According to a 2018 report by the American Cancer Society (ACS), pancreatic cancer has the lowest five-year survival rate (8%) of all cancers, and is the only disease with a disease where the number of patients is close to 1:1 in death. Whether at home or abroad, pancreatic cancer is regarded as the "king of cancer".
A 78-year-old man with pancreatic cancer stage 4 has been battling cancer for 15 months, is it lucky?
Father's last 15 months
After the elderly have cancer, it is a disaster for every family.
The signs of this catastrophe are always in the places where people are most likely to ignore, and unfortunately, it is always too late for you to find out.
To this day, more than three years after my father left, I can still clearly remember those sunny days, he was full of silver hair, striding meteors on the banks of the sparkling Songhua River...
Anorexia, back pain, pancreatic cancer came quietly
December 2013 was a very normal weekend.
My lover and I went back to my parents' house as usual to "rub rice", the warm sun in winter, the fragrant meals, the father who talked and laughed, everything was so calm and natural. As we chatted, he suddenly said lightly: "I may be sick and can't eat, especially if I don't want to eat meat." ”
Usually very concerned about health knowledge, my heart sank, my father is an old stomach disease, is it aggravated again?
After eating, I called the eldest sister, and within a few days the eldest sister took him to go for a gastroscopy, and the results were still gratifying: gastric ulcer, gastroesophageal reflux, chronic gastritis, the doctor prescribed conventional drugs, and the days returned to their former calm.
So, for the first time, we lost the opportunity to detect pancreatic cancer early, and pancreatic cancer seemed to be smiling and quietly began its invasion.
The research literature published in nature, the world's top scientific journal in 2010, pointed out that normal pancreatic duct epithelial cells gradually evolve into cancer, from genetic mutation to the formation of a real tumor cell it takes 9 years, from a tumor cell to a cell mass with metastasizing ability to take 8 years.
The window period looks pretty ahead, but early detection is very difficult.
Speaking of this topic, Qiu Baoan, director of the Department of Hepatobiliary Surgery of the Sixth Medical Center of the Platon General Hospital for his father's diagnosis and treatment, also feels a little regretful, the pancreas is located behind the peritoneum, if the lesion is relatively advanced, it is easy to stimulate the peritoneum, and pain will be felt, and it is difficult for the posterior peritoneal organ to appear obvious discomfort in the early stage. The functional effect on all aspects of digestion is not serious, and patients often have no specific manifestations except for weight loss.
In February 2014, the second chance to seize pancreatic cancer soon came again.
I went to a genetic clinical trial at a military hospital and needed me and my father to draw blood. At that time, it was not easy to find someone who volunteered to draw blood, and my father was a scientific researcher, and when he heard that he was contributing to scientific research, he gladly went there.
The director in charge of this project was very grateful, and specifically asked us, since we have all drawn blood, other testing projects that we want to do can also be completed together. I would love to give my father a tumor marker test, after all, the previous stomach disease was always a hidden danger.
But my father flatly refused, for the simple reason: "I am here to support you in doing scientific research, why take advantage of this, I have medical insurance, I want to check you can go to the hospital yourself." Probably the intellectuals of that era were so "stubborn." The director guessed what I meant, still smiling and groaning to ask for my opinion, and after hesitating, I still agreed with his idea and did not check further.
Walking out of the hospital, in the twilight, watching him stride towards a shooting star, his chest up, his silver hair dancing in the wind, very handsome! Not at all like a 78-year-old elderly man, the only concern seems to have dissipated with the wind, how can such a dashing and healthy father be related to cancer? During this time, pancreatic cancer has opened its clutches and grabbed its father fiercely.
In April 2014, I was doing thoracic spine surgery at a top three hospital, and my parents came to take care of me, both of whom were in their seventies, and in order to avoid running, they lived in a hotel near the hospital.
Late one night, his father suddenly had severe pain in his back, and the pain was so painful that sweat wet his clothes, and his mother quickly took him straight to the hospital emergency department. The doctor began to worry about acute pancreatitis, checked the pancreatic amylase, the result is very normal, because the pain site is under the back, and he has had kidney stones before, we take it for granted that it is kidney colic, the kidney was checked again, there is no problem, the pain after the pain injection was quickly relieved, it did not cause enough attention, and missed the third opportunity to find pancreatic cancer.
Suddenly, I became the last patient my father cared for
The next day, my father suddenly said sadly at my hospital bedside, when you are old, it will really add to the chaos, you are probably the last patient in our family, I take care of.
Unexpectedly, a word! In May 2014, my father's back suddenly ached again at home, and this time he went to the hospital and was diagnosed with advanced pancreatic cancer, leaving us forever 15 months later.
Probably many children will be like me, after losing a loved one, they can't help but think back to every detail and blame themselves, "If at that time..."
After my father died, many midnights, I would wake up in my dreams and repeatedly struggle with "If my father had done the gastroscope, and then added an abdominal B ultrasound examination; if I had finished drawing blood at that time, I would have insisted on checking a tumor marker; if I had not thought that it was renal colic at that time, checked a few more parts, would fate have turned to luck?" ”
For elderly parents, there is actually not much "if" to speak of in limited days, even if they look rosy, they must take them to the physical examination in time and regularly, and do a good job in each examination, which is a good opportunity for you to fulfill your filial piety.
"Tumor markers are really important for early detection of pancreatic cancer." As the father's supervisor doctor, Zhu Jianyong, deputy chief physician of the Hepatobiliary Surgery Department of the Sixth Medical Center of the PLA General Hospital, explained that screening pancreatic cancer is generally an abdominal ultrasound and tumor marker, the pancreas is located behind the peritoneum, and the B ultrasound is slightly inattentive and may not be visible, which requires the doctor to have a certain eye power.
From a clinical point of view, tumor markers such as CA199, CA125, CEA, etc., have a high sensitivity to pancreatic cancer detection, and can detect cancer signs earlier before the tumor is found in the abdomen B ultrasound.
In fact, for my father, the back pain that was mistaken for "kidney stones" was one of the symptoms of pancreatic cancer. The average person often feels that pancreatic cancer will definitely cause abdominal pain. Dr. Zhu Jianyong introduced that the actual situation is that the symptoms of pancreatic cancer are related to the location of the disease, the lesions are mostly jaundice in the pancreatic head, the eyes and skin will be yellow; the lesions are mostly in the pancreatic body and pancreatic tail when the lower back pain, is blunt pain, not like kidney stones, even can not lie flat, to lie on the side, sometimes vomiting, the stomach will be uncomfortable after vomiting will be more comfortable, and pancreatic cancer after vomiting, the pain can not be alleviated.
According to statistics from the National Cancer Center of China, pancreatic cancer ranks 8th in the incidence of malignant tumors in urban Men in China, and ranks 5th in the mortality rate of malignant tumors in Beijing and Shanghai.
Therefore, for high-risk groups, Director Qiu Baoan reminded that for example, over 40 years old, usually like to smoke and drink; have acute or chronic pancreatitis; recent weight loss is obvious; have a genetic family history; long-term digestive discomfort, such as diarrhea, etc., pay special attention to regular physical examination.
The family is in chaos, how to win the battle against cancer?
"Finding cancer is a disaster for every family, and the family generally goes through these processes: 'ignorance, panic, chaos, noise'", Zhao Wenshuo, chief physician of the Oncology Department of Beijing Municipal Hospital of Traditional Chinese Medicine, has always paid attention to the psychology of cancer families, and he is very emotional when talking about this topic.
First of all, it is a little confused, thinking that it is a misdiagnosis; after confirming the results, it will panic, and each will show its magic to find different treatment methods; it is either a folk remedy or a health care product, which is very confusing; then it will quarrel over what kind of treatment method to choose, thinking that the method introduced by themselves is the best for the patient, and even relatives will participate in the dispute, "good intentions do bad things", in fact, it is not conducive to the treatment of patients.
Our family is no exception, the eldest sister and brother-in-law went to the Cancer Hospital of the Medical Academy, my mother and my lover took the film and went straight to Peking Union Medical College Hospital, and I have been searching for the latest treatment methods and the most authoritative experts in front of the computer.
Although all this was hidden from my father, he watched us running around like this, and he also fell into uneasiness, smoking more fiercely, originally two packs a day, now it will increase to two and a half packs, and the amount of food is even more drastically reduced. Once when I advised him to smoke less, he frowned and said with a sad face, "I'm upset." "The atmosphere in the house became very strange, and we all forced our smiling faces in front of our father, and we quarreled with my father over the treatment plan behind my back.
The treatment of tumors must be raced against the clock, and it cannot be so chaotic!
How to help dad win the battle against pancreatic cancer?
The brother-in-law held a family meeting, we re-examined, the eldest sister has a wide range of contacts, good economic conditions, the treatment of this piece she has the final say; the mother transferred to logistics, according to the father's taste to supplement nutrition; and I am the youngest daughter, often with the father to talk about small talk, acting as a "pistachio", distracting his attention to the disease. At the same time, it is agreed that no matter what the result is, there will be no complaints or regrets, and everyone will look forward together.
And the father's physical condition looks good, every day to go to the physiotherapy, the cancer cells seem to be sleeping, there is no more pain, we are also secretly lucky, is it possible to "survive with tumors". From May to October 2014, he spent the last "golden age" of his life, still silver hair fluttering, walking like flying, but the amount of food decreased. Therefore, the eldest sister often took him to eat different foods in major restaurants, he did not eat much, but the atmosphere was very good, and a table of people was lively and lively.
In those days, he didn't want to eat meat, but he liked to eat a steamed potato every day, using the typical Northeast eating method, dipping sauce. Potatoes from Northeast China, Inner Mongolia and Qinghai are continuously delivered to their homes, and employees of Big Sister Company usually carry a bag of potatoes on the plane from Qinghai. Many people around wonder, potatoes are not a good thing, why not eat something nutritious?
I checked the data and found that, in fact, the potato is a treasure knot, the protein content of potatoes is relatively high in the potatoes, mainly belongs to globulins, easy to absorb, contains more tryptophan, and has better nutrition. Potatoes contain mucus proteins, which can prevent the atrophy of liver and kidney connective tissue, keep the digestive tract smooth, in addition, potatoes contain higher potassium than bananas, potassium can work with magnesium and calcium to enhance vascular elasticity. Vitamin C content is also quite good, 1 potato of 150 grams + 1 tomato of 150 grams (potato meal), because there is starch to protect vitamin C, heating will not be lost.
On the eleventh long holiday, the eldest sister took her father back to Harbin, although she had lived in Beijing for fifteen or six years, she was still a "guest residence" in her father's heart, and only her hometown was the real "home". On the bank of the Songhua River, with the afterglow of the setting sun, he quietly looked at the sparkling river, his eyes were so calm and steady, and the years were quiet, probably so.
Unable to walk for just three hundred meters, he wept for the first time before the illness
I wish time could be fixed on the banks of the Songhua River, but life is always cruel.
Returning from Harbin, Beijing was still in high spirits, but his father, who was weak and afraid of cold, put on a down vest early. One day, we went with him to the supermarket across the road, less than three hundred meters away, and used to walk back and forth easily, but this time, Dad couldn't walk! (It was later learned that the cancer cells had metastasized at this time.) ）
While sitting on the side of the road, he burst into tears for the first time since he fell ill... I blamed myself helplessly: I couldn't walk these few steps.
His father has always been strong and resolute, after graduating from college, he went to Qinghai alone, worked in the harsh places of the plateau lacking oxygen for thirty years, studied the collapsible loess, published two books, and in 1978, at the age of 42, he participated in the first national science conference because of his outstanding scientific research achievements, and was received by Deng Xiaoping and other national leaders. There are many ups and downs in life and work, he never bows his head in the face of difficulties, except for the death of his grandfather, I have never seen him cry. Such a strong man, in the face of the disease, but burst into tears, abominable cancer!
The severe condition is in front of him, the father is 78 years old, this time to the hospital diagnosed pancreatic cancer stage 4, has metastasized to the liver, lymph nodes and bones, CA199 up to 20,000, obviously does not meet the indications for surgery. How to choose from various treatments in internal medicine, TCM conditioning, morphine, and even final palliative care? Step by step, such as walking on thin ice, each step is extremely difficult and tangled.
Clinically, pancreatic cancer is divided into 4 stages, of which stage 3 and stage 4 are advanced stages, and their 5-year average survival rate is very low, the average survival rate of stage 4 is about 4-6 months, and the average survival rate of stage 3 is 6-8 months. Overall five-year survival is less than 30%.
Dr. Zhu Jianyong introduced that the treatment principles of advanced pancreatic cancer are:
Minimize the burden of the tumor;
Prevention and treatment of tumor-related complications, this requires special attention, tumor patients are threatened with life, often not the tumor itself, but because of some comorbidities of the tumor, such as upper gastrointestinal bleeding, hepatorenal syndrome, bile duct stent caused by biliary tract infection;
Improve the patient's physical condition and maximize survival.
Difficult treatment begins, with adjuvant therapy being tried outside of traditional therapy
At the end of 2014, my father was admitted to a third-class hospital, surgery could not be done, and we were very jealous of the side effects of chemotherapy, and the doctor recommended adjuvant treatment.
After the treatment, my father's physical condition was obviously better, he walked harder, his appetite improved, and he could eat a hairy crab Chinese New Year's Eve dinner.
Smoke a lot. Smoking has always been the father's self-evaluation of the standard of physical fitness, he has a cold and fever, the amount of smoking will be reduced, "smoking feels fragrant, cold must be good." "Smoking history for more than fifty years, basically two packs a day, the eldest sister bought a 3-character soft Chinese is not much smoking, I like Shanghai peony and big front door."
We objected to his smoking, and my theoretical father would always emphasize that his body had always been tough. Indeed, before the detection of pancreatic cancer, my father's body has been very tough, the heart is healthy, the blood pressure is not high, the blood lipids are normal, after retirement, he sits all day and gets the computer, the cervical and lumbar spine is not painful, the legs and feet are sharp, and he walks faster than the boys.
In fact, pancreatic cancer mainly has two major precipitating factors, the first of which is smoking, a large number of foreign research cases show that the risk ratio of smoking and non-smokers with pancreatic cancer is 1.6 to 3.1:1, which makes me regret: I really should have let him quit smoking earlier.
The whole body was golden and spread, and the silver hair was removed after chemotherapy
In the early spring of 2015, the willow color was green and sunny, one day, the father sat on the bed, enjoying the sun, and suddenly the mother found that his skin was obviously yellow in the sun, the whites of his eyes were also light yellow, and the inevitable jaundice in the advanced stage of pancreatic cancer appeared.
"PET-CT tests are not optimistic, and chemotherapy must keep up."
In May, my father was admitted to the 38 beds of hepatobiliary surgery and never came out... After being hospitalized, my father basically couldn't eat anything, and all day long like a "fire chamber", he ate a cool popsicle, and the person quickly lost weight.
Every morning at five o'clock in the morning, my mother would boil rice porridge, put the top layer of porridge oil in a small bottle, and about 20 ml of water for the elderly ginseng, which made up his diet standard for the day.
Father has a strong sense of self-esteem, never wants to trouble others, even if he is bedridden, he does not let others feed him, to support him, lean back against the quilt, drink two sips, quickly lie down and rest, and breathe hard. This is like a father who can eat a bowl of braised pork before he falls ill!
The liquids that strengthen immunity and various nutrients are constantly injected into his body, and the thymus peptide changes from one shot a day to two ...
Within a few days, a tube was inserted in my father's abdomen and began to drain jaundice, and he did not dare to move much, lying straight, and the taste could be imagined.
"Pancreatic cancer combined with liver metastasis, advanced course, jaundice is a very important indicator to evaluate liver function, total bilirubin greater than 5mg /dl, radiotherapy and chemotherapy are unacceptable, jaundice must be introduced." Wish the doctor to explain.
Therefore, even if it was uncomfortable to lie down, he kept insisting. The doctor chose a first-line chemotherapy drug, gemcitabine, and combined it with a nano-knife. Director Qiu Baoan introduced that now the clinical use of chemotherapy drugs alone, the effectiveness is not too obvious, to combine chemotherapy drugs with radiotherapy, radiofrequency ablation, nano knife, etc., the efficacy will be improved, and the side effects caused by chemotherapy will be reduced.
After chemotherapy, side effects came as promised, a lot of hair fell off, I did not go to the hospital one day, the next day to go, my father's silver hair is gone, bare head, more and more skinny, my tears came out at once.
I understand too well how important a hairstyle is to him. Father is personable, attaches great importance to his hairstyle, every time he goes to get a haircut, he will always instruct the hair stylist: according to Jackie Chan's hairstyle, the sideburns should cover the ears, and the hair should be able to flutter up. I remember in 2013, Jackie Chan cut his hair short, I told my father, he seriously looked at the photos on the Internet, and within a few days he changed it to Jackie Chan short hair.
Father, who attaches so much importance to hairstyles, is now lying sick, with four or five tubes inserted in his body, shaved his head, "burning the chamber" in his stomach, mouth ulcers in his mouth, and the sadness and fear in his heart can be imagined!
Psychological stress can cause cancer cells to spread faster, which is what researchers at Monash University in Australia found. The research team led by biologist Dr. Erica Sloan found through comparative experiments that the lymphatic system of the "pressure group" rat seemed to become a "highway", and the tumor cells spread to the whole body 6 times faster than the reference group. It can be seen how important the psychotherapy of tumor patients is!
Say or don't say, a heart-wrenching multiple choice question
My father became vulnerable after getting sick, and sometimes he would sneak away tears from his hospital bed, so we didn't dare to tell him the real condition, and we kept talking about cirrhosis and pancreatic cysts.
But we work hard to hide it, and it is even more difficult for doctors. Father is a person who loves to study, especially for his own disease, when he can't get up from bed, he also holds a pen in one hand and a book in the other, lying down every day to write a serious disease diary and check relevant information on the Internet.
The medical system of this hospital is very advanced, a medical record number is entered on the Internet, the results of the examination can be seen, he often checks on the IPAD, when checking the room, there will naturally be many questions: why is bilirubin so high? Why do cysts need to play gemcitabine? Director Qiu took an "English-Chinese bilingual round" to answer his father's questions and comfort him that his condition was improving. When turning to face other doctors, he changed to speaking the real situation in English and adjusted the treatment plan, which was a heart-warming scene that was often staged.
Tell the patient the real condition, will worry that he is nervous and anxious, and suddenly collapse! Don't tell, and I'm afraid that something hasn't had time to explain, and I regret it! In the face of patients with end-stage tumors, saying or not saying is a very heart-wrenching choice question.
This choice varies from person to person, Dr. Zhao Wenshuo suggests, although from a legal point of view, patients have the right to know and have the right to deal with the last period of life. But it is not one-size-fits-all, and the general principle is whether it is helpful for follow-up treatment.
Dr. Zhao told me that for example, some important treatments require informed consent, if you do not tell the patient the truth, you may delay the treatment, if it is not a very special situation, or inform the best policy. For patients who are particularly vulnerable, anxious, and have poor ability to resist blows, not telling them may alleviate their fear of the disease and further cooperate with treatment.
At the same time, the doctor should seriously communicate with the family, understand the true character of the patient, sometimes look at the patient with a big grin, his inner world and the performance may be the opposite; to judge whether the patient can cope with the blows in life, help the family make reasonable decisions.
After vomiting blood, the parting was two or three days
Entering June, early summer, the sun becomes brighter, through the wide glass window of the ward shines in, my father is a person who likes to bask in the sun, when he works in Qinghai, every year in the middle of summer, he will deliberately go to Xi'an for a few days on business, "good sunbathing".
When he was first hospitalized, he always sat in front of the window and basked in the sun while looking at the cherry blossoms in Yuyuan Lake not far away. Now he doesn't look at the sun, just stares at the ceiling for a long time, you talk to him, play songs, Peking Opera, he has no reaction, or occasionally indifferent glances, and then immersed in his own world. Originally cheerful and humorous, knowledgeable, very talkative father, like a completely different person, we are all worried, is not what sentence is wrong, make him angry?
"Hepatic encephalopathy," Director Qiu said. The liver is an important detoxification organ that processes blood ammonia (ammonia produced after protein breakdown). If the liver function is not good, the processing ability is poor, and the blood ammonia is elevated, the brain will be sluggish, indifferent, confused, and slurred, or "he is controlled by the disease, and he is no longer the original him."
Of course, in response to this situation, there are also clinical methods, such as transfusing some drugs that reduce blood ammonia, or using artificial liver and plasma exchange to make patients wake up temporarily. However, the liver itself has no substantial improvement, the cost is not small, and it is usually only used for pre-liver transplant treatment in the clinic.
Jaundice - ascites - sharp reduction in urine output - hepatic encephalopathy, bad news one by one, people were caught off guard, in early July, the father vomited blood! The bright red blood was so glaring against the white sheets that the familiar surgeon reminded me that "it may be two or three days of parting!" ”
Gastrointestinal bleeding is a very common complication of advanced pancreatic cancer with jaundice, Dr. Zhu Jianyong explained, because the blood supply to the gastric mucosa is not good, and can not eat, after the mucous membrane is shed, the renewal is slow, the blood vessels are exposed in the stomach acid, and the bleeding will be very dangerous. From a clinical point of view, most patients will not survive.
No rescue! The father himself decides how to leave
The so-called father-daughter mother-son relationship only means that your fate with him is that in this life and this life, you are constantly sending him back to drift away. You stand at this end of the path, watching him fade away where the path turns, and he tells you with his back: No need to chase.
- Long Yingtai
Parting, close at hand!
Back in 2006, my father and I were talking about Barkin's last days. Barkin spent his last six years in a hospital bed, with a long-term gastric tube, his mouth closed, his chin dislocated, and he had to cut open the trachea and use a ventilator to maintain breathing. He wanted to give up this treatment of life or death, but he had no choice because neither his family nor his leaders agreed. Barkin said: Longevity is a kind of torture for me.
At that time, my father said, "I am dying, and I will not rescue me!" No farewell ceremony! "I'm still joking with him, and you'll know it when the time comes!" My father affirmed that when I left my will, I had to count!
After my father's death, we sorted out his diary, and on the title page of the 2006 book, there were several wills neatly and clearly written, the first of which was "No rescue!" No intubation! "In retrospect, for the elderly, it is actually very necessary to reserve a will.
In 2013, Luo Ruiqing's daughter Luo Diandian and Chen Yi's son Chen Xiaolu and others founded the Beijing Association for the Promotion of Prenatal Wills , which are instructions signed by people when they are healthy or conscious, stating what kind of medical care they want or do not want at the end of an incurable injury or illness. To be able to make your own choice to walk the journey of life in peace, nature, and painlessness, and to make death more dignified. According to public information, more than 20,000 people have signed a pre-life will to express what kind of treatment they hope to receive.
Thankfully, before we saw this diary, we obeyed my father's wishes!
On the morning of July 10th, his father suddenly felt chest tightness, the eldest sister rushed out to find a doctor, and his father and relatives who took care of him said, "Tell Shuying, I don't rescue!" Dr. Zhu also rushed to the operating room, too late to go to the operating room, in the ward to do a small operation for him to effusion, took out nearly 1000 ml of liquid, his breathing was obviously much smoother.
In the afternoon, Director Qiu came to see his father, as if he already knew something, he could not get up, lying on the bed, holding his fists in both hands and waving at Director Qiu, "Thank you!" ”
Late at night, my father was dying, and the eldest sister lay down next to his ear, telling him the real condition and the treatment process word by word, crying and saying, "Dad, we really can't do anything." "Father left the last tears...
On July 11, at 4:50 a.m., my father left us forever.
On the day he left, he had a serene smile on his face, and I guessed he should be satisfied.
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