20.9.07
My mother-in-Law has cancer - almost certainly brought about from years of smoking up to 60 or so cigarettes a day. She is only 68 and isn't likely to make it to 69.
This is going to be a diary of the events in my life in connection with her demise. It'll be sad - tinged only with the thought that her life hasn't been one of excitement and fulfillment - and that her end is going to rather typical of her general approach to life. I'll probably expand on that comment later.

Written up on 21.9.07
History
To save her embarrassment I’m going to call her N. For many years we’ve called her PIA (Pain In the Arse) because she’s has been nothing but a burden to all and sundry. Of late she’s become PIC instead – Pain In the Chest. Somehow more appropriate! And even more of a PIA now as well.

For many years now, N has been gathering more and more weight around her already ample middle. A steady diet of cakes, sandwiches, sweets, coke, tea (with 6 sugars!!! – yuk!!!) and excessive platefuls of food, coupled with minimal exercise had caused her weight to balloon from perhaps 11 stone about 15 years ago to something exceeding 18 stone some five years ago. Being only 5’2” tall, she was as round as she was tall and had moved from size 14 to size 24. Oh yes – I forgot to mention the cigarettes – a minimum of 60 a day – chain-smoked as she leaned over the kitchen sink. She smoked more or less anything but she always tore the filters off and then smoked the rest down to a tiny stub. So, as they say – our general family feeling is ‘sympathy where sympathy due’ – one doesn’t have much sympathy for self-inflicted wounds.

Excesses of these kinds cannot go unpunished and gradually her abused system started to complain. Her heart has struggled the most and she now takes Aspirin to ward off strokes (she’s had a minor one) and something to help strengthen her heart – which is now also somewhat irregular. She’s got high blood pressure; raised cholesterol levels and has, in the past three years, become diabetic. Hardly surprisingly she suffers from anxiety and takes yet more tablets for that. Speaking of tablets – she takes sleeping tablets each night and pain-killers at random. She is also incontinent – to add to the entertainment.

The smoking has also led to her having emphysema and it was the increasing symptoms of this and her stroke that caused her to give up smoking. At least she did that – overnight – from 60 to 0. But something like twenty years too late.

Early this year we became aware that something was more seriously wrong. Almost suddenly she showed signs of apathy; became more lethargic and began to lose interest in food. The flesh of her face seemed to droop and she appeared to age before our eyes.

Eventually, sometime after Easter, we arranged for her to see her doctor for an MOT – and what he found was not encouraging. She was told that she had a hernia – a lump just below her rib cage. We, privately, were told that it was almost certainly cancer. It came as no real surprise to us - it was merely confirmation of what we’d already guessed.

Coming Up To Date
N was eventually taken in to Musgrove to be examined by a consultant. Although his examination was thorough, his reply was curt – it was too risky to operate. A bronchioscopy was arranged and performed (a mini camera was pushed down into her lungs) but we didn’t hear the results. N returned home and we just got on with life.

N in the meanwhile continued to be generally lethargic and had gone off her food – almost unheard-of. She was now also very chesty – wheezing and coughing almost continually. However, nothing more was done by any medical people – perhaps they realised that very little could be done.

On 6th September this year, she attended her diabetic clinic as usual. Not being there, we don’t know exactly what happened but it seems that the nurse realised that things were far from well and had N taken into hospital.

At this point the system let everyone down badly.

Some two hours after her appointment, her husband rang us and said “I’m worried about N – she hasn’t come home yet”. So we rang the surgery and heard that she’d been admitted to the hospital. Worse that that - the surgery had called in the Community Transport people and N had to pay them to take her in.

If I said that we were all angry, it would be an understatement. We were seething – what a way to treat two old pensioners – N having to pay and her husband not being informed. Owing to the pressure of the events that have followed, this matter hasn’t been pursued – but it will be.

N entered hospital with suspected pneumonia but it soon became clear that there were many other things wrong. She was actually running a temperature from some infection or other but an MRI scan and then x-rays soon made things clear. Soon we were told that she definitely did have cancer but until the results of the biopsy test were returned, they didn’t know if it was benign or malignant.

So her lump (which was mainly hidden by her huge stomach and her rib cage) now had a name.

19.9.07
The results were all back and the family was called in to meet the doctor and to be told the news. The oncologist was a really lovely person – who did her best to impart the news clearly and gently – and who made sure that we all understood the situation.

N has a large malignant tumour on her left lung which has also invaded the lymph nodes on her left side. It is inoperable. Her raised temperature is really caused by the cancer, as is her cough, her lethargy and her lack of interest in food. The cause – unequivocally smoking said the oncologist.

It has now been arranged for N to travel to Bristol for two doses of radiotherapy which will, hopefully, reduce the size of the tumour and relieve some of the pain and chestiness. But that is it – nothing else can be done for her. The prognosis – a matter of months and certainly not years. But cancer is a funny thing and should it suddenly spread, it could all be over in just a few weeks - or it could just fade away.

So N is going home where she can stay until things become worse. At this point in time we don’t really know what will be done to help her at home although it’s pretty apparent that there’s a veritable army of carers of one kind or another ready to help. We’ll find out more as it happens.

21.9.07
N is going home on Monday – or so we’re told. Marlene, from the Social Work Department at MPH has just phoned to confirm that home visits are being organised to help clean, change and generally assist N – twice daily to start and then to be adjusted as required. She’s pointed me to a website - http://www.dh.gov.uk/en/Consultations which relates to continuing healthcare. I’ve yet to investigate it and since we’re now to meet Marlene on the ward in an hours time I’ll probably learn just as much from her.

21.9.07 (later on)

Typically, having arrived at N’s bedside, the Doctor suddenly arrived – and five minutes later Marlene arrived too. Not five minutes after that, N’s son and girlfriend (partner) arrived so we now had seven of us gathered around her. More attention in extremis than in life…….

The Doctor explained the up-to-date picture. N has had an infection for some time which they believed to be pneumonia. They saw off the pneumonia bugs but the infection has returned and they now can confirm that the cancer is the cause. Nevertheless, continued antibiotics will keep the infection from becoming worse.

At present they can’t be sure how far the cancer has spread but they now intend to do a Bone Scan on Thursday. What a wonderful experience – an injection – a three hour wait (which in N’s case will mean three hours lying or sitting around) - followed by a 30 minute scan.

But in the meanwhile she’s to be allowed home on Monday, subject to the Doctor’s approval on Monday morning.

24.9.07 (Monday morning)

We visited her yesterday and for some reason she was feeling really quite bright and healthy. I guess that’s down to two things – the infection is under control and she’s lost a lot of weight. I don’t know what she weights now but she’s really become quite skinny by her standards. Unfortunately she has a really obese stomach but without that great lump of excess fat I’d guess that she’s down to about a size 14.

It’s quite an incredible change that’s causing my wife to curse fluently because N’s husband is the last person in the world to be able to find and buy suitable clothing for her. So guess what – my wife will have to dash around to find some clothes that’ll fit her new slim-line body. It’ll also mean that all her old clothes (and there are simply PILES and PILES of them – cupboards full) will need to be removed and taken off for recycling. More work for my wife and I.

Getting away, briefly, from N – what about her husband (whom I’ll call M) – how is he taking it? I’ve a feeling that he’s somewhat shell-shocked. Deep down he knows that her days are numbered but he doesn’t really want to admit it. We asked him directly – ‘did he know that mum was dying?’ Oh yes, he knows – but then he goes off the subject and finds something else to talk about.

My wife (his daughter, obviously) took him aside today and got him to admit all he knew. M sort of blurted out that all he knew was that N had cancer somewhere and was dying – and then he burst into tears. My wife left him to it and gradually he calmed down. Apparently he’d cried himself to sleep the other night and had cried to himself several times – so the old boy DOES have some feelings then. He doesn’t want to talk or think about her dying – he simply doesn’t want to face the truth – perhaps I don’t blame him. But then he’s always tried to dodge the truth……..

24.9.07 (evening)

The hospital phoned to say that she had been cleared for ‘release’ and that they’d be bringing her home around 3ish. Speaking of the phone – what a lot of phoning I’ve had to do. M isn’t much good on the phone (no – admit it – he’s useless!) and N can only just about use one. “It’s all these little buttons….” So I carry the title of official communicator – or something. Oh yes – forgot to mention – N’s bone scan – they want her in hospital by 9 am. Talk about a bloody awkward time of the day – and why couldn’t they just keep her in for a few more days?

Calls today:
The hospital (two departments) - to make sure that they were providing transport.
M – to tell him what’s been arranged.
The incontinence pad service - to order some more pads.
The hospital - to make sure that her prescription would be the same – that it could still be collected from the local chemist.
M – to bring him up to date.
Community transport (twice) – to get her into hospital on Thursday.
The hospital again – to organise getting her home again after her scan.
M – to tell him the hospital phoned to say she definitely was coming home.

It’s just as well I’ve retired from work (injured back) or we’d never get everything done.

25.9.07

N is safely back home. When she arrived by ambulance, it was raining. My wife was there to meet her and expected M to go out to the ambulance with a coat for her or an umbrella. No – he just stood at the door and waited – my wife had to help out. Typical of his lack of feelings.

Her first action – get her purse and count her money – three weeks pension plus her ‘big money’; her disability allowance. Then she wanted to know what was on telly – then she climbed into bed and settled down to watch and doze. Hardly a word of thanks or of affection. Sometimes I wonder why we bother….. A Home Carer was due to visit in the evening – to be followed by two visits each day to help her wash, clean and dress or undress. At present their visits are going to be something of a case of overkill but once N starts to feel any worse, they’ll be a godsend.

Hopefully now things will calm down and we’ll be able to get on with our own lives for a couple of days. M has been persuaded to go with N for her scan on Thursday – he’ll have to do without a fag from about 8.30 am until perhaps 1.30 pm!! We haven’t yet persuaded him to go with N to Bristol. “I’m not going to sit around in another hospital” he said. What he really means is that he won’t be able to smoke; he’s scared of getting lost (he can’t read very well); he won’t be able to have his regular cuppas; he’ll be bored and he’ll miss all his TV programs. A very selfish old fart.

28.9.07

A fair bit of chat but not a lot of news to add. N has now been home for a few days and we’ve popped round to see her a couple of times.

I presume that her current rather comatose condition is to do with her cancer and not just her general attitude of laziness. When we saw her last night she looked drawn and tired. She’d lost what little brightness she used to have and her trip to MPH (more on that later) must have worn her out.

Basically, at home she now gets up around 10 when the home care lady arrives – stays sitting up while she has some breakfast (just a single Weetabix with milk and sugar) – and then she retires back to bed. Her day is now something like 75% of her waking hours in bed (where she often seems to sink into a light sleep anyway) and the remaining 25% of her time is spent on the loo, having a small drink or nibbling lightly at her food.

One of the numerous side-effects of cancer is a lack of appetite apparently and this is one of the most noticeable things about her condition. Not all that many months ago she would eat pretty well everything that was placed anywhere within reach – even down to someone else’s last Rolo!! Now food has lost its appeal.

Last night when we called round she said to me that she was hungry. I asked if she’s like me to get her some fish and chips (it used to be a Wednesday evening routine) – knowing well that that used to be one of her favourite meals. She decided that would be good so I nipped out and soon returned with dinner for the four of us – N, her husband, my wife and I.

N’s plateful looked huge – a tasty chunk of battered cod and a half portion of chips. Huge – but a smallish plateful compared with what she used to scoff. Once she’d have a cod and a whole portion of chips - and curry sauce, probably followed by a large chunk of cake and a cup of tea with six sugars! Just for starters!!!

Last night she picked apathetically at her meal for a while. She dug out a few small bits of cod and ate a chip or two but then lay back and said that she didn’t want any more. “I’m not hungry” was all she said. We all looked at each other but apart from forcing her to eat, there wasn’t a lot we could do.

Eating is one thing that is important for a cancer patient if that patient wants to improve his or her survival chances – as is a positive attitude. I’m sorry to say that N is currently scoring about 1 out of 10 on each of those essentials – I don’t rate her chances of surviving beyond the doctors’ eventual deadline very highly.

Yesterday she went to MPH for a bone scan. “Bloody boring” she said, with feeling. They had to be up at 6.30 am to get ready to be in hospital for a 9 am jab – with the scan to follow three hours later. But all went according to plan. The Community Transport car picked them up at 8.15 – and eventually returned them at 1.30. Grumble, grumble from the old man. “Had to pay 75p each for two doughnuts”. He took his own flask of tea with him though – wasn’t going to pay for a cuppa as well!!!

Community Transport
Just briefly a quick word or two of thanks. What an excellent service – a door to door car or mini-bus whenever N has to go to her doctor, chiropodist or hospital – for around £2.50 a trip. They are very helpful and accommodating and have taken a load off my back. I’d have had to cart her around otherwise and with my damaged back I would find it hard to help her should she get stuck in her seat or somehow end up on the floor.

Today they have headed off to Bristol for her radiotherapy – and yes – he agreed to go with her again. Mind you, we had to pretty well threaten him before he agreed – or perhaps he does love her deep down inside! It was another early start and the ambulance transport collected them at about 8.45 am. They won’t be back until mid-afternoon – so more updating tomorrow.

That’s another great bit of organising – West Country Transport system for patients. They phoned me several days ago to confirm the travel arrangements and to ask how she would best travel. Their contact was only too pleased to answer any questions and to explain how things all worked. Very useful and helpful – it’s nice to have things organised – because it’s usually me who has to do all the planning and phoning.