Saturday, September 02, 2006

Comforting Vicki

Vicki's gastroenterlogists consulted with us over the phone several times yesterday (Friday, 1 September), after reviewing her test results from Georgetown. They believe that conducting an endoscopic retrograde cholangiopancreatogram (ERCP) would not help Vicki. The ERCP potentially could have allowed the doctor to insert a small plastic tube (stent) through the endoscope and into a blocked bile duct to open a passgage. However, the doctor's believe the real problem lies deeper in her liver, in the thousands of small tree branches of her bile ducts that the tumor has invaded.

We could continue to push for more procedures and I am sure Vicki's doctors would do the best they could to improve her condition, but the ultimate outcome would not change. One of Vicki's options includes using a stent to drain her bile ducts from inside her liver, through her abdomen, and into an external bag. However, as I noted earlier, the real problem lies in the many smaller bile ducts that we cannot drain. So we are now shifting our focus to comforting Vicki, and preparing for her imminent death.

Overall Vicki continues to fight for life the very best she can under the circumstances. She eats well. She suffers from significant fatigue which cleary affects every aspect of her life, and chains her to her bed most of the day. However, she perks up a just bit when a close friend drops by for a visit. In addition, she continues to struggle with what I believe to be only a mild case of hepatic encephalopathy which we are treating with several daily doses of lactulose. Some of her friends have signed up for rotating night-shift duty and stayed in the room with Vicki, sleeping on a mattress by the side of her bed. In this way friends provide round-the-clock assistance should Vicki require any help during the night. Those of us working throughout the day also have the opportunity for some needed rest.

Thursday, August 31, 2006

Update on Vicki

Dr. Marshall from the Lombardi Cancer Center at Georgetown called today with Vicki's test results. The blood tests were more consistent with a blocked bile duct than liver failure. However, the sonogram showed no clear evidence of an obstruction in the common bile duct. Rather, the test showed a partial blockage further up the biliary tract which has been evident in previous CT scans. Unfortunately, the net result of these inconclusive tests yields no obvious choice. We believe the best course for Vicki will be to place stents into the bile ducts in an attempt to improved the drainage and alleviate some of her symptoms of disorientation. By tomorrow we hope to complete the arrangements for conducting this procedure at either Fairfax or Georgetown University Hospital, depending on the doctor's recommendations.

The combination of the reduced liver function, cancer, and radiation treatments has dealt Vicki such a tremendous blow that she can now barely function on her own. On Tuesday night we began round-the-clock observation in our home, with close friends staying in her room at night to be sure she has ready help. She can only communicate with short words or phrases. She rarely has the strength to open her eyes and when she does she cannot hold them open for very long. When I look at Vicki I wonder how long she can survive in this condition. We try to make her as comfortable as we can.

With the help of some close friends and Vicki's parents, we have begun to make a variety of arrangements. This morning we met with a representative from Capital Hospice. After the doctors perform this next procedure (or if they perform it) we will begin Hospice care for Vicki and our family. Our close friend Jim has helped us contact a local funeral home (Adams-Green) and cemetery (Chestnut Grove), which is only 100 yards from our house. This afternoon Jim, Olin (Vicki's father), and I walked through the cemetery to review the various options. We also discussed Vicki's funeral and began preparing. I suppose I always knew I would have to deal with these issues, but I had not given them any thought over the past three years. I spent my energy and time on finding the best treatment. Even now I am grateful for the friends who carry me because I find all of these so difficult to think about.

I spoke to both Kelly and Lauren very directly over the past two days. I believe they understand but they also process grief differently. I think we adults know what to expect and anticipate the grief so we feel much more pain before a tragic event. I am not sure if children realize what might arise when a parent dies. So they may not feel the full force of the blow until Vicki actually dies or even some time later - when the sense of loss manifests itself in their lives. Kelly just came into the office while I wrote this note to say goodnight and give me a hug. She said "dad, you're doing a great job with all of this, I love you." That's a great way to end a very difficult, emotional day.

Tuesday, August 29, 2006

A Very Challening Night, Call for Help

Vicki and I experienced a very difficult night last night. However, for the first time in 24 hours she now appears to be sleeping comfortably. I urgently need help - please read through to the end.

Vicki is suffering from a condition called hepatic encephalopathy which affects people with decreased liver function due to cirrhosis of the liver. She began showing noticeable symptoms of this condition last week and has since wavered between various degrees of confusion and disorientation.

Last night the condition grew progressively more severe. She remained awake nearly the entire night, moving from one floor of the house to the other, engaging in a variety of unusual behaviors. Throughout the night I followed her around the house to be sure she did not hurt herself or do anything that might endanger the house and/or family. As a result, I have also had little sleep in the past two days. And, I certainly cannot leave the house without Vicki remaining under the constant supervision of an adult.

Vicki spends a great deal of her time in bed, usually sitting up to take pressure off of her abdomen. At times she is reponsive and alert and at other times she appears to be asleep or semi-conscious. She labors hard to breathe, which I suspect is a result of the fluid building up in her abdomen and pressuring the other internal organs such as her lungs. The cancer has also spread to her lungs so she may be experiencing some additional difficulty as a result.

I do not really know how much longer Vicki will live. I don't know if she can recover a bit from this latest series of complications. But, when I look at her and see how she is suffering I find it hard to imagine that she can survive for much longer. We will discuss all of these issues with Dr. Marshall when we meet with him later today.

Many of our friends and neighbors have helped us in a variety of ways for the past three years. I thank you on behalf of our whole family for all of the help and support. Now, during this very difficult period I ask for even more help. I am in urgent need people who can come to the house to help me. I need help watching over Vicki. I need help getting the girls ready for the start of school. I need help preparing for the end of Vicki's life.