Paul's Heart

Life As A Dad, And A Survivor

Archive for the category “Cancer”

5 Years Later… I Still Miss My Dad


For those of you, too young to recognize the photo above, the is a disc of vinyl on what was called a turntable.  The arm placed on the vinyl, had a “needle” or stylus that produced music, before there was MP3’s, digital downloads, and even CD’s (hopefully you know what those are, though as I understand they are being phased out now too).  In any case, I spent so much time listening to music this way.  I took care of my records.  No scratches, a common problem for vinyl, that could impact the quality of the sound, as well as the ability to play the music.

You see, over time, a condition might often occur, where the needle would get stuck on the record at a certain spot, and as the record continued to turn around, it would just repeat that same groove on the vinyl, over and over.  We referred to this as a “broken record.”

In life, there are many things that we face, that often get us stuck in that kind of rut, unable to get on to the rest of the record.  Metaphor aside, at least I used to be able to, just buy a replacement album if I wanted to do so.  And normally, I do not hold on to something for so long, because of that rut.  But there is one thing I have not been able to move forward on.

The loss of my father, now approaching five years.

It just has not gotten any easier.  But it is not for the reason that you think.  I have written before about my inability to grieve properly, not something I would describe as a character flaw, but rather a defense mechanism.  A mechanism I have carried most of my life, a way to protect myself.  But protect myself from what?

I have often discussed the three chapters of the life that I had with my father, a split childhood between married parents and then divorced parents, estranged for a majority of my later childhood from my father, but the second half of my life, moving on from all the hurt, rebuilding what we lost, having a relationship with someone that I considered one of the strongest people in my life.

We had a lot to mend with each other.  Things had been said.  Things had been done.  And were it not for a major medical crisis, we may never have turned that corner.  That event opened a door to discuss guilt, give explanations, offer support, and ask for help.  We began talking again.  He learned a lot about what I had gone through with my Hodgkin’s Lymphoma.  And when his health took a turn, with a major heart attack, it soon became my turn to help him with his needs.  And then as late effects from my treatments became obvious, he was there for me, something that he had not done in the past.  We were moving forward finally.

My dad had many grandchildren, but for the purpose of this story, my daughters gave him the opportunity to do what he did not do for me in my childhood.  And he loved all of his grandchildren.

Approximately seven years ago, my father informed me that his doctor had seen spots on his lungs, which would lead to an early diagnosis of emphasema.  At this point, the doctor considered it reversible, even for someone who had been smoking for over five decades.    Though he would try to quit, with various means, he was unable.  But during a follow up exam, it was now felt that my dad had developed lung cancer.  I have written more in detail about that in past posts, so I will spare the details now.

My father had asked me, to accompany him to appointments.  This made sense to him because of my history.  He knew that I would understand things being said, and be able to explain to him if he did not understand.  I would also be able to ask questions that my father might not think of.  I was also very likely to remember most if not all of my father’s medical history.  I was touched by what my father had asked of me.  Estranged for as long as we were, my stepbrother would have been the more logical choice, and I would have understood that.  But this is what my father had wanted.

But as time went on, it soon became apparent that my father was going to need more than a companion or caregiver.

As the cancer became more serious, my father realized that he needed to have decisions made in advance, in the event that he would not be able to make them himself.  At this point, again with no objections from me, my father appointed my stepbrother as his legal rep, but asked me to take on the role of his health care proxy.  In other words, should something happen that he would no longer be able to make his own rational decisions, I would be trusted to carry out my father’s wishes.  If there is one thing that my father knew about me, getting back to that character quirk that I have, disconnecting emotionally, my father knew he could count on me to follow his wishes, no matter what.

At this point, conversations between my dad and I had become dominated by his issues.  I no longer spoke of things that I was dealing with myself.  I had a lot on my plate.  I was campaigning for school board (my second campaign), my own health had been giving me difficulties from my late side effect issues, and my marriage was failing.  But I was not going to allow my dad to feel I was being overwhelmed with his issues.  I knew that I could do what my dad wanted and needed.

But in February of 2014, my father was informed that his cancer was now terminal.  My role as his health proxy was going to change from that of advocate and support, to adding comfort as his cancer would rapidly progress.

Now anyone who has ever been a health care proxy, knows this is not an easy thing to do.  Emotions must be shut down, logic must take over.  You must also balance your needs with the task of caring for someone else.

The first pressing issue faced by my stepbrother and I, was trying to keep together what had not been apart in over four decades, our parents.  My stepmother needing her own level of a different care, my father his own care, did not qualify to be kept together in the same home due to a technicality in his supplemental health insurance.  Needless to say, together, we did get them together, and a lot of funny stories.  More importantly, they were together when he passed.

But something happened during the hospice process that appears to have changed everything for the rest of us involved in this process.  And the honest reason is I do not know why.  I had followed my father’s wishes.  And even up to my father’s memorial service, everything seemed as if we would just move forward.  But as I mentioned in the beginning of this post, this “needle” seems to be stuck.

I do know that there were decisions that were made by me, that other family members disagreed with.  And again, my father trusted me to make those decisions.  One of those decisions was protecting his privacy from anyone who might try to interfere with his care.  And I totally get it when someone is dying, you want to do all you can, everything, to cure them.  But, there are limits to that, and this is where my logic took over, and actually got quite firm.

As anyone facing a death sentence from cancer, of course, you are willing to try anything, and that includes clinical trials.  These are treatments that might have hope.  And at the time that my father was dying, there was such a drug that had showed promise as a possible treatment for advance stage lung cancer.  But what I could not convince anyone of, the difficulty of qualifying for clinical trials.  Forget the fact there is no guarantee of cure, but time was quickly running out.  But even that would not have disqualified him.  But the fact that my father had experienced so many health issues over the recent years, and during his cancer diagnosis, HE WOULD NEVER HAVE QUALIFIED FOR THE CLINICAL TRIAL.  Sure, we could have fought for him, but I knew we were never going to see any victory, and all that would happen would be to have lost the last moments with my father.

But as his health deteriorated further and rapidly, so did his mental status.  And this would cause a lot of issues among all of us, because there were times that my father was so convincingly lucid, though in reality he was not, arguments over his care and handling often resulted in conflict.  It soon became a battle with just giving a dying man whatever he wanted regardless if it was good for him or not, or if it was at the expense of the care he was given.  He was dying, just let him enjoy his last days.  Which honestly, as his son, I would not have had any problem with.  But that was not what my father asked of me.

I was a monster for not allowing my father to eat sugar candy snacks and drink caffeinated drinks because that would keep him awake at night, often giving the minimal night staff problems with behavioral issues.  Rather than risk my father being ignored or worse, restrained, I restricted the things that would keep him awake at night.  No matter the pleas, “he’s dying just let him have what he wants,” that did not result in my giving him back his cigarettes to enjoy.  He had been restricted to the nursing home eventually, but that did not stop some from wanting to take him offsite for some last outdoor enjoyment.  Again, this was not possible procedurally, just another source of growing conflict.  And then of course, there was the huge disagreement of care of a hospice patient, who is dying.  Treatments and medicines are no longer given.  As Hospice is not about extending life, which would only end up being more painful, it is about making the end of days as comfortable as possible.  And that is what my father expected me to do.

As I mentioned, I had my share of things I was dealing with as well.  But many of my nights were spent with my father at the hospital and nursing home, days at work, and squeezing in my medical appointments.  And with a pending court order coming in my divorce, I had other pressing decisions to make as well, all as my father lay dying.

Again, I never asked for understanding.  I had been trusted by my father to honor his wishes, and I did just that.

My stepbrother has my father’s ashes, again, which I had no issue with.  The plans as far as I knew, were that eventually my stepmother’s ashes would eventually be combined with my father.  Again, not something I objected to.

But something happened after that memorial service that I just do not have any answers to, and why that “needle” just continues to skip.  And for that reason, I cannot grieve for my father, now approaching five years later.   Like I said, I get that there are many that did not agree with the decisions that were made, and I can accept that.  But there is more going on than anyone is letting on.  But, as communications have basically been cut off from the majority, I will never know what changed after my father’s memorial service that I have been cut off from nearly everyone, and for no reason.

Sad really, even my children understand something is not right.  My younger daughter has even offered to request some of my father’s ashes for me to have as I have been cut off from contact, for no reason, or at least none given.  While I appreciate her gesture, her being a child is not going to help it get done, though both my daughters are really confused as to why the animosity.  And I am just as confused myself.  I have not had any communication with anyone in the nearly five years since.  I have made attempts, but no response.  Evidently even acknowledging and offering sympathies for other losses are not acceptable as a temporary halt to whatever is at issue.

And so, another year passes.  Dad, I do miss you so.  And I know this is not the way that you intended things to turn out.  That is not who you were.  I know that.  Because of our relationship, the second half of our life was able to become what it was.

Below is the link to a story that I wrote, and was performed on stage, sponsored by Memorial Sloan Kettering Cancer Center, the tribute I wrote for my father.

 

And to those family members, I really do not know what I did that changed things after my father died.  And since none of you will explain to me, I guess it is what is.  It does not change my relationship with my father, or my relationship with my daughters and their grandfather.  But the door is still open.

“Why Can’t You Work?”


Over the the last twelve years of my survivorship, one question that comes up over and over and over again.. “why can’t you work?”  This question comes from many different people, former co-workers, friends, and even family.  The question coming from most of the family is really kind of a weird question, because most have all been there from the beginning, well, except for two.

A recent photo with my daughters and I, I am sure the question will come up again.  And yes, that question has come up from my daughters as well.  I have taken my time explaining my health to my daughters, because as many of the health issues that have popped up, occurred when they were much younger, and the last thing that I wanted to do was scare them with the realistic possibility of dying – a near fatal heart blockage, and a battle with sepsis.  But every year, as they have gotten older, they have noticed that I do less and less physically.  For nearly all their life, they knew me as someone who put in a lot of hours at work and at home.

My daughters were not there when I went through my battle with Hodgkin’s Lymphoma, and was treated with an exposure to radiation of four times the lifetime maximum, and several toxic chemotherapy drugs.  Thirty years ago, survivorship was based on five years.  In simpler words, we were not expected to survive past those five years.  And clearly as you are reading this, there is a problem with that thinking.  In fact, that thinking was way wrong even before my diagnosis.  Hodgkin’s had already been treated for decades before me, with even more barbaric treatments.  I personally know survivors with 10, 20, 30, and more years survival than me from Hodgkin’s.

So here is the problem, only up until a decade or so ago, less than a handful of doctors realized that survivors of Hodgkin’s were developing side effects from the exposure to the high dose radiation and chemotherapy.  And just as tragic, only a small percentage of us long term survivors, literally out of millions, we are probably lucky if 10% actually know that many of their health issues today are attributed to their treatments.

Medicine had not been teaching cancer survivorship to its future doctors and nurses.  And for the most part, even today, many medical personnel only learn of these issues from their patients.  Nothing like on the job training.  The truth is, there is actually a well documented resource available for survivors like me, as well as new survivors.  And it is available to EVERY doctor, EVERY doctor.

http://www.survivorshipguidelines.org/

The Survivorship Guidelines are put out by the Children’s Oncology Group.  So, if you are interested in researching this further, simply go to the link I provided.  Back to the question posed at the beginning.

Some cynics may say, “gee Paul, you seemed fine to do everything before the doctors told you everything that was wrong with you.”  The only part of that statement that was correct,  was not that I was able to do everything, but I was in unbelievable pain, and could get no answers as to why.  Oh, and the heart thing, I put up with the symptoms of a “widowmaker” blockage of 90% of my main artery, simply because I was not seeing any doctors because I was not being followed up.  The cardiologist who discovered this initial condition put it this way… “it was not a question ‘if’ you were going to die, but ‘when'”.

Following that, I developed a team of experts at Memorial Sloan Kettering, who discovered many things that had developed over the years, finally answers as to why I felt this way.  But getting answers was not the most important part.  Discovering how I was going to manage the issues that had now been discovered.  Everything that was happening to me could not be cured.  Everything was and is, continuing to get worse.  My health is not about getting better, but rather slowing down the progression of these issues, management.

The average person honestly could not handle hearing the things that have been done to me.  Shit, many in my family could not handle it.  Which leaves me only one option, I have to put on the “brave face” and just not let anyone know how I am feeling, or the unbelievable pain I am dealing with.  In order to do that, at least until a few years ago, was to go on multiple pain medications combined with a sleep medication because the pain was still bad enough to keep me awake in spite of being on 3 opiodes at the same time.  But all those medications were able to get me though my work day, which was important to everyone else.  Forget the quality of life that I was sacrificing just to keep others happy.

And the downside to this effort, because I pushed my body as hard as I did, my issues were actually accelerating in deterioration, my body getting much worse, much quicker.  In spite of being put on multiple physical restrictions at work from certain activities, I was still given other details which either made things worse for me or at best, continued the pace.  I had restrictions of weights, mobility, and movement.  Were it not for the American With Disabilities Act, I would have been out of a job long before that.  But because of the ADA, my employer was required to accommodate my health restrictions as much as they could, as long as there was work for me to do.

But as the years went on, I continued to push myself.  Back in 2012, and January/February of 2013, I made five trips to the emergency room (one by ambulance at 3am), two that had the potential to end fatally.  My heart surgery four years earlier was the wake up call I should have paid attention to earlier.  I should have been listening to my doctors for all those years, telling me I should consider retirement on disability because of all the health issues I was now dealing with.  But I was not prepared, especially mentally to “quit”, which is what I felt I was doing.

A couple of years after that, and some new directions that my employer was making staff and building wise, combined with actions related to my divorce, I ended up on that path to reality, disability.  I have long had the handicap placard for my car.

I do not like to use it, but will if necessary.  I really still have a hard time with the stares at the appearance of my youth and the shell of my body showing no reason to need this assistance.  But depending on the activity, if I need to carry something, or the weather conditions, my body is instantly shut down by symptoms that develop very quickly, taking a long time to recover, and I really hate that worse than the stares.

So, when my daughters ask me, “why can’t I work?”, I explain to them that I really do want to work.  But besides the issues of my health, there are these factors to consider by any perspective employer:

  •  I have limited movement of my shoulders and upper body that can actually cause me to collapse out of instantaneous exhaustion due to cardiac issues, and due to radiation damage, I have an increased risk of tearing both shoulders apart.  So I am limited to activities of no lifting any sizable weight, or repetition.
  • Having only 75% of my lung capacity, weather and climate, including indoors can have an effect on me
  • And you are only as strong as your skeleton an muscles can provide, and my body is at an increased risk of fractures and muscle injuries.
  • And of course, with Hodgkin’s being a cancer of the immune system, and having had a splenectomy (spleen removed) through the process, I am at a higher risk of getting sick, especially from people who come to work sick, or do not believe in vaccinations.

Now if you factor in all those facts, two other important details.  The last thing an employer wants is an employee being hurt on the job, because that would mean a claim on their Worker’s Compensation plan.  And quite possibly other penalties depending on what could have been done to prevent.  It would make no difference me having these issues, if I got hurt working for them, it would cost them.

And then there is this.  Following my heart surgery, I became unable to maintain a robust attendance record I used to brag about.  Until then, I used to brag about year after year of perfect attendance, including during the days of my original treatments.  In 30 radiation treatments and 8 months of chemo, I never missed one day of work.  But years later, my body could no longer take it.  Following my heart surgery, I would never see perfect attendance again, in fact, absenteeism for me dropped to 30% and near the end of my employment, I missed half of my work schedule either due to my health issues themselves, or doctor appointments to deal with them.

So, “why can’t I work?”  My daughters get it.  And so should anyone else who asks this question of me, or asks it of anyone else forced into the unintentional and unwanted decision of going on to disability.  It is not that I cannot work.  But who wants to hire someone who has all the health restrictions that I have, and the attendance record I have?  And the only way that I can get around those two issues is to be on multiple opiodes taking away the quality of my life.  My decision is an easy one to make.

I am not immortal.  And I know that the health issues that I am dealing with, have reduced my mortality a lot.  I joke that I must have been a cat in my former life, given that I have dealt with a health crisis at least 5 times that could have resulted in my death.  And if by some chance, this is more than a coincidence, I am doing what I can to take care of the remaining 4 lives that I have left.

My doctors have told me they will do what they can to make sure that I see my daughters graduate, walk my daughters down the aisle (if they choose to get married), and even see grandchildren.  I just need to do what I can do which means listening to the warnings of my doctors and not the gripes of people who feel their judgement of something they do not understand should carry some weight in my remaining years.

I cannot do the things I used to do, and not just work.  I no longer play softball and volleyball, my exercises are limited, I no longer ski or do other outdoor activities.  I do what I can, within my limitations, that allow me to enjoy the time with my daughters.  I am not crippled by my health, at least not yet, and to protect the average person who cannot handle what I am dealing with, I go through each day, continuing to only allow people to see the shell of a “seemingly healthy young man with no outside signs of health problems… who even smiles.”  Who I am on the outside is what matters to you.  What I am dealing with on the inside is what matters to me.  And that is why I am not working.

And for those in my life that still want to doubt, I carry my entire medical file with me that backs up everything I am dealing with.  Someday, my daughters will ask to see it, so that they learn the details.  But for now, they know what I am dealing with because they have seen it.

You Do Not Always Get The Obvious Warning


This year marks my 11th anniversary of the 2nd time my life was saved (my count is up to  five currently).  On this day, it was discovered that the main artery going to my heart was blocked 90%.  This situation is commonly referred to as a “widowmaker”, and for good reason.  If the major heart attack happens at that time, you are not likely to survive it.

I am always especially concerned for friends and family when I hear of someone mentioning even the slightest symptom concerning the heart.  There are all kinds of warning signs.  But unless you have had a prior incident, you most likely consider yourself a healthy person, and do not think anything else other than a minor inconvenience or discomfort.

But just as in my case, the more time that is wasted acknowledging the symptoms, the more serious the problem becomes, until one day it is too late.  Hence, “the silent killer” label.  The important thing to remember is that symptoms are often different between men and women.  But there are symptoms, and they should not be ignored.  By all rights, according to my original cardiologist, I should have died.  It was not a question of “if”, but “when.”  The fact is, looking back in retrospect, I had experienced high blood pressure for years.  But it was a chest tightness, that I could only recall having awareness, for at least 4 months.  Keep in mind, that artery was blocked 90%.  The slightest stressor should have killed me.  I am certain that during that 4 months, the blockage was not much less than the 90%.  Yet, because I did not acknowledge any ill health on my part, I ignored it.  And it could have, and should have, killed me.

I am more aware these days of my heart (as well as other health issues).  I have to be.  The treatments used to cure my cancer 30 years ago, are the causes of all my health issues.

But the truth is, because of my experience, I now know so many, inside the cancer world, and those not having had the cancer experience, who have dealt with cardiac issues, or are currently dealing with cardiac issues.  And they will all tell you the same about me.  If you are feeling anything other than normal, you need to be seen.  You are lucky enough that your body is giving you a warning.  My body tried to warn me for 4 months and I ignored it.  There are those who show no symptoms, and still end up fighting for their lives.

Please, for the sakes of your loved ones, and your friends.  Take care of yourselves.  Do not ignore the warning signs.  They are there, and they really are a big deal.  I am lucky enough to be here to tell you that.

Post Navigation