The Chronicles End

Who knew that the hospice by the Big Rocking Chair was foreshadowing?

For the first few days after returning home the pain was manageable, but as the course of steroids began winding down on Tuesday some more intense breakthrough pain prompted a trip to urgent care. Not much came of it that day, other than to move up a couple doctor’s appointments. However, things changed dramatically on Thursday night, becoming a repeat of the previous week: again debilitating pain that a bath could not solve and thus another trip to the ER. However, this time the visit lasted all night and resulted in admission the next day. As multiple CT scans failed to identify a clear cause, an MRI was finally conducted on Friday evening.

At midday on Saturday, we received a visit from one of the doctors from Dr. Saha’s oncology group, who had been begun consulting with the hospitalist and palliative care team to help identify the problem. Having reviewed the MRI along with the various other scans, he delivered absolutely shocking, stunning news.

Five spots on the pelvis. Two lesions on the liver. This was metastatic breast cancer. The date was October 1.

Over the next few days, more tests clarified the prognosis so that the oncology team could develop the treatment plan. A viable oral pain-management regimen was also developed, leading to a discharge on Thursday. That morning’s Today show had a segment on a woman who had beaten MBC four times, so things looked promising! After dealing with a couple glitches in getting a couple of the key prescriptions filled, the weekend was manageable and allowed for completion of the second round of challenge #3 in the NYC Midnight flash-fiction contest.

The following Monday—the date was October 10—Dr. Saha laid out the treatment plan: three cycles of an immunotherapy regimen, then reassessment in January. No chemotherapy. No hair loss this time! The first injections were done that day and the oral medication was ordered so that the regimen could commence the following weekend. Things were looking up.

Until Wednesday morning. Around 4am the pain flared up, but was temporarily brought under control by one of the quick-acting, as-needed meds. But by 6:30am that had worn off and the pain was now the worst it had ever been. The night doctor could hear her agony over the phone but the only advice he could offer was another trip to the ER for strong IV pain medication. By 8:30am a ketamine drip finally vanquished the pain but led to a readmission later that afternoon.

Over the next few days, the pain was more or less brought under control, but downward-trending blood and liver-function counts prompted a transfusion and growing concerns from the oncology team. Over the weekend, they determined that the cancer appeared to be moving faster than the immunotherapy could likely handle, so that regimen was put on hold and instead the treatment plan was changed to ten radiation treatments and a multi-week course of chemotherapy. Severe breakthrough pain in the wee hours of Monday morning, along with some scheduling issues among the various hospital departments, resulted in a hectic day, but the first radiation session and chemo infusion were completed by Monday afternoon.

The date was October 17.

For the next couple days, things seemed to be going in the right direction: blood and liver counts were improving, pain was manageable, and she simply looked like she was getting healthier. However, things took a sudden downturn on Friday, so they decided to move her to the ICU Friday evening. At that point, there was no indication of an acute issue, they simply felt that the ICU was better equipped to move quickly to stabilize any changes in blood counts. On Saturday that seemed like a good call: she was fairly stable, and enjoyed visits from her parents and brother and a close friend, all while enjoying a nice view of autumn leaves on a gloriously sunny day. She finished the evening with a couple rounds of Hallowe’en-themed MadLibs, which seemed perfectly normal other than being in a a hospital bed.

That was the last time she was herself.

Another rough night ensued in terms of pain, and this time her blood counts also seriously deteriorated. By mid-afternoon on Sunday, the oncologists pulled no punches: the counts were indicating the beginnings of blood and liver failure, and unless there were any signs of improvement there—soon—she would no longer be a candidate for chemotherapy treatment. And that is exactly what happened: on Monday morning, the decision was made that treating her pain was the only option left.

Fortunately, the signs were clear enough on Sunday afternoon that there was enough time for her loved ones to gather. With the assistance of a wonderful nursing team to ease her pain, she finally finished her fight with cancer surrounded by family and close friends.

The date was October 24. Her 48th birthday.

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Thus, the Lizard Chronicles are now complete, albeit far too soon. On behalf of her, we thank all of the readers of this blog for the support over the years, and you should know that she derived great joy from seeing that people were reading and engaging with her posts. Elizabeth is no longer physically with us, but her stories and ideas will live on as long as we continue to read her words.