The clinic visit, described in the poem “When “bad” news was good” was clearly all about the scan result. We had only found out about the scan the day we returned from holiday, the day before that scan. The procedure was the same as before, an i.v. injection to highlight the cancer, and then a CT scan of chest and abdomen. It was over in minutes, and we made our way home by taxi. It had to be done, to check whether the “targeted therapy” (osimertinib) was working or not. If not, it would have to be stopped, not least because it is incredibly expensive, and separately funded through a special “cancer drugs fund”.

The doctor believed she was delivering “bad news”, and so prefaced her remarks by “Bad news I’m afraid”, and apologised for the timing of the scan, but it had to be done. Janet already knew what she was going to say, because otherwise she was surely going mad, imagining the worsening pain, the progressive weakness and profound tiredness. She knew that tumour was growing, the cancer was spreading. And all the consultant said simply conformed this. She said the primary in the lung was bigger, there were new secondaries throughout the lungs, and the spinal secondaries, presumably the cause of that pain across the lower back, were also enlarging.

The doctor asked about the pain, and said Janet could come into her ward at the cancer hospital (from where Janet had only recently been discharged after 3 uncomfortable weeks), but having also seen the nurse from the Hospice at Home Team who had dicsussed her going into the Hospice for a period of symptom control, Janet made it clear that she did not want to go back to the oncology ward. The consultant then moved into a “farewell” sequence, saying that she was always here for us, and ending by shaking hands with Janet, me, and our daughter who was also there. She did arrange to prescribe dexamethasone, a potent steroid drug, aimed at reducing or preventing pain from a swellling liver, even though there was no sign of this being a problem. Janet did mention that she had previously developed steroid-induced diabetes, but the consultant seemed unconcerned by this.

So we are now firmly in the care of the Palliative specialists, and are looking forward to a brief admission to St Luke’s Hospice ( pain control.

We have been asked to test the blood glucose every other day, and today it was 8.8 mol/l, about 2 hours after a meal, which is quite acceptable.We’ll do a fasting glucose nexr time.


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