Mum's Next Steps - Anticimpatient

There ought to be a name for that specific kind of anticipation where you are impatiently awaiting news that you don’t really want to hear; I presume the Germans have one.

Our family honestly didn’t have to wait all that long for the news about Mum, it only felt that way. We saw the neurologist serving as Mum's doctor on Wednesday, and he largely confirmed what we already knew: that Mum was unlikely to be going home any time soon. She is so frail, in fact, that she is not only ineligible for chemotherapy, but they don’t even want to do a biopsy, for fear of her having another stroke when they take her off the blood thinners, or even spreading the cancer further.

The doctor said Mum had suffered between 30-40 small but damaging strokes, like a shotgun blast to the brain. The word he used to describe how these clots can avoid simple detection and mask their symptoms for as long as these ones did was both ominous and telling; he called them “insidious.”

He agrees with Tara and I that our goal at this point has to be Mum’s quality of life, and that a transfer to palliative care is what’s needed. This brought us to the discussion of timelines; just how long are we looking at here?

The oncologist had told him that based on the spread of the cancer and it’s placement, we are probably looking at four to five months.

Now, obviously, these are only estimates and are subject to change with Mum’s condition and strength, but it really puts things into perspective when you realize that, just like Dad, Mum is unlikely to see her 80th birthday.

At any rate, with chemo for the cancer and intensive rehab for the stroke both off the table, the next step would be moving Mum into some sort of palliative care situation, preferably in Leduc so Tara can be at hand in Mum's apartment and her friends can visit easily. The neurologist started the ball rolling, and we awaited the consultation from the palliative team. 

When we met with him on Friday, he agreed that moving her to care centred on her comfort was the right choice, and signed off on the request the neurologist had already put into motion.

In the meantime, the strength in the right arm comes and goes - the musculature is there, and listening, but the signal doesn't always get through. It's like a bus route that's been disrupted by construction and has to improvise a detour every time.

Mum's level of comfort is still reasonable. She is still frustrated at her inability to articulate what she is thinking, but is actually quite good at the fill-in-the-blank questions the speech pathologist left with us (e.g. "We ride a (bike). We bake a (cake).") Hopefully more connections will be made over time making it a little easier for her to communicate.

I am going over in the evenings most days, and occasionally in the afternoon, so yesterday was the first opportunity in almost a week for Audrey and me to take her out and about in a wheelchair. I don't know how interested Mum would be if not for all the attention Willow gets. The number of smiles she brings and conversations she propagates with complete strangers is absolutely stunning.  Everyone marvels when told she is not a puppy but seven years old, and it has encouraged a number of people to ask about bringing their loved ones' dogs in for a visit, which is very gratifying.

It prompted a chuckle from her when a man approached saying "What a cutie," and I deadpanned "You can't talk about my mum that way, mister," in response.

We brought Mum down to the first floor Starbucks and grabbed a couple of latte's, sharing spoonfuls of whipped cream and sweetened coffee with her. We explored the gift shop and a couple of kiosks set up in the open area before heading into the art gallery they have on-site.

The McMullen Gallery features an intriguing array of pieces by Alberta artists in a variety of mediums and is easily accessed by wheelchair. If you happen to be in the neighbourhood, I highly recommend checking it out. Mum's eye was caught by a series of intensely coloured plaques adorned with ribbons, while Audrey and I were intrigued by the rubber boots decorated with wheat. The abstract painting of grain elevators struck both us, reminding me of the one in Leduc where I grew up, and her of her father who painted them as his first job after coming to Canada.

It was a good little outing, and got Mum out of her bed for more than two hours, during which time we got our picture taken together outside the gallery and she also had a friend visit from Leduc.

After bringing Mum back to her room for a nap, the charge nurse let us know that a palliative bed had been found for her in Leduc, and they expected to be transporting her by ambulance in less than 24 hours. Tara found out the news shortly after we did, immediately after arriving at the hospital.

Audrey and I stopped for groceries on our way home, and Tara called just as I was putting the burgers on the grill - Mum was already on her way, and Tara was following the ambulance to Leduc Community Hospital.

Mum is now in place in Leduc but found the ride very disruptive. She was very restless today and complained of her first real discomfort, which they gave her morphine for. 

None of us really know what is specifically involved in terms of palliative care, or whether or not their specialists can do something about Mum's lack of appetite, but at least now she has a room to herself, fewer tests with less poking and prodding, and the staff all seem excellent thus far. I will probably be spending most of my evenings in Leduc this week, and plan to overnight there on Thursday so I can visit with her during the day on Friday, which I have off.

But now we are back once again to waiting; unsure of what we will learn, unknowing of what the future holds and uncertain of what we even want to have happen. We know where the road is going, and now pray we can take a route that suits Mum's wishes.

Flowers On the Wall

Mum's situation has made me (among many others in my family) a semi-resident at the University of Alberta Hospital, which, let me tell you, has redefined "labyrinthine" in my personal lexicon.

Despite their institutional habit of numbering every door in a  consistent and logical fashion, finding one's way around the hospital from a multiplicity of entrances can be a real challenge. I made a single wrong turn in the basement on my way back from the parking office and experienced a brief moment of genuine pants-browning error when I realized I had no earthly idea where I was.

Thankfully I was able to retrace my steps and, with the aid of some helpful signage, recover my route without too much delay, but it is a legitimately confusing place. Fair enough, I suppose; it is over a century old, with buildings added on to buildings added on to expansions and so forth. In point of fact, it is not really a single building at all - the Walter C. Mackenzie Health Sciences Centre contains both the University Hospital as well as the Stollery Children's Hospital, and although the Mazankowski Alberta Heart Institute is decidedly attached to the physical site, it is its own entity.

Having travailed the quest in the basement and obtained the fabled Pass of Parking (Monthly) and returned without having to face the minotaur who almost certainly dwells at OH1.00 WMC, my routine parking spot has provided me with the opportunity to establish a routine, uh, route, on the way to Mum's room most days. I made an intriguing and synchronicitous discovery last week on that route which has a tinge of kismet to me that feels more encouraging than distressing.

I enter 4th floor through the Guru Nanak Dev Healing Garden, probably my favourite part of a place I have every reason to resent. It is a lovely space, donated and dedicated by Edmonton's Sikh community and filled with living plants, bright, natural light, running water and intriguing sculptures.

Working my way down a number of halls with all-too-common features, it is still easy to lose my way, but I know I have come to the right place when I see a painting of flowers next to the small lounge close to Mum's room.

It's a simple, pleasant painting of flowers. The white lilies stand in stark contrast to the dark background, giving the work a bit more drama than you might expect in such a setting.

I finally took the time to read the plaque on the frame a few days ago, and was tickled pink when I discovered the title.

The next time I walked past the painting with one of the girls, I said, "This is the painting that tells me I am on the right path to get to Nanny's room. It's a good waypoint for navigation because I can pick it out from down the hall, but I am really starting to appreciate it as a work of art as well. Do you know what it's called? Why don't you check the plaque on the frame?

That's a bit on the nose, isn't it?

Knowing that the beloved matriarch that the girls call "Nanny" is just a few feet away from a painting called Nan's Lilies, listening to the Statler Brothers on an ancient Walkman that Tara rediscovered, is almost too much.

Sometimes it feels like the universe is filled with patterns I either don't recognize or perceive, or am baffled by when I do, like symbology glimpsed in old wallpaper when you stay up too late and look at it for longer than you should.

Good News, Bad News and Mum

June 2010

It turns out that Mum has had a number of strokes, but the bigger issue is that the strokes are probably being caused by cancer.

I'm sure that has shocked a lot of you reading this, and I'm sorry about that, but I needed to get the toughest bits out of the way upfront, and there is no point in being coy about it. 

Had I wanted to be coy, I would have opened with the observation of how many of those familiar old  "Good News/Bad News" jokes take place in the hospital. And this is a good news/bad news story in some ways -  it just lacks a happy ending.

The good news is that Mum survived her stroke. God bless her friends Lorraine and Judy for checking in on her and getting her to the hospital. The damage to Mum's language centre is causing aphasia, which means she can comprehend what is being said to her, but she can't always articulate what she wants to say. This would be frustrating to anyone, but for someone as gregarious and quick-witted as Mum, it feels extra harsh, and will probably be permanent to some degree.

Her thalamus has also taken a shock, which means she is unable to create new memories, just a little bit like the movie Memento. This is less likely to be permanent and often diminishes a few days after the stroke.

A speech pathologist did a swallowing assessment on Mum Tuesday morning and was worried that she might not be able to prevent liquids from going down her windpipe and giving her pneumonia on top of everything else. (Sidebar: when the pathologist started talking about Mum's tongue not being very strong, I swear I heard my father's laugh... and when I mentioned it to her later, I said he would have asked: "never mind how strong, is it still as sharp as it was?") She ordered another test for the next day (VFSS - videofluoroscopy swallow study), and positive results for that meant she could have solid food for the first time since probably Saturday. I mean, not that she wanted any, but still.

Today the occupational therapist and physical therapist got her into a wheelchair, the first time she has been out of a stretcher or gurney since Sunday night. They said strength is slowly returning to her right arm, although it is still awfully weak, and that they may try standing tomorrow morning. So there is good news to be had.

As far as the bad news goes, the doctor in Leduc told Mum on Sunday night (prior to the discovery of her strokes) that in addition to the clotting in her lungs there appeared to be a mass on her pancreas that they'd been lucky to spot, since that wasn't the focus of the CT scan.

She took it in stride, honestly, saying she'd "almost wondered" about it since pancreatic cancer had also killed her father, something I'd never known.

Tara and I met with a gastroenterologist yesterday who showed us the CT scan and pointed out the masses on her pancreas, liver, stomach and other areas of her abdomen. We can't get an official diagnosis without a biopsy, and that can't be done until she is a bit stronger, but in the opinion of him and the radiologist, it is 80-90 percent likely to be pancreatic cancer. Because it has spread to other organs, this means it is at stage IV, which means it is both inoperable and incurable.

And for better or worse, that is the way Tara and I found out that our mother only has months to live.

That's been a tough pill to swallow, obviously. And talking to Mum about it yesterday wasn't easy either since she had forgotten being told about the mass on Sunday night. She took it pretty well, again, but I suspect that this is a conversation Tara and I will need to have at least one more time.

Thank God Tara is here; I don't how I could face this without having her here. She brought Mum's little dog Willow into the ward today, which put the biggest smile on Mum's face since this whole ordeal began. Her husband Jerry will be arriving tomorrow night as well, and Mum has had a few other visitors too.

I refuse to end on the bad news side of things so let me just say this: things could be worse. We could have lost Mum outright on Sunday morning. She could have been left incapable of communication or completely paralyzed. Her stroke symptoms could have worsened over the week, instead of improving as they have.

Where there is life, there is hope. Remission is probably too much to hope for, but we have time together and have fair warning of what lies ahead. Mum is not alone. In addition to us, she has more family, and extended family, and acquaintances, and more friends than you can shake a stick at.

Thank you to everyone who has sent their kind thoughts, warm wishes, gracious prayers, positive energy and good vibes - we will take all we can get, and I know Mum appreciates it. For now, the focus will be on recovering from her stroke, and that probably means another week or two spent in the neurological ward with tests and evaluation and scans and therapy.

I still firmly believe that love is the most powerful force in the universe. It might not be enough to beat the prognosis she is facing, but we are confident it will give us all the strength we need to face it. 

December 2017

From Failing Hands We Throw

It's been a busy weekend. The first big snowfall hit Edmonton, it was the centennial of the armistice that ended the First World War, and my mother was hospitalized.

She's been on blood thinners due to a clot that formed in her right leg a couple of weeks back, but when she bailed on brunch with her friends on Sunday, they knew something was up. When they went to check on her, she was looking a little grey, and actually admitted she didn't feel very well.

This is fairly significant, as my sister and I are pretty sure that Mum's final words (may they be a long time from now) are likely to be, "I'll be fine." For her to admit to feeling unwell is largely unprecedented, but honestly, so was getting her leg looked at by a physician - I can count on one hand the number of doctor visits I've known her to go to willingly.

They took her to the hospital in Leduc and got word to me, and I burned out there and stayed with her after she was admitted. They took blood and ran tests and did a chest x-ray and then a CT scan, and there is a lot to sort out, but safe to say it isn't particularly rosy stuff we are looking at. She was crushed when they told her she would be staying overnight, but I assured her that I would pick up her dog, Willow, from her place and take her home.

This morning, she started presenting stroke-like symptoms, so they transferred her to the University Hospital. I was actually packing my bag to stay at her place in Leduc when the hospital called to let me know, but abandoned that so all four of us could go and visit her.

Mum's always been the tough one in the family, at least as far as I'm concerned (and the Old Man probably wouldn't have disagreed either), so it was rough seeing her so frail and small in the enormous gurney, wincing when the blood pressure cuff inflated periodically. She has some degree of aphasia, so you can see her working things out in her head that she simply cannot find the words for. I know that has to be frustrating to someone so expressive and quick-witted, but I know she is also taking care not to let it show. She was content to let us handle the lion's share of conversation, nodding and smiling, dozing off periodically and then looking around and confirming we were nearby.

She had consults from neurology, hematology and tomorrow internal medicine will swing by. Everyone is waiting for tomorrow's MRI before determine how best to proceed. All these fields are communicating admirably with each other, even with the week-old centralized health information system they are still coming to grips with. In the meantime, Tara is flying up from Houston tomorrow, and it will be good to have her at hand.

The two of us have already had to discuss Goals of Care, which is a determination of just how far Mum (and us) want them to go in order to save her life if those actions should be required. I know Mum wants no extraordinary measures taken, but that sort of affirmation is much more comfortably handled as a hypothetical (which will never happen) as opposed to an algorithm of probability within an emergency room environment where every outcome has some degree of occurrence.

Mum got checked into a room about five hours after the ambulance brought her from Leduc, which felt long to me but impressed the E.R. nurses quite a bit. We helped mule the small assortment of things she had brought and which I had grabbed from her place, and once she was settled in place and looking dozy, swiftly made our exit.

In the midst of all that, why would we bundle up in multiple layers this morning and go out to a neighbourhood Remembrance Day ceremony? Well, it wasn't so much in spite of her, as because of her.

Mum and Dad's commitment to Nov. 11 observances goes back as far as I can remember. the two of them have both served as Royal Canadian Legion Members and club officers, and were instrumental in organizing events in Leduc for a lot of years, and participating in them after that. Fenya and Glory have been raised the same way, and recognize that it is important to not only remember, but to visibly participate in that remembering.

In the nearby neighbourhood of Griesbach, former home of the barracks and HQ of CFB Edmonton, there is a small amphitheatre beside the lake called Patricia Square, named after Princess Patricia's Canadian Light Infantry. They march out the regiment from the Edmonton Garrison, and we had stood witness before six years earlier.

Today though, it was bitterly cold - about -26 with the wind chill when we arose. My fear was that the parade wasn't going to have anyone willing to watch it, or an insultingly small crowd. We found this unacceptable, so we layered up and made our way over. It was still only about -20 when we arrived at about 10:20, but the are was already crammed with spectators, over a hundred for certain.

As they read "In Flanders Fields," and played the Last Post, and lay the wreaths, I thought about both my parents. I thought about Dad's final years, when he was prone to confusion but could still recognize all of us and smile just because we were there. And I thought about all the young men and women there in uniform, there to pay their respects, like the rest of us, but to be recognized as well.

I knew Mum wouldn't want us to be selfish with our time, and that having our faces in that crowd meant as much to her as seeing them at her bedside in the E.R. today.

There's a long way to go before we know just what is going on with Mum, and probably a longer road after that figuring out what it all means, and what sort of lifestyle changes it might mean for all of us, but for right now, I am contenting myself with the fact that she is still with us, still knows us and knows that she has family and friends that love her.

We'll just have to sort out the rest as we go.

Many Hats, Few Smiles - Joker, Reviewed

Despite having a high degree of anticipation for it, I almost missed seeing Todd Phillips' R-rated comic book drama, Joker. 

I've read a lot of Joker stories over the years: the pulp mysteries of 1940's Golden Age tales, the goofy exploits on giant furniture in the Dick Sprang years, the crazed villainy of Denny O'Neil and Neal Adam's reinvention in the '70s, Frank Miller and Grant Morrison's psychosexual explorations in  pointedly adult-oriented stories, and of course, Alan Moore's brilliant origin story The Killing Joke.

The Joker hasn't been depicted as many times onscreen, but has similarly, and appropriately, enjoyed almost as much variety there. Cesar Romero, Jack Nicholson, Heath Ledger and even Mark Hamill have left indelible impressions of this mercurial madman, the Clown Prince of Crime. So what does Joaquin Phoenix bring to the picture?

Well, it is yet another amazing performance that he disappears into utterly, like a man diving into a deep, dark pool. It is utterly without pretention and carefully nuanced, daring you to pity him for the extraordinary torments he suffers, while scolding you for daring to hate his selfishness and eventual evil. Phoenix is remarkable and I will not be in the least surprised when his name is listed as a nominee for Best Actor.

It's just a shame this bravura performance wasn't featured in a better movie.

That's not to say that Phillips' Joker is a terrible film. It is a brilliantly shot period piece, evoking the '70s oeuvre of Scorcese's Mean Streets, among others. The score and source music are both wonderful, and help characterize a bleak and gritty world of opportunism and victimization.

But the truth of it is, all the atmosphere in the world won't help you engage me if there is no tension, and there is surprisingly little of it to be had. Will things continue to get worse for Arthur Fleck and his afflicted mother? Of course they will. Will there come a point where Fleck, like any dog, is unwilling to be kicked any longer? You bet! Will there be violence? Almost certainly.

Not as much as you might think, honestly. When it happens, it is generally sudden, awkward and fatal, but never fetishized or glamourized. But even in these meticulously applied moments of mayhem, there is rarely an unpredictable moment - I believe I counted two. Comics writer Dan Slott had a similar concern about the movies' layout, saying he'd seen it before - in the biblical book of Job.

Watching Phoenix in Joker is like watching a great master apply his skill to a paint-by-numbers kit created by a lesser artist; even when he takes liberties with the pigments to do something bold, he is limited by the pattern laid out.

As a dedicated fan of the source material, I also had tremendous problems with their depiction of the man who becomes the Joker. The "madness" that makes him an unpredictable nemesis in the comics is shown here as more of an emotional issue, and perhaps that is appropriate. Arthur Fleck's descent into deeper and deeper mental illness is less of an origin story about how a man gains his powers or abilities. Rather, it is a transformative series of events that show what happens when you pull all the supports away from someone who already feels they have nothing more to lose... as well as to people with similar mindsets who see it happening.

In fact, I don't think he is an adaptation of a comics character at all, but a re-interpretation of a specific cinematic one: Jack Nicholson in Tim Burton's 1989 Batman. Part of this is due to the interaction between Arthur Fleck and Bruce Wayne's father, but his wardrobe choices in the film's finale - purple(ish) suit, orange vest, and teal shirt - are very close to Nicholson's look in that film. Can you make an effective film about a long-standing character you've only ever seen depicted in a single medium? It's an intriguing question.

This is a tragic and intriguing character, with a handful of elements that tie him to a larger universe that will one day contain Batman, but in no way could the man we see ever be considered a foil for the Bruce Wayne's alter ego.

Batman is the avatar of preparation -  master detective, chemist, engineer, martial artist and more, plus a strategist beyond peer. His alertness borders on the supernatural. The Joker exists as his counterpoint in chaos, a man with no plan and no desire for one, but who, through keen human understanding and a complete disregard for boundaries real and imagined, still routinely manages to get the drop on Batman and his allies, because he is utterly unpredictable.

In the final analysis, my cinematic fanboy hat doffs itself to the fact that Todd Phillips even managed to get an R-rated movie made of one of DC's most well-known properties. It is a great-looking film that evokes a style and pacing we don't see much anymore and still manages to feel dangerous at times, despite being unable to really surprise its audience.

A respectful removal of my thespian appreciatory hat, in honour of a great performance. 

My plot-lover's hat remains ensconced due to a story that follows its proscribed patterns with a rigidity completely ill-suited to such a chaotic character.

My comics fanboy hat stays firmly on my head as well, and that's fine. They've used an iconic figure as a jumping-off point here, resulting in something that is less of an adaptation and more of an interpretation. 

Hopefully it won't be too long before we once again encounter a Joker on the silver screen who is both terrifying and funny. On the other hand, Joker is now the highest-grossing R-rated film in history, so who knows - maybe that's why they're so serious.