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FOR WHOM THE BELL TOLLS

So my mother is discharged from the hospital after a two-week-long stay. During this time she had an open laparotomy. Basically they make an incision down the midline of the abdomen and "take a look under the hood," in the mechanic's parlance. The purpose of the procedure was to clear infection and resect part of the colon, then place a diverting colostomy. In other words run the viable colon through a hole in her skin to one side of her belly button and into a bag.

Before this the doctors had tried to place a stent in my mother's sigmoid colon to relieve obstruction caused by metastatic breast cancer. But the stent did not take. In fact it may have ruptured her colon, causing fecal matter to leak into the abdomen. Not a good thing. The peritoneum, as the abdominal cavity is called, is a sterile place, so no bugs allowed. When bacteria do get there, they breed and cause all manner of havoc. The result is sepsis, shock, death. This would have been my mother's fate had she not been rushed in for the procedure.

Which went well, as procedures go. The doctors were able to place the stoma. They elected not to touch the cancerous portion of the intestinal tract, because by attempting to remove it they could cause it to spread, and so they will rely on chemotherapy to continue to shrink the tumor. My mother emerged from the laparotomy with "Frankenstomach" as we affectionately refer to it. There are three tubes running out of her belly. The colostomy bag in which her colon empties its contents after every meal, just like bowel movements do in others. A drainage tube for the infection doctors weren't totally able to clear. And a "wound vac" at the incision site, to drain the fluid which collects after any surgical procedure. They had to leave the wound gaping and open, and after the fluid dries up it's back in for a surgery to close the skin.

Fourteen days and now she's home. Starts to regain her strength, her appetite improves, the nurse comes to visit each day to help with wound dressings and colostomy replacements. This is the new normal. One night the drain slips out and so it is back to the ER via ambulance to see about getting it replaced. After 8 hours in the ward without food or drink, the doctors say they don't need to insert a new drain. Things are fine just the way they are. And be sure to keep your oncologist appointment tomorrow and your visit to surgery clinic on Friday. The new normal indeed, filled with medications and their side effects, and clinic visits and trips to the ER, though in the future hopefully few of the latter. It is so inconvenient.

I am amazed at how cancer treatment has advanced in only a few decades. The treatment has kept my mother alive but brought on different ramifications and permutations of the disease. If she hadn't gotten her breast cancer removed in 1994 she would likely not be around today, but she also wouldn't have cancer in the colon and be crapping into a bag for the rest of her life. Everything in life comes at a price. Take the good with the bad. And all that jazz.

My question is, do you really have a choice? Chances are that if you live to be old enough, and more people are living into their 70s now than ever, you will have a chronic disease requiring intense treatment whose side effects are atrocious and which severely affect your quality of life. Your days will be filled with toxic medications and doctor visits and other phenomenon that make you feel divorced from your natural state. You will spend most of your time just trying to stay alive. (Which I guess is what "healthy" people also do: it's called eating.)

I told a friend about my mother. What happened to the days where we grew old and just passed peacefully in our sleep? he wanted to know. What about the animal kingdom, whose members live out their lives in vigor and then when their time has come crawl off into the woods to pass into the spirit realm, quietly, alone, without ceremony, and certainly without surgery and drains and bags? Aren't humans basically animals? Why should it be so drawn out for us? But these days pets are living longer, getting diabetes, losing limbs and vision, staying around for their owners, just for the love. Which is my mother's reason for hanging around. For the love.

But I tell the dear woman this: You shouldn't have to suffer just to feel love; love is your nature. But she wants to "go the distance," a phrase whose meaning I don't fully understand. What is the distance? Is it some previously demarcated length? Isn't it the same for everyone, i.e. death? But there's no stopping mom, who is a fighter, and I do my best to care for her and don't mind, because what's there better to do? Though if it were up to me, I'd die differently. But it's not up to me. One day it will be, though. And if you're around then, save a spot for me in the woods.

Watching a loved one "fight the fight" makes you consider your own mortality. Because the bell tolls for me, and for thee. What will you do when the Grim Reaper comes calling for you?

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