Japanese beetles and greener grass

The only reason, of course, for the stent procedure was so that Earl could eat. Period. He said he wanted to enjoy the time he has left and knew this was his only option. The doctor made it sound so easy, so successful. You all know the old saying, “The grass is always greener on the other side of the fence.”
Earl was still, however, thinking of having another chemo treatment; I had told him this would have to be his decision. I secretly thought the cons outweighed the pros, including having the stent dislodged during violent post-chemo vomiting, but kept my thoughts to myself. So much has happened since last Thursday; so many things have been clogging my brain – it has been unbelievably confusing and hectic. I will try to sort out and document our days.

Pain & Nausea Management
After returning home last Friday (August 19) from the stent procedure, Earl did not want to try eating (by mouth) and we were mostly just trying to manage the pain. With the Hydrocodone being needed about every three hours, not only were we not getting enough sleep, but he was at his daily maximum dose of Tylenol. We had already increased the Duragesic patch to 75 by cutting the backing on a 50 and exposing half of another patch. As of Friday, I am on the couch whenever I sleep.

On Saturday, Debra, our VNA nurse, came and suggested that Earl get on a morphine pump which would deliver a steady dose though a line in his port. Unfortunately, due to various circumstances, we were unable to get this hooked up until Wednesday, August 24. (more explained on this later). She also suggested a different nausea med, Phenergan (promethazine) and she inserted a Sub-Q button on his upper right arm after talking with Dr. DeJoan (he is Dr. Gupta’s associate, our family doctor that had performed the first scope test with the biopsy back in May). Debra pre-filled several small syringes for me, and I had to administer the Phenergan every six hours into a small, waxy plug at the end of a little line attached to the Sub-Q button, which was taped down. It took about 5 minutes to administer each dose, since I had to put just .1 cc in and then wait a minute, until it got up to .5 cc. I was so nervous the first time that I forgot to use the alcohol wipe on the plug, but Debra told me the next day that was OK.



Eating & Living
Last week, before the stent procedure, I had bought two pounds of coffee at Dunkin’ Donuts (1 pound of de-caf and 1 pound of regular beans) and told myself I would not grind it until he could drink it. On Saturday, Earl finally had a couple of swallows of coffee. I guess I was waiting for a reaction similar to the dog (what was his name?) in the old cartoon that practically made love to his dog bone, and then shot up into the air and floated down in ecstasy. But it was not like that. I don’t know if it is the drugs or the cancer, but his taste buds are apparently not what they were 2 or 3 weeks ago, and he never even smiled. Later on, he had some chicken broth with maybe 2 bites of soft pasta in it and a few spoonfuls of home-made tapioca pudding. When I suggested something else that he could eat, he became slightly agitated and said he was just “easing” into this (eating by mouth) and to please let him do it at his own pace. The stent is only about the size of an average index finger, and of course, does not stretch like a normal esophagus, so he is limited on what he can eat, but there are many things he could eat if he feels like it. Dr. Warren had sent his resident in before we left the hospital and said he could eat pasta, Sloppy Joe, puddings, fish, etc., probably not chicken, raw vegetables and not steak. He never told us that Earl would be so nauseated (whether from the cancer being pushed down by the stent, or IF there is cancer in his stomach or from the drugs, that he wouldn’t want to eat.

Sunday seemed to start off good, with Earl feeling better. We went on the shady front porch (it was a gorgeous day!) and I got out the clippers and gave him a hair-cut. He used to have such thick, wavy (& wiry) hair; I used to say his head on my lap felt like a Brillo pad. Since the chemo, it is much thinner and it seems to have much more gray than before the cancer. With him losing so much hair, at least now it is shorter and not as much a mess. I can’t kiss his head without coming back with my lips full of hair. After the hair-cut, I helped him with a bath and hair wash, and then made breakfast. For the entire day, he had about half of a soft poached egg, a few bites of mostaciolli, less than a quarter cup of applesauce and about a half cup of cream of tomato soup, with only one can of Two Cal. Monday was even less “regular” food by mouth, but at least he took in three cans of supplement; Tuesday, his nausea was back and he took nothing by mouth and less than 2 cans of supplement. By Wednesday, I received the Nutren 2.0 (500 calories) that I had ordered on the internet on Sunday when Earl told me that he thought the Nutren he received in the hospital digested better than the Two Cal. I wish I would have know about Nutren before; I thought I had been advised (by the VNA dietician) of the highest calorie supplement per ounce that was obtainable. Also, Nutren is made by Nestle’, which, to me, is more appetizing than Ross/Abbott Laboratories, who makes Two Cal. Also on Wednesday, Earl decided he wanted to try some Cream of Wheat and toast. One bite of Cream of Wheat seemed to go down fine, but apparently the baby-bite of toast did not go down well, so he decided not to eat any further Cream of Wheat, nor did he want to try anything else the rest of the day. As I write this on Thursday, he has not wanted to eat anything today (except supplement in Godzilla). It has only been 3 ½ weeks since we sat in Dr. Warren’s office and listened to him describe the PDT and I remember Earl’s eager anticipation of performing the simple act of eating.

I’m sorry if I have been writing in too much detail—I guess I need to keep it all straight in my head to justify the “main event” of the week.

The Decision

A very important development has also happened since returning home from Rush on Friday. Both Dr. DeJoan’s office and Debra had mentioned this to me before; I just didn’t think it was time, and I did not want to make the decision myself, especially since Earl had still been thinking of having more chemo.

On Saturday, Debra talked to Earl and me about going into the VNA Hospice program. She explained that there are many advantages but we could discontinue the program at any time if we wanted. The main goal of hospice is, of course, palliative and comfort measures and this meant that no further treatments (chemo or radiation) or tests (x-rays, CT scans, etc.) would be performed. I said that it would have to be up to Earl, and he said he would think about it. Monday was not a good day—at one point, I tried to get him up to eat something and he said to leave him alone, that he was trying to talk to God and he had not yet received an answer.
By late Monday afternoon, he said that he can tell when his body is starting to shut down; he had decided he did not want to do anymore chemo and that I should call Debra. Many factors went in to this decision; please don’t think that any of us took it lightly.

Debra came over with forms on Tuesday, August 23, for the admit. Earl will still be at home, and I will still be his primary caregiver; we will have an additional nurse (Avonne), and medicines and all supplies (including a different bed) will be delivered to us. I think the futile efforts on Saturday and Sunday in trying to call Aetna, the doctor’s office, and Walgreens Home Health Care to get the morphine pump delivered played a small part in the Decision, but I’m sure it is a combination of many things. I know that Earl was on a roller coaster of pain and just did not want to do it anymore. Debra came on Wednesday to “install” the morphine pump and remove the Sub-Q button, which by this time was causing pain to Earl’s right shoulder. Apparently, the Phenergan is not supposed to be administered Sub-Q and, as of Thursday night, his arm is still red and slightly sore. He is now on a different medicine for the nausea. We shall see if it works.

Wednesday evening is pretty much a blur—we discussed things that many couples do not get a chance to discuss before one of them is suddenly taken away, but my stomach is still in knots and I am cried-out. Thursday, Walgreens came to take the old bed; American Medical came & delivered the new one; Avonne, our certified hospice nurse came over, as well as the hospice social worker, Lu. Earl was exhausted and slept most of the afternoon and evening, giving Godzilla only 4 ounces and later drinking about 2 ounces of the Nutren.

Friday, August 26, 2005, 4:55 am
In a horrible way, a weight was lifted from my shoulders after The Decision. I know he will receive more personalized intensive care and will not have the strain of car trips, or doctor visits or procedures. If there was a 1% chance that he would be cured by any of those measures, I would encourage him all the way, but there is not. It hurts me so much to see him in pain, or vomiting up what was just put in his stomach 15 minutes earlier, or how much his general stamina and strength has diminished. If anyone reading this has had even a bad case of the flu for a week and you thought you were dying, multiply it 100 times for 3 months and ask yourself if you would not only want to continue being that sick, but to know any further measures to extend that illness would make you even sicker, would you do it? Especially if you knew you were not going to get any better? I doubt it.

Sometimes the neighbor’s green grass has grubs eating at the roots and the “greener grass on the other side” is not what you thought it would be.

We should know something soon

Well, it is already after 12 noon and we are still waiting for results of the barium swallow test he took this morning; they had no openings for yesterday. A nurse told me last night that they have to make sure "nothing got punctured" - it "wouldn't be pretty" if (liquids) started "leaking into his lungs" (!) They took him down around 7am and he did not get back to his room until after 8:30. It really seemed to take a lot out of him, and was very tired and crabby when he returned to his room. He did not want to talk about it - he said he did not know how it went.
I helped him again with his tube feeding this morning - the hospital gave us Nutren 2.0, instead of the Two Cal - I wish I would have known about Nutren 2.0 six weeks ago - it has 25 more calories than the Two Cal. He also had to have a chest x-ray this morning - I'm glad they brought the machine to his room, instead of him going downstairs again.

I sincerely feel sorry for anyone who goes in to the hospital, or whatever, without an advocate, especially if they are totally unable to discuss matters with the nurses & other staff. Please don't think I am patting myself on the back; I constantly question our decisions and myself about all that has happened in the last three months. I just have to tell myself we did what we thought was right at the time. I simply find it puzzling that I have to constantly remind everyone why he is here, that he cannot be left sleeping on a guerney in the bright sun, what medicines he needs, at what dose & what time. I brought a sheet with 8 or 9 Walgreens stickers on it so they would have his medication list in his file, yet I have to remind them that he needs his Reglan 30 minutes before he eats, or that he gets the Hydrocodone every three hours, etc. For example, he had a pain pill at 3:45 am yesterday before we left home, then, of course, it was several hours before he was in his room. I had talked to the nurse as soon as I found him in his room (read yesterday's post!) but it actually took Earl "complaining" (that's a nice word) to the resident so he could get his first pain medicine around 12:45. You would think, given the history, that they would have kept up his pain management schedule as much as possible, but it was not until I (retold) the entire story to the nurse and the resident, that they started giving the pain pills every three hours.
Anyway, enough of my ranting - I just can't wait to get home again.
Depending on the results of the swallow, hopefully good, Earl will get a lunch tray of clears, and then can go home. I hope to get on the road before the evening traffic.

"I feel like there's a piece of plastic in my chest....."

And there is.

We left home about 4:10 this morning--traffic was almost non-existent on the tollway. Got to Rush about 5:20 am. After registration, normally I was only allowed to walk with Earl to the "doors to pre-op" and had to say good-bye. Today, the nurse said I could go with him to help him change clothes. After answering all the detailed health questions (again) and advising them about the PDT & the Photofrin injection, the nurse suggested I "go upstairs" with him to make sure they are aware of it.
Alright-y.
I had to put on a blue gown, although they said nothing about my probably germ-laden tote bag. We waited again and a nurse for the anesthesiology (isn't Spell Check great?) team came in and (again) asked the same questions. As she was leaving, Earl realized that the rubber band had come off his tube & his entire dupa was wet, as was the gown & sheet. After we closed it off, he dried off & was given a fresh gown and a blanket to lay on. She then sent in a nurse who was "qualified" to access his port, but they were unable to draw from it. The nurse called an attending (doctor) to see if he could do it; no. They decided they had to put in the IV (the larger line is better anyway in case they need to push more fluids) and they would check out his port while he was "under". While this was taking place, I think the stress combined with lack of sleep just got to me and I started to tear up. The next thing I know, a blue clad woman was handing me one of the hospital mini boxes of tissue. I stepped out of the curtained area to talk to her; her name was Sandra (!) and she is a Chaplain-in-training. We talked about 6 or 8 minutes more while they were trying to access the port. I finally went & kissed Earl on his bald spot (which, by the way, seems to be growing since he is losing hair from the chemo) and Sandra went with me downstairs. I will probably never see her again, but she was there when I needed her.
It seemed an eternity before I talked to the doctor on the phone in the Smith Lounge. He said it had gone well, but they had to cut off the flap on the stent because it kept crimping. The flap was kind of experimental anyway, and a pet project of Dr. Warren's. He said Earl will do the barium swallow today and if he feels well, could go home tonight. (We had been told previously he would stay overnight). We'll see.
I waited almost another hour, and finally went up to the receptionist again. She checked and said, yes, he is in his room, and what's going on here? (I don't know-you tell me). She wrote my new visitor tag as she was talking on the phone--Room 870South, no? It's North? Ok, Room 870North, and gave it to me. I went upstairs; Room 870North was empty. Ok, he must not be up yet; this is what happened on June 14. I waited - I walked east - I walked west - I walked east back to the room - maybe they used the other elevators - no - he is not there - I walked west back to the elevators I thought they used for post-op - waited - waited. OK. What's going on. I started to get worried. I went to the nurses station - OH! Mr. REINHERT? HE'S BEEN MOVED TO 871North! As I walked to 871North, I said to myself, in a loud voice, "There's NO "H" IN OUR NAME!" Earl was on his side; I noticed dried blood in various spots. He said he had been there since about 10:15 (45 minutes). (It was then that I remembered the change of nursing shift happens around that time). I asked him how he felt, and he said ...............

We'll see how he feels later today.

Memory--all alone in the moonlight

Thursday, August 11
Once Earl was out of surgery and in his room, my sister went home after visiting him in his room, and will come back tomorrow to take us home. She has numerous health problems herself, and doing something like this takes a lot out of her, I know. She will push herself to the edge of exhaustion to do for other people. I hope I can pay her back someday.

When I got back to the room about 1:30pm, Earl was sitting up with a food tray in front of him. There was broth, orange jello, grape juice, coffee and orange sherbet. I asked him “if he was supposed to have that” – he said “they brought it to me”. I checked the name & room number on the sheet on the tray—it was correct. He (very gingerly) tried swallowing some broth & orange jello. Within 10 minutes, he was bringing it all up again. He decided to hold off on trying any more. In the next hour or so, the resident on duty came in. He was surprised to see a food tray, as was the nurse, who came in later. The kitchen actually called while the resident was in the room & asked if we had received a tray. She wanted to know what he wanted for dinner. The resident (his name escapes me) wanted to talk to them. He advised them that “this patient is actually supposed to be N. P. O.”. Hmmmmmmm. Five minutes later, the fluorescent “N. P. O.” sign went up on his door.

Friday, August 12
After our exhausting day on Thursday, you would think I would sleep, but too many interruptions and a very uncomfortable "bed" caused me to be wide awake after about an hour nap and I was, again, wandering the halls of Rush. In those initial few days after the first surgery, I walked the halls, stopping where I could find some privacy and sat & cried. I would sneak a cup of hot water from the now-closed Smith Lounge & use tea bags I had brought from home. If I sat in one particular chair in the empty, low-lit lounge, I was hidden by a large pillar from passers-by in the hallway. I may have been on a security camera somewhere, but they may have overlooked it, due to my obvious semi-controlled hysteria.
Last night was different: I was able to get my hot water from the nurses' locked beverage & snack room; they give primary care-givers the code. I came down to the Atrium; there was the same tall, black, mentally-challenged old man cleaning the floors; there was soft, jazzy soul music coming from Au Bon Pain Cafe; there was the cutest 5 or 6 year old black boy in the Cafe wearing a visitor tag, but obviously hanging around the cafe at 12:45 am, because his mom or dad or whoever was working in the 24 hour cafe. He had a plastic milk crate & was busy inventing all sorts of games. I smiled as I saw him sit on the bench seat, raise his feet & put both feet in the suspended crate and attempt to rotate the crate, then jump up & use it as a step stool, looking at the racks of prepared baked goods. It felt good to smile.

I realized that I needed more than the approximately 75 minutes of sleep I had stolen and I went back upstairs. When I returned to the room, Earl was sleeping, having received his pain medicine at midnight and his sleeping pill at 11pm.
I looked out from Room 838N and north over the city. The flashes of white light from the El train as it made the curve, leaving the area under the hospital, were as bright as a flashbulb. The train has only four cars at that time of night; there are eight cars during morning rush hours. I can see the United Center and Malcolm X College very well from this room. I tried again to sleep and forced my mind to think of other things. All I could think of were song lyrics, ranging from Broadway shows (Cats) to dumb country songs ("Sleeping Single in a Double Bed"), and whenever I heard the El, "The Trolley Song."

Dr. Warren had told us again yesterday that the tumor would swell in the next few days, causing some pain & possibly a burning sensation in Earl’s chest. The tumor, supposedly, then dies (at least a portion of it) and turns the consistency of toothpaste, and is eliminated. We will be going back to Rush next Thursday (August 18) to have the stent put in, another overnight stay. Without it, the opening will not last more than six weeks. I think Earl does not want to try again to swallow until the stent is in; not because of the pain, but because of the fear of failure.

Sunday, August 14
Back at home, we try to keep medicines straight, and manage the pain. I will usually sleep on the couch until the sleeping pill (usually given at 11pm) wears off enough that the pain wakes him up. With his break-through pain med (Hydrocodone) having to be administered every three hours, neither one of us is getting very much sleep. Most of the time, I will then go up to bed, but always have a hard time going back to sleep. We have not again used the Kadian (a timed-release pain med that Carole at Dr. Klein’s office thought would work in the G-tube) since it was nearly impossible to get the static electricity out of those little white balls, into a syringe and into his tube, which clogged the next day. We had to unclog it with Coca-cola (regular, not diet!). The spitting and vomiting comes & goes, usually worse in the late evening. When I’m cleaning the cups, I think of my first experience, on our honeymoon when Earl was sick after our dinner on the Robert E. Lee riverboat in St. Louis. We each had a shrimp cocktail, I had lobster & steak and he had crab & steak. I had given him some of my lobster, but did not take any of his crab. The combination (or the amounts!) of all three apparently made him sick. That was my first experience with “in sickness & in health”.

As I finish writing this on Tuesday, Aug 16, I think about our 31st wedding anniversary tomorrow and regret all the times I was irritated over some dumb, little thing in our marriage. We will probably cry together and wish things could go on as they had been before, but will hope that after August 18, Earl will be able to eat and swallow and celebrate our anniversary, a little late.

Procedure update

It is almost noon on Thursday, Aug. 11 and I am here again at the Rush library for this post.
We left home this morning around 4:05 am; my wonderful sister picked us up and drove us here. Earl had some distressing nausea & vomiting on the trip, but it only took around 1 hr. & 10 minutes to get here. The procedure was scheduled for around 7:30 am; they want you here 2 hours before.
I talked to the doctor around 9 am and by 11:00 or so, Earl was in his room. Dr. Warren said he "got a good burn", meaning he was able to open the esophagus. He will have to stay at least overnight and will have to do a swallow (barium) test this afternoon. Hopefully, we will come home tomorrow, but are tentatively scheduled to have the stent put in next Thursday.
I will try to update more often.
Thanks again to everyone for their prayers, cards and help.
Gayle

The Morton Girl Connection

One of the most recognizable icons of the 20th Century is the Morton Girl on the blue salt box with her big umbrella and the catch-phrase “when it rains, it pours”. She has had several Extreme Makeovers; the last one looks at least 20, if not 30 years old. Being the nostalgia nut that I am, I vaguely remember mailing away for a set of 4 ceramic mugs sporting reproduction pictures of the Morton Girl through the years. The only one still in my cabinet is the one from 1914. She looks so quaint; so different from the one on the box today, but still has that huge umbrella, shielding her from the pouring rain. We all need an umbrella to shield us in time of need.

PDT
These three initials have been on my mind constantly the last week: As I think of my husband: Permanent Dirty Trick (or Pretty Damn Tough)
As I am driving: Poor Drivers Tailgate
(Morton Girl Connection: the air-conditioning in my car went out)
As I think of my husband: Pain Denies Tranquility
As I open our phone bill: Phony Dialing Target
(Morton Girl Connection: we got “slammed” and our phone bill tripled)
As I think of my husband: Preserve Dad’s Tales
(A good connection: one of our neighbors gave Earl a journal for him to write things he might want the kids to know)
As I get Government bullshit from Social Security: Postponed Disability Trust (Morton Girl Connection: after I gave them all the info they asked for, they actually sent Earl a form to fill out that asks what he can no longer do; I wrote that he can’t do ANYTHING, including EATING.)
As I think of my husband: Pharmacies, Doctors, Tube
As I fall asleep trying to get on the internet: Poky Dial-up Technology
(Morton Girl Connection: All messages disappeared from my Inbox for the 3rd time in 2 months)
ALL OF THE ABOVE “CONNECTIONS” would have thrown me in to a tizzy 3 months ago. Now I know how trivial they are, compared to what Earl is going through.

What these initials really stand for is:
Photodynamic Therapy
Our appointment with Dr. Warren on August 1st was to discuss having a stent put in Earl’s esophagus to make an opening so that he could actually eat & swallow. What Dr. Warren advised us on that date, is that at this point, the only thing that would hold the stent in place would be the cancer. IF the chemo is doing anything to shrink or kill the cancer, the stent could slip out of place and would have to be surgically removed. Besides, a stent would not be the best choice for Earl, since there is nothing to stop liquid and/or stomach acids from coming back up if he reclines or even sits down within a couple hours after eating, not a good choice for someone who tires easily. Dr. Warren then advised us of the procedure of Photodynamic Therapy, or PDT, and Earl “signed on” right away, stating that he would take quality over quantity at this point. We will go back to Rush on Tuesday, August 9th and Earl will receive an injection of a drug called Photofrin (porfimer sodium) in his port. The drug invades every cell in his body, but healthy cells have no trouble casting it off, whereas cancer cells cannot get rid of the drug. We will then go home, and return on Thursday, August 11th, when Dr. Warren will activate the drug with a non-thermal laser inserted in a scope down Earl’s throat. The activation has to be done in a window of 40 to 50 hours after the injection of the very-costly drug. (I spoke to one of the case nurses at our insurance, and it appears that the drug is covered. If it was not, we would still do it and pay it off when we get the money—it is that important to Earl (as it would be to ANYONE who has not swallowed anything since June 23rd.) The procedure has an 85% success rate. Since it was such a long-shot that Earl contracted this deadly cancer, I dearly hope he is not in the other 15%.
A major consideration of this procedure is the main side-effect of the drug: it causes the body to be extremely sensitive to light for 4 to 6 weeks. Earl will not be able to have any exposure to direct sunlight or even strong indoor lights, such as reading or examination lights, as he would suffer severe burns on any part of his body. He has to wear long sleeves, long leg pants, hat, sunglasses, and gloves home from the hospital after the injection. Also, he is scheduled for his 2nd round of chemo the following Monday, which will probably make him too sick to even want to eat, once the swelling goes down after the laser activation. Earl’s dream dinner of boned & buttered lake perch at Tiebel’s will have to wait at least a week after our 31st Anniversary on August 17. Maybe we should borrow the Morton Girl’s big umbrella to keep off the late August sun in the car on the way to Tiebel’s.

As I again think of my husband: Pray Death Transcends

Update

The process of the infusion of the Cisplatin at Porter Hospital last Tuesday took from 9 am when we checked in, until 8:30 am Wednesday when we arrived back home. There are many words to describe the next couple of days; lets just say that "horrendous" is one of them. I refuse to go into the gruesome details; just recalling it makes me want to cry.

The good news lately is that I was able to have the insurance company authorize a hospital bed and the Two Cal HN (Earl's food), which were both delivered Saturday, July 30. He has been able to get much better rest than he was getting in the Lazy boy chair. Jonathan and 3 of his buddies carried my rocker loveseat from the family room and put it in the living room, so the bed is in the family room, adjacent to the kitchen. Earl did not want it upstairs--he wanted to be by the "action". I am going to call Walgreens and Aetna again this morning, however, since (after the delivery man left), I discovered they are charging Aetna over $500 ($18.00 apiece) for the very same syringes I bought at Walgreens for $1.99 each. Since it was authorized directly by the insurance, my cost will be about the same, but that is SO RIDICULOUS, I have to let someone know, even if I have to call the Fraud line. I won't spend alot of time on it, but I have to try. The Two Cal is also about double per case what I paid online and $10 more than getting it through Walgreens pharmacy.

I've found that just writing down everything from medicine times to temp readings was getting too confusing, so I made up a spreadsheet blank & keep it on the table. It makes it much easier to find out what time his last pain med or B-M occurred.

After the chemo, when Earl was not throwing up (something must be getting through from the stomach, unless it is all coming from the lining of the esophagus) we talked again about getting the stent put in so he can have a little more normalcy in his life. Earl had wanted to stay around here, but none of the surgeons on our plan in Indiana do that procedure, so I convinced him to go & talk to Warren again. I was able to get an appointment for today, Monday, Aug. 1, at 3:15 pm. I also called Klein's office (oncologist) just to get an OK, since he is already having the chemo. I thought it would be a simple question with a call-back from the nurse after she talked to the Dr. Jennifer (the same nurse who talked to us while the pump with the 5 FU was being put on) called back & said the Dr. said that would have to be discussed at an office visit. We have an appt. today at 10 am with Dr. Munn (Dr. Klein's husband), since Klein's office hours are in the afternoon only. I am praying that starting the chemo did not preclude him from having this procedure. Earl broke down yesterday and said that "this is not a life" and "at this point" he would opt for "quality over quantity." He "just wants to eat". If the vomiting after the chemo would cause a problem with the stent, he said he will not have another treatment.

If I have neglected to respond to any card or e-mail, please forgive me. We thank everyone for your cards, gifts and, most of all your prayers. Please keep praying.