Tuesday, April 21, 2009

stable

[NB: See the bottom of this post for more updates.]

As of 5:50PM today (Tuesday, April 21), Mom is still in surgery and has been deemed "stable." Surgery began at 3PM; we're told that it might take 5 or 6 hours. When the surgery is complete, the docs will come and talk with us about their preliminary findings and probable treatment paths.

Mom will remain in recovery for a bit after surgery; she will then be moved to the Neuroscience ICU. For at least 24 hours, she'll be sedated and intubated; a respirator will help scour carbon dioxide from her brain. There's no fixed schedule for her extubation, but we know that she'll be in hospital for at least a few more days after surgery.

So much depends on what the surgeons find inside Mom's head. We were told that there were three possibilities; two of those possibilities involve tumors, and the third is infection: the mass might actually be an abscess. We were told that this third possibility is unlikely, however; if the mass were an infection, Mom would be sicker. The aggressive nature of the growth makes it highly probable that Mom will need further treatment. As we had been told last week, surgery was "just the beginning" of treatment.

Our church's associate pastor, Jeri Fields, was here with us again, along with Mrs. Higdon, a family friend (and fellow congregant) who very kindly brought us lunch. One of Mom's Korean friends, Mrs. Lindow, is a GI nurse who works at Fairfax Hospital, and she has taken the time to visit with us after her shifts, even asking after Mom and updating us on her condition.

Rewind to this morning. Dad and I woke up around 5-ish, prepped and got to the hospital around 6:40AM. I dropped Dad at the main entrance, and he tracked down one of the neurosurgeons, whom we were supposed to meet at 7AM. It's a good thing we got there early, or we'd have missed the surgeon altogether. The conversation didn't reveal anything new; Dad was told that the docs would be back before the pre-op phase to give us the lowdown on what would be happening.

Dad and I waited with Mom, who was surprised to see us in the ward so early. As always, there was a lot of hand-holding and talking and foot-massaging. My brothers David and Sean came by, fighting rush-hour traffic. We sat while Mom had routine tests done; today, she wasn't allowed to eat anything, so she was reduced to drinking a bit of water with her pills. She took care of personal hygiene as best she could, sneaking off to wash herself while I napped at her bedside (I must have slept pretty soundly to have missed all that racket), and later brushing her teeth when all of us were present. We got Mom to sign consent forms and the advance directive (a form that uses polite language to address ghoulish matters, like organ donation in the event of death, acceptance/rejection of heroic measures to save oneself, etc.). A group of docs finally came by to talk about the upcoming surgery. After all that, we were told to sit tight until Mom was taken down to the pre-op room. Pastor Jeri, meanwhile, prayed with us and presented Mom with a prayer shawl that was a gift from the congregation.

When the time came (a bit after noon), we followed Mom down to the pre-op area; she was placed in the "isolation" booth because of her MRSA. As before, we held her hands and hugged her and massaged her feet, talking all the while. Mom's mental state may have been a blessing in disguise; I'm not sure how I'd have felt in her place, acutely aware that I was about to undergo brain surgery.

We met the surgeons who would be working on Mom; they reviewed the game plan with us, outlining the risks, the hoped-for results, and answering what questions we could think of. A capable prep team set Mom up with IV drips, and once again, we had little to do but wait for the signal that it was time for Mom to go.

Soon enough, we were told that Mom had to head on over to surgery-- time for us to say our goodbyes and hope against hope that these surgeons were as good as everyone said they were. We took turns saying goodbye to Mom, none of us knowing whether this would be the final goodbye. I whispered "I love you" in her ear, and stepped back to look deeply into her eyes. She looked at me, a smile of gentle reassurance on her face, and for the first time since last Thursday, I finally allowed myself to cry. I saw that poor Sean was in the same boat.

We left the pre-op area with Pastor Jeri, and made our way to the spacious waiting area. There, we met our aforementioned family friend, Mrs. Higdon, plus two more of Mom's Korean women's society friends-- Mrs. Kopf and Mrs. Rappaport. At that moment, I would have preferred to sit alone, but ultimately, it was something of a relief to have people to talk with. I would have been a blubbering mess otherwise.

Around 5:50PM, after hearing that Mom was stable, we made the command decision to go eat. Mom's two lady friends had already left; Pastor Jeri and Mrs. Higdon remained with us until we got up to go to dinner; Mrs. Lindow also took her leave at that time. As Dad said, we've got quite a support group pulling for Mom.

Mom's elder sister and younger brother are flying over from Texas; my aunt arrives tomorrow (Wednesday) afternoon; Dad will pick her up from National Airport. Uncle John will arrive Thursday and stay until Saturday. Tonight, we'll be prepping the house for them, and I'm sure Mom will be happy to see them (thanks, Matthew and Jihae, for your kind expressions of support).


UPDATE: Mom's surgery ended around 8PM. A preliminary diagnosis, based on a quick examination of the mass removed from Mom's brain, is that we're dealing with a possibly malignant glioma-- in this case, a primary (i.e., not metastatic) tumor originating in Mom's brain. The surgeon said that gliomas tend not to have clear boundaries; at this point, the good news is that everything that was visible in the MRI has been removed, but this doesn't mean that absolutely every part of the tumor is gone.

Happily, Mom has already been extubated and is awake and responsive. The docs asked whether she was in pain, and she shook her head no. We're hanging around the hospital, waiting for Mom to be transferred to the Neuroscience ICU. Once she's there, we'll be able to see her and talk with her.

For the moment, then, we can breathe a sigh of relief. Mom needs time to heal before other therapies can be implemented (e.g., chemotherapy, radiation therapy, etc.), and the road to recovery doesn't promise to be easy. For the moment, though, it seems the worst is over.

UPDATE 2: It's 8:37 the following morning. We got to see Mom last night, sometime around 10 or 10:30PM. She spent most of her time lying in bed with her eyes closed. While she was completely uncommunicative, verbally speaking, she did open her eyes twice and stretched her left arm out twice as well. The first time, she appeared to be looking straight at me and reaching toward me, but I'm not sure this is the case, given that the second time she performed the gesture (which I saw after having switched position to the other side of the bed), it looked more as though she were simply stretching her arm. The same arm occasionally made slight movements while it rested on her body; the nurses said this was possibly a sign of discomfort with or agitation at the ambient auditory stimuli.

Mom's breathing was a bit labored and her vital signs were elevated: higher blood pressure and more rapid pulse than usual, but we were assured that she was stable and that "her labs were excellent," whatever that means.

8:45AM: Dad tells me that Mom's morning CAT scan came back "fine," though the nurses with whom Dad spoke a few minutes ago had no details on what "fine" might mean; I assume the docs will provide us with a detailed reading. Mom's also been moved from PACU (post-anesthetic care unit) to the ICU; she's in the same bed she was in when she first arrived at Fairfax Hospital: Number 10.

I'm breathing a bit more easily this morning. Yesterday was a stressful day, and though it ended well, we were all physically and emotionally exhausted. Today, we'll visit Mom in the late morning or early afternoon (they've got docs working on her right now), and Dad will pick up my aunt (Mom's elder sister) from the airport. Tomorrow, we'll collect Uncle John (Mom's younger brother). In the meantime, we'll play things by ear. We've got a week until we get detailed results from the pathology lab, and Mom will use that week to keep on healing. The docs had told us that starting her on some other form of therapy right away (such chemo or radiation) wasn't advisable, given her need to heal first.

Oh, yeah-- Dad thought that I should save the head-shaving for a barber instead of taking the do-it-yourself approach. So I haven't shaved my head yet. I really should; I look like a fat Bruce Lee.

UPDATE 3: Mom's glioma is also called an astrocytoma. The aggressiveness of such tumors is graded on a scale of 1 to 4, with 4 being most aggressive. We've been told that Mom's tumor is probably in the upper end of the spectrum, the implication being that it's a 3 or a 4. You can read about such tumors and the treatment options for them here. According to that online reference, Mom's operation, which removed all of the mass that was visible in the scans, is called "debulking." The rest of the tumor will be kicked into submission through other therapies (radiotherapy or chemotherapy), but the article notes that high-grade astrocytomas are difficult to treat successfully. In other words, we're not out of the woods yet.


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6 comments:

Nomad said...

Kevin,

Again, thanks for the updates. I'm glad to hear that the surgery went well and we'll continue to hold all of you in our prayers, and hope for a speedy recovery.

John McCrarey said...

Ditto on what Nomad said. I hope you find comfort in the strangers pulling for you and your family out here in the internets.

Stay strong, Kevin! That is the most important thing you can do for your mother right now...

Horace Jeffery Hodges said...

Same from me, Kevin, as what Nomad and John wrote.

I'll try to check in more often.

Jeffery Hodges

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Polymath said...

Best wishes and prayers for your mother's recovery.

Kevin said...

Thank you all, very much.


Kevin

Alan C said...

Finally, a small, but concrete way that I can be of help to you and your family at this time: advice on shaving one's head. CAD (cranial autodepilation) is not all that difficult. Here's the recommended method.

First, remove as much hair as you can with scissors or electric hair clippers. When you reach the point of diminishing returns with that method, switch to a safety razor. Lather up your head just as if you were shaving your face. You can count on going through several blades: you might want to buy a pack of inexpensive disposable razors, and count on using 3-4 of them.

When your head seems pretty bare, jump in the shower. Go through the motions that you would go through to wash your hair, if you had any. You'll discover bristly patches marring the apparently bowling-ball-like smoothness of your dome. When you get out of the shower, shave those patches again.

Best wishes and stay strong.