“As you can see by the blue lines and clumps, your tumour is extremely widespread.” A 3D digital representation of Jerry’s brain rotated slowly on the screen. “It’s working its way through most sections of your brain, although it’s largest near your brain stem. The technology that allows us to detect even the smaller gliomas may also allow us to treat it.”
“You make it sound like there’s a hope in hell that this alien-looking tumour can be beaten.” Jerry waved in frustration at the screen.
“The hope is thin, I admit. I’m waiting to hear from a firm in Calgary. I’ve sent them a copy of your images to get their opinion.”
“And in the meantime, what? Surgery?”
“No. It’s too late for that. If we removed the entire tumour there wouldn't be enough of your brain left for you to function, and we still wouldn’t know if we got it all. There are a few things we’ll start with, but most importantly, as we discussed on Friday, we’ll get you in on Monday—tomorrow—for a planning CT scan and then begin a course of radiation as soon as possible. The planning scan itself takes at least thirty minutes and it literally maps out your tumour for the radiotherapy. After the planning scan, it might be a week or two before we’re ready to actually start the radiation. The computer plans the course of your therapy and when it’s as complicated as yours, it can take a few weeks. This is unavoidable.”
“Lovely.” Except he didn’t think it was. “I guess it will give me time to write a will and tie up loose ends. Doc?”
“The truth, Jerry? Yes. This is an aggressive form of cancer. The prognosis is rarely positive. The survival rate is measured in decimals below zero. If you’re a stats person, I can get them for you. Many people need to hear the numbers to drive home the reality.”
“Nah, I’m good, thanks. Let me summarize how I see it, and you tell me if I get anything wrong.” He took a deep breath and squeezed Ana’s hand. She remained silent but squeezed back. “I’m dying. Sooner rather than later. Since you can’t amputate my head, a crani-ectomy isn’t possible, so you’ll be trying to find something that is. You’ll be looking at everything anyone has ever tried with any degree of success, but this late on, the odds are so slim they’ve never really been measured. I’m game for anything you want to try, just so long as it doesn’t make me worse or kill me faster. I guess that without a real, God-given miracle, I need to say goodbye to people, forever.”
“It sounds like you understand perfectly. Any questions?”
“With or without treatment, what can I expect in terms of possible symptoms rearing their ugly heads?”
“This is your brain we’re talking about, so predictions are tough, but you can probably expect more of everything you’ve already experienced, including memory loss, pain, nausea, seizures, even personality changes both permanent and temporary. I have an information sheet for you with links to every resource I use. The Internet is a great source of information but a massive source of misinformation. I’ve vetted these resources myself and even contribute data and articles to two of them, so my recommendation is both personal and professional.” He slid a sheet of crisp paper out of Jerry’s file and placed it on the desk in front of Jerry. “Seizures are my biggest concern right now because you haven’t really had any. You’ve had some blackouts and that one minor episode at your work, but nothing in comparison to what I’ve seen in other patients. With the extent of your tumour’s growth it’s only a matter of time.”
“So avoid long road trips as the driver.”
“Avoid driving. Period. Let Ana drive you where you need to go.”
“Unfortunately she hasn’t got a license.”
“Not a problem. There’s a network of volunteers who will gladly drive you to and from your appointments. Even without the potential of seizures, sometimes the treatments can hit you pretty hard and you need assistance. The phone number for that is on the sheet. There’s also public transit and taxi. Some people don’t like bothering strangers with what they see as silliness, but please know that some of these volunteers are cancer survivors themselves, or people who’ve lost someone to the disease, and they just want to give back or help out. It is a great service run through the Canadian Cancer Society. I know you’re new to town, but cancer is part of your life now, and it levels the field and makes friends of complete strangers. There is support here. Make use of it.”
“Thanks.”
“I’m not just saying that to make it easy on you. The more you make use of the resources we have available, the easier it is on your family and friends. Some of them might be willing to trade places with you in an instant, but they all wish they could wave a magic wand over your head and make the cancer go away forever. You get to fight this disease through willpower and anger and desire to not let it win, but your loved ones can do nothing but learn about the disease, try to keep your spirits up, and help you when you need them. That’s a lot of pressure for them. They’ll spend more time in tears than you will because they feel so helpless.”
The oncologist leaned in, to emphasize the importance of his point. “You don’t have to look in a mirror if you don’t want to, Jerry, so you can form a thin barrier of self-denial mixed with hope. They can’t look away from what both the disease and the treatments will do to you. Some days, inside, you’ll feel just fine, but hair loss and weight loss and other changes will be right out where they see them and tear them up and make them feel like the weight of the world is on their shoulders. Terrific staff and volunteers will help, if you let them. Be strong, but don’t let pride get in the way.” He leaned back, again.
“Now, speaking of staff to help you, your Palliative Care Specialist should be here in a couple minutes. She would have been here from the beginning but, well, last minute calls are part of her duties.”
“Palliative Care?”
“‘Palliative’ means ‘relieving without curing’. Elizabeth can explain more succinctly what she does, but in short, while my team and I are trying to cure you, Elizabeth and her staff will be concerned with a more holistic view of your situation. In addition to your physical well-being, she’ll offer professional advice, help you to understand options, offer a support system to help with the stress, and, should the disease win, help you to face it in comfort and dignity. Heck, she can even find you a lawyer to help you settle your affairs.
“You may be shocked to hear me admit that you might well lose this fight, Jerry, but you’ve seen for yourself how widespread it is. I plan on winning this fight with you because that’s the only approach I know. I will give it everything I’ve got, because, frankly, I’ve seen miracles happen. I’ve seen a dying woman given six months to live only to get pregnant and have the cancer lose the battle as her baby grew inside her and their combined systems fought back. I’ve seen congregations pray and priests give last rights only to have a patient sit up and ask for a beer and a steak.”
“That sounds like a great idea, right about now.”
The doctor laughed. “Then as soon as Ms. Puleo is done with you, go have a steak and a beer. You’re in for the fight of your life, literally, so you’d best start it with a full belly. In the meantime, though, I’ll go confirm that Elizabeth is on her way. Would either of you like something to drink? Water, tea, coffee? We have one of those one-cup machines so my assistant has built up quite a selection. Chocolate-raspberry medium roast? Caramel decaf? I’m going to make myself a green and white tea.”