Tag Archives: Maggie Callanan

Early Exits

On Monday, Brock was so unusually sick that I texted his doctor to describe the symptoms. Brock had slept for over 24 hours, he was so out of it that he could barely speak when he became conscious, and he’d managed to tell me that he felt flu-sick, which wasn’t his normal cancer-sick. Also, there was a hard, angry-red lump on his chest that was getting redder and angrier.

Brock’s amazing family doctor arrived within the hour and diagnosed Brock as having an infection. It was quite bad, and might be septic.

Brock sweated in our bed while his doctor explained the options to me, my dad and Brock’s brother in the living room.

We could:

  • take Brock by ambulance to the hospital so Brock could be given antibiotics by IV (which might not cure him);
  • stay at home and try to treat him with less-effective oral antibiotics; or,
  • we could nothing.  Brock would die from the infection, at home.

Fear not, you normal, healthy people: these would not be your options if you had an infection. You would be whisked off to hospital without the couch consultation.

Brock’s situation is unique because he is already dying. And when you know that a cancer death is looming, our health care system allows you the option to take an “early exit” (as Maggie Callanan calls it in Final Journeys), if you would prefer not to linger.

But knowing this, reading about early exits, and discussing advance care options and Do Not Resuscitate orders with Brock did NOT prepare me for the emotional tsunami of being in this situation.

Obviously I don’t want Brock to die. I want him to live for as long as possible. But I also don’t want him to suffer, and being in a hospital has many downsides for someone as weak as he is. Would they let me stay with him? Would he be comfortable, away from his collection of pillows and Lazy Boy recliner and memory foam bed? Would Isaac miss us too much, and would I be able to be with Brock at the hospital while also giving Isaac the attention he needs at home?

If I chose to keep Brock at home with oral antibiotics, would his family and friends judge me for that decision? Would I have regrets and blame myself if he died?

Luckily (oh so luckily!!) Brock and I had already discussed all of this. He’d made his wishes clear: as long as treatment meant he’d continue to have quality of life at home afterwards, he wanted that treatment. He didn’t want to spend the rest of his life in a hospital, but this infection didn’t carry that risk. He’d be treated, and then (if the antibiotics worked) he’d be back home with us, back to the Brock he’d been 24 hours before. If the antibiotics didn’t work, he would die in the hospital.

I didn’t have to consider all the options. I didn’t have to solicit advice from anyone. I just conveyed Brock’s wishes, and our course of action was clear.

It’s Saturday now, and I’m writing this with Brock sleeping beside me in our bed. He had four courses of IV antibiotics and we spent three nights in the hospital, me curled at the foot of his bed like a cat. He’s on oral antibiotics now, and the angry red rock of infection inside his chest has practically disappeared.

I am so grateful that he told me what to do, long before we faced that decision. I’m grateful that he endured the painful ambulance-stretcher trip to the emergency room, and restless nights in the hospital. We could have lost Brock this week. Instead, we’re spending a lazy Saturday together.

No regrets.

Curable vs. Incurable

One of the big “threshold moments” is making that mental shift from “curable” to “incurable.”

The first time it happened was when Dr. A (finally!!) slapped us in the face and told us how serious the cancer is, back in June. I still had to ask my question about whether we should freeze sperm, since the cancer drugs would be so aggressive and cause flipper babies if I was knocked up. What if we wanted another baby, eventually? I asked the question and it still took awhile to realize that there would be no more babies, because my husband was dying.

I’m reading Final Journeys: A Practical Guide for Bringing Care and Comfort at the End of Life (by Maggie Callanan), from the hospice library. There’s a bit in there about pain control, and about how palliative care offers many more options than a typical doctor’s T3 prescription, and I realized that Brock has more options now that he has terminal cancer. For example, he’s always had trouble falling asleep, because of that busy brain of his, and maybe he never wanted to use sleeping pills because they’re addictive, or because they’d cause him to sleep in the next morning. But fuck it, why not now? He needs all the rest he can get, to help his body fend off these monster tumours. So why not have a cache of pills and if he’s still lying restless at 1am he can pop one?

Another bit was about CPR, and “do not resuscitate” orders. It seems crazy to me to not opt for CPR and save a life if that’s possible, but the book makes the point that, if the person’s life expectancy is only a few days or weeks or even months, it might not be worth risking the broken ribs and hospitalization that CPR can entail. That phrase, “quality of life,” is becoming the mantra of our world.

More thoughts about this one, later in the day …

Our (as in, people’s) instinctual inclination is to Be Hopeful. There is judgement if we aren’t Hopeful For A Cure or Miracle. And I’m a positive, optimistic person normally, but then … there is Reality. And there comes a point where it is no longer helpful to be Hopeful For A Cure or Miracle, because the Reality is that my sweetie is very sick and will die decades earlier than expected.

I see this Hopefull-ness in Facebook comments, urging us to hold out hope. I hear it in people’s well-intentioned advice to try cannabis oil, or turmeric, or magic mushrooms, or juice, or vitamin C, or any of the many magical “cures” that will, apparently, halt the growth and spread of the monster tumours.

We waver daily between the Hopeful idea of eating three well-balanced, whole-food meals every day, and the desire to simply revel in cheesies and bacon & eggs and all the meals that we most love: our comfort foods, our convenience foods that leave more time for reading and other fun past-times. Once we accept that there is no cure, that the Reality is death, then we can let go of any guilt and forego those kale chips in favour of chip dip.

My Final Journeys book validates this. It says the priority is for the dying person to get all the calories they can, with pleasure, and if that means eating favourite comfort foods then so be it.