Thursday, October 24, 2013

Get It Out!

In October 2012 Leslie came to Baltimore,
Maryland, following a scientific conference
in Boston and we visited the
National Aquarium while she was here
The news several weeks ago that my sister, Leslie, had a mass the size of a lime in her frontal lobe came as a welcome explanation to the mysterious changes and extreme forgetfulness that had colored our nightly telephone conversations for the past two months.  Leslie had resisted my suggestions that she see a doctor until some friends finally went with her to a routine appointment and blurted out their concerns.  Now that we had a diagnosis, it was as if my spritely, intellectual Leslie was back.  My sister is a survivor and a fighter. She’s been though a lot in her 71 years, including debilitating asthma since childhood, adult onset diabetes as a result of powerful asthma drugs prescribed in her teens, and the loss of both breasts to cancer, some 15 years apart, with the latest mastectomy almost three years ago now.  We were so sure Leslie was over the hump last time, cancer-wise.  “Get it out!” she told the oncologist when asked if she would agree to brain surgery now.  

The doctors did not hesitate.  An MRI confirmed the suspected malignancy on September 30 and surgery was scheduled for the following week. Leslie asked if I would fly out to California to be with her. I requested the time off from work and booked a flight immediately.  I flew from Baltimore, Maryland, to Oakland, California, on Tuesday, October 8, the day before the procedure.  Leslie had been hospitalized for four days already, her blood sugar spiraling out of control as a result of powerful steroids they’d been giving her to try to reduce swelling on the brain and restore some lucidity so that Leslie could make reasoned decisions about her care.  

When I landed in California, I was frantic to get to her bedside as soon as possible.  Earlier in the day, Leslie had been transferred by ambulance from her local hospital in Oakland to the Kaiser facility in Redwood City, south of San Francisco, where the surgery would be performed. My brother’s wife, Jane, met me at the airport and gave me a ride to Leslie’s house.  I climbed into Leslie’s car, a five-speed Civic, and hunted for a gas station to fill the empty tank before making the 50-mile trek to Redwood City.  Once that was accomplished, I looked for the freeway onramp but found myself going in circles.  I pulled into another gas station to ask directions.  At that moment, I felt the horrific crunch of impact as a vehicle careened into her car.  I was so stunned I couldn’t even cry.  Fortunately, both vehicles sustained only moderate damage and we both were able to drive away.  I was lucky to have been in a collision with a very nice man, but the incident was the undoing of my already frazzled nerves.  I was shaking so badly I could hardly exchange insurance information with the gentleman.  I ended up asking him how to find the freeway onramp.

This is the damage to Leslie's car
Once at my sister’s bedside in Redwood City I was able to calm down.  I told Leslie about the accident and she took it in stride, asking only if I had exchanged insurance information with the other driver. Leslie was in good spirits. I was glad I was there.  We spent a pleasant evening together and then I returned to her house, where I fell into a fitful sleep, snuggling with her two wonderful kitties for company.

The next morning I made my way back across the long San Mateo bridge to the hospital.  Leslie was ready for surgery. I was ready, too. I accompanied her into the pre-op room and hugged her one last time as they wheeled her into the OR.  Two hours later, the surgeon emerged.  “We think we got it all”, he said. Pressed right up against Leslie’s forehead, the mass was relatively easy to excise without having to take much healthy brain tissue with it.  Within an hour, my sister was wheeled back into the Neuro-observation unit on the sixth floor.

Leslie waves to the camera immediately
following her surgery
“Can you say your name?  Do you know where you are?”  The surgeon had warned me that post-operative swelling would shut Leslie’s right eye, but there she lay, smiling, with both eyes wide open, the left side of her mouth no longer drooping from the pressure of the mass.  Leslie told the doctor her name and where she was and I nearly jumped for joy.  He asked her to count to ten.  She did.  I said: “Can you count to ten in German?”  Leslie did that, too.  I was ecstatic. Later I enjoyed a quiet dinner with my old friend, Pete, in Jack London Square, and slept far better in my sister’s bed that night. 

It was good to see Pete, who has been
a close friend of mine since the 1980s
When I returned to the hospital the following day, things took a turn for the worse.  The surgeon had warned me that swelling from the trauma would affect Leslie’s ability to function, but I was surprised at the speed of the decline.  That morning Leslie had been able to eat grapes and drink some juice.  By noon the swelling had shut both her eyes and she lost the ability to swallow, then to speak, then to understand.  Oxygen was administered, and eventually a feeding tube was inserted. An EEG was hooked up.  28 electrodes were attached to her skull, one by one, using an abrasive gel on her skin to help them stick.  My beloved sister winced from the pain as each electrode was attached but could not react further.  My heart ached.  They wheeled Leslie out for a CT scan.  They wheeled her out later for an MRI.  Perhaps she’d suffered a stroke in the area where the mass had been, came the opinion.  My heart sank.

28 electrodes were hooked up to
Leslie's head for the EEG
Still the doctors were hopeful. This amount of swelling is normal, they told me, and perhaps that’s all it is.   Give the condition 24 hours to resolve itself.  I had nothing but time.  Throughout these agonizing days, I had fielded a steady stream of phone calls, voice mails and email messages on my iPhone, her iPhone and her answering machine at home, providing frequent updates to friends, family, and colleagues at the San Francisco blood bank where Leslie has been a senior scientist since 1990.  I cancelled dentist and other appointments she would not be able to keep, set up long term pet-sitting services, gave a statement to Leslie’s insurance adjuster about the car accident, and met with an endless string of nurses, doctors, therapists, hospital social workers and patient care coordinators. Each night I chose a different room in Leslie’s home to clean and tidy up, organizing papers and bills and groceries that had been strewn about during the weeks of muddled thinking leading up to her hospitalization. I never stopped to eat during the day, or even to take more than a sip of water. I just wanted to be by my sister’s side, willing her to get better.

My brother, Dave, and his wife, Jane,
took me to dinner at our old family
haunt, the El Charro restaurant in
Lafayette, California
Thursday evening I had dinner with my brother, Dave, and his wife, Jane.  We ate at El Charro, the go-to Mexican restaurant of my youth.  Our family could not afford to eat out very often when I was growing up, and when we did, it was to El Charro we went.  Unchanged since the 1960s, I ordered the same thing from the menu I had ordered when I was ten.  This was comfort food at its most comforting, at a time I desperately needed it.  Jane and Dave surprised me with a beautiful bracelet for my birthday, twists of thin copper and gold wire woven among delicate chains, with a circle of sparkling crystals in the center.  It was so lightweight and lovely that when they fastened it around my wrist I decided I might never take it off.

Leslie regained consciousness
Friday, to the great relief of us all
When I walked into her hospital room Friday morning, Leslie was sitting up in her bed, joking with a nurse.  I was beside myself with joy.  The swelling had subsided substantially, just as the doctors had predicted.  One of Leslie’s eyes had reopened and, although she still couldn’t swallow on her own, she could whisper and understand what was being said to her.  A doctor came in to tell us that it was not a stroke they saw on the MRI after all, but simply a pool of blood left over from the surgery, which would soon dissolve.

Four different fluids were
being pumped into Leslie
following her surgery
The following day her feeding tube was removed and Leslie was able to sip liquid and swallow pureed food.  By Tuesday of last week she had been transferred to a skilled nursing facility on the east side of the San Francisco Bay, where she will remain for a couple of weeks, working with a physical therapist to regain her strength and mobility before being discharged home.  Leslie’s progress has been steady, and as I write this she is pretty much back to her cantankerous self.  I am overjoyed at her improvement and anxious for her to return to the charming house she shares with her two beloved cats.

Leslie's cat, Isabel, left, is a Norwegian Forest kitty.  Tia Mia
is a Maine Coon.  Both are very affectionate and playful
We don’t know what the future holds.  None of us does.  But considering Leslie’s compromised immune and pulmonary systems and all she’s been through in her life, the fact that she was able to survive at all, let alone make such a quick return to her chirpy, irascible character, is nothing short of remarkable. She’s a fighter, my sister.  And now she will live on, to fight another day.

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