Unwelcome Choices

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Waiting. In the oncology world, it is never just empty, stagnant time like it is in so many other facets of life. But rather, a mind-numbingly vacuous, black hole filled with apprehension, dread and tension, muffling every other noise of life. Though we're overly familiar with both, the emotional toll of this ever-present oncology reality far exceeds the physical demands… waiting for the next appointment, waiting for the next test, waiting for the next results which have the potential to devastate your child's and your family’s life.

This dreaded unwanted result is where Seth and I found ourselves last week – the bone marrow test positive for residual leukaemia, that we had so been hoping and praying against. It has taken even Ned’s treating team by surprise because it has happened after a gold-standard sibling transplant, with some Graft-vs-Host Disease (GvHD has an anti-leukaemic effect). The ensuing week has been a tortuous road of complex decisions that no parent should ever have to make; all options fraught with potential dangers and an immunological complexity that I can’t do justice to or accurately convey; all of it shrouding several family celebrations - birthdays, anniversary and the start of Lucy's 4th grade school year. 

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This time last week, we were hurriedly seeking ethics approval and agonisingly consenting for Eleanor to go be readmitted, put back under GA again, and have a tube inserted into her groin to collect more lymphocytes, over the course of many hours, to infuse into Ned… with only a 10-30% success rate. Knowing Ned’s life was hanging in the balance, questions were asked of us requiring emotionless objectivity regarding our children, just as a family gastro outbreak took its physical toll, and we spent hours in weary, sleepless anguish, despairing that God has allowed this.

Today, we’ve just emerged from a teleconference with leading oncologists and cancer researchers in Seattle regarding possible treatment there as the next step, at prohibitive expense, as well as their opinions on alternative developing treatments depending on Ned’s disease course from here (based on his T cell markers, his genetic makeup, his level of immunosuppression and GvHD, and his results thus far). It seems rather dispassionate and cold-blooded to be constantly weighing up various incompatible treatments (one precluding eligibility for the other, etc), balancing risks, and even waiting till disease worsens enough to qualify for further treatments; but we are so thankful to God that there even is another possible option. And after today, Ned’s specialist, Seth and I all feel slightly more reassured about our plotted treatment plan and time course, with Ned’s best interests in mind, based on these experts’ advice. Though one option would be at exorbitant cost, and there are still many uncertainties (which prevents me from giving further details), this I do know for certain: we are currently witnessing an enormous upsurge in cancer treatment technologies developing internationally, not just in Seattle… meaning that in a matter of months, there will be clinical trials emerging and treatments available for select paediatric cancers that would most certainly have been palliated only a couple of years ago.

Ned will have a repeat bone marrow test on the 27th Feb, the results of which we will get the following week. This will be the determining factor on how we proceed, whether locally or overseas. If we have a similar result to what we just had last week, we’re hoping that returning to chemotherapy in a holding pattern may buy us some time before the ideal treatment is approved in Australia, God-willing. And this gives us a slim hope that we can continue to imagine our family continuing on with all 4 precious children. 

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So after we crumble for a few days, whilst trying to maintain a sense of stability for the other children, we pick ourselves back up and recalibrate to the new "normal", with yet another adjusted frame of reference and altered perspective. And the interminable waiting, while in isolation, begins yet again... 

Groundhog Day

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Ah life. A relentless, wearying, cortisol-fuelled rollercoaster ride recently... and most of 2017 really, starting with my exams at the beginning of the year. Ned's discharge from Transplant Unit just before New Year's Eve perhaps instilled some hope that 2018 might possibly be a better year for our family... 

Ned had his transplant on the 27th November, and it went smoothly, by the grace of God – although Eleanor (present at the door during infusion, thanks to donor privilege) fainted while watching! Poor 2yo poppet had had croup 2.5 weeks earlier, then gastro 4 days prior (being admitted to hospital till the procedure), then fasted till theatre just after midday – with not one complaint. She was fairly fatigued and in pain for the following couple of weeks, but has now made a full recovery, being well and truly back to her cheeky, mischievous, vivacious self. Although now, she refers to every man in theatre scrubs as “my theatre doctor”, and calls the RCH “MY host-el where Ned goes” (as opposed to being previously named “Ned’s host-el”).

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The weeks following transplant, including Christmas, stretched out in a bleak Groundhog pattern, in a sealed transplant ward bubble, with growing anticipation of engraftment with each passing day. The days were long, and the weeks were short. Regular bloods told the story of what his bone marrow was doing, while his small body was wracked with pain (from mucositis), nausea, fatigue, incontinence and various other awful symptoms. Consequently, he soon ceased to tolerate any oral foods, and vomited up his nasogastric tube, thus condemning him to TPN (IV nutrition, so to speak). Seth and I split the weeks – Seth home with the girls half the week, while I was in with the boys, and vice versa. It was an emotionally harrowing time as we dealt with not only Ned’s immense suffering in that small room, his sadness at losing his hair yet again and missing his sisters, but we also had to stay up to speed with the medical issues, maintain necessary prompt care & constant distractions for Ned, round-the-clock nighttime care, keep the irritable baby fed and comforted, and coordinate & care for the girls on the outside of the transplant unit, all whilst being separated ourselves. It was a life that I wouldn’t wish on anyone, but it was a life sustained by God, in the capable, knowledgeable hands of a very experienced medical team, in a rigidly-controlled unit.

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Official engraftment occurred by Day +26 – a milestone based on stable bloods, showing that his new marrow from Eleanor was finally producing its own cells. It was an exciting day, but soon followed by the requisite nasogastric tube reinsertion (a very distressing day owing to initial misplacement), and the commencement of the inevitable mealtime cajoling and eating conflicts.

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Quite apart from our own family’s fractured state and emotional havoc, many families around us were suffering immensely as well. Though it’s an oncology ward, the battle mentality can make you forget the horrid opponent; the inevitable outcome that confronts some of the kids and families who you and your sick children befriend. Just as a non-cancer parent thinks “thank God that’s not us”, a non-palliative cancer parent thinks the same about reaching the end of the line – the point where there are no more cards up the treating team’s sleeves. One of Ned’s closest friends from oncology, with whom he did ward kinder classes, lost her battle shortly before Christmas, and we’ve been so grieved for her parents who have lost their precious little soul. Such a cruel, despicable, insidious disease, cancer...

Ned was discharged after 6 weeks in hospital, on many strict medication doses, full continuous nasogastric feeds, into home isolation that has to be temperature-regulated, where we’ve had to bargain with Ned (suffering from significant nausea and lacking any appetite) to eat, but only foods on a ‘clean’ transplant diet. Going back to a 2-bedroom flat with 4 children and these requirements for one of them (including the continuously-alarming nasogastric pump, which invades even the deepest of sleep), has introduced a whole new level of heightened tension and stress in our household, especially because it’s been lovely weather and Summer holidays – a time when the kids want to go out and have adventures together (but Ned has to stay away from people) and play in sunshine (Ned can’t get hot, and can’t be in direct sunlight). Seth and I have had to constantly act as super-tolerant, peace-bringing, creative, nursing, multi-tasking, consoling mediators, on the back of very little sleep. We are so thankful for God’s sustenance - the strength we can muster even when it all feels so vastly beyond our capabilities. Our patience is often tested, so Seth and I have made efforts to improve our mental health and 'sanity' by having unrelated goals we can each focus on - Seth enjoys art projects, and I enjoy all-consuming exercise. Seth's working on a glass sculpture for a small exhibition later in the year back in Tasmania, and I just (rather spontaneously) ran in a half marathon event on the weekend, which gave me that thrilling 'runner's high' for the better part of the day. 

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Though recently, the investigations for a worsening limp, fatigue and low-grade fevers came back normal, a week prior, we had a big blow - Ned’s 30-day bone marrow results came back a tiny bit positive, when they should have been negative. I must say, I’m becoming sadly well acquainted with the heartsink, sucker-punch feeling from seeing my phone ring with the name of a doctor on the screen, and the words “Hi Emily, I’m sorry to say…” And my ensuing feelings of shock, indignation and fury at God. This is not definitively a relapse, and there are some treatments that have been tweaked to try and attain a negative result, God-willing, at the 60-day bone marrow test (on 1st Feb), but every time I even so much as think of that day in the weeks ahead, anxiety and dread overwhelms me. Because there really aren’t many more cards up our sleeves… 

A nativity scene planned and executed by the kids before Transplant

A nativity scene planned and executed by the kids before Transplant

Reunited after discharge! 

Reunited after discharge! 

Day Zero

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So today is The Day. “Bonemarrowtransplant Day”, as Ned calls it. And it’s been a less-than-ideal, challenging lead-up, as often seems to befall our family. Ned was admitted to isolation on the BMT (bone marrow transplant) ward last Sunday = Day -8. In isolation, he’s only allowed to have Seth, me, Gilbert (breastfed and <6 months old) and 2 other adults visiting; not his sisters. He then had 5 days of pre-transplant conditioning to deplete his own diseased bone marrow and prepare his body to receive donated healthy marrow. On Thursday (Day -4), his 2yo donor sister, Eleanor, started vomiting and developed further gastro symptoms by Friday (Day -3), enough to warrant admission - on a different ward in the same hospital!  The logistical challenge of which parent stays with which child, particularly since it involves a breastfed baby, strict infection control and isolation, has been ongoing, but fortunately, Lucy (who then also developed gastro) was able to stay with my parents. 

Consequently, it’s been a much more fatiguing, emotional week than we anticipated, where Seth and I have been like apprehensive ships in the night, each not seeing 1-2 of our kids for a while, not to mention fresh air and sunlight. We’ve had contact precautions up to our teeth and have had to optimise Eleanor’s health quickly because Ned’s so dependent upon her marrow. We’ve been fortunate to have wonderful nurses and the same transplant team caring for both kids - all prioritising their well-being for this very day. 

Ned’s doing surprisingly well, especially given his heavy chemo on Friday that required frequent (6-hourly and through the night) showers, bedding and clothing changes. Though isolated, nauseated, and no longer wanting any of his packaged-food-only diet, he’s enjoying his new disinfected / sealed Lego, board games and toys, and tolerating nasogastric feeds. He knows his beloved little sister is giving him a precious gift and he shows her such tenderness and care when they FaceTime. 

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“Me-too” Eleanor has just been so so keen to do what Ned’s doing! I guess it’s to be expected given she was born into this cancer world and has grown up around it. She’s always wanted to “go to the doctor”, “have a blood test”, “go to Ned’s theatre”, “eat MY hos-tal food”, “sleep in MY hos-tal bed”, and has perfectly obliged us in everything. She’s especially enjoying “There’s a Hippopotamus on My Hospital Roof Eating Cake”, and thinks there’s a hippo sitting up on the roof above her (great book for hospitalised kids by the way!). She’s now mostly back to her cheeky, grinning, chatty, cuddly self, and stable enough to have the procedure done today. What a beautiful gift she’s giving! 

Lucy’s being a stalwart, resilient older sister, despite missing us all dreadfully, especially hugging Ned.

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It’s been a really tough couple of weeks for her, not to mention the months before when she’s been carrying a lot of this and other responsibilities on her young shoulders. She understands what’s happening, desperately wishes she could give such a precious gift to her brother, but doesn’t complain about not being in that role. We’ve had to reassure her many times how crucial and valued a family member she is and always will be. 

3-month-old Gilbert is still a cranky baby, but now gracing us with occasional smiles and chuckles! Ned is just loving that Gilbert’s allowed into his isolation room. 

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But today, it’s Eleanor who is going to theatre in the morning, having some of her bone marrow aspirated under GA, which will then be processed and infused into Ned, in what looks like a small bag of blood, late afternoon. It is Day 0. We have been told that from now we are to expect anything for Ned, and be prepared for organ failure, ICU admissions, symptoms of GVHD (graft vs host disease), etc, and it will be a minimum of 6-8 week stay in isolation for Ned, if uncomplicated. Fortunately he’s having the gold-standard sibling transplant - and yes, his blood type will change to hers! Restrictions, reviews and complications will continue for years. 

Today is Day 0, and time is ticking. This is a momentous day for our whole family, especially so for our darling Eleanor and our dear Ned. 

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“He gives strength to the weary... those who hope in the Lord will renew their strength.”  Isaiah 40:29-31

Joy and Trepidation

Gilbert Peter

”bright pledge and rock” 

3.54kg; 4.09pm, 23rd August 2017

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What a joy it’s been welcoming a new little one to this world of ours... but also how heartbreakingly difficult for me particularly. Into a world of tension, chaos, anxious siblings, white walls, sadness, resentment, anger, and exhaustion came baby Gilbert on that Wednesday - into the skilled hands of 2 midwives (one of whom is a treasured friend who flew up from Hobart), while my parents and my other dear friend, Jess, helped with the day's coordination. There was excitement and relief at his safe arrival, but as the overjoyed sisters and brother cuddled him enthusiastically, the happy tears had a bitter after-taste. I’ve never before experienced such contrasting extreme emotions concurrently: 2 children of ours - one tiny, pink, screaming bundle in the arms of one fatigued, luminously-pale, hairless, sunken-eyed brother. To this day, try as I might, my heart is perplexed by this juxtaposition of thrilling new life against a constant background of sadness... and my smile often masks uncertainties about how to act or what to say. I think the fact that we feel like we’re simply treading water and “surviving” on an adrenaline rush has prevented us from deeper considerations. 

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Since Gilbert’s birth however, despite being quite the discontented, unsettled child, we have had moments of pleasantness and delight - sibling cuddles and pride from showing "their baby" off, the peace afforded by a warm bath, the bright newborn eyes, wise beyond his years, cynically drinking in all the shadows and bright colours around us... Although this is my fourth precious baby, I'm still in awe of this miracle of life and the evidence of our Creator's hand in its formation. 

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To be perfectly honest, it’s been a really tough few months. For the first 7 weeks of Gilbert’s life, Ned (and thus Seth) have been in hospital, which no-one liked. Ned was SO sad he couldn’t be at home to welcome his brother and hold him every morning, Seth was sad he didn’t get those evening newborn cuddles, and I was sad (and frustrated) that I didn’t have Seth to help me with any newborn nights or sick girls, that my family was so fractured at what should’ve been a joyous time. I have also felt such guilt because Gilbert has spent a great deal of time screaming by virtue of me parenting solo and being physically incapable of tending to his (frequent) distress instantly (I’ve since found out that his diagnosed laryngomalacia and reflux are to blame for his feeding issues, difficulty sleeping and slower weight gain than my previous babies).

On this background of fatigue and emotional exhaustion are moments where the reality of childhood cancer has struck with such force. When you’re on an oncology ward constantly, you bond with other families all fighting the same battle... to win. The unspoken elephant in the room is what the grim reality of a lost battle means, and heartbreaking news from several friends has blindsided us and forced us to process our raw grief at so many other children’s suffering, particularly these friends. It’s a different world this, an “alternate universe”... one where you can’t ever feel secure about any of your kids’ health; one where bad news is often expected; one where your kids learn to pray for people “not to die”; one where making serious decisions for your child’s future, whilst juggling multiple children, emotional fatigue and sleep deprivation is considered the daily norm; one where long complex medication names are the standard language used; one where the anxiety of any situation’s risks and children’s safety overrides anything else; and one where, rather than discussing how to optimise your child’s life, health and long-term happiness, discussions simply revolve around your child’s expected morbidities and long-term survival rate; and one where your constant mental state is tense and on "high alert". 

Despite the trials though, these last few months have also finally brought us some unexpected better times. Ned was started on a clinical trial where he happened to be randomised to the trial immunotherapy drug (as opposed to the standard chemo regime that was the other trial arm). It consisted of a 28-day continuous infusion from an infusion pump in a back pack he carried constantly. We were so relieved that Ned was randomised to the immunotherapy arm (an answer to prayer) because, although long-term studies are lacking (hence the trial), it’s meant that, once he was stabilised, he could be discharged from hospital for a few weeks, carrying the infusion pump in his backpack. The alternative was weeks of more heavy chemo hooked to the IV pole in hospital till transplant. Despite most days spent in hospital still (tests, procedures, checkups, reviews, etc), it has been so lovely having him ‘home’ again. He’s really enjoyed the freedom of no IV pole, being able to play Lego with the girls again, walking with us to & from Lucy’s school, eating meals together, etc. Furthermore, given we haven't yet reached transplant time, but the clinical trial has now ended, he was approved for further compassionate access to the drug because he has responded so well to the 28-day infusion (so he can stay out of hospital rather than going back on nasty chemo before transplant). For this we are so thankful. 

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The transplant process has been set to start on the 19th November. This is the date Ned is likely to get the bed; then will start 7-10 days of 'conditioning' to prepare his body for receiving Eleanor's bone marrow - which is going to take quite a toll on his little body. The big Transplant itself is probably going to take place on the 27th November: Eleanor will go into theatre in the morning to have bone marrow aspirated, and then she'll be admitted to a ward for only a couple of nights of analgesia and other post-op management. The bone marrow will be processed in the lab for a few hours, then anti-climactically, the small bag (which looks like a blood transfusion) will be infused into Ned. From there we start the harrowing recovery day count; Transplant Day being Day 0. The first 3-4 weeks will have the highest risks of complications. 

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Thank you for getting this far - we are humbled by the interest of those following along and praying for us or simply pausing to think of us and convey that acknowledgement in some way. This was a tough blog post to write, which is why I kept putting it off, but right now, in this moment, though we are still upset about a lot of things, we are grateful Ned's our son, and we feel privileged to hold his hand and walk with him in his vulnerabilities, tears and fear, trusting God is guiding us - especially through the bleaker months ahead. 

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Credit to our dear friend, Lisa Kuilenburg, for most of the photos (the best ones!) in this post. 

Behind Closed Doors...

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Over the years, I've observed that often cancer "battles" are portrayed by the media to be just about chemotherapy infusions whilst in bed, hair loss, with some nausea and pain... a falsely palatable perception of its reality. Especially so in context of a leukaemia relapse (high-risk with much more intensive treatment). Especially so when it's a child. What a world ours is now… so far-removed from what we were living. You see with cancer, there are at least 3 arms of management - there's a routine chemotherapy schedule (always changing - spinal & IV infusions, and oral meds, procedures, surgery, etc), there's the treatment of all the side effects, and there's the unscheduled, heavy-hitting treatment for random infections causing quick deteriorations in patients who have no immune system. This means that most weeks, often on a daily basis, we deal with hours of Ned’s nausea, inconsolable crying, pain from his Hickman line (with recent complications), diarrhoea, screaming tantrums (thanks to the steroids currently), oral medication administration (some forced), frequent night wakings, physical weaknesses and incapabilities, irritability, fatigue, muscle aches, sore eyes, ulcers, slow heart rate and arrhythmia scares, food demands coupled with immediate refusal… the list goes on. When we’re in hospital, Ned can’t be left alone, so a parent (or other trusted adult) has to be with him in his room 24/7 – “sleeping” overnight in his hospital room (with all the frequent wakings, assisting with certain meds, beeps, obs checks, toilet visits, etc) with no morning respite. The 24-hour endless cycle of caring for a very sick child on chemotherapy is an all-consuming, emotionally-draining, relentless, exhausting (not just like when I was exhausted with a newborn), miserable job – amplified by the need to process and deal with our own emotions, amidst frequent physical separation, parent our daughters (with various sleeping or adjustment challenges), create new routines, learn new medication schedules, and try to physically negotiate my rather expanded girth. It’s a road we would never wish on anyone. The homesickness has now engulfed us, and we all dearly miss our friends, church, our home, and colleagues back in Tasmania – many of whom have closely travelled with us over the last 8.5 years since we moved there. Nothing can describe the dark cloud that settles over me when I open my eyes yet again with a jolt, be it night or early morning, to another scream of an unsettled child; the reality of this awful battle Ned’s enduring cannot be dreamed or slept away. Another day begins.

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Ned's fortunately had some recent (unexpected) nights out of hospital, which has meant we've been able to have a few family walks, outings, meals together and much-anticipated tram rides. Especially enjoyable since we've been joined by my parents, recently returned from their work in Africa, several weeks earlier than originally planned. The fresh air, occasional smiles and extra hands have been a bonus break from the reality; Ned's daily question of "can I sleep at the flat tonight or will I be staying here in hospital?" reminding us of how precious this time was. But our seemingly happy smiles in person or in photos do hide the ever-present, cautious apprehension we carry and the tears we often shed behind closed doors. It pains me to feel like I have to continually justify Ned’s irritable, seemingly-rude, miserable behaviour due to his steroids or other nausea / pain, etc. If an oncology parent tells you about “steroid weeks / courses”, please give your utmost sympathy. It is hell. It can dissolve families, mental health, and any last shred of a parent’s patience or ability to think reasonably. Please don’t judge it as “poor parenting”. It can turn the sweetest and most charming of Neds to a miserable, angry mess who can’t interact with anyone without screaming. It’s broken Seth and me many times.

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Please please please don’t try to suggest we're doing the wrong thing by having Ned’s cancer treated with chemotherapy, by oncology specialists, in a top hospital. My nearly 16 years of medical studies and practice have absolutely confirmed that yes, the oncologists have our best interests at heart; yes, chemotherapy (and other treatment) does work and there are thousands of studies to prove it; and yes, we’re not going to deny our precious son this lifeline… I’m sure, if you were in our situation, despite hating the damage chemotherapy can cause, you’d also cling to this lifeline offered and proven by some of the best scientists in the world.

"At least you’re in Melbourne, where you’ve lived before and thus know people.”

“At least you’re at one of the best children’s hospitals with amazing specialists.”

“At least you have the joy of an imminent new baby ahead.”

“At least you’re medical and have more insight into the day-to-day, etc.”

“At least you’re already used to sleep deprivation / being an oncology parent.”

Whilst this is ALL true and yes, we are thankful for these, any time we hear them, we feel a tiny little chip away at our souls, somewhat feeling like any of our feelings of displacement, turmoil, grief and sadness is misplaced and unfounded. Somehow feeling like we should in fact learn to be content immediately in this suffering – with just one flippant phrase. As if all of this stress is undue and unjustified. At this time in our lives, despite all the good things (that we acknowledge), it does hurt just a bit. We both cling to hope that our Saviour is travelling along beside us, suffering as Ned and we suffer, but we are under no illusions that God will certainly heal Ned. Now more than ever, with a very unknown future, we know that we need to walk in complete faith – trusting only that He will be there, that He will comfort and uphold us regardless of what each new day brings. Being Christians doesn’t exclude us from suffering; instead we must sometimes painfully sacrifice our earthly plans and aspirations while God re-directs our lives in opposite directions. All I wanted to be was a procedural / obstetric GP in a resource-poor community with Seth and our 4 (healthy) children. Now, it’s perhaps becoming more apparent that my years of medical training are more relevant to being my child’s advocate through this epic battle. And with this in mind, I'm praying that the resilience and patience we've also learned has prepared us for welcoming our 4th child into our rather chaotic lives in the coming weeks. 

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Ned's Perfect Match

Life hasn’t got much easier since my last blog post. Unfortunately Ned has had continued complications and/or infections, so hasn’t been able to leave hospital at all. And given his seeming susceptibility to any passing infection, and propensity to have slow recoveries and poor cell counts (needing frequent transfusions and constant quarantine), we’ve been told that it’s likely he won’t be discharged from the ward at all till well after his scheduled bone marrow transplant in (probably) October. This was a rather grim revelation for us since it further prolongs our family’s state of fracture… with Seth and me alternating between either overnight-ing with the girls at “home” and staying in hospital with Ned. Often, we attempt to all eat dinner together in the hospital room, but the oft-ensuing chaos is not really conducive to doing this every evening, especially given how little tolerance an easily-fatigued and irritable Ned has for either sister. Ned feels awful, has constant pain, nausea, weakness, itchy eyes, skin breaking down, ulcers, is missing his energy levels, his outdoor fun, his kindergarten playmates, and dislikes his “legs that don’t work”. Although initially being quite sad about his rapid hair loss, he’s a bit happier now it’s gone and he’s not so constantly itchy. 

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It does also mean that Seth and I are constantly busy or occupied – either with usual household / parenting duties (especially the emotional adjustment that has proven quite challenging for some of our kids), or caring for Ned, with his significant physical incapability. Accordingly, though familiar faces are encouraging, and we’ve felt so loved in having close friends fly from Tasmania or drive in to help with the juggle, it’s a bit tricky for us to take more than 1-2 hours out of hospital or away from family at any one time.

We’re relieved that Lucy’s started in grade 3 at a small, local school, just across the road from RCH, where she’s already made a few friends, enjoying classroom interaction and activities, and getting along well with her teacher. We’re also feeling blessed to have found and settled in a local church, where we can rely on lovely social interactions weekly and seek additional support.

 The other wonderful news since my last update, however, is that Ned has a bone marrow donor. The slightly bittersweet side of it for Seth and me is that his perfect match is his 2yo sister, Eleanor. Being in a state of emotional fragility already, this is challenging for us both because it means we have to involve another of our precious children in medical procedures due to leukaemia – the enormous monster we’re battling, which seems to be spreading its fingers further and deeper into our lives. We still find carrying in vulnerable-looking Ned to be put to sleep in theatre every single time takes an emotional toll, and now we’ll be handing over our even smaller child. But we’re equally thrilled that he has a “gold-standard” sibling-matched donor.

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Eleanor will have bone marrow aspirated from her hip while anaesthetised, then will spend a couple of nights in hospital for analgesia and possible iron replacement. As soon as her bone marrow is removed, it will be sent for a few hours of processing and treatment, then will be brought up later that same day for reinfusion into Ned, followed by another 6-8 weeks in complete isolation. This process will probably all be beginning in October, when we have a newborn as well, so it’s a rather daunting few months ahead… Much easier to instead focus on each day at a time and be thankful for the occasional fun family moments in the hospital room, the rare nights of better sleep, and the hearty chuckles we can still sometimes elicit from Ned. We lose track of the weekdays when we’re in hospital all the time, so time is better marked by the schedule of procedures or chemo agents being administered, and instead of the usual workers’ end-of-the-week exuberance, our weekday moods fluctuate according to the anticipation of a less rigorous day or the dread of more procedures or imminent test results.  Right now, though, we're enjoying a slightly more peaceful few days in hospital, before another gruelling month (with steroids) begins, while Ned's body recovers from the first 4 weeks of intense chemo...  

Thank you to all of you, though, who continue to keep in touch, support us, lift us up in prayer, and read our updates - this is probably our simplest portal to update you frequently if you're interested. 

The Big 'R' of the Big 'C'

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It’s been the baneful niggle of our 3-year relationship with Ned’s leukaemia… the dreaded Relapse. And when you have a first year including the shocking initial diagnosis, upgrade to high-risk, multiple complications, many infections / blood transfusions, etc etc, you half expect the ground to cave beneath your feet at THAT point. Not 3 years later… when you’ve adjusted to a less rigorous routine of “maintenance chemotherapy” and less frequent checkups, fewer blood tests and treatments. Not when your sick child has had half a year of kindergarten with no major setbacks, having started to learn how to socialise with peers and make friends, having started to develop better leg strength and gross motor coordination. Certainly not after you have a challenging year of a miscarriage, other children’s health problems, sleepless nights, fellowship exam study and exams, morning sickness of an much-anticipated new pregnancy, selling a house, buying a new house and moving. No… I have to say, for me, for the first time, the fear of Relapse had definitely fallen to the backburner as we’d been trying to negotiate all the other life stressors and demands.

Unfortunately, this is the way cancer works – insidiously and slyly. We had only approximately 7 months to go, had discussed a possible end-of-chemo party with him, and had re-booked Ned’s previously-postponed Make-A-Wish trip to Hamilton Island (a boy who loves beaches!) for July. And we’d actually told the kids so they could count down – a definite sign that this setback was unheralded.

But that niggle that I’ve always had was realised on the morning of Tuesday 20th June, at a usual clinic check-up with Ned and Eleanor… our 2nd D-day, nearly 3 years later. A result that showed that Ned’s chemo hadn’t been working and the leukaemia had come back, infiltrating his bone marrow (by 89% already!), and causing his body to stop producing his normal cells.

As our doctor broke the news to me, whilst Seth was at work 20 mins away and Ned & Eleanor were quietly playing, the worlds of our little Isham family members caved in around me. You know that moment when, as a new Mum, you’ve just been through umpteen hours of tremendously difficult, painful, exhausting labour, and you’re just barely starting to recover when you realise that you have to now learn to breastfeed AND do so every couple of hours 24/7?! Well this was it. Seth and I were already wrecked from the year that was and about to fall in a heap. Yet now we had such devastating news, we had to suddenly make and act on numerous practical decisions that would affect the whole family.  We hastily planned for me to take Ned to Melbourne the next morning to begin 8-9 months of treatment, and Seth and the girls would join me a bit later, after he’d finished school reports and given Lucy a chance to say goodbyes. Then we could start thinking about how to schedule our Melbourne lives, incorporate a new baby’s arrival, find a temporary school for Lucy, hope Eleanor would fit in around the chaos, and work out the finances without the usual income streams (fortunately and very kindly now covered by the Go Fund Me campaign set up by our lovely Carmichael friends).

I had the first 1.5 weeks here at Royal Children’s Hospital, Melbourne, with Ned, and then the rest of the family joined us. It was one of the hardest periods of my life, and I felt so alone – Ned had some horrendous days and nights… so many days of fasting and going to theatre, waking up disorientated and scared, being woken 1-2 hourly every night for urine +/- obs checks, suffering some awful side effects of chemo and infections, being burned from leaking toxic chemo under his skin, all whilst not understanding the sudden upheaval, missing his sisters and Dad, living in a very unfamiliar hospital with unknown staff, feeling miserable, and taking his growing anxiety out on a sleep-deprived, pregnant Mama.

I can’t begin to describe how sad I am about seeing Ned, and the other family members, having to walk down this agonising road again. Every hour of every day, my heart bleeds watching my 5yo sweet boy endure so much discomfort, pain, fatigue, nausea, irritability, misery, sadness, and confusion; his pale face and sunken eyes, his inability to walk more than a few steps without wanting to lie down, his lack of enjoyment in eating anything, his impossible desire to play with his sisters because of fatigue, and his regression in other learned skills and focus.  

2yo Ned at initial diagnosis in 2014

2yo Ned at initial diagnosis in 2014

My heart aches observing Lucy try so hard to adjust to a sudden extraction from her close friends, her regular school routine at a much-loved school, a home amongst bush (which she’d just started enjoying after moving 3 weeks prior), a seeming disinterest in her wellbeing from both her parents… Fortunately, 2yo Eleanor, although more emotional than usual, will always find a way to make friends or burn off energy – whether it’s careening down a hospital corridor in a toy car, or doing gymnastics over the couches at our Melbourne accommodation. It is also rather suffocating and exhausting learning all the new schedules, protocols, medication doses, etc… without interfering and advocating with my professional hat on. Seth and I were already so weary, after living this life, without respite, for 3 years, and the prospect of what lies ahead is daunting, since it includes much more intensive chemo and 2-3 months of Ned in isolation for bone marrow transplant, around the same time that we’ll have a newborn.

It is our boy though, our darling son, who is suffering the most, with infection after infection (now we’ve been here just over 3 weeks, and he’s only had 2 nights out of hospital – both of which he was very unwell and rapidly deteriorating until we went to ED). Whilst we don’t really feel “lucky” at this stage when we see our dear lad suffering, we are immensely thankful for a brilliant children’s hospital with access to world-class treatments and specialists, especially knowing that in many other parts of the world, like Congo where my parents live, many children with leukaemia wouldn’t survive from the outset. We also want to acknowledge the abundant support by several communities that have stood beside us through this upheaval, with prayer and / or constant encouragement – our wonderful church community back in Tasmania, our dear friends, my extended family in Melbourne, and an amazing medical parents’ Facebook group that have pulled together to sustain and provide where needed.  Though I’m aware of many online blogs / journals / articles describing cancer “journeys”, many people have requested regular updates about Ned, and this is the best way of dispersing this information. 

And now to re-learn exactly what I wrote my last blog post about... 

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Contentment

It’s been a while since Seth or I have written since, mentally and emotionally, the last year has taken its toll. Ned’s health is mostly stable at the moment, but the deep fatigue and tedium is well-entrenched and the perpetual battle of juggling Seth’s work and various extra-curricular demands, my work and associated ongoing study, Lucy’s schooling and emotional wellbeing, Eleanor’s infanthood requirements and necessary routines, and Ned’s regular medications, hospital visits, emotional and physical development (which seem to be lagging, with good reason), and the relentless, dreadful side effects of his daily chemo, which involve frequent emotional meltdowns and worsening anxiety. 

I keep casting my eyes furtively back to “pre-leukaemia” times (or as my friends hear it “before D-Day”) to when Seth and I were just like any other ordinary parent of average, appropriately-developing children who deal with regular ups and downs of common physical ailments and emotional challenges… A time when we weren’t apologising for a child’s anxious outbursts, or justifying his reliance on a dummy to sleep; explaining his lack of leg strength and coordination, or emphasising that his itchy, spotty skin is not contagious. A time when we felt bulletproof, we felt like "strong" parents, striving for perfection, with healthy children and ambitious plans, few vulnerabilities and weaknesses, raising our children to be "happy" people, or so we thought.

I've struggled a lot getting my head around the concepts of contentment vs happiness over the last few months. To me, the word ‘happiness’ encapsulates ideas of cheeriness, glee and joviality. 'Contentment' however depicts a more settled fulfilment, a satisfied pleasure. In this day and age, I’ve noticed the concept of happiness is being more and more sold as the essence of life, the pinnacle of ambitions worth striving for, a milestone that must be pursued, albeit an unattainable one. And what better audience to peddle this elusive commodity to than the exhausted, patience-depleted, widely-criticised group called parents. Not only must we be happy in our roles, our relationships and our lifestyle, but our children must be raised with a “perfect”, happy childhood, and nothing short of absolute perfection for their education, diet, health, lifestyle, discipline and beliefs is adequate. Apparently, everyone must endeavour to be the Perfect Parent, and they will be judged if they fall short in anyone else’s eyes or estimation of what the Perfect Parent involves, and how happy their children's lives will be. In my observation, there’s a Western societal fear of sadness, fallibility and vulnerability. As parents, we constantly scramble to seek out what the best education involves and how we can access that for our children; what the best treatment for this particular ailment is and how best we can treat our children with minimal challenge to their emotional state and fewest side effects or long-term complications. We go to great lengths to research what the ultimate foods and most wholesome, purest diet is for our children, concerned about any "pollution" we may confront their small bodies with, and then torture ourselves by reading about how various methods of discipline will cause long-term emotional harm. All this whilst we continually compare ourselves with the seemingly Perfect Parents around us - their superiority and virtue now more evident thanks to social media. 

Finally, and this is the greatest of enigmas, we not only feel shame and guilt if our child has been “exposed” to anything less than perfection, or if we’ve allowed a blemish on their lives, but we also judge others according to our idea of a Perfect Parent. 

How is it that we are in this place whereby sadness is considered a disease and happiness is the default? Regardless of how we choose to raise our children, thereby shielding them from certain uncomfortable experiences and challenges (which, by the way, I don’t think is wrong), every person on this planet will, at some point during their existence, experience fear, frustration, sadness, impatience, disappointment, grief and pain. And what do we hear from those who have experienced hardship in a particularly profound manner? That they’ve developed a strength of character they never thought possible. How are these character traits not something we want for our children? As much as we want to raise children with endless opportunities and worry-free health, shouldn't we want them to also be capable, resilient and empathetic?

I am a parent of 3 young children, and I have been the same - wanting the best outcomes for the best lives they could possibly have. But now I have a child who hasn't complied with that planned agenda, and through his young body have coursed awful, toxic substances which every parent would presumably go to great lengths to shield their children from. So I must re-check myself, my priorities and my values. No-one could claim they've had a blemish-less, disappointment-free “perfect life”, and I've certainly never met a Perfect Parent, yet I've been humbled again and again by the honest, compassionate, loyal friends I've encountered along the way. Indeed the resilience I’ve developed from my life's imperfections have been borne of struggles and pain through the years, and I believe I'm a more wholesome, empathetic and content (not “happy”) person because of it. And so I want to challenge you too, in whatever path you're travelling. 

A brilliant sermon yesterday morning reminded me that “God’s power is made perfect in our weakness”. In my vulnerability of being parent to a child with a life-threatening illness, who is on daily chemotherapy, thereby suffering from constant nausea, tiredness and often misery, I confess to being that parent in the past - desiring the perfect life for my children, and consequently giving those parenting goals undue importance, almost as idols. And my grief over these last few years of losing these lifestyle ideals has been profound, and still challenges me more often than not. 

But “God’s power is made perfect in our weakness”, and His power will be made perfect in my and my children’s weaknesses, not by virtue of me seeking a perfect life for us all. Our children and I will continue to develop joy, resilience, delight, contentment and pleasure in learning to utterly depend on Him when we are not strong, bearing testament to God’s love and steadfastness. Although I wouldn’t wish ill health on any person, I know God weeps with those who suffer, like Ned, and His power, faithfulness and love is superbly revealed in those who come to Him in their weakness.