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Tuesday, January 12, 2010

Abdominal Pain

Welcome to my blog, friends and family. The picture in the banner is one that I took this past Eid. On the left in the blue sari is my aunt and in the green is my mother

She went to the hospital for abdominal pain. Her primary care prescribed antibiotics and then she collapsed at work. Her co-workers called my aunt and she followed the ambulance to Mount Auburn hospital.

My mother went to the emergency room from work. Last year around the holidays the same thing happened so I thought that she may have succumbed to exhaustion, yet again.

After endless hours of waiting, the doctors said they suspected diverticulitis. Sounded great because you can recover from it, it happened to one of my professors, my best friend's mom. They are fine today.

The doctors ordered a CT scan to view her abdomen better. They kept us waiting most of the day as developments occurred. Several doctors read the CT and one of the doctors came in to tell us there was something causing pancreatitis; her ducts were enlarged. It was still light out when he came to tell us that. Then after an hour he said that there was a mass pressing on her organ causing the pancreatitis. Upon further review with doctors the team of doctors would decide if it was resectable.

At this point I thought it could be a cyst or some lump. After the sun had set my two best friends came by. My aunt, my friends and I talked and watched the Law and Order Criminal Intent marathon on the TV in my mother's room, making jokes about how ridiculous the show was.

One doctor came into the room a short while later to tell us more about the mass. Her first thought was that it's cancer. "It doesn't look like we can resect it at this point, but from what the CT shows the doctors are leaning towards cancer".

The plan was that my mother would be taken to MRI that night.

I remember meeting Natasha and Sujon at the elevators to tell them the diagnosis. That night they didn't take my mother down to MRI until midnight. She hadn't a thing to eat since 7AM that morning. Natasha and Sujon stayed until 11:15 while Parveen, aunt and I left at 10:30.

The following day, Friday the 18th of December they were planning on discharging my mother. Throughout the day I made phone calls to friends, Catie, and Kat mainly. My co-workers.

The oncologist came around 5pm. He took my mother's history, asking where she was from, if she had any other kids.

He told us that it could be three types of cancer: lymphoma, Islet cell carcinoma, or adenocarcenoma. The latter was the most common in the pancreas and the other two were a little more unlikely.

"If so then there is very little that science has to offer, unfortunately". When he said this all I could think was...yeah I know but...really?

A biopsy and an endoscopic ultrasound was scheduled for Christmas Eve at Beth Israel.

After many hours of weighing the benefits to my mother my cousin and I decided against it. A heavy snowstorm just passed through Belmont right before Christmas and Parveen, Jeff and I were shoveling the drive. She asked me

“What is the benefit to her to know that it's type a or type b? She'll still have that prognosis so what good does it do to her to stick a tube down her throat with a camera, a needle, causing her so much discomfort?”

I looked to Pubmed about everything I could find on Endoscopic Ultrasounds and their benefits and all such manner of articles. The figures showed no real benefit to the patient so I thought it best to spare her this on Christmas Eve, no less.


Returning to the oncologist's office for our 12 'o clock appointment my mother, my aunt and I were nervous. I don't know how nervous my mother was because she was just in pain and nauseous.

The oncologist walked into the waiting room and welcomed us into his modest office. I don't know why I imagined it to be bigger. There was barely enough room for the four of us.

I don't remember the exact nature of our conversation that day but I know that I felt calm around him. His voice, his mannerism, his ability to listen and let the patient and her family weigh things put me at ease. It also helped that he looks like my grandfather.

He gave her a prescription for a pain patch (Fentanyl), a very low dose to start.

The following weekend she did not fare well. There was no vomiting but lots of pain.

At this point I got her an appointment with Dana Farber. My mother's primary care doctor's office failed to fax relevant medical records so they cancelled her appointment.

Our oncologist saved the day and resurrected the appointment. He seemed to be on a first name basis with this doctor. He sent the clinic notes that I made a copy of for future reference and I gave a copy of the CT and MRI images on a disc for my cousin to take to the DFCI appointment at the Faulkner.

I did not attend the DFCI appointment, it was decided that they would do a nerve block and biopsy at the same time using the dreaded EUS technique. There was no way around the biopsy if we wanted to enroll my mother in any upcoming clinical trials. There are no clinical trials yet for pancreatic cancer at DFCI.

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