Prognosis?

They have never given Papa a solid prognosis. When he was first diagnosed the doctor painted a pretty grim future, at least I felt it was. Papa either did not really hear what the doctor was saying or he chose to ignore it. I think the surgeon was somewhat flustered. How does anyone get used to telling people they are probably going to die and suffer while doing it? I know that I felt a lot of empathy from him and he tried to be as straight forward as he could be. I understood him but Papa did not.

Immediately after the surgery the doctor told me he thought the cancer was already stage III. When our family doctor and I discussed this, she said if it was her, she would go home and spend as much time with her family as she could... she would not prolong things with radiation and/or chemo. Our oldest son, the RN, felt the same way, as did I.

I believe in life. I believe in God and I feel our lives are a gift from God. I also believe that death is a natural part of life. After all, no one gets out alive. Now, this does not mean that we should not fight for life when we have a chance. God has given us talented doctors, miraculous medicines, surgical techniques and tools that in other times would be considered witch craft, we should employ these gifts and thank Him for them. But as a nurse I have seen people waste what meager energy they have left, I have seen them waste resourses and exhaust their families, all in the hope of one more year, one more month, week, day... when there was never any real hope or because no one had taken the time to be honest with them.

When do we draw the line and say this is where I stop? This is where I make my stand? For me it means no ventilator if there is no hope of recovery, no CPR in an unwitnessed cardiac event, and if I am considered vegetative, no chemo, no radiation, no tube feedings, no dialysis, no antibiotics... just please keep me pain free and for God's sake, give me what meds it takes to be pain free and forget worrying about addiction to pain killers. People need to take their collective heads out of the sand and give this thought before it becomes a necessity and please write it down, make it known, review it once in a while too.

When I ask Papa what he wants, what his advance directives are, he always says "I want the same as you do," but he never specifically mentions any directions. We never really talk about him possibly being terminal either, he skates around the issue like he is on thin ice and I guess he actually may be. After the specimens came back from the lab Papa's cancer was declared to be in stage II. In our minds this announcement gave us the "go-ahead" for his radiation and chemo. The doctor said that given the size of the tumor, that Papa has about a 20% chance of making it to the 5 year survival point. That means an 80% chance that he won't make it to 5 years. Those are not very good odds. But people have come out of the woodwork telling us about their neighbor or uncle or sister-in-law's mother's brother, who had pancreatic cancer in stage IV and is now 82 and rakes his own leaves and does his own shopping etc. So one day prior to the beginning of treatment I point blank asked the surgeon what he would do in this circumstance and he said he would go ahead with the radiation and chemo so that is what we have done.

Was he honest with us? Part of me says yes, he was honest, part says no, that he felt an obligation to tell Papa to fight as hard as he could so that horrid, painful surgery that he had inflicted on Papa would not be in vain.

Last week at chemo I met an elderly woman, 75 she is. She had cancer many years ago, it was thought gone but it came back. She is very frail and also very forgetful but she said to me... "I don't want this, I'm too old for all this, but what can I do? They say I have to." She indicated her son. This is the reason for making sure your wishes are known. If my children were to ever do that to me, I would come back and haunt them.