Liver Metastases - My Mother-in-Law's Final Days
Regular Medical Checkups
My mother-in-law (MIL) was a Type 2 diabetic. For many years I accompanied her to her quarterly medical checkups. She had to prepare for these checkups by fasting overnight, and we usually enjoyed a nice lunch following the appointment. More often than not, she would give me a treat at the lunch. Her medical condition was more or less well controlled, but her kidneys were weakening.
The last two checkups, however, were different. My MIL had resolved conflicts between her sisters and they had been going on weekly afternoon dates together, especially on days when she did not need to take care of my children. Thinking back, it seems like life had plans for them to have a good closure.
I certainly had not expected this year to be her last.
The Red Flag - Liver Metastases
It is never a good thing when your doctor calls you the next day after a medical checkup. The cancer markers were so high that he asked us to brace ourselves for whatever was coming next, because life would almost certainly be different. My children and I gave her a hug the evening before her CT scan, and she said, "I should be fine."
A CT scan was scheduled at a private clinic the very next day. On 8 October 2016, results came back to show "multiple lesions in both liver lobes," suggesting metastasis of the liver. We were referred to an oncologist for follow-up in the middle of October for more tests that would determine the primary source of cancer. This information could be used to determine which treatment plans (if any) could be made.
Google taught us a lot. Our searches proceeded in more or less this order:
- "Liver metastases"
- "symptoms of liver metastases"
- "treatment/cure for liver metastases"
- "TCM for last stage cancer"
It was as if my MIL knew something was very wrong, and the symptoms of advanced cancer launched full frontal attacks on her liver. She could not hold out until the appointment with the oncologist, and she was admitted to hospital due to severe abdominal pain.
Hospital Stay (Part 1) - The First Six Days
What a relief it was to have her finally being treated. Other than fatigue, she looked so much better after Tylenol was administered into her body for the first 2 days in the hospital. In fact, she looked so well that if we had a chance to turn back time, we would probably have chosen to have her discharged from the hospital there and then so that we get that one more day going outdoors with her. Then again, she probably would have been too tired to go out, anyway.
I got a shock when I visited her on the third day at the hospital; her fingers looked swollen. Swelling had started, and the swelling stayed until the end.
On the fifth day of admission, they found the cause of her primary cancer (stomach cancer), and an oncologist delivered her prognosis right before lunch, saying chemotherapy was a treatment option. Another doctor from the chemotherapy team appeared right afterward and whisked my husband and father-in-law away before they could comfort her further.
My MIL shut her eyes for a long while and cried silently while I held her hand. That was the only time I saw her cry.
When she opened her eyes she asked me: "Is my hair going to fall out if I do chemotherapy?" Her appetite had never been very good before, but I guess this news made it worse. By then, pain had worsened, and we noticed her skin color becoming slightly yellow as the liver started to show signs of breakdown.
News that comes fast from a doctor in a hospital is never good. Given her medical condition and rate of deterioration, it was determined that immediate chemotherapy was "worth a shot." Arrangements were made to transfer her to the oncology ward - ward 48, and the first course of chemotherapy was scheduled to run over a weekend (Friday to Sunday).
Being the typical Asian grandmother that she was, she refused to have her young grandchildren visit her at the hospital.
Hospital Stay (Part 2) - Chemotherapy & Radiotherapy
Our Google searches changed to these phrases:
- "care for patient advance cancer/liver metastases"
- "diet for patients after chemo advance cancer/liver metastases"
- "caring at home for last stage cancer patients"
I read about other people's experiences online, and this helped prepare me for what was coming. I am grateful to the people who shared their stories online. Based on what I read, it seemed possible that we had at least 3-6 months left with her. No one, however, could have predicted how quickly or cruelly a body can deteriorate.
After responding well to the chemotherapy treatment for a few days, plans were made for my MIL to be discharged from the hospital. However, before that could happen, she began vomiting blood one Thursday evening. The family was called to the hospital and told that these could well be her final hours. I was not there because I had to be home with the children. We did a video call with her, and she promised my children to see them back at home soon. She kept her word.
Blood transfusions were given, and more tests were carried out. In addition to the side effects of chemotherapy, she had internal bleeding all over. Chemotherapy had failed. She became less mobile and mentally disoriented at times. Radiotherapy was scheduled with the sole objective of stopping the bleeding from the cancer tumors.
By this time, we were relying on Fentanyl patches, adding up to 75 mcg/hr to manage her pain. She had her curtains drawn to separate herself from the rest of the ward, as she slipped between normal consciousness and disoriented states. At times, she could not recognize her loved ones. She even had hallucinations of something coming for her, and she asked my father-in-law to protect her.
Hospital Stay (Part 3) - Going Home
The family was called into the doctor's office for a talk after radiotherapy. There was nothing else the hospital could do but to discharge my MIL as a terminally ill patient. The home hospice team would take over our case. The prognosis changed to "12 weeks at best." A memo from the hospital would be issued to us should we need to submit it to our employers to request time off from work.
It was a Monday afternoon that my MIL was sent home on a stretcher in an ambulance.
The home hospice nurse taking over our case dropped by to check on her. She asked my MIL if she was happy to be home. "Of course happy LAH!" my MIL said with a big, wide smile. That was the last time I heard her speak a complete sentence, like a true blue Singaporean.
Saying Goodbye From the Comfort of Her Home
After a night's rest, the grandchildren were brought in to see her the next day (Tuesday). The kids were looking forward to seeing their grandma again, but they did get a shock when they saw how different she looked. I wonder how we could have prepared them better.
She had stopped eating food. Google will tell you that this is one of the signs that your body is shutting down. Her breathing had become more labored.
By Wednesday, she had become effectively bedridden, speech was impaired, and she had difficulty closing her eyelids. Her eyes were starting to look very different.
When my children greeted her, she used all her might and vocals to shout her reply: "乖" (meaning "good, well-behaved child"). That was the last word I ever heard her speak.
On Thursday, she could no longer move a single part of her body. We could not tell when she was hit with a breakthrough pain because her face didn't seem to change expression. It just looked pale. I asked her to try blinking if she was in pain. It looked to me like she blinked, and I told her I would give her morphine. A hired caregiver joined us, and I think she was able to help my MIL feel more physically comfortable than we had been able to.
That evening, as I was tucking my children into bed, my older daughter (5 years old) requested time alone with her grandma. I explained that we could arrange that, but she had to understand that it would probably be the last time they would see each other. I added that she would need to be careful around her grandma, because her body had become very fragile.
And so, the next morning, my daughter was brought to my MIL's room for about 15 minutes. That evening she told me that she didn't know what to say, but that she ran her fingers over her grandma's hands and legs. Before she left the room, she whispered "I love you," and gave her a kiss on her cheeks.
My mother-in-law left us peacefully later that same night. Her husband and son (my husband) were by her side. She opened her eyes for the last time to look at them before closing them forever, after her husband and son gave her the blessings to let go.
Laid to Rest
On the final morning of my MIL's wake, my older daughter played something random on the piano. My mom asked for a song title, and she replied in Mandarin: "Where are you?"
A grandmother's love can be very touching, and our lives will not be the same without her. Grief can only lessen with time, and we take this as a reminder to live well.
As a parting note, I am leaving this article as a closure for myself, a gift of my thoughts to my children, and an experience to share with anyone who might find it a little helpful.