From Bad to Worse

My mother in the ER.

What can I say? My mother is old. She is frail and weak. Her days are numbered.

I was heading over to my mother's house to say goodbye before heading back to Ottawa, but her husband told me she wasn't feeling well. I arrived to find her in her chair, moaning loudly. In a heartbeat, I called 9-1-1 and arranged for paramedics to take her to the emergency room.

Needless to say, I did not go home.

I stayed with her throughout that night.

Eyes closed, but not sleeping.

The ER doc ordered a CT scan which showed a mass the size of her fist in Mom's pelvis. She gave no indication of potential diagnosis, but we all knew that cancer was likely. (Mom had colon cancer about 15 years ago.) The doctor was handling such a heavy load that she forgot to prescribe any pain medication. Nursing staff could do nothing without a doctor's orders.

The pain came in rapid waves. She was quiet for no more than 30 seconds at a time, then she would moan and call for her mommy. She gripped the bed rails with what little strength she had. I held her, caressed her face and arms to let her know she was not alone.

I dimmed the lights and closed the door, in hopes that she might sleep.

Finally, at about one in the morning, the on-call doctor came down with more information. She explained that the mass was low in the pelvis, near the rectum -- which is where Mom's cancer had been. Unfortunately, the CT scan had not given sufficient information to show feasibility for a biopsy. The next step was to do an ultrasound to get more information about the location of the mass and to determine whether a biopsy could be done.

She asked about Mom's wishes in terms of treatment. At the time of Mom's heart attack a year ago, we had frank discussions about Mom's wishes. Mom has no desire to have her life prolonged "at any cost," but she would want appropriate diagnosis and treatment, provided it was not excessive. Our absolute priority is to keep Mom comfortable.

Over the following 24 hours, Mom improved greatly.

Because of a shortage of beds, she spent longer in the ER than we would have liked, but, like a flower put in a vase of water, she perked up. We hit some bumps in getting her pain medication just right. At one point, we gave her too much, which caused severe vomiting.

The next morning we learned that, unfortunately, the ultrasound hadn't given enough information contrast CT, but Mom's kidney function was so poor that she would not be able to flush the contrast medium, which is toxic. Two days of fluid later, Mom was well enough to take the test.

But by Day 4, Mom was free of all tubes and IVs and just wanted to go home. She spoke of little else.

Harry holds her hand.

It was hard on her husband, Harry, as well. He's 89 years old and tires easily. And he missed her.

We finally had the results of the contrast CT, showing where a biopsy could be taken, but it was a long weekend, and the test would not be done for another two or three days. We asked the doctor if that test could be done as an outpatient, and he was only too happy to give permission (along with lots of caveats and detailed care instructions).

"We're happy to have her stay here -- there's a bed if she wants it. But I understand your wishes and would do the same if it were my mother," he told us. "I will leave notes in her records so that, if you do have to come back in, her treatment will be quick."

So with rapid efficiency, the paperwork was done. We bundled her up, and my sister brought her home.

After a bath and a change of clothes, Mom settled into her recliner beside her husband.

At last.

We'll know more soon, but we already know that the dominoes have started to fall. Already we are juggling care of her heart failure, her tumour, and her spirit, balancing one against the other.