Monday, January 10, 2011

Quality of Life versus Survival: Mom's Decision

Our mother has cancer again. This is the third time that she has faced this disease. A few years ago, a mammogram examination revealed a lump in her left breast. A preoperative bone scan revealed a mass in her left kidney. Results from preliminary biopsies showed malignancy in both cancers. Surgical removal of the breast and kidney cured her of these cancers.

It is unusual for a person to develop three different cancers. Mom's third cancer developed in the left lung. Various factors make the mass inoperable.  Surgical removal of the upper half of her lung could cure her of this cancer. However, her age and having Congestive Pulmonary Obstructive Disease (COPD) makes surgery a much riskier proposition. In addition, the mass is close to her aortic artery and the esophagus. The proximity of the mass to the artery increases the risk of surgery even more.

Other treatments include chemotherapy and radiation. As previously mentioned, the location of the mass to esophagus presents problems with radiation treatments that could damage the esophagus and the other lung. The drawback to chemotherapy is that it causes nausea and weakness and is disruptive to one’s daily life. It also compromises the immune system leaving her vulnerable to infections and pneumonia. Moreover, chemotherapy might add, at most, three months to her life.

The outcomes for the previous options are bleak. Aside from the side effects of chemotherapy she could bleed to death on the operating table. If she survived an operation, surgery could make her a pulmonary cripple. More than likely, as a pulmonary cripple, she would no longer be ambulatory. She would require assistance to move from the bed to a bedside commode or be bedridden all together.  This does not include frequent doctors visits and hospital stays that inevitably lead to more testing and probing needles.

There is one choice left for mom to make. With family support and ongoing medical supervision from two of mom’s longtime medical practitioners, she is opting for quality of life. Rather than risk, losing the quality of life she has now, aggressive treatment is not a viable option based on the aforementioned factors. She leads a semi-sedentary lifestyle. She moves about on her own and when the weather is pleasant, she works in her yard, taking care of the trees, bushes and flowers planted there over the years. She loves birds and keeps her bird feeders full. They are located outside her kitchen's sliding glass doors.

She can sit at her kitchen table looking out at her backyard through her sliding glass doors. It took her years to make it a small wildlife sanctuary. The concrete birdbath that she made years ago is always full to the brim with water. She still cooks her own nectar for the hummingbirds that visit her backyard each year. She delights in watching the different kinds of birds that come to feed and bathe in the birdbath. If confined to a bed, she can no longer perform the simple things that bring her joy.

The most that we, her children, can hope for is that she will eventually sleep more and as the tumor grows eventually fall into a comatose state, as suggested by a cancer specialist who works at the Ellis Fischel Cancer Center, in Columbia, Missouri.  We hope mom will not have to suffer continuous pain. Pending the time we can no longer converse and laugh with, mom, we will take every opportunity to spend time with her. With each precious moment, we try to glean memories from her past (before we came into being) and share stories that intertwine with our own lives.

At this time, science and research cannot offer cancer patients in mom’s position medical treatments that are not detrimental to the quality of life. Until better treatment and therapy exists, discussing quality of life issues should always go into the decision-making process. If you would like to learn more about cancer read, How Does Cancer Form, by Elisa Coffman, retired nurse and paramedic (and my sister).

Hospice helped us and our mom when she became bedridden. Thankfully, mom was active until about two weeks before her death. She did as the doctor hoped would happen at the end of her life. She grew sleepy more often until she fell into a coma. Because of Hospice the family was able to give mom most of her care. Her doctor notified Hospice when the time came for "end of life" care. They made sure we had everything we needed to care for mom. At our request, they did not intervene unless we asked them to.

Thankfully, our sister, Lisa, is a retired nurse and paramedic. We were lucky to have her knowledge to fall back on. She guided us through mom's transition from life to death. Even when Lisa's heart was breaking, her professionalism did not fail her. All of us are grateful that she was there. She kept her promise to mom that she would make sure she did not suffer. Mom was always afraid of pain, which surprised us kids. We witnessed a woman who had a high pain tolerance.

I remember with awe, how courageously mom took the news of her demise. After she knew her options, mom opted for quality of life. She became an example to her children and loved ones. She showed us that dying need not be suffering and fear. She died bravely without complaint. She felt her strength waning and her breath became more labored upon exertion. But she did not stop living. She never stopped worrying about her kids and she was more than glad to advise us when we needed her support. Mom tolerated our human frailties as do most mothers. She never stopped loving us and we haven’t stopped loving her. She loved her grandchildren and her great-grandchildren because they were the children of her kids. We all are a continuation of mom.   



Linda Strader said...

Thank you so much for sharing this story of your mother with the world. I have know you and knew your mother for many years and appreciate this story, I'm sure someone has read this story that is faced with a decision like this to make and I'm sure that it helped them to read this. I can't tell you I know how you feel, because I'm blessed to still have my parents, but when the time comes for the Lord to call them home, I remember what you have shared. Thank you again my friend, and may the Lord Bless you and yours.

Relay Rethy said...

I couldn't have said that better. It is so true. Though our life was not always easy with us coming from a dysfunctional home. We had a lot of anger issues to work through together and we did. We were able to be open with each other, and we were. She helped us plan her funeral and we talked about the good times and the bad. We made sure our last years with mom was an open forum and we could talk about anything, no matter how difficult. We openly talked about her dying and how she felt and how we felt. Those conversations may have not been often but we did have them. We let Mom maintain control of her death. She was going to die and that was nothing she could stop. She faced it and she decided what would happen in the end. So when death said it was going to take her, she said, "This is what I am going to do.." My was courageous. So was my brothers and sister. I felt weak and out of control. Therefore, I found myself going into nurse mode to make sure things ran smoothly. We documented. We kept times. Mom had a chart. I had to do that to maintain my control. We bound together and made the death an easier transition than it might have been. We made peace. We took care of her around the clock in her final hours. Gloria and I gave Mom her last bath before she died. I knew it was getting ready to happen and I remember saying, "Today is the day." Not long after her bath, Mom passed away. I am glad that Mom's two girls got to give her, her last bath. It was our last act of kindness and love we could give to her. We miss you Mom. Rest in Peace.