The 3:10 to Chemo

Sasha, Tutu and me, Fri, July 15th, 2011

In the remake of the Western classic film, “3:10 To Yuma,” the earnest Civil War veteran, Dan Evans, played by Christian “Yummy” Bale, works like the devil, in the service of the angels....(that being the delivery of Russell “Even Yummier” Crowe—Ben Wade—to Yuma, where he can be prosecuted and finally, justly, convicted of all the chicanery that he has inflicted on guys like Dan Evans).

Evans, while dragging Wade to the train to Yuma, reveals something to Wade. He has a bad need for his son, who is offscreen, helping, to see him do just one right thing, to erase the shame that has dulled the edge of (his) husbandry over the years: an act of cowardice he committed in the Civil War.

Crowe/Wade boards the 3:10 train politely; as Evan's son watches, Wade elaborately surrenders his weapon in front of the dying Bale/Evans. Apparently, Wade leaves in the train.

The last thing Bale/Evans has seen, therefore, is justice being done: a justice that makes the dying man a hero in front of his son.As the train pulls away, however, Wade whistles for his horse, who perks up his ears and immediately canters after the running train into the distance.

If I had to name a famous film character whose situation reminds me of mine these weeks, it is Crowe/Wade's. I am so afraid of hurting good people by departing too soon. Just because I get away doesn't mean they aren't heroes for bringing me this far.


On Wednesday, Paul Wheatley-Price, my oncologist, met my eyes with gentle, caring, tenderness as he placed himself on a stool in front of Christine and me. With the kindest of manner, he said "we have entered all the information on your pathology report into our prognosis program. I understand you are anxious to begin all the treatment as soon as possible. Has anyone interpreted your pathology report yet?"
"No."
"If you do no more treatment, there is a 25% chance that you will live five years. In other words 75% of people in your situation die within five years. Now, please understand that with chemo, herceptin, and radiation, the numbers do change in your favour. To what exact percentage, we can't say. You are at stage 3b out of 4 stages. Stage four is considered incurable; palliative. This is what we will call you should your cancer be found elsewhere on your body. You might buy some time there with herceptin and chemo, but people die from stage four cancer."


I know that Christine has seen me collapsing in her arms too many times as I read and researched in the past two and a half months, trying to get the skinny, on my odds. It has been an obsession, trying to find out where I stand. Now I know. I am NOT going to collapse now. I am going to make her proud, and make the doctor learn that telling me the truth is easy to do. If I collapse, he will start, perhaps, to mince his words in future. I need to train him to be straightforward so I am damned if I collapse or cry.


My friend Kate just watched her mom leave this world in the worst way possible. Let's look at the list of the best way first, in order to see just what I mean.


Preparation: Losing someone you love requires preparation. In everything in life, preparation gives you control. You need to feel, have those feelings validated, reflect, abstract from that reflection, develop a context in which to place the anticipated event, and honour it appropriately. To illustrate the importance of preparation in life, I offer you this anecdote.


When I was a university student I earned a loan by volunteering in a daycare for toddlers on campus. PET, or Parent Effectiveness Training, was given me by the director.

"Always go in and warn the toddler a half hour ahead of time, prior to changing his/her activity. Go in and point at the clock and say "toys will be picked up and put away when the big hand is on the top of the clock" Go in again at fifteen minutes to lunch and explain that lunch will be in fifteen minutes. At five minutes to lunch, go in and ask them to help you put the toys away. This prevents tantrums."


I have never forgotten that. It is the difference between screaming, crying, protesting against an event, and working, realistically, towards one. Giving people control of their lives in a dignified way is the best gift you can give.


Kate's mom, dad, and Kate, were not told she was in Stage Four and therefore terminal cancer. There was talk the brain tumour was a separate cancer, even. Until two days before her mom's death, when the homecare nurse happened to show Kate a piece of paper saying "palliative," none including Valerie had any clue that she was dying.

Each event in the previous two weeks was presented phenomenologically to them, by the medical experts, sans context. No oncologist had ever sat them down and given them the significance of metastasis to the brain in the context of it being one of the four organs to where breast cancer metastasizes. Nor of what it means to be Stage Four at all. Was it her age?

I brought up my interest, based on Kate's mother's situation, in having a brain scan to my radiology oncologist and to my chemo oncologist, both of whom I met for the first time last week, and was denied. They insisted to me that despite the fact the brain is one of the four organs hit by breast cancer, cells normally go to the lungs, bones, and liver first.

Yes, they say, occasionally breast cancer metastasizes to the brain before the other three, but NORMALLY it hits the other organs first. Does this seem crazy to you that I can't be scanned for metastasis to my brain? That my liver, bones, and lungs have been scanned but not my brain? Or that Valerie's cancer in her brain is immediately deemed "a separate cancer" simply because NORMALLY the cancer hits the other three organs first? You can be sure none of the doctors deeming it brain, rather than breast cancer produced a shred of proof that it was an entirely separate cancer. Why wasn't this seen as a metastasis, like it would have been had it shown in the other three organs. Why weren't they told this meant she was in Stage Four? That she was terminal, therefore?

Or let's go the other way. Let us pretend there was proof that the cancer was a separate one. The patient had a tumour removed from her brain and it did not go well. Was the danger of the surgery not going well explained ahead of time? Were people properly sat down and made to demonstrate that they actively understood the risk of the operation not going well? If this was indeed a Stage One new brain cancer, the operation was damned dangerous and people should have known what signs to prepare for and what significance was held by what phenomenon they might experience post operatively.

Or......let's go the third way...what if Kate's mom and Dad, while Kate was in Europe, were indeed told the truth at the correct time by the oncologist and radiologist. What if they were not prepared to accept what they heard and did a revision on their way home? I am thinking that telling someone they are in Stage Four when the breast cancer has gone to the brain is standard ops and probably was done correctly. In response to a follow up question of theirs, the doctor may have added a throwaway tag, similar to "or perhaps this is a completely different cancer, who knows" and in the car on the way home this less final statement, being less of a death sentence than a Stage Four cancer, becomes the preferred truth. See Meghan's heartbreaking story, for example, from the blog, "the Bee's Knees" on this exact topic. She too had breast cancer that moved straight into the brain, bypassing the more common liver, lungs, bones.

http://ms-mae.blogspot.com/2010/01/few-more-details.html

www.thestar.com/living/article/829909--unfinished-business-how-one-man-keeps-his-late-wife-s-memory-alive?bn=1www.thestar.com/living/article/829909--unfinished-business-how-one-man-keeps-his-late-wife-s-memory-alive?bn=1


The big hand was just two minutes away from the top of the clock, and they were either unaware, or hiding from their daughter, the fact a clock was in the room at all.


Personal Care: Everyone wants to spare their closest family and friends from some of the indignities of the palliative patient. In my father's case, there was a long, non-traumatic time before he died, for decision making re: who will care for the day to day nappy-changing, etc.


In my case I am going to talk to people at a care facility soon. I would like to set up a file there and one at the funeral home long before my cancer metastasizes. I would like it so that Dave is left by me a list of people and phone numbers to call for the time when I no longer have all my faculties to remember each detail. I do not want him cleaning up bodily fluids. (He will, however, be expected to put away my toys and get me to my lunch on time and he better make that lunch too, for that matter! I insist on animal crackers.)


My sister Rosemary is arranging for my wig. I'm going to start chemo after some suspicious stuff gets ruled out by a week of testing. I don't have a date. Stuff is up in the air. I will have 18 weeks of chemo, a year of herceptin and five weeks of daily radiation. Then that's it. If it comes back it is game over, give or take the borrowed time.


If you hear a train whistle a couple of years from now, stop and listen. If you listen hard you might hear the sound of a dozen dogs cantering after it. And please know I mean YOU, who are reading this blog: Just because I get away doesn't mean you aren't a hero for bringing me this far.