When I was in the sixth grade, I scraped my calf on a picnic-table screw as I backed out of the bench at an art lesson. It didn’t really break the skin that I noticed, but over the course of a couple weeks, the area became tender, swollen, and painful. I didn’t say anything to anyone because I didn’t want to be excused from P.E. class or after-school sports. Unbeknownst to me, a staph infection had set in under the skin, destroying tissue and making me ill, which is probably why one day I felt like I was carrying a 100 lb weight dangling from my knee. One night, I wasn’t hungry for dinner, sitting kind of despondent at the dinner table. My parents asked what was wrong, and now several weeks since the incident, I started crying, “Don’t be mad at me, but…”, and proceeded to lift my pant leg to expose a red, feverish swelling that made my calf look like a softball had been embedded under the surface.

In minutes, we were on our way to the urgent care clinic where they drained an infection and abscess that had neared the bone. As it was, the infection had left a hole in the side of my leg about an inch wide and half an inch deep. Another couple days without treatment and I may have lost my leg. Or at least that’s what my mom told me at the time. And everyone who knows her knows that she makes shit like that up all the time. It’s the scary nurse in her, and not the person you’d want working your suicide hotline because you’d be all calling in all “it’s just not worth it anymore. I’m on the ledge of a building and I think I’m gonna jump because the ONLY thing I have to live for is my dog.” And she’d be all “is it a pure bred?” And you’d be all “yeah, but so what? I’m standing on the fucking ledge!” And she’d be all “well, pure breds tend to have more issues which means they’ll die sooner than mutts, so, I’m just saying…” CLICK.

Last summer, my grandfather mentioned his throat would hurt. But he didn’t want to go to the doctor because it might interfere with his golfing. THIS IS WHERE I GET THIS FROM. Rather than address the issue head-on, he ignored it until it was cumbersome enough to impede his ability to swallow. His inability to eat well caused him to drop 12 pounds in a month. I think we all knew that with such aggressive growth, it was likely cancer.

By early January, he finally agreed to be seen by doctor and my mom threw around all the medical community weight she had, pulling strings to get him seen as quickly as possible. None too late, either, since he went directly from the exam table to the surgical suite to have a tracheotomy due to an impaired airway. And an aggressively growing cancer at the base of his tongue. Phone calls, last rites, wills, advanced directives, and prayers ensued. And thankfully, he emerged from surgery this side of Heaven.

Longer story short, he’s got non-Hodgkin’s lymphoma. They’ve seen more suspicious ‘shadows’ on contrast imaging, but it’s too early to tell if it’s spread. All other exams and lab work seem to indicate the cancer is encapsulated and has not metastasized. He’s one every-three-weeks chemotherapy treatment into a package of six, with likely fifteen rounds of radiation awaiting him after that. The cancer is treatable, but it’s weakened and immobilized him in ways that he is not accustomed to.

I have no doubt that my aversion for rules and my don’t-tell-me-what-to-do attitude comes directly from the genes of my maternal grandparents. And so I feel for my grandfather when he suddenly has to live a life of directives like “you can’t be exposed to germs” and “you must drink 5 protein shakes a day” and “you can’t lose any more weight or we’ll have to put in a feeding tube.” Well, that last one, that’s my mom’s latest bit of “truth”. And though it is always a possibility, he DID gain 5 pounds last week. It took him leaving the constant scrutiny of his every activity in San Antonio and going home for a few days to do it.

This brings up another thought I’ve been thinking. The following are facts: he is not getting enough to eat to sustain reasonable strength to tolerate treatment. He is immunosuppressed. He should remain indoors. The cancer itself is treatable. It is more likely for him to succumb to complications and comorbidities than the cancer itself. He is prone to bouts of disorientation what with malnutrition and imbalanced electrolytes. He has diabetes. He is eighty years old. My fear, however, is that all this documenting of his diet and measuring of his intake and controlling of his nearly every moment will squeeze out his desire to LIVE. That all this conformity to rules and adherence to every precaution are begotten at the expense of losing his sense of self/dignity.

We hear the updates from my mom and have the tendency to write it off as the predictable and persistent Chihuahua-like behavior of the Type-A/oldest child/15+ years of critical care nursing experienced person that she is. Her nursing background is a double-edged sword. She is too smart about the downfalls of the healthcare system (my grandfather went a day without toilet paper in the hospital because the staff didn’t have time to bring him more), she’s not naïve when it comes to disease progression (she does not simply depend on 5 minutes a day with a doctor to disseminate information), and because of these two things – she is unable to wrap her head around letting the medical professionals do their job (or not) because, dammit, it’s her dad.

In all fairness, we don’t see the ups and downs of the roller coaster that she is experiencing, managing her father’s care almost exclusively. This is a situation made more difficult by the fact that it’s repeating the cancer/treatment/care routine she managed with her brother (liver/kidney cancer), and her mother (breast/lung/bone cancer), both of whom died while living with my mom and receiving treatment in San Antonio.

“But Rachel”, my mother tells me, “you don’t SEE HIM like I do. It’s so hard to see him like this.” And I believe that ardently. The thought of that alone – witnessing the rapid deterioration of a pillar of your life, crumbling before your eyes to a treatable condition – with my own parent and a sibling takes my breath away.

After a few good days late last week, he spiked a fever on Friday within a few hours of having his trache removed, became disoriented and tachycardic. Too many hours in the emergency room resulted in his finally being admitted late Friday night. My grandfather, an averaged sized man with an oversized spirit, abundant musical and artistic talent, and one-size-fits-all sense of humor, has been reduced to 121 pounds. He may be discharged within a day or two, depending on the results of the cultures. Absent this most recent setback, my grandfather was to begin his second round of chemotherapy today, March 9.

I should add that he has not met the twins. He had gone home to gain 5 pounds when I was last with the kids in San Antonio. My job is walking a tight-wire to the extent that I cannot take a day off. Traveling seven hours in a car with the kids in 36 hours doesn’t work well with the kids. And even if I got the kids there and he is in San Antonio, kids are germy and he’s ill. Risk a crappy trip with the kids to meet their great-grandfather with the possibility of making him sicker? It’s tricky. So this weekend, I will go to San Antonio, driving there and back in a day so I can at least visit with him a bit, even as it pains me that he cannot hold his great-grandchildren in his lap at this time.

The fact is, I don’t know where the balance is – relinquishing assumed control to trust that hospital staff will care for him over night well enough for my mom to get some sleep; the possibility that maybe grandpa would rather quietly enjoy what little quality of life he has remaining rather than proceed with “treatments” that is further suppressing his immunity, energy, and dignity; knowing when to let go and when to keep fighting; or to know when the best fight you can give is…to let go without giving up.

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My grandfather, Agapito Lopez, passed away on Easter Sunday, 2009. Just in time to watch the Masters Golf Tournament from heaven, I am sure. You can read my grandpa obit here.

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