We went to the clinic, and as we were walking up to it, a building I had been in several times previously, I once again had the impression we were entering an airport terminal, instead of a medical facility. The Cancer Care Center is located in the "specialty" building, and is a fairly new facility. The entire front of the building is glass, with a huge three-story atrium, and three separate entrances, with carports and drop off areas for patients with special needs. It really does look like an airport. There are large waiting areas for each of the departments in the clinic, so that you are most comfortable after checking in, while you await your appointment. In the cancer area, there is a card table with a puzzle set up for the families of those waiting to be seen or for those waiting for chemotherapy patients. Gail and I are puzzle addicts, so of course, we headed straight for the puzzle table. Paul, who is still a smoker, headed outside to have another cigarette before the appointment, and Mom just sat there, waiting patiently. She didn't seem nervous, but she was very quiet, and I could tell that she was anxious to discuss her options with the doctor.
Finally, the nurse led us back to the examination room. It was immediately obvious to me that the clinic had spent too much money on outside appearances, and very little on exam rooms, because the four of us were ushered into a room which was no bigger than 9 x 10 feet, and since I am terrible at estimating sizes, that may be generous; trust me, it was small! Inside this very tiny room was an examination table, one patient chair, a stool for the doctor, a lamp, and a corner supplies counter and sink. I am 6'1" tall, and am no longer thin, and I am one of the smallest people in my family. So cramming the four of us into this tiny room was interesting. The door would barely open. It was quite uncomfortable, and very stuffy, and almost immediately, Paul couldn't take it any longer, and went back outside.
So, we waited, and we waited. I have never understood why we make appointments with medical people, only to wait until they are good and ready to appear. I understand that they are busy people, too, but then, so am I, and I really feel that my time is worth just as much as theirs, whether I am a physician or not. I realized as soon as I met the doctor that it was entirely unintentional on her part to make us wait so long, and that it was more likely that it was because she was a thorough, compassionate physician, and would take as long with a patient as she thought necessary to do her job.
Finally, shortly after Paul had returned, Dr. Penland came into the room, with a little bit of squeazing and moving around by the rest of us. I think she was overwhelmed by all of us, but she never showed it. She is a beautiful, tiny woman, and at the time was about 6 months pregnant. She came into the room wearing a lovely dress, and boots with 4-inch heels, which only made me respect her all the more, simply because I couldn't imagine walking around in those boots all day, particularly being pregnant. She took one look at all of us, and just introduced herself, and shook all of our hands. I was amazed she didn't ask anyone to leave. We had to collectively outweigh her 9 times over at least, but she took it in stride, and was completely at ease, which was comforting and reassuring, and I was immediately relieved to be in the hands of a competent physician.
The first thing she did was to open the door again, and ask the nurse to get some oxygen for my mother, in order to make her more comfortable, as Mom was wheezing a little, and still had a wet, nasty cough. She then sat down, looked my mother directly in the eye, and asked her whether she wanted the straight forward version, or should she soften the blow a little. Mom, being the person she is, asked for the blunt version. Dr. Penland maintained her direct gaze with my mother, as if the rest of us weren't even in the room, and explained to her that yes, as she knew, she had lung cancer, that she was considered to be extensive stage as it had spread to her chest cavity outside of the lung, and that there were 3 tumors on her liver as well. I asked her what type of cancer it was, and she looked at me and said the words I was dreading; mom had small cell lung cancer.
In hindsight, and after having done more research, I now know that whether Mom had small cell lung cancer, or non-small cell lung cancer, really wouldn't have made much of a difference, simply because of how far it had spread before diagnosis. The only difference is in the method of treatment, and what drugs they would use, but generally speaking, extensive stage cancer is what it is, and the prognosis for a new cancer patient is based mainly on the point of progression at which initial diagnosis occurs, not necessarily what type of lung cancer is found. At the time, however, I thought that those words were the worst we could hear, because everything I had read over the past few days had said that small cell lung cancer is much harder to treat, and doesn't carry with it the same prognosis at the outset; that the only hope for a cancer patient seemed to rely on the finding of non small-cell lung cancer. As soon as I heard those words, my hope diminished rapidly, and I began the process of resigning myself to her inevitable, impending loss. My aunt was silent, and Paul began to cry, as did I, but Mom just set her jaw, clenched her teeth, and nodded and said, okay what do we do?
Dr. Penland explained that there was no option for surgery simply because of how widespread the cancer was at the present time. She did explain that there were several types of chemotherapy that initially worked fairly well against small cell lung cancer, but that the cancer was resilient, and would quickly become immune to the medicine, and would again spread. She said that, in her experience, and no matter what she did, the cancer would spread, and that at best Mom might have a year to live. She said she could buy her some time, but that she would lose the battle, no matter what she did. The cancer was simply too fast-growing, too "smart", too adaptive, and that no matter what she did, Mom would die, perhaps very soon. But, she also said she was willing to try anything that Mom would tolerate, within reason, to keep her alive for as long as she could. She told Mom that she would do whatever it would take, but that she would also support Mom's decision, were it to be made, to not receive treatment of any kind; to preserve the quality of life, though that might mean less quantity of life. Mom steadfastly refused to walk away, and stated that she was willing to fight this disease with everything she had, and she wanted the chemotherapy, radiation, and surgery, if that were an option, but Dr. Penland again quickly assured her that surgery was out of the question.
During the first few days after Mom's diagnosis, I was under the assumption that since the cancer was so widespread at initial diagnosis, Mom had to have had it for years. I was convinced that she had simply ignored the symptoms for a very long time, and because she refused to go to the doctor for anything, she had written her own death warrant by allowing the cancer to spread so far before she finally sought medical treatment. Dr. Penland, however, corrected my assumptions by explaining that even though Mom's cancer was so widespread, she likely did not have it until just a few months prior to visiting the doctor. This is one of the worst parts of the disease; it's ability to multiply rapidly, and is precisely what makes it so hard to treat, as most people don't show symptoms of any kind until the cancer has already spread to other vital organs, and that happens within the first few months of the cancer starting. She explained that lung cancer was incredibly fast-acting, and was also the reason for the data findings of why people didn't live very long with that type of cancer; it was too insidious, and it was hasty about it.
This knowledge was vital for me at that precise moment, as it prevented me from blaming my mother for her disease for the most part. I did still blame her for having smoked in the first place, a long-standing disagreement between the two of us, but I could no longer be angry with her for failing to seek medical care more quickly. Mom said many times that she hadn't felt sick, still didn't really feel sick, which was making it so much more unbelievable for her that she was being told she was terminally ill. She just didn't feel like there was anything wrong, except that she couldn't breathe very well, but she certainly didn't feel like she was dying. Dr. Penland assured her that she probably didn't feel that way, because lung cancer creeps up on you silently, and spreads rapidly throughout the body, and that she wasn't alone in her astonishment; most patients were astounded with the terminal diagnosis.
Dr. Penland's plan was to start Mom on chemotherapy the following day, and to put her on oxygen to help her to breathe more freely. She also recommended that Mom allow them to attempt to drain the fluid from her lungs again. She explained that the medical facilities at the clinic were much more advanced than those in Glasgow, and that they would use ultrasound while they did the procedure, so they were sure they would not compromise the tumor itself, and that they would be more successful, and should be pain-free. Mom reluctantly agreed to the procedure with our encouragement, and was scheduled to have it performed that very afternoon.
Dr. Penland then went through the plan with us as to how the chemotherapy would be given; she was to receive chemo every day for three days, and then would have to return the following day, in order to receive a shot that would aid her body in continuing to produce red blood cells, something which is destroyed by the chemotherapy process. She would then have the weekend off, and start the process over again. She would have two weeks worth of chemo, and then three weeks off, and then repeat this process three times, through three courses of chemotherapy. Mom asked whether she could receive the chemo at home in Glasgow, as she lived some 275 miles away, and that it would be a hardship on them for Paul to miss much work, and for her to live with me and my family. It wasn't that she thought she wouldn't receive love and support at our house; it was simply the fact that when Mom is sick, she likes to be alone, and for it to be quiet; something with which my boys, who were 4 and 8 at the time, were unfamiliar. Dr. Penland explained that her request was reasonable, though she would not recommend it, as she really felt it would be important for Mom to be closer, in case there were complications. She insisted that my mother stay in Great Falls with us for the first course of the chemo, in order for her to make sure Mom would tolerate the drugs well, which my mother reluctantly agreed to do.
We all piled back into the van, and drove home in silence; each of us lost in our own thoughts and attempts to comprehend the news we had just been given. Paul took Mom back to the clinic that afternoon to have her lung drained, and this time, thankfully, the procedure was pain-free and produced immediate relief for her. She was breathing much more freely, and was much more comfortable at that point. We all discussed what would be done, and Gail offered to stay for the two weeks of treatments, so that she could take Mom back and forth to her appointments, and so that Paul could return to work. So, Paul went home, Mom and Gail moved in to a hotel close to the clinic so they could have some peace, and we all awaited the first chemotherapy dosage the following day. I was anxious for this process to begin immediately. If time was of the essence, I reasoned, then why weren't we administering the chemo immediately; why wait 24 hours when we had already waited 5 days to see the oncologist? That was my impatient side, but the clinic needed time to order the medicine, and to schedule Mom into the chemo center. None of that mattered to me, all I knew was that Mom was dying, and that her only hope, a very small one, was to have the chemotherapy, and hopefully, it would work. So, even though I was secretly hoping she would refuse to take any treatment, preferring that she be kept comfortable for as long as possible, instead of purposely poisoning the rest of her body in an attempt to kill the cancer, I was also grasping at the small hope that the treatment would work, and we would be able to save her.
Unfortunately, however, modern medicine has done almost nothing against this disease for the past three decades. The drugs that were to be administered to my mother were the only ones that had ever been found to have any effect at all, and it only bought people some time; inevitably the cancer won, 100% of the time. My mother, however, was resolved that it would be different for her; that she would be the miracle, and she, the avowed atheist for most of my life, another long-time point of contention between us, began to pray fervishly, and to read everything she could that was positive, and hopeful, and she grabbed onto the hope like it was the only flotation device in the ocean, and she never waivered from her resolve, not for a minute.
