My Friend’s GBM
GBM, Glioblastoma Multiforme, is a malignant glioma that is a deadly type of cancerous brain tumor. It was reported that Teddy Kennedy’s seizure was diagnosed to be caused by a brain tumor of GBM kind. At the time, he was 76 on May16, 2008. Even with the best medical resources available to him, he could not escape the cancer’s ravaging effect and passed away on Aug 26. 2009. Even today, no medical expert can explain why this particular brain cell starts to grow uncontrollably and burrows deep into the complex neural network. No surgery, radiation, and/or chemotherapy can weed it out completely. When the person is young, the body can withstand the repeated medical intrusions to keep the resurging cancer at bay for a longer period of time. My friend was 74 when he was diagnosed with GBM. The following is an account of his final odyssey on Earth.
One day in May 2009, my friend suddenly collapsed in the living room hitting his head on the floor and knocking him unconscious. He was rushed to the local emergency hospital. A MRI revealed a large tumor 2 inches above the right temple inside the brain. A surgery was performed in the brain under the scalp to remove the tumor and to relief the pressure it caused. The operation went smoothly. While he was recuperating in the hospital, the laboratory test came back indicating that the tumor was a malignant glioma, an uncontrollable growth of the glial cell that supports the neuron in the brain. It was further classified as a type 4 cancer called GBM in term of severity. Worst yet, the doctor’s prognosis was a year to 18 months to live if the prescribed medical therapies were followed. Obviously, it was quite a shock to the system realizing that his 74 year journey on Earth was about to end.
The Power Attorney
After consulting a lawyer on the matter, my friend signed a power attorney to a person whom he could trust to help him spend the possible final days of his life in peace and reasonable comfort. The task included the handling of all his assets and medical decisions in the event that he was no longer in control of his faculties. He, with the help from relatives and friends, started to research the subject extensively on the Internet. Together with the recent demise of Senator Kennedy at age 77 after battling the similar brain tumor for around 18 months, convinced him to follow through with the standard radiation and chemo therapies. The alternative of relying on faith and a different life style alone was just too subjective to be promising as a long term cure.
The radiation treatment started 2 weeks after the recovery from the surgery. It was going to take 5 weeks, 5 times a week, and few minutes at a time. The machine used was based on the latest technology called Gamma Knife. A specially fashioned head frame was positioned over the scalp for protection as well as to guide the gamma beam to the precise location inside the brain. The only immediately side effects were a scorched skin where the beam strike and a physical fatigue. The radiation treatment was intended to kill the cancerous cells that were missed during surgery. In the process, the normal and healthy cells would be destroyed also. After 2 weeks, a MRI was taken to reveal no new growth. However, the long term damage to the brain’s functions was not known.
2 weeks after starting the radiation therapy, my friend started to take the chemo drug, Temodar. It was an effective and proven drug against most cancers with tolerable side effects. It killed fast growing cells that made up of cancer, stomach linings, hair, etc. So the side effects were hair loss, nausea, and loss of appetites. My friend’s one year chemotherapy regiment consisted of a cycle of taking this drug for 5 consecutive days followed by 23 days of rest. At the end of 8th week, my friend not only lost 40 pounds of weight but also progressively lost his strength and balance. So much so that he needed the assistance of going to and from the bathroom not to mention driving a car. The doctor could only console that those were the effects of radiation and chemotherapy. The good news was that cancer had not grown any larger and my friend was not feeling any discomfort that could not be masked by painkillers.
The Nursing Home
After 6 months, my friend was bedridden with a fading memory. After consultations with the doctor and lawyer, my friend’s conditions could best be taken care of in a nursing home with round the clock medical and physical attentions. A quick research and visitation to some of the local nursing homes concluded that:
1) Average yearly cost was $60,000,
2) Average size was 100 beds with 2 full time nurses and 10 staffers/ Therapists,
3) All had vacancy and were eager to admit new patient. If the cost was a consideration, they would take the patient’s savings and assets with the deficits covered by the Medicaid.
Since my friend was also a veteran of the Korean War, he could also enter the nursing home administrated by the federal government. The veteran facility had a much better reputation and would take only the patient’s pension and federal benefits. However, there was a waiting list due to high demand and limited facility. To the relief of everyone, my friend was admitted to the local veteran nursing home in Nov 2009.
After 2 weeks of observation, this facility was deemed as good as its reputation and could be trusted to take care of my friend’s remaining days. After a total of 8 months, the doctor discontinued my friend’s chemotherapy. He was getting weaker, barely able to recognize the face of friends and relatives, and needed to be force fed. He spent most of his daytimes sitting in the wheelchair motionless in the recreation room. Finally, in July 2010, my friend had difficulty swallowing food and breathing. The recommended steps would be to insert tubes to keep him alive with machines. Since my friend had signed a letter of no tubes and DNR (do not resuscitate) in the event that there was no hope of ever getting better, It was accepted by all parties to inject my friend with painkiller only and let Nature took its course. He passed away peacefully the next day with friend and relatives at the side.
The 2 Evils
My friend had survived 14 months against this dreadful cancer. He was full of hope and energy right after the surgery and 4 weeks into the radiation and chemotherapy. But 4 months later, he could no longer walk and had a diminishing appetite and fading memory. Once in the nursing home, even with the professional care, his deteriorating condition could no longer be reversed. On the internet, many similar cases for GBM patients above age 70 are posted. It may be concluded that the chemo drug, Temodar, can be effective in stopping the growth of the brain tumor. But, it can also cause the body to weaken to such a degree that the patient can no longer recover from the collateral damages. It is a choice between 2 evils. The good news is that new drugs are in the pipeline that can target the specific cancer cell with minimal effect to the surrounding tissues.