[Updates about Vicki's condition can be found at Caring Bridge.]
“She’s in kidney failure.”
Those were not the words I expected to hear from the supervising doctor in the emergency room. I had brought my wife, Vicki, to the ER during the wee hours of the morning. She’d been experiencing a variety of symptoms over the previous couple of weeks, like sore hips, fatigue, loss of appetite, things that don’t faze you in the middle of the winter when various strains of flu are floating around. But that night she had suddenly begun to speak gibberish, couldn’t tell me my name or our address, so, thinking “stroke” and trying not to imagine the implications of that, I guided her into the car and we drove off.
At five in the morning, after a CT scan, chest x-ray, MRI, and urine and blood tests, I learned that the kidney shutdown—which had been ongoing for at least a few weeks and was behind the earlier symptoms—had thrown her blood chemistry way out of balance, toward toxic, which led finally to stroke-like symptoms. It had also surrounded her left lung with fluid, though shortness of breath was not evident until just before we left for the hospital.
A few hours later, in intensive care, they put a chest tube in her back to start draining the fluid. At about four in the afternoon a urologist inserted stents, via the urethra, into both of her ureters—the tubes that connect the kidneys to the bladder. They were apparently being pinched from the outside, as no growths or imperfections were seen inside the ureters themselves when the stents were placed, so the next step, once her kidney function was back to normal, would be to figure out why that had happened.
After the surgery she was still out of it, as she had been since arriving in the ER, so I went home and slept for the first time in 40 hours.
The next morning at eight o’clock the phone rang and the hospital’s name appeared on the caller ID. Steeling myself for the worst, I pushed the button and answered. A nurse introduced herself and said, given Vicki’s condition the day before, she wanted to make sure I spoke to her as early as possible. One word is all I need to describe her: Coherent! Her kidneys were functioning well and the chemistry had corrected to the extent that she once again knew who she was, and who I am, though she had no idea of what had been going on the last 48-plus hours. I told her as much as I could, said I’d come to hospital as early as possible, but first had to make some phone calls to assure her parents, and mine, that she had improved dramatically overnight and that they should pass that word to our siblings.
The next few days consisted of continued monitoring of blood chemistry, urine output, and the fluid draining from the chest cavity. Vicki’s sister flew in from Ohio and came to the hospital with her son, who lives an hour or so north of us. They picked up our son, Sam, who attends college about halfway between us and our nephew, and we all had some good visiting time—perhaps a little too loud for the ICU, but even the medical staff seemed to welcome the voices and laughter. And though Vicki was generally uncomfortable—chest tube, catheter, IV drips, and the basic ICU ambiance do not add up to feeling like you’re in a room at the Ritz—we took encouragement from the overall improvement and the look of relative delight on the poker-face of the kidney specialist who had ominously referred to her condition as “severe kidney failure,” his unnecessary adjective like an exponent perched at the end of the word “failure.”
A couple of days later, stabilized and out of the ICU, Vicki underwent a contrast CT scan, in which enhanced imaging shows greater detail about the organs and tissue being examined. The worrying result of that was the unidentified tissue in her gut, which was the prime suspect for having squeezed the ureters and shut down the kidneys. She was well enough to go home, but not before they scheduled an outpatient biopsy for the Monday of the next week.
Biopsy. Now there’s a word to strike fear into your heart. Not because of the procedure itself, which seems simple and safe enough in the context of modern medicine, but because of what it signifies they’re looking for.
And they found it. Cancer.
So, on to our first-ever visit with an oncologist. Top-notch doctor, all clarity and compassion. I could not have been more impressed and, well, comforted, in a way, knowing that come ever what may, Vicki will be in expert hands as we move forward and make decisions.
What we learned from that visit is that there is cancer that has metastasized “locally” from the urinary tract to the area outside the tract, in the gut, basically. What was not yet known was whether the cancer had metastasized at a distance from the origin. There were nodules on Vicki’s lungs that were not there when she had a CT scan in June 2012. They were too small to biopsy, so in order to determine whether they are cancer, they scheduled a PET scan. In a PET scan, they inject a substance into Vicki’s blood before the scan, and if the nodules are cancerous they will in effect “light up” during the scan.
This is important to know because it has an impact on the prognosis and treatment options. Going into the meeting after the PET scan, however, I must say that we were both aware that we were facing either very bad news or very, very bad news. Either the cancer was localized and could be treated with radiation and chemotherapy, with a survival prognosis of three to five years, or it had spread widely and the prognosis would be much more severe.
We learned from the PET scan that, as feared, the cancer has spread to the lungs, which means that the options open to us exclude radiation and it’s either palliative or chemotherapy.
Vicki has opted to try chemotherapy. They will be using one of the newer, “milder” chemo drugs, which should minimize side effects and slow the cancer down. But this drug won’t stop it (and neither will the other chemo drugs in the arsenal)—this cancer is not curable and, given its spread, the survivability prognosis is in the neighborhood of a year. The hope is that this treatment will add some months of decent quality time to that prognosis.
Vicki will have her first infusion in a few days, and it is usually repeated every three weeks. We will be in constant communication with the oncologist regarding the effectiveness of the chemotherapy, side effects, and everything else related to the treatment, and based on that, decisions will be made whether to change, continue, or discontinue the therapy.
This is not easy news to read, I’m sure, and it’s not easy to write, but this is the reality that Vicki, Sam, and I are facing along with our families in Ohio and New Jersey. Once we had the bad news of a cancer diagnosis, we knew that from that point on, we were likely to continue hearing various degrees of bad news. I think Vicki’s goal is to move forward with grace and to make the most of the love of family and friends, and I am counting on everyone we know to help her meet that goal.
The other day Vicki recalled a line from an old poem by Wendell Berry:
Be joyful / though you have considered all the facts.
And the line right before that:
Laugh. / Laughter is immeasurable.
I think those thoughts sum up our approach to this very difficult hand we have been dealt. The support we’ve received thus far has been overwhelming, both in terms of our morale and more concrete needs, and we are extremely grateful for that. There are silver linings to be found, renewals to experience, even in the face of death, and we intend to find and experience them. And we won’t shy away from laughter, and even a little gallows humor, along the way.
I’ve tried to lay this all out in a somewhat clinical fashion, to the degree that I am capable of that. The emotional impact of all of this is, of course, heavy, but I find myself most able to cope when I understand the facts as best I can. My point in sharing this is to give you the benefit of the facts as you—family, friends, colleagues, kindred spirits—contemplate this reality or interact with us over the course of the coming months. We appreciate your care and concern.