Out On a Limb Archives

Remembering and a Hard Lesson to Learn

One year ago this month, the nurses called from hospice at about 6 a.m. to tell us that they thought today would be "the day". For weeks before, we had known it was coming, known that her time was very short. The phone call just confirmed what I had felt anyway, that it was time. I called my mom, who lives 90 miles away, and asked her if she could come up for the day and watch our kids while we spent the day up at hospice. I couldn't expect, and truthfully, just didn't want, my children --3 and 8 at the time-- to be there when she took her last breath. It's hard enough just knowing someone you loved is gone, much less having to watch them gasp for air that never came.

My mother-in-law was 54 when she died from nasopharyngeal cancer.

In March of 2003, Rube and I were just getting ready to leave on a long-awaited vacation to New Mexico to visit Rube's dad and their family. The furthest south I'd been before then had been Denver, Colorado, so I was really looking forward to the trip.. We took one of our nieces with us--partly because we wanted someone else for the kids to play with, to help keep them entertained, and partly because I'm a sucker for my nieces and nephews, they all have me wrapped around their fingers almost as much as my own children. I just wanted to give one of them the opportunity to see and experience things that they would otherwise not have the chance to.

Two days before we left, we got a call saying that Rube's mom was going to have a biopsy performed that Monday. She had been having problems with pain in her head, double vision, etc... and had gone to the doctor. They had seen a mass in her head (not her brain), and had ordered a biopsy. Ruben talked to his mom, told her we'd stay, but she wasn't having it. She told us to go enjoy ourselves, and someone would call us and let us know about how the biopsy went.

So, we went, albeit without all the joyful anticipation we'd had before. We drove during the night, while the kids slept, and we didn't talk about it. To talk about the threat of "what if" made it too real.

We got to Albuquerque, where Rube's sister lives, that morning around 9. Got our hotel, got settled in. And we proceeded to start our vacation with the Albuquerque zoo, which has the coolest, most animated polar bears I've ever seen, lol! They were totally suckers for the crowd, doing routines on their own. Loved it!

The next morning we got an early call from one of Rube's sisters back home, to tell us the biopsy had begun, and they'd call when they found out anything. I think both of us already knew, or felt on some level, that things weren't going to be good. And when the cell phone rang with a call from one of Ruben's cousins at 11:00, while we were checking out all the great shops and stuff in Old Town, it only confirmed it. The results weren't official, but the doctor who had performed the biopsy said that it definitely looked like cancer, and that as soon as the official results came in, they would start making plans for her treatment.

We headed back to the hotel, so Rube could put in some calls to his family. I took the kids to the hotel pool to keep their minds blissfully ignorant, so that at least they could this one vacation where all was right in their worlds. When Rube talked to his mom later that night, and Rube told her we would go home, she stood firm and told us to stay, and enjoy ourselves, that there was nothing we could do at home anyway.

When we got back a few days later, we went to visit his mom, and found out more about her cancer.. It was malignant, centered in a place in her head that doctors refer to as "no man's land" because it is a place in our heads where it's a virtual tangle of nerves, veins, etc...

Nasopharyngeal cancer develops in the nasopharynx, an area in the back of the nose toward the base of the skull. The nasopharynx is a box-like chamber about 1 1/2 inches on each edge. It lies just above the soft palate, just in back of the entrance into the nasal passages. Although it is considered an oral cancer, it is different from most oral cancers. It tends to spread widely, is not often treated by surgery, and has different risk factors from most oral cancers. The nasopharynx contains several layers of tissue, each containing several types of cells. Different cancers can develop in each kind of cell. Here is a picture, courtesy of The American Cancer Society:

The area circled in red is the approximate center of my MIL‘s tumor, but located in the right side of her head. By the time it was found, it was approximately the size of a small grapefruit.

Her first appointment with the radiologist confirmed that Rube's mom would have to be here, in the town I live in, for her treatments. She was at stage 3, and we were told that the chance for success was 50-50. The plan for treating her cancer would be daily radiation sessions and chemotherapy once a week, for a total of 8 weeks.

At this point, my MIL was doing poorly. Because the tumor was getting in the way of the movement of her jaw, she had a hard time eating. Anything she ate, she had a hard time keeping down because of the pain killers they were giving her for the pain in her head made her nauseous. None of the anti-nausea meds seemed to help at all. She couldn't hear out of her right ear because the tumor was pressing on her ear canal, pinching it off. Her eyesight in her right eye alternated between fuzzy, double vision, and sometimes, nothing.

Before her treatments even began, she had to be put into the hospital, because she couldn't eat anything. The doctors put a peg tube into her stomach, through which liquid food (Ensure, etc...) could be poured in, to give her nutrition. It seemed to help some, and she was released a couple days later.

Not quite a couple weeks into treatments, she had to be hospitalized again. The treatments, and meds she was on, were wearing her system down. Her stomach no longer could tolerate the liquids given through the peg tube, and she just could not stop puking.. They inserted a pic line into her. This is like a small peg tube, about the size of an IV, with the same type of idea as an IV. It's a venous line that delivers a liquid of pure nutrients straight into her veins. Because of having to rely on the pic tube, the hospital kept her there for constant medical attention. The cancer center where she received her treatments at was connected to the hospital, so she still went to her radiation session every morning, and chemo on Mondays.

When she was about 6 weeks along, it became apparent that her body couldn't handle the effects of the treatment any better than it could handle the effects of the tumor. She was still having problems with her sight and hearing, but now her throat was tight and sore, and she could hardly speak. Radiation had to pass on her throat to get to her tumor, and in the process, it destroyed the glands that produce saliva. Often times, she was living in the past, unaware of things around her, forgetting people sometimes, and where she was. But most of the time she slept. Her body was so torn down, it needed that constant sleep to try and regenerate.

Finally, the oncologist in charge of her case, gathered us and all the family together, and told us that according to X-rays they'd done a few days earlier, there was virtually no change, only about a 6% reduction in size. Also, the tumor was growing towards her brain stem, and was only 5 mm away from it. I remember thinking; she's gone through all this crap, for nothing? I was so angry. The oncologist went on to talk about enjoying the time we had with her, and to encourage her to get well, yadda yadda yadda...I don't think any one of us were paying much attention. It's hard to when you're faced with the fact that someone you love is going to die, painfully, and there is nothing you can do without it.

To buy us, and her, whatever extra time we could, my MIL finished her week and a half left of scheduled radiation sessions, then began the task of trying to get well. It helped a lot that the chemo had stopped, she wasn't so violently ill all the time, and eventually, we could take her off the pic line, and back to the peg tube. It still amazes me that for months, that small tube was her only source of food and nutrition.

After we got her back on the peg tube, and she was feeling better, we were able to move her from the hospital to a nursing home, where her body could recuperate but she‘d have access to medical help. And it did help. She started to feel better, could take the meds she needed; she was able to tolerate drinking water, then broth, and then Popsicles. She was even able to tolerate small spoons of Jell-O once in a while. All of us were filled with a sense of anticipation, as we seen her getting stronger again. We couldn't wait for the day we went to the home for the last time, to pick her up and take her home.

Then we went to visit her one day, and the right side of her face was swollen, with her eye on that side looking like a tiny slit had been cut across her cheek. The tumor was cutting off the drainage from her lymph nodes. When we came home that night, I think both Rube and I knew that she was coming down to the wire, and that we'd never get to take her home.

A week or so later, she began having problems with her peg tube again, and keeping stuff down, so she was put back onto the pic line. The family was approached again. It was getting close, did we want to move her to Hospice, a terminal care facility.. So, at the beginning of November, my MIL was moved one last time.

The focus in any terminal care facility is not healing, but to make them as comfortable as they can in their passing. But they also went above and beyond in ensuring that we all felt as much at home there as we could. I can't say enough good things about the Hospice program here. Everyone there, from the doctor to the nurses to the cook, was just phenomenal.

Once it began, it was like a mudslide coming down. She was unable to take any liquids in her mouth, so her mouth, tongue, and throat was just one giant, dry sore. She lost control of all bodily functions, and pretty soon, the urine in the catheter bags was orange from dehydration, and from the kidneys starting to shut down. Every breath was a gasp, even when she was sleeping. You could literally see the muscles in her neck and throat working hard to draw that breath into her chest.

She would try and talk to us, and sometimes she'd talk about people who'd already passed on, sometimes she would talk to those deceased, like they were in the room with her. And more than likely, they were. Sometimes you could understand what she said, and sometimes you couldn't, due to the dryness and deterioration that the radiation had done to her throat and speech, but always, she knew we were there with her. Every day, including the last.

After I called, my mom got here around 8:30 that morning, and we kissed and hugged the kids, and left. There was so many of the family there with her that day, as had been for the last few months. Us, Rube's sisters and brother and their spouses, a couple of her sisters and a brother, some cousins, nephews, and nieces. We were all there, to be with her, when she needed us, if she needed us to help, and we were there for one another, to offer a shoulder, or take a hug.

Surrounding her bedside were her children, and their spouses, just watching her laboring to breathe, hearing her gasp, and trying to come to terms with it all. We spoke to her, held her hands, and rubbed her legs, talked about all the good times... And then it was as if we all knew it was coming, because we all shut up, and the room got quiet, and I KNEW it was coming, it was almost a presence in the room. And I turned my face away because I couldn't watch (I'm SUCH a weenie). I heard one of her sister's say, "What's wrong?" and then one of my SIL's said, "She's trying to breathe and she can't. She can't breathe. She can't breathe." And His will was done, her spirit carried far away, where she no longer had to painfully struggle to exist in our world. She was free, but God, how it hurt.

She left me with something though, as I'm sure she's left everyone else with something too.. She taught me a lesson that even when you think someone has done wrong in this world, even when they broke your heart or caused you pain, at the end of things, it doesn't matter. You let go of your resentment, and just love.

You see, what separates this from perhaps every other cancer story you've read about this disease striking down some person who was in their prime and was long-adored for their charitable contributions to life and society, is that my MIL wasn't any of those in her life before cancer. She had made many mistakes in life, in men, raising her kids, and even in treating some of her grandchildren.

I always hated seeing someone die, and all of a sudden those that had talked the worst about them, were the first to "rewrite" their past, and turn them into some saint that walked on water. But now I realize that in most cases, stuff like that doesn't come from some egotistical, much-too-late need to put up a shrine to someone they talked so bad about to make themselves feel better. And it's not about rewriting history either, or shouldn't be. It's about letting go.

I was probably one of the worst to talk about my MIL. As a mother, I had no respect for someone who had put their children through what she did knowingly, and of her choice, and as a woman, I hated how she often times stuck her current novio's wants and needs before those of her family. I hated watching her call her other grandchildren on their birthday or giving them presents, and yet my son would ask why grandma never called him, or gave him anything. I hated her fiercely when one of her boyfriends called my son retarded because of his speech impediment, and she LAUGHED. I hated her SO much for not only NOT sticking up for my son --her grandchild-- but for laughing at him.

I hated so much. And then the day before they put in my MIL's peg tube, we went to the hospital to visit her, and that's when I was able to let go. Seeing her emaciated form lying there --she had lost 40 lbs. before she even started her treatments because she hadn't been able to eat--, crying, puking, frightened, defenseless, and KNOWING that things didn't look good, I just let go. It's not that I forgot what she did, or said that the things she'd done were okay. I realized that all we had, all she had, was the present, and that was all that mattered.

She taught me that the past should never be forgotten, but it should never be rewritten also.. It should be remembered for all it was, or wasn't. The good moments should be treasured for what they were without letting the bad stuff muck it up. She taught me that the future, whether it’s minutes or years, is not a guarantee, regardless of prayers, hopes, or dreams. She taught me to wake up every morning and appreciate what IS, instead of holding onto hurts from yesterday or hanging my happiness on "I'll be happy when…” or "I'll be thrilled if..." or "I wish that...".

She taught me a hard lesson, but it’s one that, a year later, I still haven’t forgotten, and never will. Thank you, mom.

Dedicated to Betty “Tigger” Najera Archuletta

July 23, 1949 - November 16, 2003

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