad he was doing great, with no IV (the nurse removed it today but kept the connection in case needed) and no nasogastric tube.
Dr. Kauh was very matter-of-fact, reminding Dad that pancreatic cancer has a high propensity to recur. But he also pointed out that out of all 30,000 cases diagnosed annually, only 15% are local tumors which are operable. Of those, only 10% will be resectable (able to put remaining parts of pancreas back together with other organs). So Dad is already in the top 10% of pancreatic cancers.
After the doctor left, Dad told us Wendell had called. He had eaten a few bites of scrambled egg for breakfast, along with a little biscuit and a fair amount of grits.
Rolanda came in to take Dad's vitals and told us she loved Chattanooga and had visited many times.
Dad's lunch tray arrived. Food, drink, even water, tasted funny to him, probably side effects of meds and anesthesia. He did eat a smattering of most of the foods and requested a chocolate milk, which showed up an hour or two later.
Dad and I took the usual walk. He was eager to talk about the iffy prognosis and the fact that instead of the actuarial prediction based on his overall health and condition that he might live 9 more years, perhaps he only had 5 or less. Yet he really didn't know.
He said, "This puts my life in perspective. I know my time may be more limited than I thought. The important thing is to live each day as though it's your last. I need to find out what the Lord wants me to do in the time I have left--and do it."
After his walk, the pain meds started to kick in, a good thing with his incision hurting, so he settled in for a nap.
Later, Gary came and entertained us with funny stories about Trey and the pictures on his camera of his family taken by a photographer friend last weekend when their whole family was together.
Mom and I met Gary, Sherry, and Laney at Athens Pizza for dinner, and we laughed some more.
As Mom and I made a couple of errand stops on the way back to University Inn, she expressed her fears and shock.
"You know, I thought maybe one day your dad would have to have open heart surgery. But I never dreamed of anything like this. I don't think he's really grasped it yet."
I told her, "I think denial is normal. I'm not thinking of it as real yet myself. I know what the statistics about pancreatic cancer say, but I also know that God is greater than statistics, and people are individuals."
It was good to talk to Flavia today and touch base with home folks. I was glad to speak with Billie about her loss, knowing we are not the only people going through difficult times.
After another great breakfast at the trendy little Emory Village restaurant, Rise and Dine, Mom and I entered Dad's room in time to meet Dr. Kauh (pronounced "Ko"). He is a hematologist/oncologist at Emory. In Dad's recap to the doctor, I heard for the first time that the original tumor targeted by the surgery was actually larger than the scope showed. It was longer, 2.2 cm.
Dr. Kauh agreed that the node with the tumor being close to the first tumor was good. He said radiation is controversial. Europeans don't believe in it. They chose to do their trials with chemotherapy, Gemsar, alone. The German study, which included hundreds of patients, made much more sense, however, than an American study which only used 43 patients, due to the doctors' bias against enrollment.
Chemo and radiation had been standard care until the last three years. In 2003, patients treated with chemo only did best. Chemo plus radiation was 2nd to last. Dr. Kauh's inclination with clean margins like Dad's is to shy away from radiation.
The regimen he uses--standard with most oncologists currently--is Gemcitabine (produced by Eli Lilly as Gemzar) . Most patients respond with few side effects. Normally they experience flu-like symptoms for two or three days after treatment. The protocol is once weekly for three weeks in a row, then one week off. Blood counts are taken to ensure the patient remains healthy.
This goes on for six months, with a total of 18 treatments. The window after surgery is 4-8 weeks, depending on the individual's progress.
The doctor told Dad he was doing great, with no IV (the nurse removed it today but kept the connection in case needed) and no nasogastric tube.
Dr. Kauh was very matter-of-fact, reminding Dad that pancreatic cancer has a high propensity to recur. But he also pointed out that out of all 30,000 cases diagnosed annually, only 15% are local tumors which are operable. Of those, only 10% will be resectable (able to put remaining parts of pancreas back together with other organs). So Dad is already in the top 10% of pancreatic cancers.
After the doctor left, Dad told us Wendell had called. He had eaten a few bites of scrambled egg for breakfast, along with a little biscuit and a fair amount of grits.
Rolanda came in to take Dad's vitals and told us she loved Chattanooga and had visited many times.
Dad's lunch tray arrived. Food, drink, even water, tasted funny to him, probably side effects of meds and anesthesia. He did eat a smattering of most of the foods and requested a chocolate milk, which showed up an hour or two later.
Dad and I took the usual walk. He was eager to talk about the iffy prognosis and the fact that instead of the actuarial prediction based on his overall health and condition that he might live 9 more years, perhaps he only had 5 or less. Yet he really didn't know.
He said, "This puts my life in perspective. I know my time may be more limited than I thought. The important thing is to live each day as though it's your last. I need to find out what the Lord wants me to do in the time I have left--and do it."
After his walk, the pain meds started to kick in, a good thing with his incision hurting, so he settled in for a nap.
Later, Gary came and entertained us with funny stories about Trey and the pictures on his camera of his family taken by a photographer friend last weekend when their whole family was together.
Mom and I met Gary, Sherry, and Laney at Athens Pizza for dinner, and we laughed some more.
As Mom and I made a couple of errand stops on the way back to University Inn, she expressed her fears and shock.
"You know, I thought maybe one day your dad would have to have open heart surgery. But I never dreamed of anything like this. I don't think he's really grasped it yet."
I told her, "I think denial is normal. I'm not thinking of it as real yet myself. I know what the statistics about pancreatic cancer say, but I also know that God is greater than statistics, and people are individuals."
It was good to talk to Flavia today and touch base with home folks. I was glad to speak with Billie about her loss, knowing we are not the only people going through difficult times.
Chapter Eleven: One Foot in Front of the Other
Thursday, January 22
Sometimes it's discouraging to keep going, when nothing seems to happen and the news isn't what you'd hoped for. Dad couldn't get his colon going on a regular basis. Worse, he'd insisted on the pathology report being delivered to him personally, and the surgical intern, David, brought it to his room Thursday night, after Mom, Gary, and I had left. He called Gary to get his take on the report.
It was good, and it was bad. There were 28 lymph nodes tested from Dad's surgery. One had a tumor. With any cancer, lymph involvement isn't good. But it was only one out of 28 and located near the originally-discovered tumor. Both had been removed. There was no perineural invasion, also a good sign. The grade of the cancer was moderate, rather than aggressive, meaning a slower-growing cancer.
Dad and I took our customary tour of the floor, right after Dad swallowed his pain meds. With perfect timing, after about 20 minutes of walking, Dad followed the delivery of his lunch tray into 1009.
Lunch was a production, because Dad's blended vegetable soup was, as he put it, "blended spices with too much pepper and tumeric." He discussed this at length with Leith, Dr. Galloway's P.A. They talked about consulting with a dietician (not necessarily about the soup!) and a medical oncologist.
After Dad's "mediocre" lunch, he wanted a bath. Laura the nurse would switch his IV from right arm to left but leave it out until his bath was finished. He was glad to take his first shower since before surgery. The orderly then showed up to take Dad for an x-ray.
While Dad was out of the room, Mom told me she had read the path report and talked to Gary. He felt the one lymph node was significant. It upset him, because he had talked with an oncologist friend who works all over Atlanta, and she did not give him encouragement about survival with pancreatic cancer.
I know statistically things don't look great. But individual lives and God's plans often foil statistics. I'm praying for people to work for Dad during recovery and chemotherapy, so he can keep doing what he loves, stay positive, and feel like he's making a contribution.
Sometimes it's discouraging to keep going, when nothing seems to happen and the news isn't what you'd hoped for. Dad couldn't get his colon going on a regular basis. Worse, he'd insisted on the pathology report being delivered to him personally, and the surgical intern, David, brought it to his room Thursday night, after Mom, Gary, and I had left. He called Gary to get his take on the report.
It was good, and it was bad. There were 28 lymph nodes tested from Dad's surgery. One had a tumor. With any cancer, lymph involvement isn't good. But it was only one out of 28 and located near the originally-discovered tumor. Both had been removed. There was no perineural invasion, also a good sign. The grade of the cancer was moderate, rather than aggressive, meaning a slower-growing cancer.
Dad and I took our customary tour of the floor, right after Dad swallowed his pain meds. With perfect timing, after about 20 minutes of walking, Dad followed the delivery of his lunch tray into 1009.
Lunch was a production, because Dad's blended vegetable soup was, as he put it, "blended spices with too much pepper and tumeric." He discussed this at length with Leith, Dr. Galloway's P.A. They talked about consulting with a dietician (not necessarily about the soup!) and a medical oncologist.
After Dad's "mediocre" lunch, he wanted a bath. Laura the nurse would switch his IV from right arm to left but leave it out until his bath was finished. He was glad to take his first shower since before surgery. The orderly then showed up to take Dad for an x-ray.
While Dad was out of the room, Mom told me she had read the path report and talked to Gary. He felt the one lymph node was significant. It upset him, because he had talked with an oncologist friend who works all over Atlanta, and she did not give him encouragement about survival with pancreatic cancer.
I know statistically things don't look great. But individual lives and God's plans often foil statistics. I'm praying for people to work for Dad during recovery and chemotherapy, so he can keep doing what he loves, stay positive, and feel like he's making a contribution.
Wednesday, January 21, 2009
Chapter Ten: Can't See the Forest for the Trees
Wednesday, January 21
After a late start and breakfast and a call from Dad to bring bottled waters, we hit the Coin Laundry on North Decatur. Once Mom and I had stashed the dry clothes and hung the damp ones everywhere, over furniture and hangers and the shower, we set out for Emory University Hospital.
Dad seemed okay yet disappointed with the fact that he wouldn't be released on Thursday. He felt pretty sure the doctor would allow him to leave Friday. He caught us up to speed:
1) His epidural was capped, as planned, at 6 a.m.
2) He felt perky at 7 a.m.
3) He disconnected his IV cart, put his robe on, and started hiking.
4) He was rolling along after 6 laps and planned to continue--until he saw his tray arrive at 7:25.
5) He felt fantastic--of course the epidural continued its effects for 2 hours.
6) He ate, and a little pain began to plague him.
7) He had been given two pain pills for the transition, but hurt a little more later.
Mom was chomping at the bit when Dad said he was going to give us an update on the doctor's report. He wanted water first. She accused him of being dramatic, but the pain meds were slowing his thought processes.
Finally he got out that the pathology report was still unavailable. Dr. Sarmiento had come in mid-morning with an entourage, including the intern David Liang and a fourth-year resident, whose name Dad couldn't recall. The bottom line was that there was no way he would go home Thursday. If he was able to eat at the next level and no complications developed, he would certainly be released Friday. They encouraged him to stay around town for a day, to make sure he was okay.
They also discussed chemotherapy with Dad, and he saw it wasn't considered optional, no matter the results of the path report. He would find a place in Chattanooga to receive the Jemsar, alternate weeks. It would probably affect him for two or three days, as most patients had few side effects from this drug, but it could vary. He would need 12 treatments, which would be distributed over six months. The good news? Administered to all patients with pancreatic cancers, no matter the extent, Jemsar doubles the survival rate for a five-year period.
The time he would begin chemotherapy is yet to be determined. He hopes the pathology report is available Thursday. A pancreatic pathologist who works closely with Dr. Sarmiento has been studying the tissue.
Dad mentioned an oncologist in Chattanooga whom he might choose. The protocol for the Jemsar treatments was worked out in Germany. At least four people Dad or Gary have consulted in the past two weeks quoted the German study on the effectiveness of the Jemsar treatments.
One consideration of the timing of the treatments was Dad's work schedule. He wondered whether he could take treatments late in the week and work again by the next week's beginning. Mom and I pointed out to him that it would be difficult to know exactly what worked best until he'd undergone a treatment and seen how it affected him. He agreed.
Dad seemed somewhat discouraged by the news and the lack of news, by the lack of bathroom activity, and by the food. Mom and I hoped for a better day for him tomorrow, though it seemed to be a decent one from our perspective. He had handled very well the transition of the pain meds from epidural to oral. He was eating fairly well.
With two fewer tubes--his catheter and epidural gone--Dad could manage his robe by putting his free arm into the sleeve and draping it over the other shoulder. We walked and talked, as he pushed the IV cart, until the food tray carrier neared his room. He stopped to negotiate with the dietary worker. He wanted a vanilla pudding to replace the chocolate.
We ended up nearly pulling his stitches out while he tried to eat. Mom and I narrated our sighting of a housekeeping cart upturned and the laundry spread out to dry over various furniture. I told a funny story from one of the family vacations Steve and I had taken with our kids. We were all laughing hysterically when Gary walked in.
Mom and I visited a while with Gary, then grabbed dinner while he was with Dad. When we returned, I misunderstood a message from Eric. We waited, thinking he was coming, but a phone call proved it was TOMORROW he'd be in Atlanta. Gary had left. Dad was sleepy and not up to a walk, so Mom and I called it a night.
After a late start and breakfast and a call from Dad to bring bottled waters, we hit the Coin Laundry on North Decatur. Once Mom and I had stashed the dry clothes and hung the damp ones everywhere, over furniture and hangers and the shower, we set out for Emory University Hospital.
Dad seemed okay yet disappointed with the fact that he wouldn't be released on Thursday. He felt pretty sure the doctor would allow him to leave Friday. He caught us up to speed:
1) His epidural was capped, as planned, at 6 a.m.
2) He felt perky at 7 a.m.
3) He disconnected his IV cart, put his robe on, and started hiking.
4) He was rolling along after 6 laps and planned to continue--until he saw his tray arrive at 7:25.
5) He felt fantastic--of course the epidural continued its effects for 2 hours.
6) He ate, and a little pain began to plague him.
7) He had been given two pain pills for the transition, but hurt a little more later.
Mom was chomping at the bit when Dad said he was going to give us an update on the doctor's report. He wanted water first. She accused him of being dramatic, but the pain meds were slowing his thought processes.
Finally he got out that the pathology report was still unavailable. Dr. Sarmiento had come in mid-morning with an entourage, including the intern David Liang and a fourth-year resident, whose name Dad couldn't recall. The bottom line was that there was no way he would go home Thursday. If he was able to eat at the next level and no complications developed, he would certainly be released Friday. They encouraged him to stay around town for a day, to make sure he was okay.
They also discussed chemotherapy with Dad, and he saw it wasn't considered optional, no matter the results of the path report. He would find a place in Chattanooga to receive the Jemsar, alternate weeks. It would probably affect him for two or three days, as most patients had few side effects from this drug, but it could vary. He would need 12 treatments, which would be distributed over six months. The good news? Administered to all patients with pancreatic cancers, no matter the extent, Jemsar doubles the survival rate for a five-year period.
The time he would begin chemotherapy is yet to be determined. He hopes the pathology report is available Thursday. A pancreatic pathologist who works closely with Dr. Sarmiento has been studying the tissue.
Dad mentioned an oncologist in Chattanooga whom he might choose. The protocol for the Jemsar treatments was worked out in Germany. At least four people Dad or Gary have consulted in the past two weeks quoted the German study on the effectiveness of the Jemsar treatments.
One consideration of the timing of the treatments was Dad's work schedule. He wondered whether he could take treatments late in the week and work again by the next week's beginning. Mom and I pointed out to him that it would be difficult to know exactly what worked best until he'd undergone a treatment and seen how it affected him. He agreed.
Dad seemed somewhat discouraged by the news and the lack of news, by the lack of bathroom activity, and by the food. Mom and I hoped for a better day for him tomorrow, though it seemed to be a decent one from our perspective. He had handled very well the transition of the pain meds from epidural to oral. He was eating fairly well.
With two fewer tubes--his catheter and epidural gone--Dad could manage his robe by putting his free arm into the sleeve and draping it over the other shoulder. We walked and talked, as he pushed the IV cart, until the food tray carrier neared his room. He stopped to negotiate with the dietary worker. He wanted a vanilla pudding to replace the chocolate.
We ended up nearly pulling his stitches out while he tried to eat. Mom and I narrated our sighting of a housekeeping cart upturned and the laundry spread out to dry over various furniture. I told a funny story from one of the family vacations Steve and I had taken with our kids. We were all laughing hysterically when Gary walked in.
Mom and I visited a while with Gary, then grabbed dinner while he was with Dad. When we returned, I misunderstood a message from Eric. We waited, thinking he was coming, but a phone call proved it was TOMORROW he'd be in Atlanta. Gary had left. Dad was sleepy and not up to a walk, so Mom and I called it a night.
Chapter Nine: Watching Grass Grow
Tuesday, January 20
Mom and I arrived in 1009 to see Dad again sitting in the chair, feet pillowed and resting on another chair. He had hustled ten laps earlier and made two grateful bathroom trips.
Lunch came. Dad was already tiring of the liquid diet.
David Liang, the surgical intern, came and discussed Dad's case with him. IF--and all was conditional--Dad could manage pain without the epidural, lose the Foley catheter, get rid of his abdominal distension, have regular bowel movements, and convert--gradually--to a soft food diet, he would be dismissed Thursday. Everything would have to happen pretty quickly, considering where he was today.
Mom and I learned, after trying to reserve our room for longer, that we would have to change rooms, and then we would not be guaranteed a room after the first extra night (Wednesday). Emory Inn was sold out through the weekend.
I called University Inn, at the other end of Emory's campus, and we reserved two rooms Thursday through Saturday. Guess Thursday is Moving Day!
Dad's epidural meds were increased in a gradual distribution, with the option of a bolus--a sharp, one-time increase. His pain was bothering him, causing him to be irritable. His spirits, unlike yesterday, seemed low.
We watched various parts of the Inauguration and accompanying festivities on Fox News throughout the day, with some lively commentary from Mom and Dad.
After his liquid lunch, I followed Dad on fourteen laps. He was cheered on by Elaine, Laura, Jean, Margaret, and all the other techs and nurses on his floor. Elaine said, "You're looking marvelous, Dr. Hixson."
Druing his walk, I noticed the fluit in the catheter had turned pinkish-red. We reported this to Jean, his nurse for the early part of the day. She sent Laura, who was taking over. Laura joked, when my dad suggested talking with the surgical intern David, "I might not have thought of that myself."
Laura returned. My dad had a choice--go ahead and cap the epidural, give him two Percoset, and wait three hours to see how he would do, or follow the orders currently in place: cap the epidural tomorrow at 6:00 a.m. Either way, three hours after the capping, if he was managing pain acceptably, the catheter could be removed. At this point Laura doubted there was any infection from the catheter--only some trauma and irritation. She was probably right, as the bleeding seemed to stop after his brisk walk.
Dad asked if she could order him a Dulcolax for later to stimulate the colon.
Laura said, "Why do you want dynamite to 'do the job?' It's gonna happen on its own."
He said, "I'm a little impatient."
I laughed. "As if she couldn't tell."
"You remind me so much of my dad, " said Laura with a laugh. "I don't know whether I should kiss you or what! Just give it time."
Later, Gary came to visit, and a few minutes after, Sherry brought in Laney and her friend Liz for a brief stop. Gary stayed after they left, and he had a long talk with Mom when I took Dad for his next walk--after the suppository he'd wanted.
Dad went straight to the bathroom from his laps. Gary was willing to help so Mom and I could leave for our dinner reservations at the hotel. Sherry, he assured us, would bring him carryout home so he could rest.
Mom and I had a pleasant dinner at the quiet Le Giverny and retired for the evening.
Mom and I arrived in 1009 to see Dad again sitting in the chair, feet pillowed and resting on another chair. He had hustled ten laps earlier and made two grateful bathroom trips.
Lunch came. Dad was already tiring of the liquid diet.
David Liang, the surgical intern, came and discussed Dad's case with him. IF--and all was conditional--Dad could manage pain without the epidural, lose the Foley catheter, get rid of his abdominal distension, have regular bowel movements, and convert--gradually--to a soft food diet, he would be dismissed Thursday. Everything would have to happen pretty quickly, considering where he was today.
Mom and I learned, after trying to reserve our room for longer, that we would have to change rooms, and then we would not be guaranteed a room after the first extra night (Wednesday). Emory Inn was sold out through the weekend.
I called University Inn, at the other end of Emory's campus, and we reserved two rooms Thursday through Saturday. Guess Thursday is Moving Day!
Dad's epidural meds were increased in a gradual distribution, with the option of a bolus--a sharp, one-time increase. His pain was bothering him, causing him to be irritable. His spirits, unlike yesterday, seemed low.
We watched various parts of the Inauguration and accompanying festivities on Fox News throughout the day, with some lively commentary from Mom and Dad.
After his liquid lunch, I followed Dad on fourteen laps. He was cheered on by Elaine, Laura, Jean, Margaret, and all the other techs and nurses on his floor. Elaine said, "You're looking marvelous, Dr. Hixson."
Druing his walk, I noticed the fluit in the catheter had turned pinkish-red. We reported this to Jean, his nurse for the early part of the day. She sent Laura, who was taking over. Laura joked, when my dad suggested talking with the surgical intern David, "I might not have thought of that myself."
Laura returned. My dad had a choice--go ahead and cap the epidural, give him two Percoset, and wait three hours to see how he would do, or follow the orders currently in place: cap the epidural tomorrow at 6:00 a.m. Either way, three hours after the capping, if he was managing pain acceptably, the catheter could be removed. At this point Laura doubted there was any infection from the catheter--only some trauma and irritation. She was probably right, as the bleeding seemed to stop after his brisk walk.
Dad asked if she could order him a Dulcolax for later to stimulate the colon.
Laura said, "Why do you want dynamite to 'do the job?' It's gonna happen on its own."
He said, "I'm a little impatient."
I laughed. "As if she couldn't tell."
"You remind me so much of my dad, " said Laura with a laugh. "I don't know whether I should kiss you or what! Just give it time."
Later, Gary came to visit, and a few minutes after, Sherry brought in Laney and her friend Liz for a brief stop. Gary stayed after they left, and he had a long talk with Mom when I took Dad for his next walk--after the suppository he'd wanted.
Dad went straight to the bathroom from his laps. Gary was willing to help so Mom and I could leave for our dinner reservations at the hotel. Sherry, he assured us, would bring him carryout home so he could rest.
Mom and I had a pleasant dinner at the quiet Le Giverny and retired for the evening.
Chapter Eight: Red-Letter Day
Monday, January 19
Dad called early from the hospital, "needing" Pilot pens and moisturizing cream. He was excited that the intern had heard activity in his abdomen.
After our Evans' breakfast and quick shopping trip, Mom and I made our habitual trip to Emory Hospital. As we told Adrian, "another exciting day of watching the IV drip" (and my parents nap!). It turned out to be a stellar day.
Dad was up in his chair with feet propped on the other chair's footrest, his head leaning against an improvised towel-pillow taped to the wall. When he'd just settled into bed for a brief nap, some visitors we'd known were coming but forgotten about showed up--Ben Haden and Wendell Jones. We enjoyed wonderful fellowship, enhanced when Dr. John Galloway showed up. He was accompanied by a quiet pre-med student named Laura, who attends Erskine College, John's alma mater.
Dad was pretty wound up, feeling lots better than the previous day, especially since his pain meds had been adjusted to better encompass the top sector of his incision. As Ben and Wendell were about to leave, the tech who was to transport Dad to X-Ray knocked on the door. We asked him if we could delay a few minutes to say our goodbyes. Ben prayed with us before he and Wendell departed.
Dad returned from X-Ray elated. They'd allowed him to look at his pictures, and no obstructions appeared. All the backup appeared to be in his colon, he surmised, because he'd begun his pre-surgery prep too late in the day on Wednesday.
Then nurse Laura, whose own mother ironically had died from pancreatic cancer, sadly after being diagnosed in stage four, brought Dad the highlight of his hospital sojourn--a tray for lunch!
Of course, it was all liquids, but he did get a variety of those--apple juice, tea, beef broth, jello, and Italian ice.
Dad and I took off on his triangular laps around the floor and finished eight, so engrossed were we in conversation.
Trey came by before Gary was to drive him, Ann, and Jack to the airport for their flight back to Kansas. I'm so glad he came to spend time with Mom and Dad.
Dad called early from the hospital, "needing" Pilot pens and moisturizing cream. He was excited that the intern had heard activity in his abdomen.
After our Evans' breakfast and quick shopping trip, Mom and I made our habitual trip to Emory Hospital. As we told Adrian, "another exciting day of watching the IV drip" (and my parents nap!). It turned out to be a stellar day.
Dad was up in his chair with feet propped on the other chair's footrest, his head leaning against an improvised towel-pillow taped to the wall. When he'd just settled into bed for a brief nap, some visitors we'd known were coming but forgotten about showed up--Ben Haden and Wendell Jones. We enjoyed wonderful fellowship, enhanced when Dr. John Galloway showed up. He was accompanied by a quiet pre-med student named Laura, who attends Erskine College, John's alma mater.
Dad was pretty wound up, feeling lots better than the previous day, especially since his pain meds had been adjusted to better encompass the top sector of his incision. As Ben and Wendell were about to leave, the tech who was to transport Dad to X-Ray knocked on the door. We asked him if we could delay a few minutes to say our goodbyes. Ben prayed with us before he and Wendell departed.
Dad returned from X-Ray elated. They'd allowed him to look at his pictures, and no obstructions appeared. All the backup appeared to be in his colon, he surmised, because he'd begun his pre-surgery prep too late in the day on Wednesday.
Then nurse Laura, whose own mother ironically had died from pancreatic cancer, sadly after being diagnosed in stage four, brought Dad the highlight of his hospital sojourn--a tray for lunch!
Of course, it was all liquids, but he did get a variety of those--apple juice, tea, beef broth, jello, and Italian ice.
Dad and I took off on his triangular laps around the floor and finished eight, so engrossed were we in conversation.
Trey came by before Gary was to drive him, Ann, and Jack to the airport for their flight back to Kansas. I'm so glad he came to spend time with Mom and Dad.
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