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I thought it would be helpful to write down some details of how all these recent events came together. Some of you will have seen some of these details before but much of it will be new.

Mom always had heartburn and I do remember her having a lot of antacids when I was younger. It’s something she never made a big deal of and I had honestly forgotten about it until just recently. Hearburn by itself is annoying but in serious cases when left untreated can lead to a condition known as Barret’s esophagus. While the stomach lining is capable of handling the low pH associated with gastric contents, the esophagus is very sensitive to them. In this condition the epithelium of the esophagus becomes damaged and some of the underlying cells start to grow in abnormal ways. This is where lower esophageal cancer begins. Now not many people actually know about this and I’m sure until very recently mom didn’t either. She probably just dismissed it as an annoying problem that wasn’t anything to worry about.

Around January or February this year I was speaking to her over the phone and she was telling me about some stomach pain she had. I had recently recovered from an episode of gastritis and what she described sounded quite similar to what I had. I told her it was important to see a doctor and she was started in a proton pump inhibitor which raises the pH of the gastric contents and reduces the irritation. It sounded like it was helping for a bit. She said she wasn’t able to eat some of her meals and was replacing them with Ensure, which is what is used for some patients who can’t have solid food.

I think over the next 7 months things got progressively worse, since by the time she called me on October 3rd she wasn’t eating any solid food at all. It turns out the problem was that it was too painful to swallow, since the tumor that was developing right by the junction of her esophagus and stomach was getting large. I don’t know when her doctor started to think it might be esopageal cancer, but he did have her go for a barium swallow and an endoscopy near the end of September. These two techniques clearly indicated the presence of the tumor and he told her on Oct 3rd. A biopsy was done and she was to have the result the following week. The doctor ordered a CT scan as well, which helps indicate the size of the tumor and if it had spread.

Until about 2 weeks before this, she was living life as usual – working at her job (which is quite physically demanding), spending time with her guy friend and taking care of her place and her dog. She decided to take sick leave to spend some time recovering, likely because she had noticed how much weight she lost and because she started to have more pain. She didn’t tell me about any of this until she had her official diagnosis from the doctor. She called me after work and said in a straightforward voice “well I have the big C” and my immediate reaction was to ask if it could be removed. For certain types of cancer, surgical removal and therapy is often quite successful so at first I had hoped something like this was possible. However she laid it all out to me just as her doctor had for her and I realised that the treatment wasn’t pleasant and that she likely had less than a year.

If the CT scan was good, the next step would be to remove her esophagus and the tumor and rebuild it with a part of her stomach. The more you think about this, the more you realise just how invasive this kind of surgery really is. There are a lot of complications associated with it and I don’t think it would have been pleasant for her at all. The problem was that she had lost so much weight (over 30 pounds) that she wasn’t even in good enough shape for the surgery. In order to help her gain some weight, the doctor had her come in for a feeding tube to be installed on Thursday. This is a routine procedure to help someone who can’t eat on their own and has very few complications. Nevertheless, mom seemed quite worried about it and I told her it was nothing to worry about.

During our phone conversations Tuesday and Wednesday night she asked me questions about how the plans for the baby were and if we had picked any names yet. I told her we were going to find out the gender in November and she said that she really wanted to be around for that. I was still trying to be hopeful and thought she would be around for April and could actually see her grandchild. I was really upset about all this and spent most of Tuesday night and Wednesday morning crying. I decided to go to work since I needed to be distracted from the thoughts I was going through.

Since I found out I was pregnant I had been thinking a lot about my childhood and all the things mom did for me as a child. She really loved me and did everything she could for me. She wanted to keep working but gave it up to take better care of me. She spent over 10 years at home cooking, helping me with projects, teaching me things (I really remember “helping” her make cookies at Christmas and pizza) and encouraging me. Of course we had tough times and being such a practical woman, we often didn’t share our close feelings with each other. Her life was far from tragic but it certainly had it’s elements of loss and hardship in it, including the death of her brother and father when she was very young and her mother having to give up the family farm.

So thinking about all these things made me feel particuarly upset since out of all the times you want your mother to be around in your life, it is when you are having your first child. I kept saying to my co-workers that I would have to have a “help hotline” where I could call her and ask how she did things with me. When she told me her diagnosis I was particularly upset since I knew this would never happen and was really worried she would never experience the joy of having a grandchild. After years of warning me not to have children when I was too young, we both knew that it was about time something got started. Thankfully I let her in on the secret before anyone else and I even told her when we were making our plans to start trying. I’m really glad I did that.

So on Thursday Oct 5th she went to the hopsital for the placement of her feeding tube. She called me Thursday night from home and said she was really tired but ok. She thought she would be fine staying at home by herself but fortunately my aunt had the good sense to come over and bring her to her house. My mom stayed there until Monday morning. She was supposed to have an appointment the following day to actually learn how to use the tube and start the feeding with it, but was too tired. The appointment was rescheduled for Tuesday after the thanksgiving weekend. It must have been annoying to have this thing in place and not even be using it all that time. I spoke with her on the phone at work Friday and she sounded quite bad and her smoker’s cough sounded about a hundred times worse than normal. I spoke to her again Saturday and briefly on Sunday. She started on some painkillers Friday since the tube seemed to be irritating her stomach and she sounded quite a bit better on the weekend, but very tired and, for the first time, a bit scared. We discussed plans for me to come visit her before November and I told her I could come anytime and had a week of vacation left. She wanted to wait until her results on Tuesday and then we could decide. On thanksgiving Monday my aunt emailed me and said she had to take mom to the hospital and that she would be staying there. In retrospect I realise how serious the symptoms she described to me were, but at the time neither of us thought it would be as serious as it was. Mom was very dehydrated and the nurses had a hard time putting in an IV and she had thrown up some of the contents of her lower digestive tract, which is clearly an indication of a serious problem. At this point I was thinking it would be good to come on Wednesday rather than waiting for later in the month and asked my aunt to keep me posted. I was really worried. Around 1 AM she called and said mom had gone in for emergency surgery and there was about a 50% chance she would not survive.

I booked a flight for the following morning at 6:45 and packed. Dan and I stayed up all night and discussed the plans for the coming week. I booked a taxi at 5:15, cancelled some appointments, informed my co-workers and headed off to the airport. Dan went to school the following day without sleeping and told his voice teacher, who had gone through the death of one of her parents and insisted he be with me. She said he could take a few weeks and she would make sure it was ok with his other teachers. She was (and is) incredibly supportive and told him the most important thing would be to be with me. I took my flight and was in pretty bad shape myself. I hadn’t heard how the surgrey had went so the entire time I was expecting anything from her death to finding her conscious when I arrived. I worried a lot about how the next few months would go and if she would be staying at the hospital or would recover enough to have the surgery (if they hadn’t already removed the tumor). I knew she wasn’t in good enough shape for the surgery and tried to prepare myself for the worst.

When I landed, Dan’s parents picked me up in Calgary and took me to Red Deer. On the way I spoke with my aunt, who said things were “very bad” and that she would meet me at the hospital with my mom’s personal directive (a document stating the wishes of someone who is not capable of making medical decisions, especially those about life support). I realised things were probably going to end that day. When we arrived at the hopsital I went to the ICU to see her. I had been quite worried about how I would react when I saw her. In some ways it was better to actually see her but it was also the worst moment of my life.

Here is where things will get a bit descriptive, so if you are squeemish, proceed with caution. She was in a room by herself and hooked up to at least 2 IVs and a respirator. She was lying turned slightly on her side. I saw there had been another feeding tube (at least that’s what I think it was) placed in her neck. Of course she was completely unaware of me. Dan’s mom suggested I feel her hand and I tried to take her right hand. It was cold and stiff. That was where the IV was hooked up and I saw a large bruise where it had been inserted. Her cathetar bag had filled with blood, indicating her kidneys were not working anymore. I knew from seeing her that it was over. There was absolutely no way she would recover from this. I met with the ICU doctor who had taken over her case and he told me about what happened. Essentially the tumor was very large and had begun to destroy her gastrointestinal tract. He said the tissue lining it was “paper thin” and the presence of the feeding tube had perforated her stomach and colon. I don’t know if this was gradual or sudden, but it does explain the pain and tiredness she had experienced since Thursday. She had subsequently developed an infection. During the surgery they did their best to repair the damage, but her body was ready to go. They made some very heroic efforts to keep her alive, mainly since they knew I was coming and wanted me to decide what should be done as her only next of kin. There were three drugs being used to keep her heart beating and her blood pressure was 60 and dropping. He told me that she had lost the function of almost all her organ systems, the loss of each reducing her chance of survival by about 20%. I knew her wishes from her personal directive and we discussed the three options. First, we could continue her treatment and tests and wait for her to die, which could take quite some time. Second, we could stop the tests and gradually withdraw some of the treatments (i.e. the drugs helping her heart beat) and she would pass away within a few hours. Third, we could stop all treatment including the respirator and she would die within a few minutes. He recommended against the third, being the most traumatic and drastic. I asked him to proceed with the second. In the meantime I was waiting for my Dad to arrive and when he came I told him what had happend he went to see her. He needed to go outside for a few minutes and during that time (about 5:20 PM) the nurse informed me that my mom had passed away. When he returned I told him and he saw her again. I left my information and the name of the funeral home with the nurses and went to my aunt’s house.

During all this, Dan’s parents were with me and did everything they could to support me. It was the best thing they could have done, since it would have been worse alone. It was a very hard thing to go through but I was glad I could see her one last time.

In: Mom, baby | | #