Now What?

Today, as you may recall, was Doctor Day. Last week, on the 9th, Papa had a CT scan to evaluate his progress or lack there of. Then Wednesday was his last chemo... all the blood work was right that time, thank goodness. Then today we saw the big man. He told us that the CT scan showed fluid in the pleural space of Papa's right lung. He asked... have you been coughing? Any shortness of breath? Do you have pain in that area? All answers were no, no coughing, no shortness of breath, no pain.

He recommended that Papa have the fluid removed so that it can be determined why he has it in the first place. He said they would look at the fluid microscopically and see if there were cancer cells in the fluid. Ut Oh!

I asked the doctor, if this could be a metastasis. He said it could be. I asked, when pancreatic cancer spreads, where does it most commonly spread to. He said liver most often, then lungs. Ut Oh! But there is no sign of anything in his liver and the tumor marker, the CA19-9 was 57, down from the last one.

Any other reason Papa might have fluid on his lung? He had a heart attack a few years ago but there was no damage. But... he also has asbestosis from working as an iron pourer many years ago. So far he has been asymptomatic with the asbestosis, but maybe it is showing up now. Of course we did not think to ask the doctor about this when we were in the office. That would have been just too easy. I fear I know his answer anyway.

The doctor wanted to schedule Papa for a thoracentesis (where they remove the fluid) right then and there but Papa said no... he wanted to wait and see if it would resolve on it's own, and if it didn't, then he would have the thoracentesis. I could see the doctor furrow his brow, he wants it ASAP, but you know Papa and hospitals. So the doctor scheduled Papa for a repeat CT scan to be done in the middle of May and he cautioned ME to call him immediately if Papa became short of breath, had an increase in coughing or pain and if his belly starts to swell up (that would be from fluid too) and of course, if he became jaundiced again.

When we got home I had to go to the storage unit to start sorting through all the junk in there and I used the opportunity away from Papa to call the doctor's office to get a bit more information. The main thing stopping Papa is that he does not want to be admitted to the hospital, he would rather die... literally. But I found that the thoracentesis would be an in and out thing, done in the X-ray lab. He would be home the same day. When I got back home I explained to him that he needs to have this done now. I told him there would be no hospital stay but that the longer he waits, the more chance for the cancer, if that is what it is, to get entrenched. When Papa is not put on the spot, when he does not have to make snap decisions, he is able to see things more clearly and he agreed to have the procedure done as soon as it can be arranged. I have to call the doctor tomorrow and let them know, it will most likely be next week cause he has to be off his coumadin for five days before the procedure.

So now we are playing the waiting game again. I am feeling very pessimistic right now. That fluid is not a good sign and I do not think it is the asbestosis causing it. I asked the doctor what he would do if it is the cancer and he said more chemo. More chemo... but to what end? Another thing he said, and this horrified me really, is while pancreatic cancer often forms nodules and tumors like Papa had before, sometimes it spreads like a mold... it is flat, he described it as almost like a film, covering and spreading, but it can not be seen on CT scans or x-rays. So it could already be wide spread and we can not see it.

What do I say to Papa? Should he fight this? Should he have chemo again? It seems so easy to sit in a lounge chair for three hours every week and let noxious chemicals drip into your body. He had no vomiting, only occasional diarrhea, some increase in nausea but he has been able to go for rides, he plays with our grand kids, he watches MMA every time it is on TV, but chemo was none the less a pain in the ass, a grind, an albatross. But I firmly believe that chemo is what has kept Papa alive, it is why he is still here, that and prayer.

I can not make up his mind for him but I know he will ask me what I think he should do. This is my nightmare... that I say the wrong thing, and I fear it will be the wrong thing, no matter what I say.