Reluctant messenger

Tomorrow I'll drive the 5.5 hours back to my hometown with an urgent and terrible mission: I have to explain to my mother that her oncologist does not want to continue giving her chemotherapy. Her oncologist is incredibly skilled and a nice guy to boot. He does not want to see my mother suffer any more than she must, given her diagnosis (small-cell lung cancer, recurrent and extensive) and her prognosis (terminal). I spoke by phone with the oncologist following a 48-hour hospitalization my mother had, during which she received mainly respite care. She got to be taken care of 'round the clock, got regular meals, regular meds. My siblings had not realized that although they were taking care of her in the evening, overnight, and the morning, there were big swaths of daytime in which she had no energy to stand long enough to prepare meals. Further, she's so confused most of the time she forgets whether she's taken her meds on-schedule (despite an easy-to-use chart and a many-compartmented pill minder). The combination of weakness and badly-timed med consumption landed her in the hospital, where they couldn't do much more than keep her well-fed and well-hydrated. Her cancer has advanced from her lungs to her lymphatic system. So now she has lung cancer throughout her abdomen. And while the cancer in her lungs responded to the chemo-plus-radiation routine, the cancer in her lymph system, which received no radiation, spits in the face of chemo. She has months.

As the cancer has advanced and the chemo has circulated through her radiation-injured brain, my mother's cognitive function has suffered. Examples: While she was in the hospital, she kept telling nurses that she used to have cancer, but now it's in remission. If she takes a nap during the afternoon and wakes at twilight, she thinks it's early morning (despite many clocks in the house), and begins doing morning things like making coffee, trying to get the paper, and *headdesk* taking her morning med doses (rather than the evening ones). In short: My mother cannot be alone for more than 2 or 3 hours at a time. But she has been hope-filled: she's convinced she can get better. It's like watching a crippled kitten try to play. And tomorrow I have to tell her that her doctors are pretty sure she will not get better, and I need to ask her if we can call Hospice.

I'm hoping she'll say yes: we need Hospice services badly. When I'm not there, my siblings must take turns supporting my mom. Here's how it needs to work, starting now (a ramped-up version of what they were doing): Each day someone must be there to prepare breakfast and make sure she takes her morning meds. If she has even a twinge of pain, they must make sure she takes a pain med before it gets out of hand. Then someone comes by and makes her lunch, checks her pain level and suggests meds if needed, sees if she wants to take a drive somewhere or perhaps a walk to the corner, or to sit on the porch in the sun for a while. Someone needs to be there at tea time to check on her med schedule and pain level, to see if she wants a snack. And then there's the dinner-and-overnight shift. And someone has to be on standby to take her to medical appointments. I go every two weeks and stay at 1 week, and during that time, nobody takes shifts except to come give me a break.

As Mom's cancer advances, she'll need even more care. And that's why we need Hospice. But we can't get Hospice until my mom understands what's going on with her and makes the decision to not seek another chemotherapy protocol. I pray that's what she does. If she insists on chemotherapy, it will need to be aggressive. And it wouldn't make her better. It wouldn't extend her life. The chemo she's already had horrified me in its devastation of her. I don't know if I'd be able to bear seeing her go through something even worse, when we could spend our last months together so differently.

It feels horrible to ask for good wishes in this mission. I'm going to ask my mother to gather her courage and surrender. More heartrending: I'm going to need to ask her more than once, since she doesn't remember things well. And I'll need to keep reminding her about the reason for the asking. It'll be the worst thing I'll ever have had to do. It will be one of the kindest things I'll ever do for anyone. Except, perhaps, to care for them through their last days and to sit beside them through their last moments.