once more unto the breach

I arrived late this morning, around 9:15AM, but still managed to be there when Drs. Kerr and Leiphart stepped into the room. The upshot: the surgeons have to get clearance from Dr. Yoho, the infectious disease specialist managing Mom's current antibiotic treatment, but in all likelihood, Mom will be going in for a third surgery tomorrow, June 9.

"I don't want to go in and just do the same thing," said Dr. Leiphart, "and get the same result," i.e., surgery followed by yet more MRSA infection. His plan is to treat the infection as aggressively as possible, which will probably include scraping out the cavity in the brain where the main mass of the tumor had been removed. This will, in turn, mean cutting out "a couple millimeters of tissue," according to the doc. He will do his best to preserve Mom's "executive functions," but when I asked him how Mom will turn out-- cognitively and in terms of motor coordination-- his answer was a frank, "I don't know."

The surgeons are also going to speak with Dr. Yoho about the feasibility of feeding a catheter into the brain cavity so as to drip the antibiotic solution directly onto the infected tissue. I imagine we'll know more after this discussion occurs.

Dad has a long list of to-dos today, including a rather urgent dental appointment, as he lost a tooth last night. He'll be by the hospital much later today. He's managed to get in contact with MD Anderson, but is displeased that NCI hasn't gotten back to him yet.

Mom is lying so quietly on her bed in the hospital, fast asleep. She has no idea what's ahead of her. And I'm glad.

UPDATE: Mom ate nearly all of her lunch today, and even tried to vocalize a few times. One utterance was a distinct English "no" when I tried to feed her some smashed [sic] potatoes; another was a distinct Korean "aigo" (an interjection that can mean anything from "whoops" to "oh, my!" to "woe is me!") as she was fussing with her own clothing.

Mom was also able to shake her head no, something she hadn't done yesterday, despite being able to nod yes. Today, both "no" and "yes" were in evidence as gestures made with her head.

Just got news from Dad (who's been both at home and driving around on various errands) that some anesthesiologist called him, and it sounds as if surgery is a definite go for tomorrow. Like my brother Sean, who has expressed a great deal of frustration over how Mom's treatment has been turning out, I'm anxious about the prospect of more brain tissue being removed. Part of me feels that any surgeon's first instinct will be to cut out the problem, and I wonder whether tomorrow's surgery is really necessary. Why not catheterize the cranium and flush the site with antibiotics directly, then wait and see?

Dad's been trying to get in touch with both NCI and MD Anderson about Mom's treatment. Before Mom gets tomorrow's surgery, it would be nice to have a second opinion. The problem, though, is that the surgeons at Fairfax consider the infection problem to be urgent enough to warrant this very sudden surgery. The problem for us, as a result, is that we've barely had time to process the news that Mom will be undergoing a third operation, and further, that we'll have no time to ask anyone from a different health care facility to look at Mom and offer another opinion.

I hate this goddamn tumor. From the beginning, the tumor's aggressiveness has left us no time to consider options and organize treatment in other than a hasty, ad hoc manner. The infection is to blame as well, of course, but it's an unforeseen consequence of the initial surgery. The tumor is the primary culprit. Sean's frustrated question to me was something like, "Are they just incompetent, or is it really this hard to treat Mom?" I don't know; I'm not a medical professional. Mom has many nodules in her forearm veins, making it hard to give her a regular IV. Her lungs have always been susceptible to things like bronchitis and pneumonia (she may have pneumonia now, in fact, according to her recent chest X-ray). Her tumor is of the worst possible type. It turns out that she's among the 4% of people who get this sort of post-operative MRSA infection. How much bad luck can one woman have?

"Nothing they've tried has worked," Sean said, highlighting the competence issue. Mom's debulking surgery led to the infection. The radiotherapy and chemotherapy had to be stopped because of the infection. The second surgery obviously didn't get rid of all the infection. The post-surgical vancomycin regimen resulted in a serious, body-wide rash. The attempts to put an IV in Mom's forearm led to a series of-- as it turned out-- unnecessary needlesticks. The current daptomycin regimen apparently isn't working fast enough to combat the infection in Mom's brain. As you, Dear Reader, can imagine, this sort of track record doesn't make us hopeful that tomorrow's surgery will accomplish much of anything. There isn't even a guarantee about Mom's cognitive and physical states after the operation. So I understand what Sean is feeling, and although I'm inclined to believe the docs are doing the best they can, part of me wishes they could do even better. Much better.

In comparing this negative post to yesterday's somewhat more positive one, I think the reader should be aware that, from here on in, it's going to be an emotional roller coaster for everybody. There will be bright spots, of course; we can always hope that the tumor can be stopped in its tracks for a few years and that Mom can regain some of her original self over time. That would be the best outcome. But the bright spots will be far outnumbered by the difficulties that lie ahead. That's not pessimism talking; it's realism. If wishful thinking helps you, fine. It's not my way. I've never counted myself among the relentlessly optimistic; I find such a worldview to be a recipe for insanity. Hope has its place, but it's bounded by the dictates of biology and physics. False hope is the leprous offspring of one's refusal to acknowledge what's actually happening. So I'll keep hope, but won't give in to false hope.


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