Friday, June 24, 2011

To cut or not to cut, that is the question

Chris is about 7 yo and has cancer of his R leg.  When he came in the first time, we told him that we needed to do surgery to cut off his leg and the tumor to save his life.  The family went away to talk about it and didn't come back for a number of months.  When they came back, the tumor had grown considerably, to about a volleyball and was just below his knee.  They still weren't ready for surgery, so we offered chemotherapy, which they agreed to.  The whole time we were doing the chemo, we were telling them we still need to do surgery, but when they saw the tumor shrink and his leg go back to almost normal size, they never even considered surgery.  We did about 8 rounds of chemotherapy and then wanted him to go for radiation in a town about 6 hours away.  We didn't see or hear from him for 2 months, but assumed he went and was getting treatment.  Today he comes back with his mother, having never gone to Lae and not getting chemotherapy for 2 months.  So when I asked Bill to see a pt, he says that Chris is in his room and that his leg today is the size of a very large grapefruit and he has swelling of his lymph nodes.

Once again the topic of surgery and amputation comes up between Bill and Chris and his mom and once again they are in denial.  Chris starts to cry when Bill asks him if he is ready to have his leg cut off.  This isn't easy for any of us.   I understand he doesn't want to lose his leg, and I understand his parents don't want him to have to lose his leg, as then he can't work or fight or do much in their culture here.  However, the alternative to surgery and an amputation is that sometime in the near future little Chris will die.  He doesn't understand that and I am not sure the parents do either.  They saw the cancer shrink one time with chemo, I am sure they think it will happen again.

I do know that Chris's quality of life for the past 9 months has been pretty good, he even had a spell where he didn't need crutches and was walking on his own, so I surely wouldn't want to take that away from him.  Unfortunately, in our setting no one agrees to an amputation until it is too late.  The family never agrees to surgery until the cancer has already spread and the leg is huge and they realize we were not making it up, but at that point there is nothing we can do.  Our chemotherapy works a little, but is not a cure for them.

The questions kept coming up in my mind wondering if we should have done something different.  Did we hurt them by trying to help and offer what we could?  Is having the cancer shrink and increasing his quality of life for 9 months a bad thing if in the end he never has surgery and dies from this cancer?  If we would tell them we have no chemotherapy and that all we can do is surgery, would that actually make them have the surgery?

I have no answers and know that each case is unique, but I also know that we have two (Peter and Christ) 7 yo boys with the same cancer who will die without surgery and whose families aren't ready for us to do surgery.  Would you please pray for them.  Pray that God would change their hearts and that they would allow us to do surgery which could save their lives.  Pray that we would have wisdom and compassion as we share with them and be able to help them understand this illness and the consequences of it.  Pray that we would continue to show Christ's love to them as we can for them no matter what they decide.