Donna’s Cancer Story: Terminal

This is the twenty-seventh of thirty-one installments of Donna’s Cancer Story, which will appear daily in serial format through the month of September to recognize Childhood Cancer Awareness Month.  Each post will cover one month of Donna’s thirty-one months of cancer treatment. 

Tiny Dancer

(All photos courtesy of Joel Wanek, Joel Wanek Photography)

In her last week of treatment, a lump was detected in Donna’s neck by the staff at the proton beam radiation center.  At the end of her morning treatment, I was called back to the recovery room, just as I was every day.  Greeting me, standing over a still sedated Donna, was one of the medical directors.  Oh, no, I thought, what is this?  There was no suspense involved,  “I see a lump in her neck and it is suspicious for tumor,” he said.  Just like that.  The pit that exists in every Cancer Parent’s gut grew from a pea to a watermelon for me within moments.  I had seen the lump in question in passing the night before.  Donna was in our room with her playmate and I was walking out into the hall when I turned around to say goodbye and saw it.  A fear flashed in me, but Donna’s neck turned and it was gone.

Except it wasn’t gone.  It was there and it was suspicious for tumor.   I knew it.  I felt it.  It seemed impossible, as we had had clean scans just fifteen days prior, but cancer knows no boundaries.  It does what it wants when it wants.  True fact.  The suggestion was made to head over to the local hospital for an MRI.  One of Donna’s sedating doctors who had treated her previously was there and had generously agreed to stick around and sedate her for the scan.  We could take her right away.  A dual sedation is never recommended by medical professionals, that’s why Donna had her picc line inserted without it, but in dire cases, you do what needs doing.  Clearly, this was a dire case. 

I called Mary Tyler Dad at home in Chicago and caught him on his way out the door.  He drove directly to Bloomington to meet us at the hospital.  He made record time.  I felt terror.  If you have not felt terror, you don’t ever want to, and if you have felt it, you know precisely what I mean.  Images seem to work better than words, so you can think of it as a swirling, growing, angry hurricane of hell in the middle of your gut.  You are powerless. 

Thankfully, Auntie was with us and came to the hospital.  I don’t remember getting there.  I do remember registering.  Sitting with my family in a waiting room, such a benign, innocuous space.  I don’t remember my children there.  I remember my sister and her knitting bag resting on a chair.  I remember bringing Donna into the MRI room, but not dressing her in a gown or her being re-sedated.  I remember the kind face of the doctor who had sedated Donna numerous times at MPRI.  I remember sitting in the cafeteria with a turkey sandwich in front of me, but not how I got there or how it got there.  I remember Mary Tyler Son wailing, and me not being able to hold or comfort him.  I remember Mary Tyler Dad finding me and holding me.  I remember splitting the sandwich and it tasting like lead fabric.

The scans were complete and we all joined Donna in the recovery room.  She was hungry and ate french toast sticks and syrup.  We were both sticky as she was sitting on my lap.  We were discharged and a friendly nurse wheeled me and Donna out the door to the car, “Hospital policy,” she cheerfully remarked.  In the car on the ride home, we heard from Donna’s doctor in Bloomington that the lymph node was not attached to tumor.  It could be cancerous, but it was not the tumor we had been treating.  That brought comfort.  The plan was to finish out the week and follow-up with our team at Children’s in Chicago.  This put a pall on our last week of treatment and our remaining time at Jill’s House.  Of course, it did.  For Donna’s sake, we worked hard to focus on what she had accomplished.  53 proton beam radiation treatments spread out over twelve weeks.  We had lapped every other guest at Jill’s House.  All our neighbors had moved on and back home. 

Donna’s going away party was lovely.  Our closest friends, the manager and her children that lived onsite, were there and kept us from jumping off a cliff.  There was pizza and decorations and a dance party.  Oh yes, a dance party.  I have such a beautiful sense of that last evening, spent in the company of dozens of people affected by cancer.  Some young, some old.  We all danced together.  We put bean bags on our heads and pretended to be sleeping fish.  All of us.  You have not fully lived until you have danced with young and old alike. 

Obituary Photo 

We got home late on a Tuesday night.  On Wednesday morning we headed to Children’s to meet with Donna’s oncologist.  Within minutes it was clear that there was concern.  It was confirmed by the look in Dr. Stew’s eyes.  He is an outstanding human being, that man, but he does not have a poker face.  We met with a surgeon and had a CT scan of Donna’s lungs.  In hospital time, those things take days or weeks to schedule.  Unless your daughter is dying.  Then, it is mere minutes.  After the scans, we were sent home to await the results.  I dropped Mary Tyler Dad at home with the kids and went along to the grocery store.  We weren’t even home long enough to get milk and bread before the call came.  Donna’s lungs were covered with lesions, her lymph nodes were full of cancer.

I got the call driving down Touhy Avenue, the milk and bread in the trunk.  I had to pull over.  It was Mary Tyler Dad who called me.  I called Dr. Stew immediately.  There was nothing to be done.  The forecast called for a good summer, possibly fall, but Donna would die.  It was the first week of June. 

The plan was to put Donna on an oral chemo that could eek out several more months, we hoped.  She was completely asymptomatic, so preserving time was the goal.  If the oral chemo was easy enough for Donna to tolerate and had the chance of extending her life by weeks to months, we decided it was worth it.  No more hospital stays.  No more scans.  The cancer would run its course, but with Donna living so vitally, we wanted to prolong that as long as possible.  Dear Donna.  My daughter was dying of cancer and to look at her was a total disconnect.  Dr. Stew had said once of her, “She may have a brain tumor, but she is not a sick child.”  He nailed it with that statement.  Donna had lived with cancer since she was twenty months old, but it never prevented her from growing, learning, developing, being a child.  That was one of our blessings. 

I wrote at the time:

“Today, right now, she is not suffering.  She is chatty, hungry, silly, thoughtful, playing catch and riding her tricycle.  Two years ago this week, when it was first learned that Donna’s cancer might have spread to her lungs, we had a prognosis of 2-3 months.  If someone had said on that day that Donna will survive two years plus I would have thanked my lucky stars.  Now that that time has passed, I remain grateful, but hurt in my bones that more can not seemingly be done to right the terrible wrong which grows inside her.  It is so wrong to lose a light this bright, a girl this loving, a daughter and granddaughter and cousin and friend, and sassy willful wonder.  I ache.  We ache.  But there is not a lot of time to ache right now as Donna still thrives.  We must connect to that while we can.” 

And so we tried.  Her VP-16 was disguised in pudding and her Temodar was disguised in ice cream.  These are meds that an adult would swallow in pill form, but Donna was too young for that.  Instead, I put on blue rubber gloves to protect my skin from the poison I stirred into her pudding and ice cream.  God help me.  Donna would sit on her Daddy’s lap and we would all resign ourselves, the three of us, to what was done in the name of preserving the life she had in her.  Like most young children, Donna did as she was told.  It is heart wrenching to spoon feed your daughter poison that you know, at its optimum, will provide a few more weeks to her cruelly young life.  But that is precisely what we did.  A wise RN told us early in that if we let her, Donna would be our guide.  We let her, and it was clear to us that Donna wanted to be with us still, despite the injustices of a mother and father spoon feeding her poison laced ice cream and pudding.  Seconds after the last spoonful, Donna would pop up and out of her Dad’s lap and race to the kitchen room or play room or to her brother.  Yes, she was our guide.

Several weeks later, Donna danced in her studio’s annual dance recital.  It was Father’s Day.  Her hair had started to thin, she would lose it again, we knew, and some low grade fevers from the chemo had started.  Donna had practiced her dances throughout her time in Bloomington.  When we returned, she joined her classes again.  Her teacher and studio could not have treated us with more kindness, sensitivity, or love.  Donna and Mary Tyler Dad were given private lessons to perform with some others in the Daddy-Daughter Dance.  It was Donna’s favorite.  The studio director made certain to accommodate Donna on this day with the knowledge that she would never dance publicly again.  We had reserved seats in the audience.  We got to watch a dress rehearsal so we could see Donna on stage more than once.  A professional photographer was brought in to capture the day for us.  All of this was discrete.  My guess is that the folks in that audience who knew Donna was dying were sitting in the row reserved for our family.  We remain grateful for this beautiful gift of a day where Donna was just another girl, nervous to dance in her first recital.  

Blues Brothers 

Somehow we sat in that audience of over 500 proud and happy parents and we watched our girl, knowing she would leave this world much too damn soon.  Somehow we didn’t wail or convulse or vomit.  Somehow we kept this news to ourselves, stifiling the urge to yell and scream and rail at a universe that could be so cruel.  Somehow Mary Tyler Dad performed with Donna, his Father’s Day gift that must last a lifetime.  Somehow you’re still reading this note.  Somehow I’m still here to write it.  Somehow my beautiful Donna is not with me.

Tomorrow:  The Bubble

Donna’s Cancer Story: Infection

This is the twenty-sixth of thirty-one installments of Donna’s Cancer Story, which will appear daily in serial format through the month of September to recognize Childhood Cancer Awareness Month.  Each post will cover one month of Donna’s thirty-one months of cancer treatment. 

Pensive Donna 

(All photos courtesy of Anne L. Geissinger, Pixeldust & More)

Ten days of this month were spent in a children’s hospital in Indianapolis with a double port infection.  During those ten days I must have thanked my lucky stars approximately 673 times that we lived in Chicago and were treated at Children’s Memorial.  Donna’s beloved tubey had to come out, requiring the insertion of a picc line in her left arm.  These were scary, awful days.  Some of the worst since 2007’s stem cell transplant, and that’s really saying something. 

The origins of the infections were unknown and while many children with cancer experience numerous infections, the only infection Donna ever had was during her stem cell transplant.  The worst thing a Cancer Parent can hear in the midst of treatment is ‘infection.’  Scratch that.  ‘Relapse’ is the worst word, though infection is a damn close second.  Wait, you can add ‘terminal’ and ‘hospice’ to that list, too.

The ten days felt more like ten years and included being transported to Indy from Bloomington via ambulance due to Donna’s raging fever that came out of nowhere and sent her into a shaking bundle of discomfort.  Terrible ER care.  Misdiagnosis.  Hearing from our team in Chicago that Donna had an infection before the Indy team even knew.  How that is even possible is still beyond me.  Alarmist rhetoric from an unfamiliar oncology team that clearly were annoyed by my advocacy skills.  Perhaps because they were on the receiving end of them?  I was told by the head of pediatric oncology that Donna was receiving ‘adequate’ care.  “Adequate care,” I told him, “is not good enough for Donna, or any child in your care.” 

Blue Eye

This is a bit stream of consciousness, so bear with me:

Staying in a hospital room with two children, one of whom wanted OUT (Donna) and the other of whom (Mary Tyler Son) was not allowed out of the room because as an infant he was not yet fully immunized.  This was at the start of the swine flu epidemic, for added drama and paranoia.  A port removal surgery scheduled at 9:30 p.m.  I remember being with Donna in surgery, and Mary Tyler Dad being in Chicago, but have no memory of where Mary Tyler Son was or who was with him during those hours.  My Dad?  You?  

Placement of two IVs in Donna’s hands, rendering her unable to use them at all; we called them her “claws.”  A picc line insertion done without any sedation, Donna screaming to the surgeon, “NO MORE LIDACAINE!”  A surgery without sedation is incomprehensible.  Going back and forth daily to the proton center via a 70 minute ambulance ride so we wouldn’t fall behind in treatment.  The RN that had to accompany us talking on her cell phone the whole ride.  Some EMTs offering Donna donuts on the ride home and others refusing to allow her to eat because of liability reasons.  Donna losing her will. 

That was scariest of all.  When the IVs were inserted in her hands, without any discussion with me about placement, they left Donna unable to feed herself, move herself in bed, or play easily.  She simply started to fade.  It was sad and scary and painful – – no doubt duplicating how Donna was feeling herself.  We got through it, and returned to Jill’s House in Bloomington to resume treatment, but those ten days were scarring in so many ways. 

Donna on her bike 

Remembering these days now, I still feel so impotent to stop what was happening.  I am certain that the care at that Indy hospital must be better than what we experienced, but it feels like Donna’s care was doomed from the moment she was wheeled into the ER.  Having worked in health care for so long, I know that sometimes that is precisely what happens.  Mistake after mistake, arrogant doctors who cover other’s mistakes with defensiveness, unfamiliar staff who saw us as a short time problem to endure.  And Donna caught in the crossfire.   

Later in the month, on another trip home to Chicago for scans, we got the best news possible, that the small lesion in Donna’s neck was shrinking.  The proton beams were working.  Donna was recovering from the infection setback/trauma as were Mary Tyler Dad and I.  We saw the lights at the end of the proverbial tunnel, but I lost some of my fight this month. 

In working to advocate for Donna, in trying to discuss all of the mistakes and mishaps made by hospital staff that harmed our girl, I was defeated.  Even the most basic of things.  I could not take Mary Tyler Son in the halls, which meant I could not leave to get food for myself.  I was not allowed to order food through the hospital.  I was not eating.  A nursing mother not eating and no one seemed to care. 

Family in Bloomington 

When I asked to speak to a patient advocate, the gal I was referred to listened politely, but only wanted to know if I planned on hiring legal representation.  I stepped back.  Donna and Mary Tyler Son needed me more than I needed to grind my axes and rail at the injustices of alarmingly poor pediatric care.  We just wanted to get the hell out of Dodge. 

It was suggested during this period that I might want to start Mary Tyler Son on formula – – that the stress of nursing was too much in the midst of this cancer chaos.  I strongly declined.  Some days the only time I held him was when he was suckling.  I wish I remembered more about his infancy.  Those lost memories are another casualty of cancer.

All of the photos you see today were taken by my friend, a photographer, who visited with her youngest daughter for a week to tend to us and shoot Donna.  More than any others, these photos cut to my core.  They capture Donna in all her splendor, remind me of her wisdom, her wonder, her tenacity, her strangely knowing eyes.  The deepest blue eyes I have ever seen.  My memories of Donna are shaped by Anne’s photos of her.  That is a gift I can never repay.  Taken just a couple weeks after the infection ordeal that was already becoming a memory.   

Wonder

You see, the wind blew with Donna’s health.  When she was well, we were well.  When she struggled, we struggled.  She had no inclination to wallow in or pity her situation.  She wanted to live.  She knew, intuitively, that life was a privilege and she did not waste a moment of hers. 

Tomorrow:  Terminal

Donna’s Cancer Story: It’s a Boy!

This is the twenty-second of thirty-one installments of Donna’s Cancer Story, which will appear daily in serial format through the month of September to recognize Childhood Cancer Awareness Month.  Each post will cover one month of Donna’s thirty-one months of treatment. 

This next month was a rough one.  When it rains, it pours and these days, it was like a monsoon.  On the first day of this month, scans showed continued growth of Donna’s tumor, albeit slowed.  With our due date less than two weeks away, though, the docs decided to stay the course for one more month — two more rounds of the current regimen.  Not good, but at least we would have some space and time to welcome the new baby with a certain level of predictability.

Ha!  In Cancerville, there is no such thing.  The only thing you can count on in Cancerville is pain and heartbreak.  About twelve hours after leaving the hospital, Donna developed a fever and we were told to bring her in to the ER.  This was Christmas Eve, it was three in the morning, and there was a blizzard happening.  We got stuck in the alley twice just trying to get the car out.  Sigh.  Donna, though, was making the best of it.  Poor Mary Tyler Dad was out trying to push the car, I was inches from delivery, and trying to steer the car with my big belly in the way, and Donna?  Donna was in the back seat singing about the weather.  Oh, that girl knew how to have a good time.

We got out, into the ER, which was blessedly empty.  Have I ever mentioned the rock star treatment kids with cancer get in the ER at Children’s?  The oncology resident always informs the ER to expect you.  When you arrive, even if the place is packed, which it usually is, with snotty, sad, bloody, hacking, miserable kids and families, you go to triage.  When you get your turn in triage, they know who you are and are waiting for you.  The routine of temp, height, weight, etc. is done and then you are ushered into a private room.  Don’t get me wrong, you wait like any other family, but because of your kid’s immune issues, you get to wait in the comfort of privacy, which is a huge blessing in such a stressful sitution.

Okay, the ER docs checked Donna out and could find nothing wrong with her.  As was often the case, her fever dissipated with arrival at the ER and her mood was good, though tired.  Four hours later we were sent to clinic and day hospital to receive the already scheduled chemo.  We went home, Donna played and ate, and went to bed early. 

Twelve hours later, on Christmas Day, Donna awoke, sad and not feeling well.  No interest in Santa or gifts or anything that didn’t involve resting in her Daddy’s arms.  Poor girl just had no ambition, as Da would say.  We cancelled our family holiday and all stayed in pamajas for the day.  Auntie and Uncle were visiting and we made our own modified holiday cheer.  Until the vomiting started.  Just before her afternoon nap, Donna vomited.  When she woke, she vomited again.  For a few hours, it was every hour on the hour.  There was no fever and it was Christmas Day and the docs told us without fever, just keep her hydrated and wait and see.  That should have been our cue.  “Wait and see” never bode well for Miss Donna.

The vomiting stopped about 1 am and Donna slept through the night.  When she awoke on the 26th, it was with a fever and gray pallor and sunken eyes that I did not recognize.  It is impossible to describe what you feel as a parent when you are staring at your child and you do not recognize them.  We booked it to the ER.  There was no singing this time. 

Donna was quickly diagnosed with a “critically dangerous” low level of carbon dioxide in her blood.  The fever and vomiting had created the perfect storm of chemistries in her body over a matter of hours.  She moved into a deep sleep in the ER and could not be roused.  Doctors were buzzing and before we knew it, Donna was transferred to the pediatric ICU.  What the what? 

Gratefully, with constant hydration, our girl came back to us in a matter of hours, though a much less animated version of herself.  The docs also found RSV, a virus that can be extremely dangerous for immuno suppressed children and infants.  We were two for two in those categories and alarmed.  I implored the child inside of me to stay put.  Donna was transferred out of the PICU and onto oncology the next day and the day after that we were discharged.

The girl we brought home, though, was not the girl we hoped to bring home.  Donna was listless with little appetite.  She was back on overnight fluids, which always managed to have the reverse effect of taking away her thirst.  She laid on the sofa and watched tee vee and napped.  That was just about our speed, too, as we had both developed colds ourselves.  Poor Auntie and Uncle got lots more than they bargained for in this visit.  Merry Freaking Christmas!

Mary Tyler Dad wrote about this in our journal:

“I’m realizing how thin Donna’s reserves actually are.  One good cold put her in the ER twice, PICU, and on the couch watching TV at home for another week.  Donna is a happy, growing girl, but one bad bump and we’re in the hospital again.  I think I spend as much time as I can in denial.  Things like this remind me of how lucky we’ve been, to have stayed on the tightrope like we have.  You get so comfortable walking around, you forget you’re on a tightrope altogether.  And then, whoomp, you’re in the net and you remember . . . right, right.  We’re on a tightrope.”

A few days later, I went to the hospital myself.  You can tell it’s been a rough week when going into labor feels like a guilty break.  Sigh.  With Donna better, but still not nearly herself, both her parents left her to deliver the baby.  More guilt.  Intense guilt. 

Mama holding photo of Donna 

While I had informed my ob about Donna’s RSV, he clearly did not see the same significance with it as the labor and delivery staff.  When I casually mentioned Donna at home with the RSV cold to my nurse, everything stopped cold.  We immediately went on lockdown and I was treated kind of like a suspect, complete with interrogation.  Who?  What?  When?  Where?  Why?  They did not care that I had discussed it with my ob.  Plans were made to move me to an isolation delivery room where all docs and nurses would have to scrub and gown each and every time they saw me.  This was a pain, I know from the stem cell transplant, and it did not endear me to anyone.

Before we moved, I was given my epidural.  I knew enough of pain and had no desire to feel the pain (or wonder, for those who dig natural childbirth) of delivery.  Mary Tyler Dad had left the room at the doc’s request for the needle stick and within minutes I started to feel funny, woozy.  I passed out.  A few minutes later I came to with literally dozens of doctors and nurses surrounding me.  No Mary Tyler Dad.  The doc told me that my and the baby’s vitals were dropping and I would require a C-section.  I cried and wailed and started screaming, “This baby has to be okay!  My daughter has cancer!”  Oy.  I was strapped to the gurney watching the flourescent lights above spin by as the team ran me to the OR. 

I still don’t know what happened, but my vitals improved.  The baby’s vitals improved.  The doc cautioned everyone to take a breathe and wait, to give my body a few minutes to see if it would recover on it’s own.  It did, and about eight hours later Mary Tyler Son was born.  It was not the blissful delivery I had with Donna.  This one was a bit more work.  When the baby came out, Mary Tyler Dad said, “It’s a boy!”  My first thought upon seeing my baby was, “Damn, a penis.”  Isn’t that awful?  I had so been hoping for another girl. 

Masks with Jay<

As is often the case, I was wrong.  I held Mary Tyler Son for the first time and fell in love with him.  He was a natural latcher and within moments of his birth I was nursing him.  Wow.  My baby, Donna’s brother, my boy. 

With the RSV, there were lots of precautions to take.  Donna could not come to the hospital, nor could they be in the same room when we returned home.  Donna would not hold her brother for thirteen days.  We had zoning in the house:  Donna downstairs and Mary Tyler Son upstairs.  We needed to wear masks and gowns when with the boy and I felt deep sorrow and anguish about that.  I know how important faces are to newborns, specifically their mother’s face, and mine was covered.  I hated cancer in those days.  I was angry.  Cancer had robbed us one of the most precious times a family will ever enjoy.  Bastard cancer. 

Donna holding Jay 

Tomorrow:  Surgery 4.0