Through the drizzle and fading twilight, I walked from my school back to MD Anderson where we'd spent the last 4 days. Up the escalators, a short jaunt to elevator T, and up to the MRI floor. My brother was still getting his MRI as my parents waited in the chilly waiting room. As I walked up to receive the rundown on how the visit with the radiation oncologist went, the look on my mother's face portended a grim assessment. Her only words said through a clenched mouth, "I wish you had been there."
My brother has bony metastases throughout his pelvic area causing him considerable pain. Option 1 was to knock them back with radiation to alleviate the pain. From reading the radiation oncologist's summary, it was concluded that beam radiation was off the table. The pain is diffuse and does not localize to any one met. To irradiate all of them would be to invite disaster. There are simply too many of them. To make it worse, my brother and parents could overhear the telephone conversation between the radiation oncologist and attending oncologist. (Note to self - never allow yourself to be overheard by the patient having a medical conversation with another doctor). I think the phrase that stood out to my parents was when the radiation oncologist, whom we had invested hope to be able to alleviate the pain, uttered something to the effect of, "I'm not sure why you sent him to me. There's nothing I can do."
Option 2 is to pump my brother with something along the lines of strontium or samarium. Those preferentially will go to bony tumors and hopefully knock them back a bit. That would then be followed up by enduring another round of chemo. And so we wait to hear back from the nuclear specialist. Even that, though, is palliative only. It's to reduce pain and suffering. There are no curative or restorative therapies proffered. So I try to reconcile what I know medically, statistically, clinically with being a brother, a son, a human. And I guess I'm still ruminating what to do with that. Yesterday, I took the day off from studying and tried to find some understanding of that. I meditated, I pondered, I grew angry, I pontificated, I blustered, I grew sad. All that I can conclude is that I find no absolution in my rational point of view. And so I tell my brother, I'll be there for him every step of the way to whatever end.