"Mom, this is the last time we've seen each other, you went over there to be fine, don't forget about us, we'll all be fine..."
I gently stroked my mother's cheek, looked at her emaciated face and cried silently, thinking that I would not be able to bear the joy of kneeling in the future, and could not help but cry.
But I could only endure the grief and cry silently, because it was in the hospital, at the door of the operating room.
I knew that in the operating room that I couldn't see, there were people with me saying goodbye to my mom.
(Mother's organ donation certificate)
Dad put his arm around my shoulders and choked up and said:
"Let the doctor come."
Many medical staff spontaneously stood in two rows, and the sound was particularly clear in the silent night:
"Now let's start the silence."
The door to the operating room closed slowly in silence, solemnity and solemnity, and this became my mother and I's final farewell.
One day in early June 2019.
Today my mother sat on the couch, frowning, covering her stomach with her hands, looking uncomfortable, and I put down the work in my hand to look at her:
"Your stomach hurts again?" Was the quilt not covered last night? Do you want to give you a warm baby again? ”
I have seen this situation several times this month, every time I use the warm baby, she can be better, I think the mother is after all more than 60 years old, the elderly physical function declines, there is a small illness and small pain is also normal.
But gradually I found that she did not eat very well, even her favorite braised meat, did not move her chopsticks, and then only ate a very small bowl of food every day. Sometimes, when I saw her come out of the toilet, I was also very worried, and when I asked her what was wrong, she just said "it's okay".
Until the end of June, she seemed to say to me very casually:
"I went to the hospital a few days ago to take a CT, if you are free these days, accompany me to the hospital to get it."
I was shocked, and quickly asked her what was uncomfortable, and she said to me:
"My urine during this time was a little weird, very dark, that kind of tan."
"When you look at me, it feels yellow too."
"I thought that my kidney was wrong, so I went to the hospital to see, the doctor said that the kidney is very good, may be liver and gallbladder problems, let me go to Xinhua Hospital (Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine) to do a CT."
"I can't understand what the doctor says, you have time to go with me, I don't have to worry."
Although my mother said it very easily, I could feel her restlessness, while calming her, while quickly searching for her symptoms on the Internet, the results were not good results, and my heart sank.
(Mom's inspection report)
I accompanied my mother to Xinhua Hospital to get the CT report, and the doctor asked my mother to wait in the corridor of the examination room, and then said to me very seriously:
"Judging from the CT results, your mother's liver and gallbladder problem is a bit serious, and the passage where the bile flows out grows something, blocking the road, so people will turn yellow." It's not yet certain what it is, and it could be a bad thing. ”
"Does something bad refer to a tumor?" Almost instantaneously, I thought of this worst-case outcome.
"Well, you hang up a general surgery department in our hospital, let Dr. Gong Wei show you the film, and arrange the next treatment."
I don't know how I came out of the clinic, my head is blank, but the moment I go out and see my mother, my sanity is back, listen to the doctor, first find Dr. Gong to see, in case the situation is not so serious as we think?
But the truth is not always as good as imagined.
After watching the film, Dr. Gong told me directly:
"Your mother's problem is indeed a bit serious, so hurry up and get a full in-patient examination to see if there is a chance of surgery."
I have searched on the Internet before, so I have some expectations in my heart, so I want to accompany my mother to finish the examination first, at this time we are all hiding from my mother, did not tell her the real situation, worried that she can't stand the blow.
Miracles did not happen, and the results of various tests were indicating that my mother did have cancer, probably gallbladder cancer. We only knew that the gallbladder would grow stones or polyps, but we never knew that the gallbladder could also become cancerous. Before, there were relatives in the family who had surgery for gallbladder stones, and my mother also ran forward and ran to take care of them. Every time she talked about her own gallbladder stones, she said it was okay, no pain, no need to care.
Dr. Gong was in the doctor's office to discuss my mother's condition, and there were two treatment options to choose from.
[Plan 1: No surgery, only a drainage tube, because my mother is a tumor in the extrahepatic bile duct site that blocks the bile duct, and the tumor blocks the normal outflow of bile into the intestine, just like the traffic artery is blocked, and the traffic flow cannot pass. Bile remains in the liver, and then enters the bloodstream, the mother will also be yellow, the urine is also yellow, and the appetite is not strong. Conservative treatment is not surgery, find a way out of the common bile duct where it is blocked, and put a drainage tube, which is equivalent to taking a detour or finding a trail to lead the bile out. 】
[Plan 2: Surgery, the tumor is cut off, equivalent to us moving the car on the road, the road is clear. However, the tumor staging is relatively late, the operation can only cut off the lesions visible to the naked eye, and some small lesions may not be removed, and it is likely to recur or metastasize after surgery. 】
We finally decided to surgically remove the tumor, after all, carrying a drainage bag on the body for a long time will have a lot of impact on life. The operation lasted for more than 7 hours, and my family and I waited anxiously at the door of the operating room, looking at the cold door, and secretly praying in my heart that my mother was safe.
After the operation, Dr. Gong told us that it was indeed the tumor in the neck of the gallbladder that invaded the common bile duct, causing obstructive jaundice, and patiently explained:
"Your mother's gallstones have been around for more than thirty years, and the presence of long-term stones and the chronic inflammation accompanying the stones are a chronic injury to the gallbladder, and the long-term stimulation of gallstones and inflammation slowly induces cancer, so this tumor grows out of the gallbladder, but the tumor grows to a certain extent and invades both the gallbladder and the bile duct."
Late July 2019.
After the operation, her mother's mental state was OK, and the doctor suggested that she do chemotherapy several more times to consolidate according to her physical condition, but she did not expect that this was strongly resisted by her:
"I don't do chemotherapy, chemotherapy is done by people who have cancer, you see people doing chemotherapy on the side, which one is not painful?" I don't do it! ”
No matter how much we tried to persuade her, she was unwilling, because she really didn't know that she was already terminally ill with cancer, and we didn't dare to say it. In the end, she recovered almost after the operation, under our persuasion, she agreed to do chemotherapy, but only once, after chemotherapy she had a serious physical reaction, vomiting, unable to eat, blood test also suggested that white blood cells were reduced very badly.
Considering her physical condition, if chemotherapy is barely enough, the effect may not be good, so we gave up the plan to continue chemotherapy and ushered in a calm time of nearly 4 months. But my mother still ate very little, I would steam an egg white for her to eat every day (she could only eat half of it), plus half of the liquid food, fruit and vegetable juice, make some nutritional powder, eat less and more meals, the overall situation is not bad.
In early December 2019, something changed.
One day, she suddenly began to vomit intermittently, and at first she could still have some vomit, but then she just spit acid water, and when the acid water could not spit out, she vomited. We thought at the time that it was less than 4 months after the operation, maybe it was a little too much during the recovery period, or the food was too hard, so we adjusted her diet first, but it didn't work.
The vomiting lasted for 1 to 2 weeks, and I also ran to the hospital several times, and finally went to the hospital, because she could not eat anything, could not drink water, and the whole person was very weak.
After this hospitalization, my mother never came out again.
We had no choice but to tell our mother the truth. Because the tumors have metastasized many times, there are many small tumors on her liver, abdominal cavity and other organs, and some tumors have also compressed the stomach, and there is no chance of surgery. Moreover, at present, there are no targeted drugs with significant effects for gallbladder cancer, and chemotherapy is the only option, but doctors say that advanced gallbladder cancer is not sensitive to chemotherapy, and even if chemotherapy is done, the effect is not satisfactory.
But what can be done? We can only hope that the chemotherapy drugs can make this damn tumor smaller, and the mother knows that after a long silence, she said:
"Then do chemotherapy."
She insisted on enduring the pain and did two chemotherapy treatments, but the effect was not good, we really couldn't bear to see her suffer like this, so we discussed with her what to do with the treatment later, my mother cried for a while, and after crying, she figured it out, and her eyes were soft and bright, and she said softly:
"I have lived for more than 60 years, and I have experienced everything that I should have experienced in my life, and I am very content with you."
Because she really didn't have the strength, she paused for a moment, gently held my hand with her dry hand, and said:
"The only thing I can't let go of is you, you said you are not married, who will take care of you in the future?" Who brings you children? ”
"And your grandparents, you have also grown up, and you will take care of the elderly with your uncles and them in the future."
"Your father is also a lot older, and in the future, you should pay more attention to him, pay attention to his body, don't be like me, you know?"
She was confessing the aftermath, she couldn't let go of us, she didn't want to go, I was really sad, I couldn't do anything but cry.
The result of our final discussion was to stop chemotherapy, infuse her with nutrient solution to maintain her life, and also signed a voluntary renunciation of invasive treatment that may be used in the future rescue, so that she can smoothly complete the last journey of her life and walk with dignity.
(Mom's Organ Donation Agreement)
In early March 2020, when my mother was declared brain dead, I was approached by the hospital's organ transplant coordinator, and I knew what they meant.
Many years ago, Grandpa signed an agreement on voluntary organ donation, he felt that people live this life, clean when they come, clean when they leave, it is enough, he does not want any cemetery, in the future to donate the body, so that his organs can also help others, is the great love of the world.
Influenced by Grandpa, my mother also signed an organ donation agreement a few years ago, and now that she is leaving, her cornea will be reborn in another person, although I don't know who that person is, but I always think that somewhere I don't know, my mother is still looking at me from a distance, silently caressing me with her eyes.
My mother's story is coming to an end at this point, thinking back to these past days, I am still heartbroken to myself, but some experiences I also want to share with you, hoping that the things that we ignored at the beginning can be alert and helpful to others.
Testimonials from family members
1. Don't ignore the small illnesses and pains of the elderly at home. My mother was busy taking care of me when I was young, and after retirement, she was busy taking care of my grandparents, and her life was always busy and busy, and she didn't have much rest, always putting others first and putting herself second. This busy state also gives us the illusion that her body is particularly good, and when she is uncomfortable, we do not pay enough attention to it at the first time.
2. If gallstones are found, they must be removed. Our family has no family history, only my mother gallbladder stones for more than 30 years, long-term gallbladder stones caused by inflammatory stimulation, it is possible to induce cancer. My mom is a typical example of this situation, in fact the probability of this happening is very small, but even the smallest probability can happen. Small illnesses dragged into major illnesses, which really make people regret it.
Expert reviews
1. Gallbladder cancer: the new "king of cancer"
Pancreatic cancer is always said to be the "king of cancer" and one of the most mortal cancers in the world. In recent years, everyone has realized that gallbladder cancer may be more dangerous than pancreatic cancer!
Gallbladder cancer is one of the common malignant tumors of the biliary system, and the incidence ranks 6th in gastrointestinal tumors. In recent years, the incidence and mortality of gallbladder cancer have shown a significant upward trend, and surveys have shown that more than 80% of patients with gallbladder cancer survive for less than one year, and the five-year survival rate is only 5% [1].
Although the gallbladder is small, it is relatively close to the liver, stomach, pancreas, and intestines. If the gallbladder becomes cancerous, it is easy to affect the surrounding organs. Gallbladder cancer is a quiet killer with no symptoms in the early stages. When you seek medical treatment after the onset of symptoms, it is often advanced gallbladder cancer, which is difficult to treat, and the quality of life of patients will be greatly affected.
2. How far away from gallbladder cancer if I have gallbladder stones?
Let's start with a set of data [2-3]:
About 85% of patients with gallbladder cancer have gallbladder stones.
Patients with gallbladder stones have a 13.7 times higher risk of gallbladder cancer than people without gallbladder stones.
In patients with gallbladder stones, people with a single stone diameter > 3 cm have a 10 times higher risk of gallbladder cancer than those with < 1 cm in diameter.
The gallbladder is responsible for storing bile in the human body and helping the body digest. Stones produced in the gallbladder are called gallbladder stones. Although the stone is benign, if it is not treated in time, the long-standing stone will continue to rub and stimulate the mucosa of the gallbladder wall, resulting in shedding, necrosis, hyperplasia of the mucosa, and inducing the occurrence of cancer.
Therefore, the harm of gallbladder stones to the body is not only the appearance of pain affecting life, but also the risk of cancer should be paid more attention to. In particular, asymptomatic gallbladder stones, like a "time bomb", lucky patients may not have the disease for life, and it is more likely that cancer will occur quietly, secretly lurking in the body, and eventually suddenly erupting.
3. Which gallbladder stones need attention?
Found gallbladder stones, cut or not? This is something that a lot of people struggle with.
Doctors usually ask first: How did you find out you had gallbladder stones?
Many people experience acute cholecystitis because of gallbladder stones and experience severe "biliary colic". It is generally believed that symptoms of gallbladder stones, such as the onset of cholecystitis (abdominal pain, fever) and other conditions that affect life, it is recommended to remove the gallbladder.
More people learned of the presence of gallbladder stones in the body by chance during the physical examination, and usually did not feel any discomfort. However, as mentioned earlier, gallbladder stones have the risk of inducing cancerous development of the gallbladder, so asymptomatic stones should not be taken lightly!
In particular, the following situations are recommended to be actively addressed [2,4]:
Stones >3 cm in diameter: studies have shown that the diameter and number of gallbladder stones are positively correlated with the occurrence of gallbladder cancer.
Gallbladder stones > 10 years: the long-term presence of gallbladder stones will form a chronic inflammatory microenvironment, which can easily induce cancerous occurrence.
Thickening of the gallbladder wall and appearance of calcified or porcelain gallbladder: Uneven calcification or punctate calcification in the mucosa of the gallbladder wall is considered a precancerous lesion of gallbladder cancer and requires early management.
Polyps with the gallbladder > 1 cm, progressive enlargement of gallbladder polyps: polyps with this feature have a malignant tendency and need to be treated as soon as possible.
In addition, studies have also shown that congenital pancreatic bile duct confluence abnormalities, cholecystic adenomyosis, biliary tract infections, primary sclerosing cholangitis, smoking, obesity and diabetes, and family history of gallbladder cancer are also risk factors for gallbladder cancer. Gallstones that combine these factors also require vigilance.
bibliography
[1] McNamara MG，Lopes A，Wasan H，et al. Landmark survival analysis and impact of anatomic site of origin in prospective clinical trials of biliary tract cancer[J]. J Hepatol，2020，73（5）：1109-1117.
[2] Biliary Surgery Group of The Surgery Branch of the Chinese Medical Association, Biliary Surgery Committee of the Surgeons Branch of the Chinese Medical Doctor Association. Guidelines for the diagnosis and treatment of gallbladder cancer (2019 edition)[J].Chinese Journal of Surgery,2020,58(4):243-251.
[3] Ren Tai, Li Yongsheng, Geng Yajun, et al. Treatment mode and prognosis of gallbladder carcinoma in China from 2010 to 2017[J].Chinese Journal of Surgery,2020,58(9):697-706.
[4] NCCN Clinical Practice Guidelines in Oncology: hepatobiliary cancer(2021 Version I) [EB/OL].http://www.nccn.org.
Editors: Wu Jiaxiang, Ye Zhengxing
Proofreading: Wu Yihe | Typesetting: Li Yongmin
Operation: Han Ningning | Coordinator: Wu Wei