To treat… or not.

My dad was diagnosed with prostate cancer on his 82nd birthday. I expected it when his PSA test started increasing. He had a biopsy.  I couldn’t attend the appointment for the results but asked my mom to make sure she found out his Gleason score. When she called me on his birthday, I heard it in her voice before she said the words.
Cancer.
It’s considered an intermediate- risk tumor.  There is no metastasis. But given his advanced age and other co-morbidities, namely the Alzheimer’s, surgery is not recommended.
At his age, hormone therapy and radiation is recommended. Without treatment, he has perhaps 10 years.  But that means the tumor will get larger, he’ll have more lower urinary tract symptoms of obstruction and likely bone pain from metastasis.   Radiation is not easy.  It involves daily trips to the hospital for weeks;  20-39 radiation visits. That’s 20-39 days that my mother has to drive him to and from hospital and pay exhorbitant fees in parking. My mom went through  radiation treatment for her own breast cancer 15 years ago. She still remembers how hard that was on her. How difficult now will this be on my dad? He asks her several times a day what the next doctor’s appointment is for. Because he forgets. How difficult will this be for my mom to take him to the hospital day in and day out,  in his already semi-frail and de-conditioned state?  Is it cruel to put him through treatment? Is it cruel not to?
After meeting with his radiation oncologist and learning about a new treatment protocol involving only 5 weekly visits for radiation therapy, it looks like we will be embarking on treatment for my dad.  He seems to understand the side effects of treatment and that it means weekly visits to the hospital.  Of course, he’ll ask many times why he’s going but that is okay for now.  Five weekly visits is going to be much easier for my mom.  If and when it gets to be too much, we’ll make a decision to stop.  But for now, he/we are going to fight this.

A Bad Week.

It’s Saturday night, I think. Honestly this week has been a blur. I feel terrible complaining because I know for a fact there are others struggling with a lot more this time of year (a few of them are my own patients), but I have to say this has been one of the crappiest weeks I can remember.

It started off with me getting some kid of flu/GI virus that decimated me for close to 36 hours, then I get the phone call that my dad is going to the ER and after spending 15 hours at the hospital he gets admitted. I missed seeing a theater performance of Cinderella with my daughter and my aunt that day. (I’m still really bummed about that).  When I got home that night, around 1am I found my husband in bed with shaking chills. He spent the vast majority of Wednesday in bed. Despite exhaustion, I took my older kids to an indoor play center to blow off some steam. Later that night my brother, wife, stepdaughter, and my best friend came over for an already-planned Christmas Eve-eve dinner. Husband and I were exhausted but it was wonderful to have family over and they helped out by wrapping all of our kids’ Christmas  presents.

Christmas eve saw husband going out for last minute gifts, still unwell.  I took one of the kids to see Pappou in the hospital. The kids watched Santa on Norad as he made his way from Morocco to Ireland, we set out milk and cookies for him and the kids went to bed with zero fuss.  Husband and I settled in to watch our annual holiday classic, “Die Hard”, and promptly went to bed around 10pm.

Christmas morning the kids were up early, as expected.  Christmas gifts were opened in a frenzy.  I had planned on taking all the kids to see Pappou in hospital, so after breakfast everyone got ready, except husband who was still not feeling great.  Over the course of the morning, my older son, the 4.5-year-old, started complaining of a tummy ache.  He barely touched the apple juice he got from my mom, nor the donut.  He looked pale and complained even more about his tummy so we left the hospital after a short visit.  The entire car ride home the little guy was moaning.   As soon as we arrived home, he was curled up on the couch with his new Star Wars blanket.  Ten minutes later, he’s running to the bathroom calling for me and threw up.

Merry f*&king Christmas.

We were expected at my brother-in-laws house for Christmas dinner later that evening.  I called my mother-in-law and told her everything. I wasn’t sure we should bring my son so I warned her that he and my husband may be staying home.

As it usually is with stomach flu, once you throw up you start feeling better.  My son seemed to make a pretty fast recovery and I spent the afternoon watching him build Star Wars Lego. The 7-year-0ld was happily entertained with her new Nintendo 2DS from Santa.

Later that afternoon, with the two boys (husband and son) feeling better we piled into the car and headed west to my brother-in-law’s house.  We were going to arrive about 2 hours late, but I had called my mother-in-law to explain.  When we were about 10 minutes away I suddenly remembered that we, well I, had forgotten the dessert.  Among the chaos of the week, I had gone out to buy two pies and ice cream as we were expected to bring dessert.  We found an open Shoppers Drug Mart and were saved.  Cheesecakes and eclairs to the rescue.  (Seriously though, could this week end already?)

Christmas dinner was lovely.  Husband and I ate but neither of us were particularly hungry.  For me it was likely due to the stress of the week, my appetite has been shot. For husband, well, he was still recovering from the illness.  An hour after dinner, my older son started turning pale again and complained of his tummy hurting.  With profound apologies, we piled back into the car and drove home.  Thankfully he wasn’t sick in the car but he did fall asleep and didn’t wake until almost 9am the following morning.

Boxing Day.   Another trip to the hospital to see my dad.  A relatively uneventful day and I was beginning to think the worst was over when the 2-year-old started screaming.  Husband went to see him and called out – “He threw up.”

OMFG.

That poor little boy emptied his stomach over the course of the next 5 hours.  I slept on a cushion on the floor of his room and he finally stopped dry heaving at 2am.  He was awake at 6:30am as if nothing happened.  Meanwhile husband is curled up in bed, moaning.

Stomach cramps.

What the actual f&#K?

I’m ready for this week, hell, this year, to be over.

Only one person has been spared so far … my daughter.

Pray for me.

 

About those kids… 

It’s two days before Christmas. We haven’t quite finished getting the kids’ presents and nothing has been wrapped. 

I had a fitful 4 hours of sleep last night while husband lay next to me with the chills. As if things couldn’t get worse he is sick with whatever flu-like illness I had a few days ago. 

The kids have been cooped up so this afternoon I took them to an indoor play center so they could run around and you know, be kids. 

On the way there, I told the older kids that their Pappou (grandfather) is sleeping at the hospital and that I was there very very late last night when they were sound asleep. Of course the older one asked why and I tried to explain. 

My 4.5-year-old son: “Mommy you should have told me you were home. We could have talked and I would have gone back to sleep.”

The 7-year-old daughter: “Wow, mommy that sounds like a long day.”

Sometimes I underestimate my kids. They understand a lot more than I give them credit for. 

Waiting. 

Waiting in the ER as a family member is boring and nerve-wracking. Waiting as a family member and a physician, watching your parent wince in pain is excruciating.  

When I arrived he was seated in a wheelchair in the “Green Zone”, where the sprains and strains are waiting. He looked pale and sweaty and his heartrate was about 110. (Normal is 60-80). I found the nurse, explained who I was (daughter, not doctor) told her in medical terms what I had found when I saw him.  She did an ECG (normal except for the fast rate) and moved him into the main ER. And two hours later we are still waiting to see a doctor. He is triaged as “back pain” and so we wait. 

I finally couldn’t take it anymore watching him wince in pain and asked a nurse if we could get him something for pain and moved to a bed.  About twenty minutes later the doctor shows up and my dad is lying down in a bed. He’s still sweaty and in pain. He also says he’s a bit winded and has a bit of chest discomfort. 

The squeaky wheel gets the grease. 

Percocet on board and labs drawn. 

More waiting. 

And the worst of it? I was supposed to be with my daughter and Aunt watching a live production of Cinderella. 

A Little Worried.

Day 12 – National Blog Posting Month.

Being a doctor who is also a daughter has its privileges. I can navigate the system on behalf of my parents. I can advocate on their behalf and ask for tests and referrals. I can attend appointments and understand what is being discussed.  I can find out results before they do.

It is fraught with disadvantage as well. With their permission, I am privy to tests results before they are. I understand what their diagnoses mean and if I don’t, I know trusted resources to educate myself.  I understand in general terms what “illness trajectory” means. Specifically, I have seen what illness trajectories look like.  I also know what the end may look like.

I am the one my family looks to for advice and comfort.  I have to be strong and composed. I can’t let them see that I’m worried.