Visit to the Juravinski Cancer Centre – For Glioblastoma Multiforme (Brain Cancer)

Today was the first visit to the Juravinski Cancer Centre in Hamilton for my dad, with my mom, brother and me. This was the first time I had visited a cancer center and the last few weeks are the first time in almost 30 years that I have actually given cancer much of a thought.

I like the center. It’s clean and it was warm and I had the thought that it would be a comfortable temperature in the summer. There is a hospital like feel to the place and there’s no mistaking that you are in a health care facility. Missing though, thankful, was the chaotic semi-shell-shocked movements and anguish you get from the masses in emerge. At a cancer center everyone is there for a reason and everyone inside the building knows it. It’s all about the cancer and the people it’s killing.

The way this place worked today was simple. It’s a clinic and there are a team of doctors and health care providers who are specialized in cancer treatment. Our team had a neurosurgeon and a neurologist because of my dad’s diagnosis of Glioblastoma multiforme or GBM (brain cancer) – I would imagine that they’d have a specific type of surgeon and specialist for different types of cancer – along with an oncologist, 2 radiation doctors and a nurse.

The nurse introduced herself, chatted and collected a detailed health history, current medication, information about how my dad ended up in the hospital, symptoms, and she asked for any imagining that had been performed. She asked if we had any questions and left with the CT and MRI results.

The oncologist was next, he came holding, among other things, a picture of one of my dad’s MRI images. He chatted about about the key stuff – the last 6 weeks and ultimately what the neurosurgeon has said at the hospital 2 weeks ago – GBM, a brain tumor that cannot be removed. This doctor agreed. He showed my dad the MRI and pointed to a thing in the center that doesn’t look like anything else on the page.

He preformed a complete neurological exam and explained the next hour. The team of doctors would meet and review all of the information and then would be available to discuss the opinions on treatment and the prognosis. “Come back to the same room in about 30 minutes.”

He was nice, like the nurse. It sounds silly to say “nice” but that’s what they were. Try walking into a room with a time bomb, hand it off to a family, and still have them think you were nice. It was completely professional and if it hadn’t been for why we were there, I think we would have talked about how nice the whole thing was while we waited to hear what could be done about it.

Some food at the cafeteria / lounge that had a piano but no singer. The family chats back and forth about stuff. I’m looking around and starting to feel strange because as I look at each group of people I’m trying to guess which one of them has cancer. If you haven’t played this game, you don’t really win when you guess correctly. There’s a table of 3 people, one is dying, the two that aren’t are going to be grieving their asses off soon. You can’t guess who is who without looking at their faces and when you do, you see a 21 year old son with his mom and grandmother, mom’s in a wheelchair because she has cancer. I felt rage deep inside that made me want to wreck something for what’s about to happen to this poor kid. I suddenly wonder what type of cancer killed the cafeteria singer and as I do, my eyes meet Des’ and he’s just seen the kids future too. I glace away towards my dad unwittingly winning another round of the stupid game my brain is playing.

We head back to the room and the doctor returns. He presents the treatment options. The tumor cannot be removed so my dad will never be cured. If he wants to fight it, they’ll remove as much of the tumor mass as they can, give a course of radiation and chemo, some recovery time and then more radiation and chemo. He’s free to do nothing about it, and that isn’t an unreasonable choice. The nurse and doctor spoke candidly about GBM and what’s in store when you battle it. Your life lengthens by months. But they have to open your skull and cut pieces of tumor out while avoiding causing serious brain injury. The goal of this is to create enough space for the swelling caused by the radiation and chemo to fill without causing cognitive impairments.

The fight is brain surgery, then radiation and chemicals to kill cells. Give the body some time to recover from all of the trauma and go at it again.

It’s reasonable to say no thank you because it can be a rough ride, with no guarantee of doing much. And there are no halfway measure. You’re 100% into the fight or you are not. It’s becomes a philosophical issue more than a problem to be solved by science because with cancer, the science isn’t strong enough to offer guarantees. You throw the kitchen sink into the battle or you don’t. Either way, you are now dying from something.

The team of doctors came in and answered all of our questions. They removed the shame from making any choice while offering 100% of their focus to fill their piece of the treatment puzzle. Again, it was really professional and the conversation was honest and caring. The time-lines are estimates, the tumor is serious, the treatment is not a cure and it can be rough. Consider your options and we’ll talk next week. After the thank yous and the goodbyes we head home and they go to meet their next round potential soldiers in the fight against cancer; which is good because these are the type of people you would fight for and they are also the type of people you would not feel bad saying no to. They made it clear that there is only one right choice and that just happens to be the one that my dad will make.

I’m not sure if I’ll ever be back to the Juravinski Cancer Centre in Hamilton. Right now that’s up to someone else. But if I go back it won’t be with a sense of trepidation or fear because my dad would be in good hands there.

Afternoon Naps

I have never really enjoyed sleeping in the afternoon. For one thing, waking up the second time is tougher. For another, the quality of sleep isn’t of a very good quality for me. But the main reason why I’m not a fan of afternoon naps is because of the hypnagogia phase of this type of sleep. This state always kind of bothered me because the imagery of dreams doesn’t tend to happen here and you get a raw stream of clear pictures and dialogue about EXACTLY what your brain is processing.

A couple of weeks ago, a Tuesday afternoon, I had a dream were I was telling someone that my uncle Kevin (oldest brother on my dad’s side) “had gotten it from exposure” in reference to his cancer. In the dream I was attempting to create a logical difference between my uncle and my father. As I drifted awake I became aware that I could hear my parents talking in the computer room. I wasn’t able to make out what they were saying, but the tones of their voices was causing me to come awake with a touch of anxiety. “Are you having a stroke?” I hear my mom say. “No” in a soft relaxed tone is my fathers reply. I’m now standing looking at my mom and dad. I ask my dad how he’s feeling, go through the stroke check list and there’s nothing alarming. He’s fine. His thinking is seems a little off, but not really. It’s tough to tell to be honest. A few days later, after returning from the doctor with my brother, there’s a change to his medication for his heart rate and a “there seems to be something I’m not getting” from the doctor. The next day he improves so the crisis ends.

Sunday my dad is thinking a lot more clearly but his stomach hurt. Monday he’s tired and not feeling so good. It looks like a stomach flu, a fair possibility. I take an afternoon nap. Out for a short while I wake-up hearing my mom say “we need to take your dad to emerge”. And off we go.

He gets a CT scan, there’s something in his brain that shouldn’t be there so he’s transferred to Trillium Health Sciences (Queensway / Hurontario) Mississauga’s neurosurgery department for an MRI to find out what it may be. It’s around 11:30 am Wednesday when he gets back from the MRI. He’s sleeping and his vitals are normal. I take a some time to research brain tumors on the internet.

Turns out brain cancer as a primary tumor is rare. Most brain cancers are a result of a cancer spreading from a different part of the body. Brain cancer as a primary tumor is rare in people above 70. There is a genetic link, but that accounts for 5% of it. My uncles bone cancer was the result of exposure at work. My dream from the week before was starting to settle very unpleasantly on what was suddenly become a new reality that was hard to understand and manage.

When the neurosurgeon gathered around the family at 5:40 pm and said glioma my heart sank.

Now what does this all mean? The hypnagogia phase is a possible gift of insight for a lot of people. What I did with the information that I was given the week before the cancer diagnosis is sort of a mystery. I didn’t say to anyone “my dad has cancer.” You don’t say that unless it’s true and I didn’t want to be right about what I had felt in the dream. I did pay more attention to his movement and the things he said, but other than the stomach pain he was improving. To the best of my knowledge, I hadn’t considered the possibility of my father having cancer before that nap. But the thought had been present and working on my brain for 8 days before the doctor said it.

The family is stunned. My dad is 68, hasn’t been a smoker in years, rarely worked with PVC (the only chemical conclusively linked to glioma), is active and healthy, and has always had a fantastic brain – a natural problem finder and solver, an ongoing learner and an articulate communicator. It just strikes me as a little unfair that everything about him is still in great working order, that he’s taken care of himself, his body and his mind and now as he begins to enjoy his retirement his genetic code presents this new challenge.

I’m not sure when I’ll take another afternoon nap, I suppose when I need some more of that hard hitting unfiltered clarity that my conscious mind can’t seem to draw out.