One day or another, almost every one of us will get bad news from the doctor. But I had imagined that it would be delivered more formally and compassionately than it was to my father that day he lay on a hospital gurney six months ago.
‘If this new drug doesn’t work like we hope, the cancer will take you soon,’ the doctor informed my father, too matter-of-factly, it seemed to me.
It was a brief meeting at Vancouver General Hospital. My father, Alex Gold, studied the doctor’s face, and listened carefully. He had propped himself up, the overhead fluorescent lighting glinting off his bifocals. If he was upset, he didn’t show it. I’d seen him handle news of a major car repair bill worse than this. He didn’t register anything other than satisfaction that the appointment was finally over.
But our journey to do battle against his metastasized cancer had just begun. My father, a widower, is 85 years old, and cancer cells have been quietly residing inside his prostate since, to the best of our knowledge, 1997 (the year he was diagnosed). He is one of the 73 men on average in Canada who are diagnosed each day with prostate cancer. An average of another 11 die from the disease daily. By the end of 2012, an estimated 26,500 men learned that they too have cancer in their prostates, according to the Canadian Cancer Society. Many will elect to have surgery that is called a prostatectomy, which can cause impotence and/or incontinence. Others will forgo treatment entirely, betting on the potential for a better treatment to come along, or the chance that something else will ‘take’ them first, anyway.
Being stubborn, and a gambler by nature, after diagnosis my father refused surgery and radiation treatments to eradicate those cells, against the advice of his urologist, a master surgeon who is highly respected in his field. So the urologist treated him with hormone suppression therapy, which basically slowed the cancer by cutting off the hormone supply it needed to grow. Every few months my dad would get his blood tested to ensure that his all-important PSA count had not gone up too high. (PSA stands for prostate-specific antigen, which is a glycoprotein secreted by the prostate gland cells. A spike in a man’s PSA can indicate a presence of cancer in the prostate, although other factors can cause PSA to fluctuate. A doctor may want to investigate the possibility of prostate cancer further with a digital rectal exam and possibly a biopsy.) My father’s PSA count was never too far above 5 or 6, and if it did spike, it always seemed to come back down with another injection of the drug therapy.
This routine went on for 15 years. My siblings (a sister and brother) and I thought, Cancer be damned; our father had basically been cured. When his time came, it would undoubtedly be due to something else. After all, doesn’t everybody say that when you have prostate cancer, you usually die of something else?
The fact is, cancer has a will of its own. It’s like a psychotic house guest that has declared war on its host, and it’s working overtime to figure out new and improved methods of destruction.
My father’s cancer had stuck around his prostate without doing much of anything at all’until one day, sometime in the fall of 2011, it figured a way around the drug therapy. Suddenly, it had the keys to expansion. The cancer grew large enough that his urologist could do a digital rectal exam and feel a tumour about the size of a nectarine. My father’s PSA shot up to a shocking 100.
I accompanied him to his doctor’s visits, sitting in the waiting room, bracing myself for increasingly higher PSA numbers, and worse news. ‘I’m glad I have daughters,’ the urologist said to me during one visit, ‘because you never see sons in here.’
I’d become caregiver, advocate and amateur medical researcher on all things prostate cancer. My father’s pragmatism made it easy to stay focused and productive. After one particularly dismal checkup, I asked him if he was afraid. ‘Not at all,’ he said, in a tone that sounded like he’d been challenged. ‘I take each day as it comes at me.’
And the days kept coming, but unrelentingly so. A sick elderly person’s health can turn into a set of dominoes. One problem kick-starts another. For a month, my father underwent daily rounds of radiation, even though the oncologist said the tumour was too big for it to work. My brother, Rob, and I took turns accompanying him on these daily treatments (my sister, Erin, lives in Ontario), but after a couple of weeks, the routine began to exhaust my dad and he grew to hate it. During one of these visits, the doctor discovered my dad’s bladder was retaining urine and was dangerously full. The tumour was blocking his urethra, and he needed a surgical procedure to clear it so his bladder could empty. Simple enough, said the doctors.
Following the procedure, an MRI revealed the cancer had spread to the bones in his back. He was prescribed pain-killing narcotics’and then began suffering from delirium, a little-known and serious medical emergency that often happens to the elderly. It seemed to me he was insane. Delirium is nothing short of traumatic for family members, never mind the patient himself. Suddenly my father was convinced he was hovering in mid-air, and had other waking nightmares.
It became an exhausting roller coaster: Dad was either hallucinating, or in excruciating agony if he didn’t get his medication on time. The deep ache inside his bones caused his legs to tremble uncontrollably, and one time, I watched in terror as it even pushed him into a seizure. After trying to care for him at home, I took him back to the hospital, where he spent the next two months.
The delirium eventually went away, but the cancer didn’t. It continued to wage battle against my father’s body. I learned during that time that the medical system works only if you do. When someone you love is ill, you need to do more than show up at their bedside with fresh fruit and a newspaper. You need to assume the role of advocate, and fight for the best health care possible, because people do slip through the cracks.
I visited my father’s leading-edge urologist and as a last-ditch attempt to stop the cancer from spreading, made an appeal to put my dad on a trial study for one of the experimental drugs that have emerged in the past five years. So last summer, the urologist put my father on the British-made abiraterone, which has already prolonged many lives in the U.K., and had just been approved in Canada. ‘If it were my father, I’d want him on it,’ the doctor told me. That was good enough for me.
My dad’s PSA had soared to an incredible 2,200, but since starting on abiraterone’every morning he swallows four large, oval pills on an empty stomach’it has fallen. My father has gone from bed-ridden and confused to slowly walking with a cane. Sure, he’s a frailer version of his old self, but he’s here, with us, still fighting. With 24-hour nursing care, he lives a modified version of his former life, still able to attend poker night and hang out with the boys at Tim Hortons, but not quite strong enough anymore for golf.
The cancer hasn’t gone away; it’s still lurking there, in his prostate and in the bones of his back. But the pain has eased. And a recent X-ray shows the cancer hasn’t spread any farther. His oncologist gives full credit to the abiraterone, and for now, it seems that this new wonder drug is keeping it mostly at bay. In the world of advanced cancer, sometimes that’s as good as it gets.