Day 2: Uncertainty abounds

This is Dave again. I spent the day with Mom at John Muir Hospital in Walnut Creek, where I'm happy to report that the entire staff is cheery and helpful. Mom's in the oncology (cancer) ward, which might account for the professionalism and good care. There's a section of the hallway with touching plaques donated by families who've lost a loved one, all thanking the staff for their efforts.

Patio had a solid night's sleep for the first time in quite a while, and is in good spirits, in spite of how reasonable it would be to be despondent.

We met with two doctors today, one who is a gastroenterologist, and one who is the oncologist. Dr. Lane, gastro-guy, recommends a procedure that will be carried out in the afternoon of Thursday, Jan. 3rd. It's called an ERCP (Endoscopic Retrograde Cholangiopancreatography); five bonus points for you if you can pronounce it. They'll put Mom under anesthesia (less than you would have for surgery) and insert a flexible fiber cable with a camera on the end of it, through her stomach and into the duodenum, the first "pipe" leaving the stomach. (I'm figuring this out as I go along, so forgive me if I make mistakes - or correct me in the comments.) The device also has the ability to make incisions, perform biopsies and cauterize incisions. There are two primary goals: 1) insert a tube that will drain the bile that is not currently draining, and 2) take a biopsy (of the liver or pancreas?) to determine what type of cancer Mom has.

As the doctor says, if all goes well, both of these will be successful, her skin will return to its normal color, and a (likely) chemotherapy regimen can be determined. If the biopsy is unsuccessful, a needle biopsy from outside the stomach will be necessary (probably on another day.) And if the drain tube doesn't work, it's possible that an external tube will be required. Let's hope that doesn't happen, because you end up with a bag for the bile waste on the outside of your body.

Mom's oncologist, the lyrically named Dr. Jewel Johl, explained that the chemo regimen is determined largely by the type of cancer, and you can't know that until you have a biopsy. At this point, he's quite certain that there is cancer, but can't know what type. He didn't want to speculate about the many possibilities, but did say that it takes 48-72 hours after extracting the biopsy to get the result, and maybe two weeks after that the chemotherapy can begin. Just to complicate things, he also said that the hip pain that Mom's been suffering from is potentially related to the cancer. So the shot that she was so looking forward to for the relief it might provide, will have to wait until after a bone scan. And it's difficult to distinguish cancer from arthritis in a bone scan. Of course. Otherwise it wouldn't be so difficult.

Basically, there are a huge number of unknowns about what may happen even in the next week or two, much less what will come over the longer term. We've all seen how strong the desire is for some kind of certainty: what kind of cancer is this, when does the treatment start, and how long does it last. But the nature of this disease, and indeed life itself, doesn't follow our notions of how it ought to be. But Mom has been so strong and positive in the face of it. She's not pretending like it's not happening, or avoiding looking at it. She's looking it in the face, acknowledging that it stinks, and says that all she can do is take the next step, and face it as it comes.

If you click on the "comments" link below, you can add your own comment, which we'll be sure to get to Mom.

Love,
Dave