white elephant: a daughter's journey

birthday pies, sailboats, and high winds, OH MY!

2012-02-18T10:07:00.001-06:00

last weekend, we were able to come to Cali to celebrate Dad's 65th birthday, or what i call 'the-newly-eligible-for-medicare birthday.' Dad's birthday was on a Saturday, so we all had to prep the day before; unfortunately, i didn't have enough time & ingredients to make Dad's sugar-free apple pie, so we settled for a low-sugar store-bought one from Whole Foods and bee's wax (literally) candles.

we also tried to make the candles look like numbers on dice; but as you can see from photo, it's kinda hard to make out the '6' and '5'. hey. we at least tried, right? we had a huge late lunch after church service and didn't even get a chance to take our typical SDA nap since we had to be at the harbor for Dad's surprise sunset sail before 5pm. well, it was only a surprise for our parents. everyone else was on board. we were all told by my bro D (who also made the sailing reservations) to dress warmly and we set out to Sausalito, a small harbor town right outside of San FranciSco, where we would board the sail boat. once we started walking onto the pier where sailboats were docked, the parents figured out that we were going on a boat. it shouldn't be a big deal to Dad being in the US Navy and Coast Guard, right? ummm, as our sunset sail trip progressed, Dad's facial expressions grew more and more animated as the boat began relying on the sails instead of the engine to propel us into the Bay. in the middle of February, the Bay has chilly 'high sea' winds that wanna take a huge chunk off your face...at least, that's how it felt during the sail. being the only one who's spent any significant time on a sail boat, i explained to D that sometimes the boat tilts to the side when the sails catch any wind. maybe we should've told Dad since we found our boat at a 45-degree angle in choppy water for a good bit of the trip. as you can see from some of the photos, i think Dad was either looking up at the sails and praying that they wouldn't rip or hoping that he & Mom wouldn't fall over the edge into the cold white caps they found themselves awfully close to.

pictures of harbor and other boats...i think these were people who were too late to set sail

when we left harbor, the sky and the water looked like this. then...

then the water started looking like THIS and the boat went to a 45-degree angle...and stayed there.

the parents were sitting at the stern (or the back of the boat). mom's amused and dad's, like, 'uhhh'..

despite the choppy waters, the insanely strong wind, and sporadic praying for safety, we had wonderful views of the Golden Gate Bridge, as well as Alcatraz Island and San Francisco proper. though Dad & Mom will probably never set foot on a sailboat for a long time from now, it was definitely an experience to remember. i've included some photos of the trip. i can't take credit for all of them since D clicked away and took the great pictures you see here.

dad: "we survived my birthday gift!"

Frisco aka San Francisco at sunset (note Coit Tower + Bay Bridge on L &Ghirardelli Square on far R)

after several hours on the boat, we docked at the harbor and headed for dinner at Dad's favorite sushi place (though he only gets the vegetarian bento box), the infamous Sushi House located on Alameda Island.
for a party of 6, we had to wait for a bit (remember, it's Saturday night and this place doesn't do reservations for indoor seating) but we got the larger round table with booth seats that comfortably sits 8-10 people. SH has been a favorite go-to place for any meal for several years because the sushi is fresh and the prices are quite reasonable. orders of sashimi and special rolls were passed around and shared. we were so stuff on only a few orders of this and headed back to D's pad on Alameda where Dad opened the rest of his gifts: an iPad, birthday and gift cards.

tuna sashimi

the lion king roll: baked california roll

salmon sashimi

all in all, Dad's birthday celebration was a success. he was surrounded by family and love, even with the adventure of the sunset sailing! happy 65th birthday, Dad!

oregon roll: tuna + avocado

me (photo op of D) trying to get through all the sushi

happy 65th DaD!!!

2012-02-11T11:52:00.002-06:00

today, we celebrate another year of life, another year 'out of danger,' and another year of celebration. we have so much to be grateful and thankful for. so, DaD, we celebrate you and thank God for blessing you (and us) with another day of life. happY 65th BirthDaY, DaD!!

winter break come & gone...now onto birthday plans

2012-01-17T17:11:00.002-06:00

1st batch of Christmas cookies made for family + friends

How was everyone's holidays? Having to split my winter vacation between in-laws in MD and my family's side in CA, I've literally been in 3 different time zones this past week. Prior to returning to St. Louis this weekend, I got to spend quality time with the husband in the DC area, as well as Ma, D, & cousin E in northern California. Dad is still in the Philippines visiting family & friends, having a grand 'ole time hosting & attending parties in the motherland. I wish Dad could have been Cali when I visited; but it was nice to spend time attending groupX 'core body' class and bouldering with D, while cooking & shopping with Ma. I'm hoping to get a job out in CA after graduation in May, so that we (M + I) could be closer to my where my parents live. I've had some opportunities to speak with possible employers during this last trip to CA, so we're crossing our fingers (& toes) that things work out professionally for me.

D & I have been talking about throwing Dad a shindig for his 65th birthday in early February. We've thrown around ideas (e.g., boat tour, dinner, party, etc.) but we haven't finalized anything quite yet. Our other bro, G, is an emergency medicine resident in OH, so he'll probably not be able to make it because of his erratic work schedule. Good news is, I was able to get my Feb. ticket to CA for whatever shindig we decide on for our father. Dad has never had a huge hooplah done for his birthday (mainly, our fault and he's out-of-the-country during that time) and we want to make it memorable...special. After all, after the past year, he's battled stage IV metastatic colon cancer and survived: Dad deserves the honor.

updates in the new year

2011-12-19T08:31:00.000-06:00

Dad's been in the Philippines for the past few weeks to visit family and take care of some family business. He's overseas and apparently having a wonderful time, but I still worry about him: having been given another license at life, Dad may overextend himself. I think the pilipinas is wonderful for vacation and food, but I remain wary of the medical care provided there, especially after my grandparents' hospitalizations. Unless you have a bit of extra money (thank God for my family here stateside and the U.S. dollar), my grandparents were able to get better care than what the typical Filipino hospital would be able to provide. If Dad gets sick while abroad, we'll all be even more worried about his health.

Mom's been the one who's been in better contact with Dad since the cell service where he's at is a bit spotty. I haven't talked to him but I think he knows in his heart that I remain to think about him (yes, worry about him) and pray for him. So until I hear any new or my feelings of worry for Dad subsides, I bid you all a wonderful holiday until after the new year. Aside from my worry, I remain grateful for Dad's miraculous remission from that 'ugly C word.'

a funeral, family + food (vegan-style thanksgiving)

2011-12-02T11:50:00.001-06:00

Thanksgiving '11 spread: vegan + 'real' turkey

Guilty. That's me. I've been such a slacker in keeping up with blog updates and no wonder I've got no followers except my faithful husband, M. Besides who wants to follow a blog about a daughter complaining about how much cancer really does suck? If I weren't in the situation that provoked me to write this in the first place, I probably wouldn't be following me either. There's happier things to talk/discuss/blog about better than the 'ugly C word.' Who are we kidding if we really think otherwise? I'm just hoping for a venting space in the www.com arena where I can call 'mine' and where somewhere in this crazy world, someone out there is realizing that they are not alone in their own struggles dealing with a family member with cancer.

Anyways, tragedy happens and when it does, it frackin' pours. A couple weeks ago, our grandfather, Lolo[i] J died. I'm sure that there are plenty of people out there who would rather say 'passed away' but that's not necessarily what I believe happens. I suppose it makes 'the living' feel better about death when they say 'gone to a better place' when someone dies. Lolo J 'went to sleep' while he rested in his bed far far away in the Philippines. He had suffered a severe stroke several weeks after his wife, Lola[ii] A, died in 2008. He had never really recovered after Lola. Since both grandparents were the only living grandparents I've ever known, losing both of them has been quite a blow to my brothers and I. We grew-up knowing how crappy a cook Lola A was while Lolo J could make a mean goat entree. We all knew Lola's voice when she would read her Bible or sing old Christian hymns. Lolo always had a stick of Wrigley's spearmint gum or a kind word to offer us. They were our babysitters, disciplinarians, friends, companions, & confidants, as we got older into adulthood. They were the main reason why I'd even bother making the 22-hour journey from the East Coast to my parents' homeland twice a year: to see grandma & grandpa come into their older years, after returning to the Philippines from decades of stateside living.

I've missed both funerals. In 2008, I was single, working full-time and attending LSAT[iii]preparatory classes. Mom was already in the Philippines when Lola A died and us three kids could only afford to send one of us grandchildren: we sent our youngest brother, D. This time in 2011, I'm married, a full-time grad student and trying to balance all my responsibilities to our two big dogs, caring for Dad post-surgery and keeping our long-distance marriage alive in the midst of all this recent chaos. M + I had already planned to spend Thanksgiving with my folks in California and agreed to spend Christmas with my in-laws in Maryland this year. Dad was still recuperating from his extensive surgery and it was too early to have him making a transpacific flight in more 'foreign' (more like 'potential bug country') soil, so Mom went to the Philippines to make funeral arrangements for our grandpa as long as M + I agreed that we would still be coming to CA to be with Dad. An uncle, one of our cousins, and D were able to fly out to the homeland to help with arrangements and support Mom. A typical Filipino viewing of the embalmed body lasts for a week, to allow all family and friends to make the horrendous trek (by foot, bus, or if you're fortunate, by car) from near and the far provinces, to see the body and pay the respects to the grieving family. Mom opted to have the burial sooner rather than later (a day before the end of the typical viewing period) since the burial date would have fallen on Thanksgiving Day. We don't consider ourselves superstitious, but Mom didn't want to celebrate Thanksgiving with an annual reminder of Lolo J's burial day. Mom said the burial was beautiful as it took place in the early morning hours. Lolo J was put to rest next to our grandmother's grave site as the sun rose, Mom said. Since there is a 14-hour difference between Central Standard Time (CST) and Philippine time's zone, I was in the midst of delivering a 60-min. presentation on emergency department services during my health policy & law class. I wore all black with scarlet lipstick on: my intended attire to my grandpa's funeral if I was there. I remember feeling somber during that class presentation and thinking to myself, 'What the hell am I doing up here in front of my peers and professor, trying to present on such an insignificant topic when Lolo is going 6-ft under at this precise moment?' I then focused my brain on the fact that I would be flying out early the next morning to CA to be with Dad during this time. 'I can cry then and not now,' I promised myself as I continued to speak about what EMTALA[iv] means.

Dad + I ~ Thanksgiving 2011 (San Jose, Calif)

The day before Thanksgiving, I arrived in San Jose where Dad picked me up from the airport. Dad was looking much better and feeling better (he says) since I last saw him earlier this month after the surgery. It was just nice to be with Dad: Just father and daughter. It's been the first in a long time since it was just Dad and I. There's always been other family around. Our relationship has never been perfect (I've made no such claim in the past that it has been) but it's been more 'real' and relaxed. We're more honest about our feelings (that's big for Dad to talk about feelings) and what we think. Coming from a more traditional Filipino household than others in America, talking about serious and sometimes uncomfortable subjects is not the norm. Most times, it's swept under the rug until it rears its very unhappy, ignored head, like a pimple waiting to be popped. As the years have gone by and especially this past year with our wedding and Dad's cancer, we as a family have become more honest.

Dad + I got to catch-up on family news, being vegan (Dad is now) and recalling our memories of the interesting places we've lived (e.g., Huron, S.D., and Lumberton, M.S.). Our more in-depth conversations tend to happen over a meal or a long car drive. Our family loves food more than the average family because a shared meal is like glue--a cohesive--that brings us together. A reason to eat something extraordinary to satisfy the palate and a conversation that promises to fire-you-up or convince you to take a different stance. I never said our talks were boring: Dad has a tendency to bring something up that way off tangent, that will make you laugh and/choke on the food in your mouth because it's so bizarre and definitely 'not kosher.'

Thanksgiving Day

Quinoa with kale + corn

I spent most of the early morning trying to figure out how to initiate Dad's top-secret recipe for basting/seasoning the turkey for M who would be arriving later in the morning. I had gone shopping the evening before for last minute items for the vegan recipes M + I found online to try out for Dad. This would be our 1st vegan Thanksgiving (minus the real turkey centerpiece) and it was going to take me a bit more time than usual to make the staple side dishes. Dad was able to figure out the turkey situation and load it into the oven for its roast while I traversed on the Calif. highway to pick-up M from the San Francisco airport. My reunion with M was heartwarming since we hadn't seen each other in over 3 weeks. We both had the same thing in mind for our 'breakfast' and got our holiday coffee fixes at the closest Peet's Coffee & Tea barista.

vegan corn pudding

vegan potato-bread stuffing

The rest of the day, M + I set in to working our magic on the vegan recipes: Who knew that tofu could be used like that? We got to sit down (finally) for our Thanksgiving dinner as a family--us three--during the late afternoon. Dad was excited to taste all the vegan dishes we prepared and he raved about the staple for any vegan/vegetarian Thanksgiving, the Tofurky.[v] We had so much food (on the table and in our tummies), that we had food coma and in bed by 7pm, which ended-up being a good thing: M + I were up at midnight to hit the Black Friday craze at the mall. Errr, we'll speak of that, maybe, never.

The rest of our visit, I spent studying to catch-up on some homework and Dad + M caught-up on 'guy stuff.' We did the usual as a family: Sabbath, church, finding an awesome slice of NY-style pizza a mere walk from my parents' home, dog-walking the 'rents rat terrier, Rufus, and searching for a specialty store that did 'no sugar' apple pie for Dad. All our gallivanting around may seem insignificant to most. And even if our family was split-up during our favorite time of year and for our traditional Thanksgiving dinner because of a family death, I feel that it was the closest I've been with Dad because we got to spend so much time, just him and I. Isn't that the point of the holidays? I know I raved about food this and food that, but we know that food is just a catalyst to the main feast: family opportunities to love, laugh, feel and remind each other 'I love you.' And if that means up to my nose in vegan food, then so be it. It's worth it.

[i] Lolo means 'grandpa' in Tagalog, the national language of the Philippines

[ii] As lolo means grandfather, lola means 'grandmother'

[iii] The entrance exam for law school

[iv] Emergency Medical Treatment and Active Labor Act

[v] Find it at Trader Joe's stores

post-op day 3 + discharge day: walking-out as a stronger man

2011-11-12T10:44:00.001-06:00

Post-op day 3. It's Sabbath, the day of rest. M, my mom, & I attended Sabbath school (an adult Bible study) and church service at the local church. Being Seventh-day Adventist is woven into the fabric of our lifestyle. Yes, Dad's in the hospital but he understands how important it is for us to leave his bedside and attend church. And though 'attending church' will and cannot save us, he understands that it brings us closer to fellow Christians and to the God who loved us first. It may seem 'weird' or 'different' as to why we would leave our Dad's bedside to attend a service; but for us, going to church is more than just the outward appearance of being dressed-up for a service: it's a place where we can totally focus our attention on God. Dad gets that and didn't feel neglected because we left for a few hours. He understands the importance of what we do. Like I said, you may not 'get it,' but when a distinct spiritual practice (e.g., praying before you eat, reading your Bible daily, or having conversations about God) is such a part of your life, steering away from it seems so 'foreign.'

After church, we went back home to grab some lunch, change, and head over to the hospital to spend the afternoon with our family and Dad. Mom brought some homemade pansit (a traditional filipino noodle dish) vegetarian-style for Dad just in case he would be able to eat 'real food' today. D arrived after church service in Oakland and we all sat around Dad's hospital bed, entertaining him with our stories, memories of our childhood and news of our future. Dad is more coherent today to actually listen since they've taken Dad off of the epidural pain medicine and also removed his foley catheter. He had his own great news to share with us today: He passed gas early this morning. Repeatedly, he described. With that, Dad had a wide smile (as wide as his face can allow it). We laughed and clapped in approval. I know this seems weird to rejoice in, but flatulence is such a prized activity after such an extensive surgery. To all those non-medical people out there, this is a HUGE deal for a post-operative major abdominal surgery patient (see blog "post-op day 2"). Farting means progress. Farting means the surgery 'worked.' Yes, such a disgusting human activity is relished in a surgical recovery ward. Because farting means hope. The next task would be to have a bowel movement or poop. This would be the utmost test of the viability of Dad's colon surgery. Little did we all know, it would happen before we would leave this day. Then Dad would be allowed to eat 'real food.' Dad would continue to eye the plastic tupperware that held the pansit for his just-in-case meal for the day. We spent most of the afternoon with our parents until early evening when M+I headed with D to spend the rest of the evening with D and his friends. Mom would spend another night at the hospital by Dad's bedside. We were all praying and 'crossing our fingers and toes' that Dad would be discharged during post-op day 4. There's no reason why we couldn't continue to hope.

Discharge day (post-op day 4). After breakfast, strong coffee and a morning walk on Alameda Island, I got the text from Mom that meant extra good news: Dad's getting discharged today. Be here at 11am to pick us up. M+I quickly dressed for the day, packed our luggage and woke up D to haul us back down to the hospital to meet Dad upon his discharge. When Dad walked out of the hospital, you would've thought he was one of the visitors: Dressed in a striped button-down shirt with cufflinks, dress slacks and leather designer shoes. Dad spoke to a couple of the staff who took care of him and thanked them personally. Some of the nurses were shocked to see him in 'that condition' (e.g., dressed-up and walking out of the hospital instead of being wheeled-out in a wheelchair). Dad could sense that most everyone was thinking that, so it explains the extra 'strut' he had walking out. Mom nicknames Dad 'JoFer' (a combination name of two well-known filipino actors, Joseph Estrada and Fernando Poe) when he oozes with confidence, especially today. Good for him, because Dad should be happy with his progress after the hell-and-back surgery and recovery he's had to go through with all of us witnessing it. I laughed and smiled: our Dad is back. Later this day, Dad went on a walk with Mom and actually breathe-in the fresh air outside of a hospital room. If Dad keeps this level of activity and optimism up, he'll make a breakthrough. So very proud of Dad.

Post-op day 5 until now. The following days after Dad got home, he became a bit despondent. Maybe because Mom and I weren't pushing him into a routine that he was use to while being in the hospital. Maybe it was the pain. I felt crushed and helpless because I didn't know what else to do for Dad to 'feel better' than continue to remind him (through words, deed and prayer) that we are all there for him: I reminded him about taking his medications and eating at the best times. I tried to encourage him to not give-up on exercising (e.g., walking around the neighborhood). I continued to include Dad (his recovery, his pain, and his countenance) in my daily private prayers to God. During my last day I was with my parents, my middle brother G had flew in to stay with the parents for the weekend. It would be G's first visit since May. I feel that Dad's spirits were lifted, knowing that G had arrived and that he was there to help out with Dad, even if it was only a weekend visit. Dad's level of physical activity increased during those last hours before I boarded my plane back to STL. He even laughed and contributed to funny stories of when we were kids. It was good to see Dad out-and-about and smiling. Smiling is always a great sign of hope, in any situation.

I left Cali about a week ago. Since then, Dad's had his visit with his surgeon this past week and got his incision staples removed and replaced with steri-strips (these white little pieces of tape that go perpendicular to the incision to hold the healing skin borders together). His surgeon, Dr. K, continues to be 'very impressed' with Dad's recovery. Mom's updated me that Dad's been more active physically and taken to 'speed-walking.' Dad's also become vegan. Kudos to him, since it's quite difficult for most of the world (me included) to adjust to that kind of diet. In the following weeks and months, Dad will determine what kind of treatment he will want to pursue: chemotherapy, radiation, 'alternative cancer therapy,' or all of the above. In these early stages, I know that Dad's against the chemo/radiation route, but only time will tell what he'll eventually choose. Acupuncture, medicinal cannabis, and diet/exercise changes (which he's already doing) are still to be considered. But in the end, Dad should still be empowered to do what he wants for treatment. Most times in medicine, we health care professionals (or HCPs) have often taken away this 'empowerment' of choice and freedom or 'autonomy' from cancer patients to make rational decisions about their course of treatment or end-of-life issues. Most of the time, we want these sometimes-'time-limited' patients to choose the treatment that would cost us HCPs the least amount of time, heartache, struggle and money. Most always, we HCPs want our patients to conform to our needs or preferences, not their needs or preferences. In the majority of these cases, we brand them as 'noncompliant' if they don't adhere to what we strongly recommend the patients to do. In the end, we (HCPs, doctors, and even family members) need to realize that it's the rationale (the one who can make decisions for themselves after all information provided to them to do so) patient who should decide what should happen. After all, isn't it their bodies that they are making decisions about and not ours? If the tables were reversed, I wonder how many of us would be as proactive about our own treatment, our own care, and our own body?

I'm proud of Dad. As the days turn into weeks and the weeks into months, I'm becoming to realize that that 'ugly C word' will not hold Dad or our family down. There are times we will be discouraged by the prognosis or disheartened by the side effects or effectiveness of cancer treatment (whether its Western medicine or alternative therapy). We will sometimes be overwhelmed by feelings of inadequacy in 'being there' for Dad or the guilt of not 'being there' enough. But all we got is now, the present, to let him know that we love him. As a clinician and a daughter of a cancer patient, I've come to know that it is possible in 'beating' cancer. I see this in the simple and sometimes disgusting things: in the farting, in the pooping, in the walks around the nurse's station, and in Dad's 'half smiles' and jokes. We may not cure it now and Dad may never be cancer-free; but with each small yet priceless 'victory,' we're beating cancer's arse to the pulp. And that truly, is what winning's about.

post-op day 2: 'entourage' walks + waiting to fart

2011-11-07T22:53:00.001-06:00

Cell phone rings. It's 7:30am. I'm so jet-lagged and disoriented, I forgot almost forgot that I was even in Cali, sleeping with my hubby. Omg, it's so early. It's Mom on the phone: she needs us to come by the hospital as soon as possible to keep Dad company while she ran some errands that morning. "He's getting loopy on that epidural," Mom said. "It's the epidural pain med that's making him be this way. I want him to feel safe here [in the hospital]." I oblige and hang-up. Didn't I just crawl into bed 5 hours ago, after picking husband from the airport? But we gotta get ready and head out. Alameda is a good 45-minute drive back to Dad's hospital and Friday morning traffic in this area is nothing to be messed with. I roll over and wake up M, then bang on D's door to get ready for the day. My head is screaming, "Where's my coffee??" I look in the bathroom mirror at my reflection. Man, it's already been a rough morning.

Post-Op Day 2. This is when the endorphins are gone from the 'excitement' of the surgery and reality sets in: The gauze dressing that covers the surgical 'battle scar' (e.g., wound with staples on his belly) and gets evaluated by the surgical team. Today, Dad gets a visit from the surgical resident and someone from the anesthesia department comes in to check-up on his epidural Dilaudid for the pain. When we finally arrived to Dad's hospital room, the doctors had already made their morning rounds (e.g., visits to each of their patients at the start of the day, to discuss treatment, do an assessment). Dad was still in bed, snoring. He looked so tired, more so than yesterday (post-op day 1). Those endorphins, I tell you. Dad hasn't touched his morning breakfast tray of clear liquids (the repeat appearance of hospital gelatin, diet clear soda, and cranberry juice). It looked like Dad had had an exhausting night. Later on, Mom told me that he wanted to walk the nursing unit around 3am until he finally got tired and went back to bed.

Today is the first time M has ever seen Dad like this. I can only imagine what M thought (not being from a medical background) about seeing his father-in-law truly sick like this. I can't tell you how seeing my own Dad in a hospital gown with all these tubes connected to him, honestly disturbed me. I kept thinking that this isn't real. This isn't Dad because Dad doesn't get sick enough to have other doctors operate on him. Dad was always the one in pressed, clean clothes, always ready for a heated political discussion or to play with our big dogs. This was not my Dad, wearing a stupid, flimsy 'uniform' (gown) and hugging an 'abdominal pillow' (to hold close to his belly when he coughs, as to not 'stress' the incision area) so that it doesn't cause the shooting pain to the fresh 'wounds' whenever he changes position in bed or in the chair. This cannot be my father who has a narcotic coursing through his veins that's making him 'feel different,' funny and a tad paranoid all at the same time. This is just another surgical patient with his overbearing family members. At least, if I were one of the surgical nurses on this floor, I would be thinking this. Nope, this IS Dad. And being his daughter, I feel so helpless because right now, I don't know how to help him except to be that annoying family member that's always asking the nurse all these nonsense questions, like, "where can I get more ice water?" or "do you have any extra pillows?" Note to self: I will never take for granted the embarrassment of one who must be the patient and wearing a stupid gown or having to press a stupid 'nurse call button' so someone can help you get out of your chair or go to the bathroom. Being a patient strips you of your identity except for the ID bracelet that has your legal name and barcode the nurse hast to scan to make sure she's giving the right medication to the right patient.

Today's goals for Dad are the following: (1) Walk around the nursing unit at least 4 times, (2) eat (more like drink, since he's still on a clear liquid diet) whatever is on the meal trays, and (3) pass flatus. Yup, you heard me. Fart. Dad's been burping and hiccupping ever since he got out of surgery, but he has yet to pass gas via the 'other end,' which in this scenario, is quite important. Girls, do you remember when you had your first period and you were freakin' out because you didn't know exactly what the hell was happening but your moms were always was so happy and wanted to celebrate the day? Well, farting after an extensive abdominal surgery is that kind of a 'big deal.' It means that peristalsis (digestive system workings) is happening and an even bigger deal, the surgeon didn't screw the sewing-up-the-colon part. Dad's so anxious that he hasn't accomplished goal #3 and is fixated on it for the rest of the afternoon. [Side note: When you're in the hospital, you're priorities change. You become fixated on making sure you can pee, fart, eat without vomiting and poop. These often 'disgusting' activities of daily living is a tell-tale sign if you're recovering or not, especially after a surgery.]

During this day's walk around the unit, the 'entourage' (that's what Dad and his family are called) walks beside Dad's walker he uses to ambulate while D pushes the IV pole again. M joins our walking tour this afternoon. I feel so bad for him because I don't think M's been in a hospital this extended amount of time and he's not use to being around sick people everywhere. We (our crazy medical family) grew-up learning the codes to get into the break room of our mom's ICU unit to get some snacks or knew where all the empty hospital rooms were so we could watch the football game. With Dad + Mom working in the hospital ever since we could remember, we kids were never fearful of the daily hospital grind. As I walked in front of Dad to clear his path down the hall, I'm stealing glances toward M to make sure he's not about to be ghastly white and getting dizzy from the stench of industrial cleaning solution, some nurse's lunch from the cafeteria, and the smell of 'sick people.' What a hospital smells like. M's not fainting or clammy yet, so we continue with Dad's jaunt around the surgical/orthopedic unit.

The rest of the afternoon, we chat in Dad's room while he practices the breathing apparatus called an 'incentive spirometer' (helps prevent pneumonia and promotes deep breathing/diaphragm exercises). Our conversations today range from "Dad, please eat the gelatin (I personally wouldn't)" to "What are you plans this weekend?" I notice that the Dilaudid is making Dad quite drowsy today and a slight bit anxious. Probably one of the side effects he's experiencing. He looks like he did an entire day's workout so we let him rest. Tomorrow is Sabbath (the 'rest day'), so we'll come by after church service in the morning. Post-op day 2 is down for the count and so is our worn-out Dad.

TO BE CONTINUED...

post-op day 1: colons & 'mj'

2011-11-05T15:34:00.000-05:00

Dad holding me, pictured with my cousins. Maryland, circa 1981

Colon resection with hepatic lesion ablation secondary to metastatic colon carcinoma. What does that mean to a lay-(normal) person? It means "surgery to take out some of your parts so that you can 'beat death'." Statistics are out there on how good (prognosis) this kind of surgery will turn out. Mixed reviews, I tell you. Coming from a medically-skewed family, we have our own opinions on the outcomes and professional friends who are experts in any medical treatment and/or procedure. We always want the second or the third opinion, even when we've been dealt the 'death card' ('stage IV' or "metastatic"). We always want the best treatment possible so that we practice what we always promised to our patients when we took our Hippocratic or Nightingale oath. We strive to be the producers of healing or at least give it all we got to try. Funny thing is, the patient doesn't always agree. Dad is no exception.

This past 10 days, I've been away visiting my parents and D in San Jose/East Bay area. Dad had the extensive surgery (see first line) the day before I arrived. The phone call Dad and I shared while Mom drove him to the hospital for the surgery is heart wrenching: I was trying to give him a positive vibe and remind him how much his family loves him and is praying for him. Towards the end of the call, I couldn't speak anymore because the crying that was stirring in my throat was swallowing all the words.

"Dad, you know I love you, right?"

"I know, Anak, and I love you." [Silence, except for the cell crackling] "Just be faithful and pray."

"I am Dad, but." [Choking-up sound] "I just want you to be okay."

"I will. Don't worry too much and I'll see you tomorrow. Take care, Anak, and here's your Mom." [Dad hands the cell over to Mom who's trying to drive safely and calmly, I imagine]

"Mom, you there?.."

I had class later that day but couldn't focus. I kept looking at my cell phone, hoping Mom would call me already to bring good news. I knew the surgery would take at least 4 hours and scared to death that it might take longer. I was distracted that I don't think I necessarily understood all the concepts being said regarding bioethics. Ironic, isn't it? I was going through my own struggles with what autonomy, beneficence, nonmaleficence, informed consent or cancer treatment really meant. What does it mean to anyone, really? Heck, I know the theory behind it; but didn't quite 'get it' until it happened to my family.

After several hours, Mom finally called: The surgeon said Dad did well and 'they got all of it.' 12 inches of his colon and ablated several lesions on his liver. Adenocarcinoma. Cancer in the colon and cancer in the liver. I crumbled to the floor close to the restroom and started tearing-up, holding the phone like it was some kind of lifeline. I thanked God in my head and hurried back to class. I wasn't going to sleep well that night.

Post-Op Day 1:

After two connecting flights, I finally arrived in San Jose where Mom picked me up from the airport and we drove straight to the hospital to see Dad. Post-operative day one. This is critical day for a surgical patient. It's the earliest times to see if the surgeon did a good job or not. Can the patient tolerate the pain on the epidural pain medication? Is the patient burping or passing gas [flatus]? Can the patient drink water and not vomit it back up? Dad was already sitting-up in the adjacent chair to his hospital bed when I arrived. He looked groggy (or was that the look of being 'high' from all the Dilaudid going through the epidural line in his back?) and exhausted. A surgeon once told me, "Your body goes through hell and back when you go through major surgery. It's as if a semi-truck just hit you at 60 mph and backed up into you again. At least, in the operating room (or O.R.), it's a 'controlled kind of trauma'." Dad should be allowed to look so tired: He got 'run over' by a 'semi' and he deserves to rest. But he wants to walk. Like, outside his room. Oh my God, I thought in my head. Is he delirious or am I being over-protective?

Dad circled the entire surgical unit five times with his walked and his "entourage" (what we were nicknamed some of the nurses). Mom walked beside Dad, I walked in front of Dad to make sure the hallways remained clear for him to roll his walker right through, while D handled the intravenous (IV) poll with its numerous pumps and IV bags of medicine and saline. Dad was so proud of his progress (in my opinion, pushing it too much on post-op day 1) and decided to reward himself with a nap.

When he awoke later that afternoon, Dad was ready for his clear liquid diet tray: Gelatin, vegetable broth, and two cranberry juice cups. Dad asked sarcastically, "They call this a 'meal tray'?" He 'ate' it all up anyways after much prodding from his family of nurses (Mom, D, and I). Then I dropped the bomb of a suggestion:

"Dad, how do you feel about medicinal cannabis?"

[Mom looked so shock as soon as I said the 'C word' that I thought she almost choked. D was trying to hold back his laughter]

"I'm serious, Dad. There are studies to show that marijuana actually helps with cancer pain and that's why oncologists prescribe it."

[Awkward silence]

"Since you're not too fond of the pill narcotics and its side effects when you get home, I thought you could bring it up with your oncologist when they do your follow-up care."

[More awkward silence and then D finally belts out his infamous 'your crazy' laughs]

I will not tell bore you with all the details of the conversation that ensued regarding 'medicinal marijuana' and the fact that I even mentioned it to my quite conservative parents. I also shared with Dad the acupuncture experiences I had prior to coming to California and he liked that it (acupuncture, not weed) helped with my shoulder/neck pain. At the end of the conversation, Dad quietly nodded and said, "Okay, I'll think about what you've said."

That night, Mom slept in Dad's private (meaning, only for 1 patient) room on the foldout chair cot. D drove me to the airport to pick up my husband M who had flown from DC after work to spend time with my family as well. Post-op day 1's night was the first night in a long time, I felt comfortable sleeping in a bed. Back in St. Louis, I had taken on the habit of sleeping on the couch with days on end. The bed seemed 'too comfortable' and I felt, eh, maybe 'guilt,' for sleeping in one when I knew Dad was so sick. M + I spent the night at D's home. We would make the drive early in the AM back to the hospital to see what Post-op Day 2 would have in store for our family.

TO BE CONTINUED...

"D, you are the Kuya now"

2011-10-23T22:25:00.000-05:00

Balboa Zoo, San Diego. Circa 1986. "D" is sibling on far left.

One of the beautiful places my brother D has introduced me to. Circa 2011

If my brother, D, read this, he'd probably freak the hell out that I'm actually writing about him in public. On a blog. But I am. D inspires me. Many may not think it's a big deal, but coming from our family, you'd see why this kind of admiration is a big deal.

Growing up as the eldest (and only girl) of 3 first-generation Filipino-American children, I was 'delegated' (by Filipino birth order standards) certain responsibilities and expected to set the standard for what was appropriate behavior or manners. One of my earliest instructions as a child was to "watch da boys," or my younger brothers. G is 13 months younger than I and almost 3 years separate D and me. As 'Ate' (pronounced ah-tee) or older sister, I was deemed with the responsibility of making sure my brothers would stay safe, stay out of trouble, and most importantly, stop reading my journal (as I found out was a common hobby for them when I was 10 yrs. old). I taught them how to tie their own ties and cook a good meal. I listened to them talk about girls they liked and fear of rejection. I covered for them when the 'rents were questioning their whereabouts on certain school nights. I know I set the bar pretty high for them growing-up. They always felt like their work or talents, whether it was in the classroom or doing chores or performing in front of people, was always compared to me. The brothers felt they there no match to their beloved Ate, the "older sister who took care of everything and did everything too well...or too perfect."

But I loved them both more intently then I loved my blond Barbie dolls or my 5th grade supposed-BFFs who seemed to conspire against me because I liked the 'wrong' boy (or the boy they wanted for themselves). My brothers were not only my familial responsibility as Ate. "Da boys" were my life. I took my sisterly obligation seriously, even as a young child, and made sure I was always there to bandage a skinned knee or take the heat from the cops about driving a "souped-up car" (illegal modifications done to it, compliments of G during our early twenties).

Then we got older and set off for our own adult aspirations, careers, and lives. I don't take as much responsibility for anything on account of them, since they have to answer to their own issues (G is now married and D is a pretty independent single guy). I know it's weird to try to explain this kind of 'Ate responsibility' to someone who is not of our culture, but it's a real thing. I don't consider it bad, but I feel like it made us even closer than most siblings are. D feels comfortable calling me up at any time of day and I always know that if I need to crash at some one's house, G will always open his home to me. We not only love each other differently as adults (e.g., instead of sharing our Lego's, we always offer to 'spot each other' when money's tight), but our sibling responsibilities have changed. Lately, D is the one who has inspired me: How he lives his life and how he has become the twenty-something-old man he is. D is fearless in his avid love for rock-climbing, traveling, and running marathons, but he's also just as fearless in his love for his family and for God. During these very tough times when I couldn't be with Mom & Dad during the surgeon consultations, doctor visits, or even just to hang out at their house to keep them company, D has stepped-up in being the one to call G or me with updates, accompanying my parents to Dad's medical visits, and showering our parents with the love and support I wish I could give them day-in and day-out beyond text messages and phone conversations. But I can't since I'm here and D knows that. He has his own adult life to contend with (professional, academic, social/love), but D makes the time to let those he truly love know that they are loved. In this present time, he has shown to be the 'Kuya' (pronounced kuh-yah), the older brother; because of how D has masterfully handled Dad's situation.

Today, I dedicate my post to my youngest and thought-to-be-more-rambunctious-and-foolish brother, D. No, we were all mistaken: you are the epitome of awesomeness. Written with love, your Ate.

Bearable

2011-10-18T23:35:00.000-05:00

October sky on hike close to San Jose, CA

>24 hrs. Can't shake off this left arm and scapular pain, not associated with any injury. It's so bad, I'm getting numbness in my hand. After several self-medicating doses of heat pads, acetaminophen, rest and even more aspirin, I still can't get rid of the pain or numbness. I'm just calling it 'nerve and anxiety pain.' Dad's PET scan was today, just 3 days before his first surgery. I may have been thinking about it too much last night during a B-school lecture because that's when the pain and numbness started. The meds or heat aren't helping. Maybe I need to start on thinking about other things. It's starting to affect me physically.

Bearable. What is that? Isn't it good enough to wake up in the morning, walk my dog, brush my teeth, and do my ethics' class readings? Is 'functioning' equivalent to 'bearing'? I don't know the difference these days. I'm worrying about Dad and counting the hours till the scalpel hits his belly and what his recovery entails. I know I shouldn't be fixating on those things, but I'm guilty for it. In the back of my mind, I'm also thinking about that biopsy needle hitting my neck during the same time frame.

A good friend of mine recommended that I "breathe...and take in what each day has to bring. That's all we got." I'm learning to listen to that kind of candid advice and bear it, because "that's all we got."

"A" for apples, animosity and ambivalence

2011-10-16T12:21:00.000-05:00

Sunset on California coast, June 2010

"A" is for apples. Don't they often say that to you as a kid to make you eat more fruits and vegetables: an apple a day will keep the doctor away. Dad loves apples, but that didn't keep those gastroenterologists (gut docs), primary care physician (general internist), endocrinologist (diabetes doc), or surgeons (you get the point) away. When Dad was diagnosed with diabetes in 2008, he changed his lifestyle habits completely and I was beyond impressed: he cut out meat (except fish), stopped the Breyer's ice cream rampage (man, they put out good strawberry ice cream), and started exercising more often. He wanted to use lifestyle changes to battle the chronic disease. He was so successful, Dad started weaning himself off the diabetes medication and was able to keep his blood sugar in-check. He was looking healthy, vibrant, and happier. Then Dad started traveling. A lot. He would be going from DC to California to the Philippines and back again, several times a year. The frequent time changes and chaotic travel habits took a toll on him. Did you know stress can raise your blood sugar? That's what happened. Poor Dad: He was back to square one with dealing with diabetes a week before his colon cancer diagnosis. Back on the medications and frequent blood sugar checks. He wanted to beat the chronic disease holistically (e.g., proper diet, spiritual prayer, and exercise/playing his violin. Literally), but it wasn't working. Dad's still on a ovo-vegetarian diet (he's cut out dairy products except eggs). He is exercising in the hospital's gym and taking enough fiber (also found in apples) to prepare him for surgery next week. My youngest brother, D, who's been quite the health feign since moving back to CA several years ago, has pushed for Dad to do the "bowel cleanse diet" this upcoming week. I don't know about that. I just say, let Dad have some control over what he wants to eat and allow him to do the best he can. No fads or gimmicks. Just let the man eat, for cryin' out loud. There's a chance that the surgery on Friday will resect enough bowel that he made need a colostomy bag. A double whammy: Not only is there a chance for several feet of bowel to be taken out, there's also a possibility for a "poop bag." Talk about body image disturbance and insane post-operative pain. I'm sad and distraught about the situation, but I can only imagine the thoughts going through his head. I'm sure "what the hell?" is one of them, or a less "curse-like" rhetorical question...

"A" is for animosity. I'm sure you get this already, but I'm angry at cancer. Pissed-off actually. But how can I possibly have these fiery feelings towards something (an "it") that cannot feel or hurt or anything, except spread and destroy tissue, organs and lives? At times, I cry because I'm so angry and there are not enough expletives to describe the animosity I feel about the "C word." God's been working on my heart, so I choose to be angry at "it" and not at people. Life's unfair and it sucks, but there's got to be more than that for us human beings. Dad believes that. He's always said, "We're only travelers in this world and this [world] is not our forever home." His faith is unbelievable and he's okay with what this life deals him; but I'm not. A daughter, born and raised in the faith, I still ask my questions and scream for the unfairness of it all. I scream at "it" or cancer, because I have no other "it" to blame besides the devil...but that's another story. I reek of animosity towards that ugly "C word."

"A" is for ambivalence. As the days go by and the countdown begins to Dad's big surgery and my own biopsy, there is a small daily dose of ambivalence to what I'm dealing with these days. If not, you'll find me as the crazy woman crying hysterically in your local Walmart because I saw another pink ribbon awareness pin (October is "breast cancer awareness month"). These days, I have to mentally shutdown my feelings while I'm in public, so that I don't appear insane when I start crying all of a sudden. I've started putting Kleenex in my purse, for those just-in-case times. I suppose that's part of the reason I've invested a stockpile of waterproof mascara for those days I have to be out of the house and I expect the the waterworks. During my recent visit to CA to see the 'rents, Dad was also dosing himself with a small portion of ambivalence; ergo, the white elephant in the room. He spoke not of cancer or colon or anything related to it. He spoke of his nerve pain in the scapular region (Mom and I call it "referred pain") and I told him about acupuncture instead of Vicodin. Mom says Dad hasn't touched the pain pills since he was prescribed it. Dad's all about holistic so he won't touch the stuff. But addressing the pain is what will get Dad to talk about "his health issue."

We don't talk about cancer right now outside of his doctor's visits; but we'll talk about recovery, pain control, and life. We talk about what makes him laugh. One memory that comes to mind was during my last CA visit, Dad watched me chase down a runaway stroller (minus the baby) that was heading from a parking space into the street. The unsuspecting mother who had turned her back to the stroller to fasten her baby into the car seat, yelled out, "Sh&^*!" and Dad just laughed as I went into my high-school sprinting mode and caught the stroller before it made it to the road and returned it to its owner. This is an example of Dad's ability to still laugh at the craziest things. He may be ambivalent for a bit concerning his diagnosis, but Dad's still got a sense of humor. Even if he doesn't want to talk about "it," Dad still laughs. These days, that's what we all need to hear anyways.

The ugly "C word"

2011-10-15T15:38:00.000-05:00

This is Dad, on my wedding day. He's so happy. Dad's delivering his father-of-the-bride speech during the reception: honorable, distinct, and proud. Dad memorized his speech and knowing Dad, I wouldn't have expected any less. He's like that: well-intentioned and always doing his best when it comes to his family. Dad's best is always more awesome than is expected from any father. His speech was to-the-point and well received...his blessing in every word. It meant so much to me hearing him speak on one of the most beautiful and most important days of my life.

That was 7 months ago. Just four weeks from today, Dad was diagnosed with progressive colon cancer after a routine colonoscopy. Dad couldn't even tell me himself, so he handed the cell phone to Mom after I had called to see how the colonoscopy went. I found out during a class break in one of my business school lectures. I choked and want to collapse down in the hallway and cry; but I couldn't. I was in shock, because there is no history of colon problems in Dad's family. So what did I do when I found out that Dad was diagnosed with that ugly "C word," I went back to class and sat through a business lecture. I didn't want to think about cancer or Dad having it. I almost felt like I had no heart, because if I allowed myself to feel things at that exact time, I would've faded into a crumble of defeat: crying my head off and screaming, "Why?!"

After that night, I called my parents every day, just saying "hi," followed-up by a call to my husband M (who works in the east coast), to cry and repeat my questions of "why dad?" I cried every day and at times, just bursting into tears during conversations with close family and few friends. I avoided having casual conversations with anyone, in fear of being asked, "how are you doing?" and having to think about my answer to such a casual question. I spent the next week or two, holed-up in my new apartment, alone and scared. From that point forward, any time someone would mention "cancer," I'd physically flinch and avert my eyes. I didn't want them to see my tears.

Two weeks ago, I flew out to California to see my parents. During my visit and even during the times I took him to his diagnostic tests, Dad never mentioned the white elephant in the room: cancer. Neither did I. Mom and I spoke of it often and never in Dad's presence. Mom says Dad's in denial. I respected that, so I never pointed to that white elephant. The pain is sometimes so great when I think about that white elephant in the room, there are no words to describe how much "that ugly 'C word'" has truly affected my life. That's why I speak up here. Maybe that's why Dad doesn't talk about it.

Last week, we all found out that Dad's cancer has metastasized (or spread) to his liver. He is scheduled for surgery on the 21st, the same day I have my own biopsy on my thyroid. See, what I'm talking about when I mean "white elephant in the room"? I don't even talk about my own health fears. Sometimes I think it's best to let it be: may the white elephant go stomping around, while all of us try to stay out of its way. I write because that's how I'm dealing with all of this. Allow this to be my own entry in "a daughter's journey in her father's cancer."

Curse that "C word." I'm still not done asking God, "why??" I want answers, but I don't know what I'd do with it if I knew. So I share my journey in asking..

To learn more about colorectal cancer, please view the following links:

http://www.ccalliance.org/
http://preventcancer.org/prevention/preventable-cancers/colorectal-cancer/
http://www.cancer.org/Cancer/ColonandRectumCancer/index
http://www.eifoundation.org/programs/eifs-national-colorectal-cancer-research-alliance