April 3: Peggy’s April Fool’s Day Surgery

 

Peggy’s April Fool’s Day surgery (aka percutaneous ablation with internal fixation of right acetabulum) came 47-days after her Friday 13th surgery. We had to check-in at the hospital, which is an hour’s drive north of here, at 6:00 a.m., which is five hours earlier than we usually get out of bed. In order to mitigate our fatigue, we spent the night before surgery at the Mario Pastega House, which is affiliated with the Episcopal Church and is for the use of Samaritan Medical Center patients and their families.

The surgeon remove a walnut-sized tumor from a bone in her hip called the ilium, and then secured the bone with glue and screws. Three hours after she awakened, three male physical therapists in their twenties came to test her movement and to give her advice on how to move when she got home. As they helped her walk to the bathroom, she peed on herself (she blamed it on a nerve block), so it was a good thing she isn’t shy. In fact, Peggy is so not-shy that, after showing them the incisions on her hip, she shocked one of her therapists by baring her abdomen so he could see the scars from her February surgery: “Why are you showing me this?” he asked, and I explained that she was proud of her belly because the three big scars were put there by a grenade that exploded when the Vietcong overran the field hospital at which she was a nurse, and she had to protect her patients with an M60 machine gun (a more likely explanation was that she was loaded to the gills with morphine).

Peggy’s ability to walk increased so rapidly after getting home from surgery that she soon traded her walker for rubber-tipped trekking poles. By the next morning, she had abandoned those also and was moving about the house with the aid of walls, chairs, and tables. She is now two days out from surgery, and is exhausted, in pain, and limps badly.

The CA-19-9 blood test measures pancreatic cancer. A healthy person’s level is zero to 37. Before starting chemo last June, Peggy’s level hit 2,550. Thanks to chemo, the number dropped into the 600s, but rose to 1,100 in December when the chemo stopped working. After her spleen and lower pancreas were removed on February 13, it was hoped that her CA-19-9 level would drop again, but it instead hit 4,480 on February 23, and to 6,340 on March 23. This could mean that the tumor in her hip (which had been treated with radiation) is active again, and/or that the cancer from her pancreas has spread to an additional location. When she told Marc (her primary oncologist) that the pain in her hip had returned, he concluded that the former was true, and put her on a new chemo regimen. He also ordered a “minimal residual disease” test called the Signatara that can locate tumors by finding—and tracing the origin of—even a small number of malignant cells that appear in the bloodstream. She will have her next CA-19-9 test on Monday, April 6, with the results being available on Tuesday. We’re hoping that her March 23, Signatara results will also be available next week.

Marc was unaware that the excision of the tumor on her ilium was even possible, and because he was out of town, she couldn’t talk with him during the interval between me finding a doctor who could perform the surgery and her having the surgery done. Fortunately, Nick, her surgeon, was able to get Marc’s consent before Peggy and I left Nick’s building last month. Had Marc objected, Nick might have cancelled the surgery were he like her previous surgeon (the one who did last year’s bone biopsy and port installation, and this year’s pancreatectomy) who said he wouldn’t make a move without Marc’s consent. After all, a surgeon’s livelihood is partially dependent upon Marc’s referrals, and while patients come and go, relationships between oncologists and surgical oncologists can last for years.

When Peggy sees Marc on Tuesday, he will no doubt put her back on some form of chemotherapy because it is possible that those new spots on her lungs are malignant and/or that malignant cells have landed in other parts of her body. Only 3% of stage four pancreatic cancer patients are alive five years after diagnosis, but I don’t know how celebratory they feel. If Peggy believed that she could only prolong her existence by feeling as scared, grief-stricken, and altogether miserable as she has felt this past year, I don’t know what she would do. 

If I were to compare her reaction to pancreatic cancer to that of an imaginary average patient, I would say that she has done very well indeed. Perhaps her worst moment came upon receiving her diagnosis, but another bad moment came while she was in the hospital following her first surgery, and became so overwhelmed with fear and grief that she asked for a therapy dog. An hour later, she was crying into the fur of a miniature black pug named Wiley whose life is devoted to providing counsel to sick people, frightened airline passengers, and youthful criminals—he unwinds by running agility courses with Ina, his adopted mother. I don’t know what emotional cost dogs like Wiley pay, but he did his job so admirably that Peggy taped his photo to our bathroom mirror. We humans might have our place, but dogs and cats offer that which we are unable to get from one another.

Peggy often thanks me for all that I do for her, and I respond that my life would be meaningless without her trust and reliance. I’ve surely accompanied her to over 100 medical appointments during the past ten months. I missed one office visit because I had a medical appointment that day, and I missed five radiation appointments because she said that I wasn’t needed. I also attempted to beg out of taking her to the hospital for her latest surgery. My hope was that she would spend the previous night with Ilse—a friend who lives near the hospital and is like a sister to Peggy—and that Ilse would drive her to the hospital the next morning and comfort her until she was taken to the O.R. for the three hour surgery. I would then drive up from Eugene and arrive while Peggy was still in recovery. I hadn’t even finished proposing this before Peggy objected so strenuously that I didn’t say another word. We sometimes talk about the fact that, should she die, I will have no one to care for me as I am caring for her, nor will I have someone who trusts me to make medical decisions for her as she would make them for herself.

In caring for Peggy, I am observant and intuitive, but I’m also moody and tend toward depression. There are days when I’m gregarious, and there are days when it pains me to talk to anyone. For three months or more, I’ve also been having a problem with my left heel, which hurts so much at times that I limp (today, both of us are limping). At its worst, the pain is like that of stepping on a nail, and despite wearing two to four inserts at a time (the number depends upon which shoes I have on), the problem has gotten worse. I’m to see a podiatrist in three weeks. My foot pain is made all the more burdensome by the fact that Peggy has so little strength and energy. No matter, though, things are as they are, and they could be worse. I often tell myself that I won’t be able to bear it if even one more thing goes wrong, but then it does.