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Medical Forum / Diseases and Disorders / Breast Cancer / March 2005How do I break news to teenagers.
Just back from my wife's New Year's Eve appt with her oncologist. She has been fighting for the past 7 years breast to bone to liver cancer. Today, she has decided after numerous varied chemo treatments to end her fight and call for hospice help. It's very, very difficult to manage her pain and nausea and hopefully hospice can help us with what her oncologists says is probably 3 months but no more than 12 months to live. Though my 2 teenagers are aware of their mother's grim diagnosis, they are not prepared for me to tell them that she will not liver for very much longer. My daughter, who is 18, is planning to go back to college for spring semester in about 2 weeks. I am wanting her not to go back, but I am wondering if this is wrong. I will ask hospice to talk to her about this, but I was wondering if anyone out there has any advice. I am absolutely crestfallen right now. I love my wife of 24 years so dearly. Thanks. > Just back from my wife's New Year's Eve appt with her oncologist. She has > been fighting for the past 7 years breast to bone to liver cancer. Today, [quoted text clipped - 9 lines] > wondering if anyone out there has any advice. I am absolutely crestfallen > right now. I love my wife of 24 years so dearly. Thanks. I would think you might also get some useful help from the hospice people. Your kids may be better prepared than you think. I have never faced a situation of this magnitude but on a MUCH smaller scale, my daughter was prepared for some bad news (imminent death of a pet) that we tried to stave off in view of a bout of depression at age 15. She learned of our efforts later and told us she felt bad about watching the pets failing health but figured if we weren't ready to give up, she would tough it out. As I said, the scale is very different, but your kids' understanding may be greater than you would guess. In any case, best wishes for you all. >Just back from my wife's New Year's Eve appt with her oncologist. She has >been fighting for the past 7 years breast to bone to liver cancer. Today, [quoted text clipped - 8 lines] >this is wrong. I will ask hospice to talk to her about this, but I was >wondering if anyone out there has any advice. There's a strong probability that your teenagers understand more than you think - I'm sure they're not stupid, perhaps they just haven't talked about it with you. Whatever, of course you'll have to level with them - the facts will be all too apparent soon enough. Different people handle tough times differently - maybe your daughter needs the distraction of college work to help her through this time. Then again, maybe she wouldn't be able to concentrate, and would 'waste' a year. You'll just have to talk to them about it... All I can suggest is - be honest about everything. You needn't hit them with a sledgehammer, but you can't put too much of a sugar-coating it either. >I am absolutely crestfallen right now. >I love my wife of 24 years so dearly. Thanks. I can understand - I lost my wife of 25 years just a year ago, after a long battle with BC and Alzheimers. It still hurts like hell, but our son has been a big help to me in getting the rest of my life together. > Just back from my wife's New Year's Eve appt with her oncologist. She has > been fighting for the past 7 years breast to bone to liver cancer. Today, [quoted text clipped - 9 lines] > wondering if anyone out there has any advice. I am absolutely crestfallen > right now. I love my wife of 24 years so dearly. Thanks. Has your wife seen a radiation oncologist? (We did not realize the current situation when you posted the "hydrocodone" question on alt.support.cancer). Your daughter may well do better at College, unless she's needed at home for practical reasons or you are planning family time to travel. Palliative care can make a big difference with symptoms and support for your wife and take a load off the family. They can be there also when you tell your teenagers or perhaps a special session with the teens, after you've had the family talk, but do check with them first. They've much experience in various situations. There's usually a pastor or a counselling service at Colleges, not to mention other students who've had similar experiences who can be a big support to other teenagers. Please try to keep the cross-posting going, others on the other newsgroup, may have some important input. J > > Just back from my wife's New Year's Eve appt with her oncologist. She has > > been fighting for the past 7 years breast to bone to liver cancer. Today, [quoted text clipped - 28 lines] > > J Thanks for replying J...My question about the prefix hydro was just out of curiosity in regard to helping my wife minimize her pain...she has hydrocodone and hydromorphone and I was just trying to find out what it all meant. Anyway, she's on 40 mg oxycontin now and is using the deluded for breakthrough pain. This past day was a very, very difficult day for us. My wife has been fighting this thing for 7 years now with multiple varied chemo regimens, scores of radiated sites, multiple reconstructive surgeries, etc. I want my daughter to stay home because her college is a 5 hour drive away and we are financially tied currently....It really is a weight. My wife was diagnosed last Nov 02 with liver metastasis, so this is not too much of a surprise. But I am definitely in the ANGRY stage. > .My question about the prefix hydro was just out of curiosity in regard to > helping my wife minimize her pain...she has [quoted text clipped - 7 lines] > diagnosed last Nov 02 with liver metastasis, so this is not too much of a > surprise. But I am definitely in the ANGRY stage. Thank you for explaining. It's so sad to know that others are celebrating and wishing each other a "Happy New Year" just when you get the bad news. That's enough to make a person angry in and of itself. I see that everything that can possibly be done has been done (radiation). Palliative care will take the burden off you of understanding pain medications. We're obviously (as you've seen) not chemists on the other newsgroup and the person who had the "compendium of" apparently isn't around at the moment. I am truly sorry. We (alt.support.cancer) recently lost Lowkey. He had a daughter, perhaps around the same age as yours. She stepped up to the plate (as they say). Their relationship fluorished once they had more time together and she was a blessing in the lives of Lowkey and his wife during his whole treatment and last months. Shauna (recently passed away also) and her father Stephen fought the battle together. They danced in the halls of the hospital while she was undergoing treatment. I was fortunate to have many special exchanges with my Dad before he passed away, not so with my mother sadly. Either she didn't know about her cancer or someone decided to keep the information from me. (I lived far away from them). So while having to forego her college, at some point your daughter will appreciate the time she will have at home with her mother (and you and the family). I can certainly understand your anger, anger at the cancer, anger at why your wife's cancer did not respond to treatment, anger at the (perhaps) now useless reconstruction (costs), anger at the prognosis. Perhaps even anger at the fact that many others with breast cancer do obtain long remissions. Angry at having to deliver bad news to your children. Anger at the upcoming loss of your life partner. Tim will be along shortly. He nursed his late wife through all the stages of this disease. I'm sure he can be of assist and a comfort to you also. He's a wise man. You did the best you could with the information and treatments available. You did (and are doing) the best you could for your wife and children. Please know that. I would think that the liver involvement would be the prognostic factor in your wife's cancer and perhaps the reason for the nausea. Although we did "get fooled" by Lowkey. his liver was involved also, but he passed away from something totally unrelated, brain hemorrhage. So when the oncologist gave a wide range for wife's prognosis, perhaps he was basing it on the (current size of) liver lesions or function, yet allowing for the unexpected (unless he wanted to soften the blow when he gave you a prognosis by giving a wider range). Palliative care are usually quite good at assisting with that. They do a careful and comprehensive assessment. The financials (alone) are a good reason to ask your daughter to forego her college. I think you are doing everything right in planning to ask hospice to talk with her. Please know that I (and others) on the alt.support.cancer newsgroup care deeply. They'll be along shortly. We'll be there for you anytime, if you remember to cross-post (or if, at any time, you decide to just post on alt.support.cancer). J > Thanks for replying J...My question about the prefix hydro was just out of > curiosity in regard to helping my wife minimize her pain...she has [quoted text clipped - 7 lines] > diagnosed last Nov 02 with liver metastasis, so this is not too much of a > surprise. But I am definitely in the ANGRY stage. Be angry, it is an emotion that all of us go through at some point and is perfectly natural. As far as your teenagers are concerned, be honest (if they accept honesty) and explain calmly to them the situation and what is on your mind and then let them make their own decisions. When my husband was dying from a GBM4 brain tumour, my eldest daughter had recently joined Girl Guides and was all set up to go to her first Camp. I didn't overly want her to go but decided that if I forced her one way or the other she may later resent me for it. I got her to sit down and write a list for and against going and she made her own mind up. She decided herself that she wouldn't go this year (there is always next) and boy am I glad that she did. By the time that camp was due to start, Tony was in a hospice. You will have mighty decisions to make, you can only do your best (and you are doing so right now), it is a horrible position to be in and I feel for you right now. If you want to rant and rave - please feel free to do so, there are willing ears here to offer comfort and support. Hugs Alayne > > > Just back from my wife's New Year's Eve appt with her oncologist. She > has [quoted text clipped - 57 lines] > diagnosed last Nov 02 with liver metastasis, so this is not too much of a > surprise. But I am definitely in the ANGRY stage. You have every right to be angry. I'd worry if you weren't. :) Seriously, tho, there are many here (a.s.c.) who have been down the road you're on, and are here to help in any way they can. I hope you'll come back and post as often as you can. Do you have a "name" we can call you? Hang in there, and remember we're all hangin' with you. Trish > I want my daughter to stay home because her college is a 5 hour drive away > and we are financially tied currently....It really is a weight. My wife was > diagnosed last Nov 02 with liver metastasis, so this is not too much of a > surprise. But I am definitely in the ANGRY stage. First, tell your daughter how you would really like her to stay at home for a while, 1 semester or 2, whatever you think. Be honest with yourself before you decide to tell her. Do you really want her to stay, or do you REALLY REALLY want her to stay? Tell that finances are real tight right now. Also, Dr. Phil said something that makes sense. I know that we all want to give our children the best, but parents paying for college is not a right, it is a luxury.  SignatureSay no to fixed width tables. They look terrible in all browsers. > Just back from my wife's New Year's Eve appt with her oncologist. She has > been fighting for the past 7 years breast to bone to liver cancer. Today, [quoted text clipped - 9 lines] > wondering if anyone out there has any advice. I am absolutely crestfallen > right now. I love my wife of 24 years so dearly. Thanks. Part of this question rates as a "frequently asked question", and rather than answer again I'll refer to our FAQ pages, in this case http://www.cancersupporters.com/kids.html I know teenagers will baulk at being called kids, but in my experience my 22 year old still has not accepted the responsibilities of adulthood, although of course he claims all its rights. Even a couple of months ago he came home on a weekend leave from the army and ran up a ?100 chatline bill on my phone, having come in drunk at 4am. My first reaction to the college issue was that she must carry on. Life must go on, and you would not want to create an impact on her education that will last. Losing her mother is a big thing, but it comes to us all eventually, the last thing she needs is to lose her educational opportunities as well. The long term object is to minimise the impact of the loss. Of course she needs to be fully aware of the probabilities before she leaves so that she can make the necessary preparations so that if her mother dies while she is away, she will not feel cheated and having things left unsaid. In the end it has to be her decision, but if she were my daughter I would make it clear I hoped she would continue. Whatever you do, please don't push her into an expected pattern of grieving, after seven years of the eventuality becoming ever more real, many people find at the end that the grieving is already done and the main thing is to get on with life in its new configuration. However in your reply to J you say the reasons are financial, and that is a different issue. The financial problems faced by carers for terminal cancer patients, especially those with children, can be serious and are not, in my view, adequately discussed. If you can't afford to keep her at college, or at least at her present college, then that is too bad. It might be worth investigating whether she can get outside help to remain on her course in these exceptional circumstances. On this front I was relatively fortunate, or at least, prepared. I am self employed and sell my time by the hour, so it was relatively easy to adjust my work to allow me time to look after my then six year old daughter while still earning enough to pay the bills. I was aided in this by being fired by a major customer at about the same time (after they had attempted a hostile takeover for my business). Nonetheless it was a hard haul, the balance sheet was well in the red for the whole of the last year, caring and housekeeping left little time for work and the expenses were significant even though the UK NHS paid most of the medical bills, and social services provided a little home help. At the end came the costs of the funeral, plus another ?1000 that my son overspent beyond his student loan, plus hospital fees for my Russian mother-in-law after a (pedestrian) road accident, all at once. And of course, once the patient had died, all help from Social Services ceased. It took about six months to get the books back into balance, and then years of debt repayment, there is still a little left to pay but not enough to be taken seriously. Is there something special about New Year's Eve? It was the turn of the millennium when my wife went into her final decline, we were just preparing a little snack and drink in front of the TV and about ten minutes before the bells she started vomiting. We made what was probably the first emergency call of the millennium to our regional cancer centre and she went into hospital the next day for blood transfusion and stayed several weeks. That was in practical terms the end of her life, although she lived another three months she was mostly asleep or disorientated. That night one of the ladies then on this group also lost her father who had been suffering with another cancer at the same time as she had bc. Tim Jackson Sorry to hear about your wife and angry is a very normal response. As far as teenagers go I would be as honest as possible. Your daughter is old enough to make up own mind up but you should give her the opportunity with all the pertinent information. Hospice will be help especially with symptom management. I don't know what else to say but this is a horrbile disease . Alex passedpast wrote: << Today, she has decided after numerous varied chemo treatments to end her fight and call for hospice help. >> I am so very sorry to hear of the difficulties that your wife has had. <<It's very, very difficult to manage her pain and nausea and hopefully hospice can help us with what her oncologists says is probably 3 months but no more than 12 months to live. >> I do hope that they can help her with something that will give her relief. I want to share a story with you re. prognosis. There is no way to guarantee. Each person is different as are different cancers. My colleague, who has lymphoma had a stem cell transplant 2 years ago. The cancer returned a couple of months later. In February, 2002, he was given a prognosis of 2 weeks to 2 months. He didn't want to sit around at home waiting to die. He got his affairs in order and told everyone he was "ready to meet" his "maker." He returned to work part time, with great difficulty. He barely had the strength to stay for the several hours he came. He persisted. That was 22 months ago. He is now working 32 hours/week. He had the support of his family and church (Latter Day Saints). His wife decided to help him with alternatives for the first time. He didn't believe in them but allowed them to do this since he felt it would help them. Some of the things he began taking include milk thistle and flax seed oil. The tumors in his liver cleared up. The other tumors (elsewhere) have remained stable. He is not cured but for the moment is doing 'okay.' What I am trying to say is one cannot predict prognosis all the time. It is a rough estimate. In addition I wanted to say something about your daughter, your wife, and college. My husband's former hygienist had ovarian cancer. Both her children were in college. She felt that their job was to be in college. Her son wanted to take a leave and come home to be with her. She wouldn't hear of it. It was more important for her that her children remained in school. She passed away almost 2 years ago. Her son will be graduating this year and plans to go to medical school--possibly in oncology and research. Have you talked to your wife--what would she like. I know having one's family around may be comforting but at the same time, life does go on. What will be best for everyone in the long run? What I am hearing you say--is that your daughter wants to return to school. I am guessing that she is a freshman and lives at school. How far away is her school? I think it would be harder for her to take off--especially at this time. There is no way to predict for sure how much time your wife has left. If things worsen and she finds it difficult to remain in school, she can always take a leave of absence. I am not sure that hospice should be talking just to 'her' but to the family. You might also want her to talk with an outside counselor experienced in grief counseling, if needed, and/or someone in a leadership and counseling position of your religious domination. Again, I do think it is important that your wife's feelings also be considered. If I were in a situation like that I would hope my children would visit but would not want to interrupt their normal routine. As a mother their independence and success is something that makes me proud and it is my job as a parent to insure that they do what they can to hopefully become their 'best' self whatever that may be. I did not bear children for my own personal needs--but to help make the world a better place. Again, it is not 'wrong' to want to have them around but it is not necessarily 'right' to change their lives even more than what they will have to deal with after their mother is no longer here. They do not have the same relationship to their mother as you do--they shouldn't. I know, though that in many ways what you are going through is much harder on so many levels than what your wife is dealing with. I would like to suggest that you explore counseling for yourself at this time. My best thoughts are with you and do hope that your wife does become more comfortable. {{{Hugs}}} and prayers... > passedpast wrote: << Today, > she has decided after numerous varied chemo treatments to end her fight and [quoted text clipped - 61 lines] > My best thoughts are with you and do hope that your wife does become more > comfortable. {{{Hugs}}} and prayers... Thank you all so very much for replying to my question. Today, Jan 2, Hospice is coming into our lives to set up care. My wife, Christine, mental state is still strong, and thus is the primary decision maker in her care. I am her health care proxy when that time becomes necessary. In November of 2002, a routine ct scan discovered liver involvement. She was originally diagnosed with breast ca in 1996 (also pregnant at the time, a whole other story) and bone metastases in 2000. Other than bone pain that was managed with 800 mg of Ibuprofen twice a day, she was physically unsymptomatic of her cancers. This changed dramatically midway through October of 2003, when she experienced malaise similar to having the flu. Her labwork showed elevated cea, thus she had a cat scan and mri which showed multiple increased liver involvement in all lobes. At this time, she found it impossible to continue working (she's been a maternity RN for 23 years), and had to go on disability. Since November of 2003, her condition has worsened; she's lost 30 pounds, finds it difficult to eat, has episodes of breakthrough pain and nausea/vomiting. In addition, she's suffering from the multiple side effects from her chemo regimens, most recently, hand/foot syndrome from Doxyl. Anyway, I talked to my 2 teenagers. My son, 16, has been living through this took the news of the short life prognosis as well as any male adolescent could. However, he has his own issues, and this is also a very long story, and is on Celexa and Abilify to treat his condition. My daughter is 19, and went off to college last September 2002 as a first semester freshman. Her college is a little bit more than a 4 hour drive from our home. It wasn't until she came home from college for Thanksgiving did she see her mother for the first time truly suffering from cancer. She cam home from college a week before this Xmas to find her mother's condition worsened. However, she avoided talking to us about this situation, even when we attempted to bring her in to a discussion. My wife had liver function blood tests and another ct scan done at the beginning of this week, and we found out her Doxyl treatment was unsuccessful. On New Years Eve, we were scheduled to go to Boston at Dana Farber to talk with her oncologist, but my wife was too uncomfortable to make that trip. Instead, we talked to her secondary oncologist locally. It was there where my wife decided that she wanted to call in Hospice after hearing what her local oncologist and Boston oncologist conferred upon. Back to my daughter. My wife is torn between wanting her not to go back to college as opposed to staying home. Deep down inside, however, she wants her to stay, mainly because her college is relatively far away, and if her time is as short as she's been told, she would appreciate having her family close by so she can enjoy relating to them as long as her mental status is clear. However, she does not want her daughter to feel like she is being punished for her mother having cancer. Financially, with my wife on disability and my hours cut down because I want to be around my wife during her waking hours to care for her (I only work 11 to 7 shifts now), our income has decreases significantly. Our daughter has some financial aid, but we have to pay $880 a month to her school, which we are able to do by tapping a home equity loan. This aside, the true reason my wife wants her not to go back to school next week is because her condition is deteriorating so fast and she fears that if she goes off, she won't see her again. This is very important to my wife and I don't think its terribly selfish. I explained this to my daughter, who was understandably crestfallen. I assured her that she will be able to return to school and that I will do all that is possible to help finance it when that time comes. I was pleased to see that she came around and is now putting her mother ahead of her college now. I'm so sorry about this long post, if you've read this far you truly are Jobe like. I'll update you sometime nextweek with a new post after we talk with Hospice. Thank you again. Thanks for further explaining. The situation is quite difficult. I would leave the decision up to your daughter, although would strongly involve both she and your wife together in coming to concensus. This is a very difficult time for all of you. In addition, just wanted to add, freshman year of college when a student lives away is probably one of the major adjustment changes they will make. It is not something that can be easily left off to which they come back to. Depending on the classes, it might result in a delay in picking them up until the following year, rather than semester. In addition, it will result in a change in social structure as well. If she is in a certain dorm with a certain roommate, she may not be able to return to that same dorm--and that alone will result in re-establishing herself, socially, all over again--both in terms of finding her place and making new friends. Some are better able to do this than others. For some it is a great effort that is quite emotionally draining as well as so much more difficult. However, I do understand all that is taking place with your family. Often colleges and universities can grant more aid to students at times like this. In addition, she may later be able to get a part-time job. If there is anyway she can be in school and come home for weekends, I think it will be so much easier for her. At this time her identity is very much tied up with her new school life. This is where much of her support comes from--socially--which is so very important, particularly for girls. If this is changed, she may not have a support system to go back to. She will have to begin all over--from a perspective that she is not familiar with--someone who has lost a period. Not only might she have difficulty adjusting to this, she may not have anyone at school who can help her in the way she may need. Although losing a parent is very upsetting and a major life event, I would think by having her not return to her environment of support at this time, it might result in more of depression than would otherwise be expected. It is important for her to make this decision and for you to do whatever you can to support whatever decision that she does make--without giving her any added feelings of guilt, anger, and/or anxiety. As I mentioned before--during the last stage of my husband's former hygienist--who was at stage of hosipice--she told her son that his job was to be in school and to do the best he could--that meant more than anything to her. Of course she would rather have had him around but as a mom she wanted what she felt would be best for his success. That made her happier more than anything else. He did, however, fly home on weekends--he was a 10 hour drive away. Another thought--don't know where you are located--but wonder if there is an airline available that would give reduced/complimentary rate under special circumstances. So sorry to hear that fate has dealt you&your wife& family with such a vicious blow. I can't help with your question on how to break the news to teenagers but I just felt I had to say something. I'm sure your kids know more than you think. Kids are afterall very knowledgable these days. It will be a hard decision for your daughter, whether or not to continue at college or be with her Mother in what could be some of her last months. I don't envy her decision. It will be very tough for her. How can she possibly decide, to be away from her Mom at such a hard time. On the other hand, her education is very important also. My thoughts are with you at this very sad time. I hope you&your wife still have some wonderful times together. Doctors afterall, can only guess on life expectancy. They can't be certain. So just enjoy every moment you have left together. I have no doubt that you will cherish your time left together, whether it be long or short. Best Wishes, Shaz x > Just back from my wife's New Year's Eve appt with her oncologist. She has > been fighting for the past 7 years breast to bone to liver cancer. Today, [quoted text clipped - 9 lines] > wondering if anyone out there has any advice. I am absolutely crestfallen > right now. I love my wife of 24 years so dearly. Thanks. |
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