Unity Farm Journal - First Week of November 2014

When you’re a farmer, you’re often faced with the life, death, and sickness of those living things who depend on you.

Recently, my father in law was diagnosed with a Stage IV Neuroendocrine Tumor on the head of the pancreas.  Ironically, it’s the same disease that Steve Jobs experienced.   Chemotherapy began this week and we’re hopeful that shrinking the tumor will relieve some of his symptoms.   Cure is unlikely and many difficult decisions await us.

With Stage IV cancer, surgery is not an option.

If we do nothing, the highly aggressive tumor will cause rapid decline - weight loss, weakness, and susceptibility to falls/infections.

If we proceed with full cycles of chemotherapy, there may be reduction in tumor burden improving life quality or there may be side effects that make the situation worse.

We’ll work hard to respect all of his wishes on the journey ahead.  Chemotherapy and medications are meant to be palliative.   If complications occur, it’s likely that he will want minimal intervention.

He lives at the farm and needs to climb a few stairs, which is increasingly difficult,   We’ll need to think about mobility solutions, home care assistance, and possible relocation of his living spaces to the first floor.  We’re heading into cold and icy weather, so likely we’ll have to build a wheelchair ramp in and out of the house.

Having experienced the death of my father in March of 2013, the end of life process is still fresh in my mind.     As Atul Gawande outlines in Being Mortal, we’ll focus on life quality, not quantity.    My father-in-law and the dynamics of the entire family are paramount.     We’re rethinking the pattern of our duties and our activities.  I return to Boston from Europe tomorrow and I will not travel for the remainder of 2014, deferring all distant meetings and speaking responsibilities.   We’ll take each day one at a time, and I’ll creatively juggle my time using Skype, FaceTime, and teleconferencing to balance home/family needs with work needs.   My colleagues and BIDMC leaders are all very supportive.

Each of us will die.     The goal is to ensure that death is dignified and pain free.     My wife’s battle with breast cancer led to remission.    My father-in-law’s experience of pancreatic cancer will include the entire spectrum of emotion, from sadness to love and hope.   For now, medication, hydration, and spending time together is the most compassionate care we can deliver.