Thursday

The first doctor we saw this morning was the pulmonologist who felt that despite what the other (apparently the resident got in a lot of trouble by asking an "outside" doctor for input) pulmo doctor said that he felt it was a mucous plug instead of the tumor growing that caused his lung to compress and stop working. The tumor has infiltrated and has compressed on the airways but that does not seem to be the sole reason for the collapse. He then suggested that we consider letting him go in with a scope and clearing out the mucous, but the problem with that is that we would have to put Chris back on a tube and, given his condition, and the fact that he recently received chemotherapy, do not lend themselves to a good outcome.

On one hand there's an opportunity to improve the quality by letting the doctor go in and clean things out, but since the lungs will continue to create the mucous, we would be fighting a battle that we cannot win.

When the oncologist came in to see us, she said she had been trying to talk to the pulmo doctor because she wanted to find out for sure if he had to be intubated. She felt if he did not it might be worth trying because if they could get the lungs inflated again they might be able to do some targeted radiation on the tumor, strictly for palliative purposes.That in turn could buy time enough to get another round of chemo in him with the goal still being to get it to the point where it could be maintained.

Before talking to the oncologist, Chris's palliative doctor's resident adjusted his medication so he can get morphine once an hour if he needs it and also can get some morphine in his breathing treatments, all in an effort to get him to stop feeling like he is going to stop breathing at any moment. It's this level of anxiety and also a touch of depression that's gotten Chris to the point where he decided today that it's time and he has asked to be moved to hospice. I asked him if he wanted to come home or if he wanted to stay in the hospital and that's what he said he wanted.

He always has the choice of coming back to oncology and can opt to take his chemo should he want it in a few weeks, but at least in the hospice unit he will find it very peaceful, and will not be interrupted at all hours of the day and night. He will also be made very comfortable so that he will never, ever be in pain, suffer or worry from here on out.