The day that news came

Liduina phoned me late in the evening after another hectic day: the oncologist had contacted her with blood test results. I wasn't given any details, but apparently the results indicated that Simon's liver function is now absolutely insufficient for what his body needs. The practical meaning of this is that Simon has about two weeks, maybe more, perhaps less, until he will lose consciousness. After that, it's a matter of days to a week or two until his body gives up without nourishment.

Now that Simon's liver is unable to adequately clear out all the poison from Simon's blood, Simon will get more and more hazy, sleepy and confused from the fentanyl (an opioid receptor agonists about a hundred times stronger than morphine) plasters and nose spray.

The oncologist had planned to perhaps give Simon a blood transfusion to make him feel better, but decided against that because Simon's haemoglobin levels were fine... to me that sounds like a strange reason not to give a blood transfusion if the primary goal was to give some clean blood to a person with dirty blood, but oh well. So now that the blood transfusion won't be happening, there's nothing more the oncologist can do for Simon. Simon's GP (huisarts) has now taken over doctoring Simon.

Before the weekend I was wondering, Simon is getting more and more confused because of the fentanyl. He's taking the fentanyl against pain. The pain is actually due to a blocked bile duct (from the gall bladder). The blockage is also causing Simon's jaundice. One doesn't need a gall bladder to live. So if the surgeon were to remove Simon's gall bladder, the pain would go away, and Simon would not have to use (as much) fentanyl any more, and he wouldn't be (as) confused. Why not remove the gall bladder? Liduina relayed this question to a nurse, who acknowledged the idea. Unfortunately, it is now too late for removal as the cancer, liver and gall bladder are apparently all one big bulk of grown together mess. Ouch.

All in all, it's a good thing Simon's brother Matthew was here for the weekend and got to see Simon in an alert state for most of the evening on Saturday! It was a nice family dinner—with Simon, Liduina, Matthew, (my) Sjoerd, his boys, me and some music—which lasted till an hour or so before midnight.