Pathology

Well, we got the pathology results back.  And surprise surprise, it is about as bad as it could be.  12 lymph nodes were positive, the tumor returned in a multitude of places in the bladder, it also spread out all the way through the bladder wall at the site of the original large tumor so that my dad was upstaged from T2b to T3, there was residual cancer at the right ureter margin, and, he also happened to have prostate cancer.

Damn.

These results, particularly the 12 positive lymph nodes, mean the cancer is more likely than not swimming freely through my dad's body.  If it hasn't implanted somewhere else already, it very, very likely will sometime in the near future.  However, the surgeon and my dad's other physicians are not ready to give up hope, which is reassuring to some extent.  The next step is to get him enrolled in a clinical trial - frustrating because nothing has been proven to work for this kind of cancer at this point - these trials are just tests to see if something new works - and he only has a 50-50 chance of getting treatment since the trials are placebo-controlled.

So... we will hope to get into a trial, and hope that the cancer never shows up anywhere else.  The surgeon said that even though the right ureter margin was positive for CIS, risk of recurrence in the upper tract is only 2-4%, and if it happens is usually 5-7 years later, so no additional surgical treatment is needed for the ureter (unlike in breast cancer, where if the margins are positive for cancer they just go back in and cut out a larger area around it).

I had a good cry on the phone to Josh about it - he is in Utah for a few more days.  My parents came home from Chicago today, we're all kind of stunned I guess you could say.  I really appreciate all the offers of help and support that are flowing in, but really there is not much that anyone - including me - can do.  It is good to receive little notes of encouragement, and to know people are praying for my dad and for my family.  It is kind of amusing to me that I am supposed to be studying with all of this going on.

One thing that has been odd or interesting for me during all this tumult is that my faith has remained completely unshaken.  I have not questioned God or His role in all this, or grown angry towards Him.  Perhaps that time will come later, if my dad passes, but I have watched several people die, patients whose care I have been involved in, including children and babies.  Upon watching the light of the soul pass out of their eyes as their last breath was breathed, I found no place for anger or doubt in God's plan.  I know 100% that death is a natural end to life, and I believe that it allows us to return to God's presence, that our spirits pass on to some kind of existence that also intertwines with this world.  So I am not angry at God to think that my dad might die.  We are all supposed to die, and though my father's death may come earlier than any of us would hope, I know there is no answer to "why," and I know it would turn me bitter and terribly sad to start walking down that path of questions.  Instead, I have actually found more comfort than usual when I have spent time in reading my scriptures.  I believe that death must come to us all, and that God's role in death is to serve as a great comforter to those left behind when it happens.