I remember sitting in Dr. Timmerman's office last summer when he looked at us and said "with a tumor this size, that there was a 30-40 % chance that there were cancer cells already working that were not yet evident." The normal treatment path would have included chemotherapy to treat these cells, but that Mom's physical condition did not allow for this rigorous course of action. So it was decided to use the Cyberknife to treat the large tumors in her lung. This meeting was described in the blog entry of Thursday, August 4th of last summer.
So today, the cancer is once again active.
In Mom's words as best I could transcribe from a telephone call, "Kirkpatrick (her oncologist) said the latest PET scan showed more cancer in the lymph nodes surrounding the pulmonary artery. It is active. Cancer cells use more glucose so when the radioactive glucose hits active cancer cells, it lights up like the Fourth of July... I told him I was interested in quality of life not length of life... It could be treated with small doses of chemotherapy which would not have drastic side effects and radiation which would take out her energy and strength.... Kirkpatrick will consult with Timmerman, who is on vacation but who should be back in town any day now.....Need a different way of looking at Hospice. Start an early base line with hospice so they will be better able to help in the end stages."
That's the end of my notes. They were getting ready to leave to go meet Helen and Will for enchiladas at El Fenix. I left work early and met them at the restaurant. Mom and Dad had margaritas. Spirits were good and we rehashed our recent vacation time in Santa Fe.
Conversation became more serious back at their apartment after dinner. Mom said at the beginning, "We all knew this was coming and is no surprise..." Service plans and crematorium contract were out on the dining room table. Lists covered the spare bed in her bedroom. She's been planning this event for a while now.
The first topic is DNR orders. She has a form signed by Dr. Russo. It needs to be witnessed by non-family members, then copies will be distributed. They should be easily and readily accessible to emergency personnel; or anyone who might drive her to a hospital. When DNRs are needed, there is rarely time to look in files. Will got information on bracelets, which are not casually obtained.
DNRs are not casual documents. They do not allow resuscitation. Period. No CPR. No paddles. No breathing tubes. If you're young and in good health, you probably don't want one. According to Wiki, there is a move to change the designation to AND. Allow Natural Death.
As Susan and I found out with Marilyn a few weeks ago, the closer one is to the Great Alternative, the more difficult the choice becomes. As Marilyn said, "I want to live." The DNR can be revoked by the patient at any time. Click here for a copy of the Texas DNR.
Of more immediate concern is domestic help. The Senior Service they have been using fired Mom this week. She wants their services more as domestic help than caregiving. So she has some leads and will begin the search for someone new today. Isabelle is OK every other week for cleaning and Mom does not want ot have to train someone else to clean. She does want someone several times a week to do laundry, change the sheets and chop a few vegetables.
Dr. Kirkpatrick also said it would be a good time to start investigating Hospice so that when the time comes that she needs the palliative care, the relationship would be in place. She was going to talk to Bob Dannals for a recommendation.
I think that's brings things up to date.
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