Hallmark Moment

 Entry 1     9:03 a.m.

Jenny is away at VM to do blood work, in advance of the chemo regimen which she begins today. The chemotherapy is called GTX, and consists of 3 drugs: gemcitabine, a taxol derivative, and capecitabine. The capecitabine is in pill form, and is taken daily. She also receives an infusion once a week for three weeks. Then she has a bye week, no pills, no infusion. It is 12 weeks in total. The treatment regimen, which I believe I discussed in an earlier journal entry, has been around for a very long time, since before the breakthroughs that increased the 5 year life expectancy to 2.9 percent. 2.9 percent.  Gemcitabine has been the go to drug for treatment since the 1990s, but doesn't do much, truth be told. It isn't completely ineffective, but most people die at 4.5 months on the regimen, so, it doesn't do much. 5-FU with cisplatin is the wonder treatment, that works until it doesn't. The alternating between the gemcitabine regimen and the 5-FU regimen really has extended her life, but neither worked anymore after 12 months. And, the last chemo, as evidenced by her scans was an abject failure. Supposedly, the gemcitabine may actually work again, but its effects will be modest, as we were told by the palliative care doctor. He warned her that with each new chemo the returns are diminished.

Update, and color me shocked--Jenny texted to tell me her therapy isn't until 10:40--she made a mistake. I checked, she has turned off her location tracker again. I responded to her text and got no answer. Then I texted again and again, "Bueller?" I called twice. No answer. She called me back, and sounded strained. The background was muted, like she was in a bloody closet. What the fuck. I suspect she is having coffee near the school--Jeanne drove her to chemo--with Eric el pinché, or is visiting Eric el pinché at the school (a more likely scenario) and he will drive her to VM for her appointment. It explains why she was somewhere so muted--she didn't want me hearing the yelling of kids in the gymnasium. This is galling. I am not going to monitor everything she does. I do want the tracker on, medical emergencies here are a real possibility, but she turned it off years ago. We installed them when Leiney was sick--and claims with each new iPhone, since 2017 or 2018 it just doesn't work. It works on my work iPhone just fine, so you do the math. Also, she forgets she told me in 2017 or 2018 she intentionally turned it off because she didn't want me to track her. I had just noticed it wasn't working--we pay for the service--and said to her it wasn't working. I am such a dumb ass. Her strangely defensive response should have been a clue. I let it go, and never worried about it again until 2020. 

Jenny started texting me around 9:15  last night asking me to come snuggle with her in bed.  Seriously.  Several texts, all I am sure were intended to be very sweet. When she was in agony last week, I did go to her room and hold her through the pain for a long time. But, we have the pain under control now and snuggling he isn't a regular gig for me. She has a boyfriend she has said and proven she will not stop seeing because, in her words, she needs as much joy in her life as possible. At any expense. At my kids expense. At his wife's expense. At my expense.  I pretended to be sleeping, rather than have the conversation that would have resulted in nothing but argument and invective hurled.

If we didn't have kids, to avoid as much pain and anguish for myself as possible, I would leave her to experience this unbridled joy alone and save my dignity. it is everything within me now to ignore the voice screaming leave, leave, leave. I know that is the anger boiling over. I have been through this before. I am doing this for my kids, for me, and because I love her and don't want her to suffer. I need to care for her until the cancer wins, or I would not be able to forgive myself. Still, staying is a  bit more than irksome. 

Jenny asked me last night to get her vape pen, she has finally managed to find a way to smoke pot for her cancer, which we have been told is the best way to deliver the THC that manages pain, hunger, and purportedly fights cancer. I went upstairs to her bedroom to get it. I opened the drawer where she keeps it and found a greeting card, surely intended for Eric el pinché, whose birthday is next week. Bless her heart. It is a banner week for me.  There were actually two cards, the other more romantic, I won't post it here because why?  Will she give this one, or the other? Both? He is on her list of farewell letter recipients to be sure, and I am more than sure. 

Now that I know all that I need to know, I do not need to know anymore. I am going to keep repeating that mantra in the voice of the Mad Hatter all day. 

 

Entry 2     11:19 a.m.

Well, I put two and two together and figured this out. It was announced on Friday there would be no school today in Seattle, so students could get tested for COVID-19.  The kids are to come to their schools to be tested.  So, Eric el pinché has no class and no classes today, either. Thus, she schemed. Jeanne took her to see Eric el pinché. Then, to cover her tracks, Jenny texted me, in case I saw the appointment time in the medical record. Again, in 17 months she has made no errors in appointment times. Thus, the reason she sounded like she was in a closet is because she likely was in a contained space in the school to call me. It also explains why it took her so long to call back. In all my years conducting investigations, I have never made hypotheses without sufficient data, and my theory may be shit.  But, it makes sense to me. It doesn't matter, ultimately. She is seeing him, will see him, put him before the kids, her sisters, and me. When she was unsure if Jeanne could take her yesterday, she started making noises about going today to look for soup places--something the internet might make unnecessary. She was looking for a way to see him if this plan fell through, knowing he had much of the day off or relatively free, and the wife at work. The tangled webs we weave.

Entry 3     1:23 p.m.

How does one quell anger? Any number of ways. Forgiveness is not in my repertoire at the moment. It will come again.  But today, it is Jenny's sorrow at learning she has ascites. it was in the medical record and in the discharge report, but somehow she missed it when she finally looked at the report on Saturday--the oversight a surprise to me. I guess she always eventually looks, even though she tries not to and says she isn't going to do so. I blame the oncologist. Today, when Dr. P told her, she lost it. Ascites was the coup de grace for my mother, the final blow that ended her fight with cancer. Had the doctor not helped mom exit, she would have drowned in her own fluid made by the cancer. Jenny has minimal ascites.  Tiny amounts. Here is what I found in the literature about ascites and PDAC. Note this article is from 2006--so the correlation between ascites in PDAC and death have been known for at least 15, maybe 16 years:

Malignant ascites can be managed for extended periods in patients with other types of cancer such as those of gynecologic, gastric or colonic origin. We have noted, however, after treating multiple patients with both resected and non-resected pancreatic cancer on various protocols at our institution that regardless of the type of intervention employed, the new onset of ascites in these patients usually heralded imminent demise. The purpose of this study, therefore, was to examine this phenomenon and determine the exact prognostic implications of new onset ascites to better guide subsequent treatment and to counsel patients more effectively. We hypothesized that new onset ascites in patients with pancreatic cancer would be associated with those factors commonly attributed to the final stages of the disease and that death would soon follow its manifestation.

Survival in months

	Overall	Resected	Unresected	p value
n	15	4	11
From diagnosis	11.2 ± 12.10	20.8 ± 20.22	7.7 ± 5.65	0.06
Ascites free	9.0 ± 12.06	20 ± 20.32	5.1 ± 3.86	0.02
With ascites	2.2 ± 2.56	0.8 ± 0.43	2.6 ± 2.85	0.24

 

So, she has a reason to be scared. 

The sample size is ridiculously small, but then most people with PDAC are dead before they get the fluid buildup that is ascites.  Still, I could find no study to contradict it.  She has minimal ascites, fwiw. The study found that "Cytology does not appear to be important – the mere presence of ascites is what really matters." In other words, it didn't matter if the ascites contained cancer cells or not when looking at the impact on life expectancy. It is likely the peritoneal carcinomatosis, the new cancer in the sac that protects the internal organs, is driving the ascites.

Another article I read states that peritoneal carcinomatosis creates massive ascites and median survival time is 6-7 weeks. Yet still another said bluntly, "Prognosis of patients with pancreatic cancer presenting with PC [peritoneal carcinomatosis] remains extremely poor. Treatment options are scarce and, given the magnitude of the problem, efforts should be undertaken to develop effective treatments in experimental and clinical studies."

Sheesh. One final note. The original study I looked at above, also recommended against chemotherapy once ascites have been discovered.  The article closed, stating this:

"Based on our clinical impression and now, this study, when we observe it, we seriously weigh the utility of continuing chemotherapy with toxic side effects." More recent articles say the same thing. Jenny met with the oncologist today, and tonight begins chemotherapy.

She was so sad when she got home, and all I could do was rub her arm. No soothing words could salve her hurt. It is terrible. I need a thesaurus so I can find every synonym and permutation of same for the word terrible to use when describing her plight, our plight.