The $64,000 Question

We knew over two weeks ago that Mom's cancer was back. We knew it was in the lymph nodes in her neck. Last week, we learned that it was not in her stomach. Yesterday we found out that it is in lymph nodes not only in her neck, but her sternum, her abdomen and her adrenal glands. There are suspicious nodules in her lung, as well. "Stage 4 metastatic cancer"; that's what the doctor called it.

He's a good egg, this oncologist; a nice Irish boy. As Mom, Dad, my brother and I sat in the tiny exam room, he enthusiastically described a variety of chemotherapy treatments. Taxotere and carboplatin (what my Dad is getting) are too harsh for her. But there are other treatment regimens to consider. He talks about studies and a drug called 5FU (yes, really) and antibody treatment if the tumors are HER-positive.

We ask questions and he answers them. Mom's system is very sensitive; she has reactions to lots of medications, including most antibiotics. She takes coumadin. She doesn't tolerate codeine-based pain medications. He says the good news is that no cancer showed up in the liver. "If it was in her liver, there wouldn't be much we could do at all and I wouldn't recommend chemo in that situation." He almost makes it sound like things could be worse.

He tells us that we can choose to forgo chemo: "It's a perfectly reasonable choice", he says. He would, however, radiate the tumor in her neck to minimize discomfort, because without chemo it will most certainly continue to grow and will press upon nerves and blood vessels.

What he does not talk about is life expectancy. When I ask about "progression", he carefully skirts the issue. I know there is no crystal ball and if there were, I probably wouldn't like what I would see in it, anyway. When I finally pin him down, asking if he can give us any sort of timeline (he seems to like this term better than "life expectancy"), he says 6 to 13 months. I ask if that is with or without treatment. He says, "With and without."

Dad, a man of quick decisions and goals and action, is ready to commit to something. For him, a plan is a necessary thing; inaction and indecision are torture. My brother and I pull him back.

"Let's discuss this, Dad. It's a big decision."

The doctor agrees. "I will be seeing you on Tuesday for your next treatment. We can finalize our plans then. We have time."

We decide to schedule an appointment with the radiation oncologist right away, to have a look at what can be done for the large tumor in her neck and book the appointment before we leave.

After hugs all around, we start to separate in the lobby, heading off in our different directions. And then I reconsider. I look at my brother. He meets my gaze and nods.

"Let's find a place to talk a bit before we go."

There is an empty room, right off the lobby. Chairs surround a table near a cooler filled with Ensure and there several wigs on stands perched on nearby book shelves. We pass by the magazine rack and Mom stops to look.

"Hey, there's the Field & Stream you were reading the last time we were here, Mom!"

She chuckles. I don't know if she actually remembers or not, but she plays along, lingering at the rack. She picks up a magazine and starts flipping the pages. I take her arm.

"Mom, let's leave the magazines. We need to talk about what the doctor told us. Let's go in here and sit down for a few minutes."

We sit at the table and all that's missing is a deck of cards. Dad looks over at the cooler.

"Have you ever tried that Ensure? God, it's awful stuff. I tried it when I was trying to get my strength back after the surgery, but I couldn't get the stuff down."

Mom fusses with the silk flower centerpiece.

"So, Mom, what do you think about what the doctor had to say?"

She shrugs. "I don't know what to think."

I go into lawyer-counseling-client mode.

"Mom, the decision about whether to have chemo is up to you. For some people, they want to know they tried everything; for other people, the chance of more time just isn't worth feeling rotten.  We have to balance out what is the up side and what is the down side of treatment."

"I just don't know." She pauses, looking down and then back up, at Dad.

"I would hate to think I could have done something about it and didn't, but I have lived a long time. I have had a good, long life."

"Mom," my brother says, "You can always stop the chemo if you start it and it makes you miserable. You don't have to continue it just because you started it."

"I just want her to be comfortable," Dad says, looking across the table at her.

"I guess you just do what you have to do," she says as she shrugs her shoulders again, looking rather lost. She rotates the flower arrangement and examines the container it is in.

Mom looks pretty. She recently had her hair permed and it's short and curly; mostly silver. Her eyes are the same pale aquamarine they have always been. She is wearing her favorite blue print silk blouse. But for the lump on the side of her neck, which really isn't very obvious, she looks fine. You would never know she has cancer.

We finish our discussion with no clear resolution, only the agreement that we will talk among the family and finalize plans by Tuesday.

I shouldn't be writing. I have too much to do. Everyday stuff: laundry; cleaning; parent-teacher conferences this afternoon; preparing for my book club hostessing duties tonight. But I can't; not until I process this latest twist in the road.

I wish she had a strong opinion about what she wanted. I wish she felt one way or another. I don't feel right steering her. It should be her choice. But what if she can't make the decision? Could she ever forgive us if we said,  "no chemo" and she went quickly? Would she forgive us if we said "yes" and she got sicker and felt awful? And what about Dad? He is beating the cancer that attacked him and he needs our support, too.

Yesterday was a hard day, but it was also a day for celebration. It was Mom and Dad's 62nd wedding anniversary.