“Do you think Dr. Carson has given up?”
April was, to steal a few words from T. S. Eliot, “the cruelest month.” That is not to say it was the cruelest of the many months Joanie had been involved in this battle with cancer, but this last April was one of the many.
The radiation in Minneapolis had been harder on her than we had expected, and the hospital stay for hypercalcemia of malignancy and hypokalemia had taken a toll.
Her appetite had gone south, and it had gone south in a big way. She lost a lot of weight since her stay in the hospital, and if she had weighed 120 pounds when it started, she would have weighed about 90 pounds now. Fortunately for her, she had some weight to lose. She was a tall woman, and carried extra pounds, something that bothered her from time to time, but in this instance, it turned out to be a blessing in disguise.
After we met with Dr. Thomas on the 27th, Joanie told him she was not ready for the next round of chemo, the one Dr. Carson had recommended, and would call him when she was. We weren’t scheduled for anything else for a few weeks.
Joanie spent most of May trying to get back into the swing of things at her office. As much as she tried, she was basically only spending the afternoons there. She was able to go out to lunch with some of her friends, and go on walks in the afternoon with Betsy Dalrymple. When she would be ready to come home, I would get a call. She still wasn’t eating that much, but was managing to keep the pain under control with Dilaudid.
Dr. Thomas had ordered a CT scan for the 21st of May. This would be the first since the radiation had ended some seven weeks ago. From this we would know if the radiation had worked, or not. It was a fairly tense time, especially on my part. If Joanie was worried about it, she didn’t let on to me.
The CT scan was a disappointment. I had picked up the radiologist’s notes, and it showed that not only had the lesions in her right chest wall not shrunk, but they had grown. The nodule in her left lung had also grown, though not substantially. I was at a loss as to what to do with that information. I decided to do something I had done before when I knew something before we were to meet with her doctors, and say nothing to her. I would let them be the bearer of the bad news.
One thing the radiologist suggested in his notes was to have an MRI done to get a more definitive picture, and Thomas scheduled one of those for the 25th. When Joanie wondered why, the answer I gave her was that they wanted to get a better picture of what was going on. She bought it, or at least I hoped she did. I wondered sometimes if she wasn’t more aware of what was going on than she let on.
The MRI confirmed everything the CT scan had shown, and did it in more detail.
We were to meet with Dr. Carson and Dr. Dusenbery in Minneapolis on June 8th. That is when the doctors would bring the bad news. We were to take CDs of the CT scan and the MRI along with the notes with us when we met with them.
We were left to wait again. This time, I waited with the knowledge that Joanie was going to get bad news. I couldn’t bring myself to tell her what I knew, because, I only knew what I read in the notes, and there were, no doubt, other ways to look at what I saw. I was, after all, a layman, not a doctor, and as such couldn’t really interpret to her what I read. Besides that, both Dr. Carson and Katie would be better at handling the information than I could ever be.
On June 7th, we left Bismarck for Minneapolis, and it was an uneasy time. Joanie was more subdued than normal, and before we left the house, spent more time than usual with Bailey and Brandy. We would meet Ginny and Ed for dinner, and as it always did, it gave Joanie a lift. When we got back to the hotel, she became quiet again.
The next morning, we walked the few short blocks to the Phillips-Wangensteen building where Dr. Carson’s office was, and checked her in. We waited for only a short time, when Bev, one of Carson’s nurses that knew Joanie well, called her name, and we went down the long hall to find one of the examining rooms and wait to see Carson.
After the usual small talk, and Dr. Carson’s assessment of Joanie’s condition, she got down to business, and told us that the lesions hadn’t shrunk, and she was going to recommend that Joanie embark on the Gemzar chemotherapy regimen. She told us she was going to consult with Katie, to see if they were in agreement on this course.
As she got ready to give Joanie a physical exam, it was my cue to take a walk. I went up the three floors to get outside and have a smoke, and make a couple of phone calls. They were not the calls I wanted to make, but I felt I had to.
When I got back down to the room, Dr. Carson was gone, and Joanie had gotten dressed, and I could see from her demeanor that something was bothering her. She didn’t say what it was, and from the clinic we walked over to the hospital to Katie’s office to hear from her on what the scans had revealed about the radiation.
Katie, who always put Joanie at ease, did so again today. She was surprised at what she had seen on the scan and the MRI, and really didn’t have a good explanation for the radiation not doing what they had hoped it would. I knew she felt badly about it, and I would hear more from her later. We left her office, with Joanie still quiet, and I think somewhat overwhelmed about what had happened this morning.
We walked back to the hotel to get some breakfast at Applebee’s. They had taken over the main dining business at the Radisson, I suspect on a lease arrangement. Once we got seated, we were waited on by the fellow who had been the main bartender when the Radisson ran the dining room and bar. He had been there since 1998 when I used to spend a lot of time there, and he remembered both of us. Joanie got a smile out of seeing him again, and he remembered that she worked for the governor. He got a good tip that morning.
We ordered coffee and something to eat, and Joanie started to relax. I didn’t push her, and I just waited for her to tell me what was bothering her, and then she stunned me when she said, “Do you think Dr. Carson has given up?” It almost took my breath away.
I sat there for a brief moment, and told her I didn’t think that was the case, and fumbled for reasons why I felt that way. Then she told me that while I had been out of the room, she had used the word “hospice,” a word that was anathema to Joanie, and a word I’d never use around her under any circumstances.
I told her I didn’t think Dr. Carson was giving up, and also that she was doing what doctors have to do in dealing with their patients, and that is to make sure they are aware of all of the options in their treatment that are available to them. I tried to be as convincing as I could be, but I’m not sure she bought it. I felt so sorry for her right then, but all I could do was try and help her understand that this battle was not over, and give her the support she needed from me.
We finished our breakfast, went upstairs, picked up our bags and checked out.
The trip back to Bismarck was a long one. Joanie sat quietly for most of the trip. It was obvious to me was still trying to process what she had learned this morning, and didn’t want to talk about it.
I tried, as the miles rolled by, to make some sense of it myself, and all I knew was that we were facing more uncertainty, and Joanie was keenly aware of it.