The other shoe finally drops.
This latest hospital episode of Joanie’s was a dark time, probably the darkest in the last seven years. Something had gone horribly wrong, and as she lay in her bed on 7C, we had yet to hear exactly what it was, and with that ignorance came the uncertainty, and with that uncertainty came the creation of scenarios, ranging from best possible to the worst. It is inescapable, when you are faced with situations like this, that you spend much of your time wondering what is happening, what is going to happen, and how is this all going to affect your patient.
As for Joanie, she was still in the process of healing from the lung surgery, and as far as she was concerned this was just another speed bump on the way to being called a “cancer survivor.” It was an attitude I did my best to reinforce at every point. As I reflect, I’m not sure she needed that from me, for her spirit was so strong that had I not been there, it wouldn’t have changed a thing.
Joanie continued to do well. They were doing chest x-rays every morning to see if all was well. The chest tube was still in and draining, and on Tuesday, Dr. Maddaus told us it would remain for at least another day. Later that day he came in and the changed the tube, and we were told it would not be out before the weekend, and possibly not until Monday. That was put a damper on her spirits, as she was getting antsy, and eager to go home.
She was still asking me about her hair everyday, and the phone calls from John Hoeven to all of her many friends came in daily, and there were many of them. On Wednesday, when I got to the hospital she was alert and looking good. The chest x-ray in the morning was positive, and we were told there would be no new chest tube today.
At times when she would doze off, I would either go out for a smoke, or go up one floor to the cafeteria to get a cup of coffee and a doughnut. My usual place was by a window from where I could look across the Mississippi and see the skyline of downtown Minneapolis, a place where Joanie and I had spent so many happier times. These moments gave me time to think about what was going on, and try to sort it all out.
Trying to make sense of a situation you know is critical, without finding yourself dwelling on the negative aspects of it is difficult. As a caregiver, you will find yourself thinking such things, and that is okay. There is no way to avoid it, and if you are aware of that you can deal with your own negative thoughts without transmitting them to your patient. You are, after all, only another human being thrust into a situation over which you have no control. All you are trying to do now is your best to help a person you love get what she needs, and to be there to give her all of the positive support you can give her. It ain’t easy, but it can be done, and that’s your job.
Back in her room on Thursday, she was off the IV, choosing her own food and we were doing good bit of walking around the halls of 7C. Maddaus said the x-ray was “great.” and now they were waiting for the drainage to subside so they can pull the chest tube. Ginny stopped by in the afternoon, and that helped her spirits as it always did. The evening was quiet, and when I went back to the Radisson, I felt that come Friday, we might get a break.
Friday morning, I got to here room, and she didn’t even ask me how her hair was, so I kidded her about that. She just smiled and shrugged. She was off the heart monitor now, and so the only thing standing in our way out the door was the chest tube. It was not to come out today, another disappointment, but the weekend was looking better now.
Saturday was a really big day. While the chest tube didn’t come out, they had an x-ray scheduled for later that evening, and if all looks good, it will come out Sunday morning. That was to be the best news of the day.
The other news I got that day wasn’t that good, in fact it was worse than I had imagined. I had a visit with one of Dr. Maddaus’ residents, not the one I referred to earlier, but a Dr. Aasheim. He had stopped by Joanie’s room to check on her, then he took me out to one of the computers in the hall, and brought up the pathology report we had been waiting for these past eight days.
These were the facts that we now had to deal with. Aasheim told me we were definitely not dealing with non-small-cell lung cancer, but it was indeed metastatic cervical cancer. Metastatic is one of those words you never want to hear if you are dealing with cancer. He said one of the lymph nodes Maddaus had taken was positive for cancer, and there was vascular invasion involved. What that meant that it was on the move through the lymph system. He also said there was pleural involvement, and what that meant that the tumor had extended to the pleura, which is the membrane that surrounds the lung. The biopsy that Dr. Carson had taken from the neovagina also tested positive for cancer which was also invasive, another sign that this had become a very serious situation.
I wrote everything down as fast as I could, and was numb. I couldn’t go back into Joanie’s room right then, so I went out for a smoke, and to take some time to process the news I had just been given. I just stood outside, pacing and smoking, and trying to get a grip on what might be next. I knew already it was going to be chemotherapy, since we were now dealing with a systemic problem.The cancer was no longer confined to the cervix, but had spread, and I didn’t know of any other treatment approach that could be used at that time. The thought of that alone almost made me cry for Joanie. I thought, she’s already been through so much, and now this. It wasn’t fair.
My immediate personal problem was what do I tell Joanie, if anything, right now. I chose to be a coward, and would wait for Dr. Carson to bring the bad news. I knew it would be devastating, and I didn’t want to have to deal with it myself right then. Joanie had an idea, but she knew nothing for sure. She never asked me if I knew anything, and so I didn’t have to lie to her.
I stayed at the hospital that night until they came around ten o’clock to take her down for an x-ray. When she got back she gave me the okay to leave. As I left her that night, I told her I think we’ll be going home tomorrow, if the pictures are okay. She smiled and told me she was planning on it.
As I left the hospital that night, I felt tired, more tired than I had felt in a long time. I stopped at the bar in the Radisson, ordered a Scotch, and just sat there alone, wondering where this was going to take us.
The only thing I knew for sure right then, was that wherever it was going to take us, it would test every bit of her will, strength and courage.