Wednesday, August 31, 2016


The Last Walk 3

            I suppose if one had much experience with cancer, as oncology professionals do, one would discern a pattern in the progress of the disease.  Karen’s oncologist, Dr. G, tried to give us a sense of what we could expect.  This was in July.
            First, he said, there is a small chance chemotherapy would completely kill the cancer.  Karen might be cured and live for years.  Much more likely, however, chemo treatments would achieve “control” of the cancer.  In Dr. G’s words, this meant each round of therapy would kill much of the cancer but not eliminate it.  We could expect the disease to return every time.  By a kind of natural selection it would return stronger, more able to resist drugs.  Eventually, even using different anti-cancer drugs in the chemo cocktail, the disease will kill Karen.  “Control” thus means that Karen might live a year or as long as five years.  Perhaps 70% of cases achieve control.
            What Dr. G left unsaid (I’m drawing conclusions on my own here) is that 5% and 70% leaves a quarter of the cases in which chemo has little or no effect.  Without treatment, Dr. G said, the cancer would kill Karen in six months or less.
            The “typical” history of the disease is a generalization from many cases.  Dr. G summarized for us not only from his own experience but the medical literature.  But Karen’s case is not the typical case; it is one particular case.  She and I will go through the ups and downs of this cancer, and it’s not conforming to expectations. 
            I had to take Karen to hospital.  Here’s the story as far as we know it.
            Chemo knocks Karen’s blood chemistry for a loop.  Kills cancer?  We hope so.  It definitely reduces her hemoglobin.  Blood with reduced oxygen carrying capacity produces deep fatigue.  So: cancer à chemo à lowered hemoglobin à fatigue.  She had her first transfusion eighteen days ago.
            Karen also takes medications for pain.  Lots of them; I won’t go into details.  Let’s just say they are powerful.  Pain meds act on her nervous system (duh); combined with the extreme fatigue they interfere with her mental functioning.  She starts a thought or a sentence and can’t finish.  She falls asleep in mid-thought.  So: cancer à pain meds (+ fatigue) à confusion.  After 30 years as a clinical psychologist this frightens Karen.  Most of those years were spent administering neuropsychological tests; she is familiar with the various stages and forms of dementia.  On Sunday, amid tears she feared people using that word about her.  It’s the drugs, I said.  “My brain is structurally sound,” she answered, lucid for a few seconds.
            Then Karen noticed that her left leg was swollen.  That was the last bit of evidence.  I took her to hospital.  Emergency Room staff worried at first about a blood clot.  Testing seemed to show that wasn’t the problem, but her kidney function was off.  They ordered transport to a larger hospital.
            On Monday, at St. Vincent’s she had her second transfusion.  Over the next two days, her fatigue lessened, but only a little.  The hemoglobin problem was solved (temporarily anyway), but pain meds and messed up blood chemistry were still there.  It turns out that chemo sometimes causes certain kidney diseases.  Who knew?  On Tuesday we thought maybe her chemo cocktail would have to be changed.  She’s due for chemotherapy next Tuesday.
            Tests: ultrasound pointed to problems with the right kidney.  They wanted to perform a CT scan “with contrast,” which means injecting a special dye into the patient; this test is top of the line.  But the dye is nasty stuff and dangerous if the patient’s kidneys are working properly.  On Wednesday, an ordinary CT scan, without contrast, revealed a kidney stone. 
Many years ago, my father suffered terribly from kidney stones.  But this stone is good news!  The problem may be correctable without compromising Karen’s chemotherapy.  Surgery is scheduled for Thursday.  Meanwhile, hospital staff has more carefully calibrated her pain meds, and she sleeps more peacefully.  I hope she can come home a day or two after surgery.

            This, and other “Last Walk” posts, are collected, along with many other essays, on my blog:

1 comment:

  1. These articles about the Last Walk are very sad and difficult to read, but also very beautiful and encouraging.

    Thank you.