Vita Longus
Ten years ago I treated an 84 year-old gentleman for an aggressive lymphoma that was desperately trying to kill him before being blown away itself by chemotherapy. Too bad for the cancer - it lost (har de har har). I saw him recently and after chatting with him discovered that he has lost all recollection of the ordeal he went through. I joked with him about this:
“So you don’t remember taking chemotherapy, eh? Well, it’s not like you’re missing out on fond memories of your Academy Award acceptance speech. Take this as a blessing, that you can’t remember all the suffering you went through.”
He gave me a blank stare. I soon realized that his mind is not just weak - it is as desolate as a burned out Ozark mountain forest, with nothing left to walk through but the unrecognizable ashes of his former life. Because he did not die from cancer, he has lived long enough to develop Alzheimer’s disease.
I guess this is what my 9th grade English teacher was referring to when she asked me to define the term irony. I pray that my patient forgives me for my help in cursing him with a long life.
CABLE COMPANY CAPER UPDATE: “No, we can’t string a temporary line from the pole to your house. If we come out there, we’re going to bore under your patio and put in the permanent line.” “Look, I’m a doctor and need internet access at night to care for my patients. When can you do this?” “Let’s see…it looks like our first available appointment is on the 15th.” “Oh, the fifteenth of this month?” “I’m sorry. I do mean the 15th of May, but it will be in 2014. Hello? Hello? Are you still there?”
Your a very funny man and I enjoy your sense of being. Thank you for that post on green tea I was totally bummed on the reports. I just thought well I still have Chocolate.
Comment by Sweeti — May 12, 2006 @ 12:40 am
…And if they say something bad about it I’m putting my fingers in my ears and going LA,La,la,la,la,la,Laaaaaa.
Comment by Sweeti — May 12, 2006 @ 12:42 am
Doesn’t always happen that way. My grandfather had an aggressive lymphoma (is this a common cancer in older folks?) 17 years ago. He just had his 90th birthday and is sharp as a tack. After surviving two wives, he swore off women - until this cute gal in his retirement community came along…
Comment by Amka — May 12, 2006 @ 7:55 am
Ha, brilliant links, as usual
Comment by Ali — May 12, 2006 @ 4:59 pm
What do you say to a friend who’s just been diagnosed with stage 3b/4 papillary adenocarcinoma of the lung? Is there anything encouraging that one can say beyond I love you, what do you need?
Comment by Promenea — May 12, 2006 @ 8:19 pm
I love you, what do you need is great. Better is I love you, can I drive you to chemo.
Maybe it’s time for a back up dial-up.
Comment by Emmy — May 13, 2006 @ 12:24 am
btw: Here’s a link to my blog. I read yours all the time. http://journals.aol.com/calvertyaya/ThePinkTeeShirt/ And why are you feeling guilty about giving him ten more years? I’m happy with the two that my onc bought for me. If he told me today that I had cancer again I wouldn’t regret the effort that was put forth to gain those two years. Besides that my grandmother died of Non-Hodgkins Lymphoma that metastisized to her brain. I’m sure that I don’t have to explain to you her mental state at the time of her death. If you’ve done your job well, as the outcome of his cancer would suggest, don’t bother to second guess it. It will only hurt you in the end.
Comment by Emmy — May 13, 2006 @ 4:30 am
btw: Here’s a link to my blog. I read yours all the time. http://journals.aol.com/calvertyaya/ThePinkTeeShirt/ And why are you feeling guilty about giving him ten more years? I’m happy with the two that my onc bought for me. If he told me today that I had cancer again I wouldn’t regret the effort that was put forth to gain those two years. Besides that my grandmother died of Non-Hodgkins Lymphoma that metastisized to her brain. I’m sure that I don’t have to explain to you her mental state at the time of her death. If you’ve done your job well, as the outcome of his cancer would suggest, don’t bother to second guess it. It will only hurt you in the end.
Comment by Emmy — May 13, 2006 @ 4:31 am
So why are you beating yourself up for giving this guy 10 more years? I’m happy with the two my onc bought for me with his leadership and superior knowledge and use of damnable drugs. If he had to tell me today that he thought that I’d die soon, I’d tell him thanks for the extension. I doubt that your ex patient is too much concerned with the fact that he went from cancer to dementia. Dementia seems to take care of that. He doesn’t remember the cancer and he’s unlikely to remember in the end that he used to be able to remember. If he can be in a supportive environment maybe his passing won’t be a chore for him.
Don’t try to readdress the issues. You and your patients do what seems best in the moment. If you had a re-do button, you’d do the same thing because the circumstance demanding the decision would remain the same. This introspection only will make you hurt.
Comment by Emmy — May 14, 2006 @ 2:23 am
hilarious thanks!
Comment by Feisty — May 14, 2006 @ 4:30 am
Your so funny with your links! I loved the casino one.
Seriously though, my Mom died of end-stage alzheimer’s. For the most part I had no idea where she was at, in her mind, most of the time. I do know that wherever it was, she seemed pretty content to be there. I do realize that prior to alzheimer’s she would have wished to be dead rather than get that horrible disease.
The thing is, once they reach a certain stage, they don’t know they have it. She also didn’t know that she had suffered horrible arthritis that caused her pain and loss of mobility for many many years. She forgot about pain, and either she wasn’t experiencing it or it wasn’t happening, I do not know. I only know, she stopped talking about it and moved around alot better when she no longer knew she had arthritis.
She had been a smoker for years. One day she got up and had forgotten she had ever smoked. Just like that, the habit was broken. Of course, she also forgot she had children or had been married for more than 50 years.
The early years of dementia are the hardest for the person suffering it. When they sporadically do all these strange things and then realize they have done so. The questions I heard over and over were “What is wrong with me? Why am i doing these things?” “Cathy, I think I’m losing my mind and don’t know what to do about it.” “Why did I tell the Doc. that the year was 1111, I know that isn’t right.”
One day she called me at work and told me my son had been in a terrible accident, her crying was uncontrollable. I rushed to the hospital, almost getting myself in an accident, only to find that my son was not there. He was at work and nothing had happened. Her dreams had now become her reality.
The later stages are harder for the child or spouse, who is taking care of them. How does one deal with a parent who doesn’t know them? How are you supposed to react when your mother drinks dish soap or pours ketchup on her hair?
There is a book called “The 36 Hour Day” that does a good job of explaining all this, for care givers. Named appropriately, because for alzheimer’s and other dementia patients and their care giver’s, the days never end.
You gave that man 10 years.If he has forgotten a time filled with pain, fear and anxiety, that can’t be all bad. You did good!
Comment by Cathy — May 15, 2006 @ 7:44 am
Hello
What is the risk of CNS involvement with lymphomas, or with chemotherapy treatment of lymphomas?
Comment by Pony — May 16, 2006 @ 6:13 am
Irony helps in many situations, only not everyone is able to mock in a kind way….so you can, congratulations!
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Comment by Jonn — July 16, 2007 @ 6:43 pm
Data from the study, the largest of its kind, contradicts some previous studies that found that ibuprofen might exceed others in its class when it comes to preventing this type of dementia. Besides ibuprofen, other types of NSAIDs include naproxen and aspirin.
But the bottom line, the study authors said, is that the findings don’t support the use of NSAIDs to prevent or treat Alzheimer’s, at least not yet anyway.
Comment by Alzheimers disease news — June 6, 2008 @ 7:43 pm