That distraction takes me away from Mom's scan results. I wrote the doctor midday yesterday just to share i'd read it but hadn't talked about it. The doctor replied she was talking to a pulmologist, and my sister texted me to let me know she'd read the results too. By the time i was on my way over after work, the doctor had replied to my sister and i again to say she had spoken to my Dad and Dad wanted to talk to us.
Dad hadn't read the report, i think, so i think he was in shock when i arrived a little after 5 pm. If i hadn't read the report i would have been baffled by their communications. L-- texted me and asked if she should come over: Dad said yes, so L-- was present for some of the discussion. Mom's cognitive decline plus remaining aphasia manifests partly in failing to set context leading to a good deal of "Are we talking about...?" questions. Mom had noted how sweet the staff were after the scan so she had clued in that something was wrong. But i don't think Dad's really explained what the concern is to her, the word cancer hasn't been uttered. He did figure out how much the lower nodule has grown since the January scan, so i think he has a good understanding of the potential aggressiveness. (The nodule size change was added to the report yesterday afternoon, presumably by the pulmologist.)
Dad blurted out that he had told the doctor he wanted to be fast in addressing "this" and wanted to fight it. Dad's shock and his problems with unfamiliar multi-syllabic words created a similar barrier for communication, though: i didn't think it was going to be useful to ping him for more details. L-- and i compared notes after we were home. It's clear a PET scan is the next step. Then there is a thoracic "laparoscopic" procedure to get the upper nodes. I thought Dad was saying that's how they would treat the tumors, but it only makes sense as a biopsy (and the lower nodule sits there untouched). I can't recall now if we talked about proton radiation only in the context of the PET scan (which i thought was protons but it's positrons) or as a possible treatment. Mainly i remember a brief puzzlement over how safe proton radiation would be for a scan. Alpha radiation is horrible but blocked by skin, a proton is one fourth of that.... Well, positron emission makes more sense.
Dad also had a long digression about a study on aphasia mom had been invited to participate in. He was concerned about how using a current to measure brain function would release hydrogen and oxygen. I answered (making up stuff) that cell membranes isolate water as water and that release and buildup of hydrogen and oxygen wasn't an issue. I'm not totally right: apparently 1/3 of the water is in the extracellular fluids [here]. I'm going to have to follow up on why water splits with a current because i think Dad's assertion that it always does is wrong.
I suspect Dad hasn't consulted Mom at all about what she wants, and i have a nagging concern about the pulmonary fibrosis reading. Mom had such a terrible cough for years. L-- remembers it as around twenty years. Mom didn't follow the asthma treatments she was prescribed, so i can imagine a practitioner assuming the diagnosis was obvious.
Hrm, "Aggressive Treatment of IPF Patients with Lung Cancer Rarely Best Option, Experts Say" [here]
I've written the doctor to inquire whether the pulmonary fibrosis observation is a concern, and i'll see what she says. Reading the article above, i see that the PET + laparoscopic-like thoracic biopsy planned is the recommended step in diagnosis.
Poor Dad. When Mom had her stroke he found out that her wishes were that he make the decisions. On one hand, that trust says something about their relationship. On the other, it puts the complete responsibility on Dad in negotiating cognitive decline plus cancer treatments.