Of Pirates, Pioneers, And Being Heard

As he stood before me, he nodded somewhat unwillingly. “Okay, fine. Just one picture…”

Chase was going to “his hospital”, and he was going as a pirate.  Because nothing says “this is who I am” like a pirate costume. Due to a slight cold, I would not be joining them on the oncology floor that day and so it was extra special because it was “time for just Chase and Daddy” – the very best.

Occasionally, I drop hints in my writing about Chase’s aggression and I have trouble doing much more than that for several reasons.  I think mostly because there is rarely any redemption or beauty that would benefit you from reading about it in greater detail. It is sad and ugly and Chase is deeply ashamed of it. Whenever we talk about what happened during his angry moments, he dissolves into genuine tears, promising never ever to do it again.

And so, there has become this other quiet side to our lives that in some way seems less real because I don’t write or talk about it the same as I do other facets, and yet, it is extremely real and taxing in our home and on our family.  

Over the years, Bob and I have experienced shock and judgement on the occasions when Chase’s struggle rears it’s head in public.  There are comments and suggestions, and the response that always breaks me a little: tears and the quietly whispered aside – “I don’t know what to say but I’ll pray”.  I think I’d say that same thing to me if I were seeing it from the outside for the first time too. 

And over the years, as people have witnessed the struggle in hospital and out, we’ve been told that we as parents were overindulgent and we must be spoiling him, that Chase needed boundaries, that he needed more control over life choices, that we were giving him too many choices, that we weren’t treating him normally, that we were treating him too normally, that the anger was his reaction to the out-of-control-ness of life in cancer treatment, that it might be the anti seizure medication he takes every day, that it stemmed from anxiety, that we needed to change his diet, that we needed to change his supplements, that we needed to change his environment, that it could be circumstantial, and various other things.

One of the hard, out of control moments
One of the hard, out of control moments

We’ve thought many times about getting help for him, but weren’t even sure what “help” should look like or who should provide it.  We were often told that he was too young and his brain was still developing too much for anything to be of assistance, and were even told at one point that some specialists had no paradigm for a child who’d been through the extreme brain and emotional trauma that Chase had experienced.  It was as if everybody knew on some level that it was happening, but nobody knew how to deal with it or what was at it’s root.  A very isolating feeling.

Hearing that it was something we were doing was especially difficult. In the first week that Chase was diagnosed, Bob and I had determined that one of the very best gifts that we could give him was the gift of normal.  His life had become extraordinary and we desired to keep that out of his way as much as we could, and so, we instituted loving boundaries in and around the chemo and treatment.  How do you give a “time out” to a child whose life is a giant hospital bed punishment? You can’t… but maybe if a toy got thrown in anger, then the toy went into time out for a few minutes. Small things like that – the things that made him like his brothers and sister, like the other kids outside the hospital walls.  But it was a constantly changing situation in which we were (and still are) always having to weigh out what’s chemo damage, what’s tumor damage, and what’s Chase. It was during this early season that I found the phrase I love so well: “There are only so many hills you can die on.” But despite our efforts, the rages continued unchecked. We felt like we were doing everything good parents were supposed to do. How was this our fault?

We plunged forward and fought these fights ever week and sometimes every day, and yet, we’ve felt largely unheard.  Not because anybody’s ignoring us, but because I truly believe that the pediatric cancer survivor field is still significantly unfolding in this area. Think about it: Chase’s cancer has only been defined by name for about twenty years and it’s only been about seven since his treatment began as a clinical trial, changing statistics from completely terminal to marginally terminal, and suddenly, Chase’s generation of survivors are living long enough to really see what happens after the dust settles.  Some days, our lives feels like the cancer equivalent of the old Oregon Trail – where we just circle up the wagons and try to survive. 

Bob and I often liken Chase and his treatment to a house fire. When he  was rushed in with his large mass, he was a house consumed. The teams of doctors were almost like teams of fire fighters, working collectively to extinguish the deadly blaze on all levels. You do what you have to do to save.  And then we were done and thankful… But, who helps rebuild the house?  You can’t expect the firefighters to do that for you.  

Chase works with a occupational therapist during chemotherapy
Chase works with a occupational therapist during chemotherapy [photo credit: Cameron Dantley]

This is ultimately what lead to Chase going to the hospital as a pirate this cold winter morning – we were on a search for builders – master builders. (Sorry, this is what happens when you’ve watched The Lego Movie a couple hundred times with your kids) It was time to work at rebuilding and Chase’s primary team of doctors had recommended that he was now old enough for a neuropsychology evaluation.  We were cautiously optimistic, having been warned that it may not explain his aggression, but would definitely show some of his strengths, weaknesses, and how he learned.  But we could still hope. Maybe there would be something – anything – that could provide us with a clue as to how we could help him.

And so it began, hours of testing, piles of paperwork, and then a two hour meeting for which I was conferenced in. And Chase sat in the back of the doctor’s office and over the speaker on Bob’s phone, I could hear Matt Redman singing “10,000 Reasons” from the iPad. Some things never change. But what we learned in the meeting was both life changing and life amazing.

I marvel how so many cancer parents know exactly where their child’s tumor was located in the brain.  I am not one of those parents. I asked some other crazy and weird stuff at the time of his diagnosis, but I never asked exactly where the tumor was located. At 6cm with midline shift and tumor cell metastasis, it seemed to be everywhere.  Which is why it stopped me dead in my tracks to realize for the first time in three years that Chase’s tumor decimated his language center.  Did you hear that? Chase shouldn’t be able to talk.  I need to say that again because I want it to really sink in.  Chase shouldn’t be able to talk.  Those of you who have met Chase know the truth, and I’d like to think that through this blog, even those of you who haven’t met Chase know the truth.  Chase talks.  Oh my word, does he talk! And well, too. So take just a moment and breathe in this insane miracle of a brain that, freshly cut and traumatized, made the decision to move knowledge to a safer area, and compensating for itself, retained power of speech even after hours of being open on an operating table. God is good.

But the damage and the compensation and the radiation all carried a price and it had to come from somewhere. In this meeting, we found out that it had been taken out of a few areas, including Chase’s executive functions – his emotional regulation.  

What followed were long and breath-taking explanations in which instance upon encounter began to click into focus and understanding for us, and several times, I was tempted to burst into tears on the conferenced call just because the meeting was the most incredible revelation.  

There are only so many times you can be told that you’re doing something wrong as a parent before you begin to believe it, and this meeting was the first time in a very long time that it was acknowledged and known beyond a shadow of a doubt that Chase’s aggression isn’t due to something we’re doing or not doing. There is damage, it is real, and we learned that there might actually be ways to heal, or at the very least, help.

There is not a magic cure. The process of working with a traumatized brain like Chase’s is a life-long one.  There will be more therapies, more meetings, and possibly even medication to help retrain and replace some of what has been lost.  And this will change and grow as Chase changes and grows.  

So why do I share all of this?  First, because if someone had told me three years ago that survival would be this complicated, I wouldn’t have believed them.  And there are a lot of struggling survivors around almost all of us, so look to them with understanding and grace.  Second, neurological issues are often simple in their exhibited symptoms yet mind-blowing in their actual complexity. So, the next time you’re in a store and you watch a mom deal with a screaming, wailing, kicking, on-the-floor child, know in your own heart and mind that it could indeed be an issue of boundaries and you might do something different if it were your child…or it could be that her child’s shirt hides multiple port scars and his hat covers a giant resection scar and that mama is dying just a tiny bit inside because she doesn’t know why he’s on the ground, what made the anger so great over something so small. And as you watch her, know that she’s been to places that broke her and she’s being broken once again in the aisles of a store and she wishes for just a second that things were different.

We are so deeply thankful because, three years ago, we didn’t even know if Chase would live let alone function, but we are weary parents, and the bald pirate has a long road of work ahead. So we rely on neurological sciences, survivor breakthroughs, and prayer – knowing that our seemingly accidental stumbling through it all is part of a good and hope-filled master plan. And we begin yet another facet of this life . . . moment by moment.   

“…More than 95% of survivors will have a chronic health problem and 80% will have severe or life-threatening conditions.” – St. Baldrick’s Foundation

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Marking A Year Of Another Kind

Bob and Chase preparing for the MRI - Thursday, August 14, 2014
Bob and Chase preparing for the MRI – Thursday, August 14, 2014

We’re supposed to “throw back” on Thursdays and “flash back” on Fridays and today is yet another date to mark.  Recently, we’ve had an awful lot of “one year ago”, “two years ago”, and so on, but sometimes the days are really long, the years are short and stressful, and rehearsing our previous survivals and God’s goodness to us in them is the only way to keep breathing.  And so, we go back…again.

One year ago today, I stood in the barren kitchen of a newly bought house (a seeming symbol of a fresh start), staring out at the view that would be my new back yard, and listening to the voice on the other end of the phone as my stomach dropped: “His spine looks clear and overall, his brain looks amazing, but…”

Those words kicked off a season of deep shadow that has been some of the most difficult waiting since his initial diagnosis.  The every six week scans, the waiting for growth… 

But today, we are stopping to mark and remember that Chase has now lived for one year, one whole year with his tumor bed growths/radiation effects/whatever they are and he’s lived as fully and well as ever he can.  We’re so thankful.

It’s incredibly frightening to write these words -about how well Chase is doing and how long he’s gone without an issue- when he’s about 72 hours away from another MRI.  But no matter what happens in this next week, today is a good day and we’ll take it one breath at a time in the… moment by moment.  

Do not be afraid or discouraged, for the Lord will personally go ahead of you. He will be with you; he will neither fail you nor abandon you.” Deut. 31:8

Answering Questions

Since Chase’s most recent evaluation, we have received quite a few inquiries which have led us to compile a list of frequently asked questions.  Feel free to tack on other questions in the comment section at the end of this post.  Our hope is that this assists in both the understanding of Chase’s treatment and gives a small window into the life of a pediatric cancer patient (a world in which Chase is one of way too many).

1. Why does Chase still need chemo if the cancer is gone?
This is probably the question we hear most often, and here’s the answer.  The scans showed that the tumor deposits are gone and while they don’t see any more tumor or cancer cells, he isn’t considered “cancer free” because there could be more cancer cells free-floating that just haven’t manifested themselves at this time.  And even if his body was completely cancer-free at the moment, this is a vicious, virulent cancer known to recur in the first 18-20 weeks after diagnosis.  Think of it like a weed in your garden or yard: not only would you pull out the weed that you see, but you would also desire to make the ground (via a weed killer or the like) as inhospitable an environment as possible for the growth of any further weeds.  Think of this stage of chemo as both an errant weed killer and a future weed deterrent.

2. How much more chemo does Chase need?
The chemo schedule (or “protocol“) that Chase is on calls for a total of 51-54 weeks of chemo.  At this point, he has completed 17 weeks or cycles (it’s actually been closer to 20 actual weeks that have passed as his earlier chemo dates were often slightly delayed by his fevers and low counts).  He will probably complete his chemo regimen around the first anniversary of his surgery and diagnosis.

3. Why does Chase still get fevers and need blood and platelets if the cancer is potentially gone?
Chase still gets fevers and needs transfusions because those are side effects from the chemo, not the cancer.  And yes, it is harsh… but dying of brain cancer would be more harsh.

4. Can this kind of cancer spread?
In a manner of speaking, yes.  For more technical information on this, I’d highly recommend checking Wikipedia’s AT/RT link.  In laymen’s terms, I can tell you that AT/RT has rarely been seen to spread beyond the brain and spine.  On occasion, it does move to the kidneys, but that usually only occurs with the genetic form of the disease.  Hence our flying Chase’s tumor to Boston to be studied by a geneticist and having his kidneys checked (it was concluded that Chase does NOT have the genetic form of AT/RT).  Could he possibly be at a heightened risk for more cancer and other cancers in his lifetime because of his AT/RT?  Very probably.  But it’s not happening today, so we’re not going there today.

5. Chemotherapy vs. Radiation?
In Chase’s case, he needed both.  His protocol calls for a chemo induction, then a reduced chemo schedule during radiation, and pending a good evaluation, a slightly reduced chemo schedule for the duration of the 51-54 weeks.  Evidence suggests that they have not had success curing AT/RT without some form of radiation.

6. Does Chase understand cancer and his diagnosis?
Chase understands that he doesn’t feel well and that there are all sorts of things that have to happen to him, but he has no paradigm for words like “terminal” and “malignant.”  Not only is he just three, but he’s probably suffered some memory damage, so it’s actually a little unclear on how much of his life he even recalls before his diagnosis.  To him, being in and out of hospitals is just a way of life.  In fact, he loves his hospital because he’s a bit of a big deal. 🙂

7. What does Chase eat?
Nothing.  Many of the chemo drugs give him nausea and a couple of them give him painful sores that can go anywhere from his mouth to his esophagus and even intestines.  Early on in his treatment, Chase was put on an IV nutrition system to ensure that his body maintained nutrition, weight, electrolytes, sugars… all the essentials needed to survive.  As of today, Chase is attached to a bag for 16 hours of every day.  He does at times put a bite of food in his mouth, but usually spits it back out. 

**Sidenote: Chase “attaches” to the bag through his central line – what is basically a surgically inserted tube into an arterial vein in his chest.  The tube splits on the outside of his skin so that there are two lumen (or small hoses) through which he can be “accessed.”  When he is not accessed (meaning the tubes are not in use), they fold up neatly into an ace wrap that covers his chest.  This is the site that needs the dressing change every week.  Because of this, Chase is at increased risk for things like infection and pulmonary embolism.  However, the benefit is that he is virtually “needle free.”  All labs, chemo infusions, and most medications can be administered in his line which is such a blessing!  For this, we are more than happy to figure out the no swimming, no bathing, “carry a crash kit everywhere you go” lifestyle of a small child with (in his own word) “tubies.

8. Does Chase sleep?
The answer to this question is multi-faceted and best-answered “at times.”  The chemo and (especially) radiation have highly affected his sleep patterns so he suffers from disturbed sleep.  Every night is not created equal.  Some nights, he’s up only a couple of times, and others, it’s every 20-30 minutes all night long.  For now, there are two things we know about this issue: it’s almost guaranteed to happen every night and, per a word with his attending oncologist, doctors have seen sleep improve greatly when chemo is done. 

9. What are the long-term effects of this cancer and the treatment on Chase?
This is a question we don’t have verbalized to us very often, but I think it’s one that everybody considers, so I’d like to try and address it a little even though it’s hard to define at this particular moment.  We know that due to the tumor placement and size, there was most likely some brain damage, especially in his memory center.  Not so much like amnesia; more as in damage that will cause him to struggle to make memories in the future.  We also know that a couple of the chemo drugs Chase is taking could likely damage his heart and his hearing.  This is why he gets (and will get for the rest of his life) scheduled EKGs and hearing tests.  In fact, we have already seen small evidences that his hearing is changing.  Lastly, we know that the radiation (even proton radiation) is known to cause brain damage and stunted spinal growth (not in all cases, but Chase had his whole brain and whole spine radiated).  This is at times hard to discuss because many of these potential difficulties to overcome are based on our treatment decisions and are (at this moment) hypothetical.  What we know right now regarding Chase’s future is what we’ve always known to be true: our hope and joy come from God alone.  I so love the phrase coined by the mother of another brain cancer patient: “Defined by God, not by cancer.”  So we will meet and undertake each new facet of Chase as it becomes apparent… moment by moment.

I believe that it is very easy to get overwhelmed by all these definitions and descriptions.  In fact, I get a tightness in my chest every time I list all these things we do in a single day and all the life-time implications they hold.  With this in mind, let me end these questions and answers with a reminder–to myself and to any and all who read: Chase was designed this way by God.  God has–in His all-knowing, perfect and loving mind–designated cancer as the awful yet awesome refining for Chase and, by extension, our family.  We will consider it joy then, because we will someday see Jesus, and be perfect and complete (James 1).  And in whatever life God has for Chase, we see promise because we know that he has been fearfully and wonderfully created by a God who loves him more than we can fathom (Psalm 139).

Moment by moment.

How To Fry Cancer: A Typical Radiation Day

At the time I started writing this post, Chase had completed 17 of his 30 radiation treatments.  He has now completed 22!  These radiation days can be pretty intense and it’s not unusual to start the day in one location (usually home) and end the day in a completely different location (the hospital).  So as you can imagine, these days are never, ever dull.  [sidenote: “Chase” and “dull” are rarely in the same sentence]

Here’s what a normal radiation day looks like … no wait, scratch that.  Here’s what a radiation day last week looked like (we reserve the word “normal” for the days we don’t arrive in an ambulance).

Chase arrives for radiation on the hospital transport. The mask is to hopefully minimize the germs…when he remembers to hold it in front of his face.

There is a beautiful built-in fireplace which runs the length of the waiting room wall (picture a lovely five start hotel lobby) and Chase loves it.  In fact, he refers to the radiation center as his “fire hospital” – not to be confused with his “fishy hospital” (a name derived from the aquarium in the lobby of his primary care hospital).

First, Chase gets his vitals done (blood pressure, oxygen saturation, etc) – which he hates – and then he gets to put a sticker on his sticker chart – which he loves.  The radiation center staff kindly provided a sticker chart tailored to each child so that they can “check off” the days and see the progress they’re making.  Chase’s chart was presented to him with Cars characters on it.  Do they know him or what?

Here’s the sticker chart from around Day #6…
Chasey with his radiation nurse, Roshena. He loves his “Miss Roshena” and I believe he’s actually proposing to her with a plastic ring he found in the sticker box. So classy.

After he’s “cleared” for radiation, we walk to the room he calls his “spaceship“.  This is the time when he’s usually clutching the iPod and listening to/singing with 10,000 Reasons.  I wish I had better pictures of this room.  One of the most striking things is his mask lying by the table.  I can actually see his profile in the contours of the mask and I find myself staring at it every time we go in.

The radiation mask
In the “Spaceship” – the anesthesiologist administers the drug as Chase falls asleep on my shoulder (sorry about the blurry quality – this was as good as we could get)

Almost every day, as Chase falls asleep, he says “I’m so brave, I’m so brave...” over and over to himself.  It took me almost two weeks of this to get to the point where I wasn’t crying as I walked out of the room.

After Chase is asleep, I leave him in the “spaceship” and wait in the lobby.  On this particular day, I had a particularly wonderful “Good Samaritan” who brought me a particularly needed drink.  In other words, my dad brought me coffee.

Thanks, Dad!

After radiation is complete, the nurses allow Chase to sleep off the anesthesia for a little while, at which time, I join him in recovery and once they’re sure he’s stable and alert, we are free to go.  Sidenote: for Chase, “alert” usually means “ninja“.  A side affect of anesthesia for him is crabbiness – which means it takes three people to get him dressed on many days.  A sidenote on my sidenote: when you read that last sentence, please don’t shake your head or cry at the thought of adults struggling with a small boy.  Picture with a small, wry smile on my face as I type because I love his fight and although it is at times overwhelming, his stubborn, ninja-fighting, never-say-die attitude is a perfect God-given match for his cancer.

This day (that I took most of the pictures), we finished it as we’d started: on an ambulance.  Once he got back to the hospital, he was given a little more chemo and then we were able to be discharged!

Back in the ambulance bay and sleeping off the morning – head shining with post-radiation lotion.

…and that is one of our more average radiation days!  (ambulance and chemo not included)

Moment by moment.