There's No Place Like Hope

At about the same time that my dad was diagnosed with terminal cancer, one of his best friends was also diagnosed with cancer.  His friend had to go through surgery and chemo during the same weeks that Dad did.  That friend was so sick that he couldn't attend Dad's memorial service after Dad died.  And that friend has been battling his disease ever since, dealing with more surgeries, more chemo, more complications, more pain.

I know it must have been so hard for his friend to miss the memorial; I'm sure it must have been really tough for him to assimilate what had happened to my dad over a relatively short amount of time, during which my dad and his friend did not have contact with each other because they were both so sick.  My dad, in fact, was never told of his friend's illness; Dad was having such trouble grasping the facts of and coping with his own diagnosis, and, as I've mentioned before in regards to my grandmother's declining health, we felt that it would have been unbearable for him to hear about serious issues befalling someone he loved, especially when he was powerless to help that person.

My dad and his best friend Bob, many years ago, just before the Boston Marathon

Recently, I emailed my dad's friend to let him know that I have been thinking about him.  In his response, he said something that gave me pause: he said, "I have a chance, and I guess that's all you can really ask for in this life."

I think he's right; as long as a person has a chance, as long as they have hope, they can look forward to something better, and sometimes that's all a person needs to keep going.  

The dictionary says that hope means "to expect with confidence."  I think there's more to it than that, though.  I think hope is somehow genetically woven into our beings so that we can survive, even through the roughest of times. We are fueled and inspired by stories that bring us hope: hope and trust in mankind, hope that other people will help us when we need help, hope that tomorrow will be a better day.  We say that it gives us hope to hear about others who have succeeded or who have had something good happen to them - and we are so intrigued and motivated by the exchange of hope that there is even a website called Gives Me Hope where people can submit their thoughts about things that have happened that inspire them to hope and that allow them to believe in the potential.

For a long time after my dad died, I felt foolish when I thought back to the way we were so hopeful that he would beat the odds.  I felt like I'd somehow been tricked or that I'd misinterpreted the information in such a major way that I could never again trust that what I was seeing real or true.  Looking back at my Facebook posts from during the time when Dad was sick and seeing things I'd said like "starting to feel at least a little hopeful," I felt ashamed at the way I'd stepped out of character and had let my emotions overrule my logic.  I felt like the hope that I had clung to during Dad's illness had been unfounded, irrational, desperate, even ridiculous, but, over the course of the last couple of years, the words of my dad's friend and a few other things that have happened have caused me to start thinking of hope in a totally different way.

While my dad was sick and in the months that followed his death, I was active on a couple of websites for brain cancer survivors and their families.  I posted and commented and read the posts and comments by others about various treatments for GBM and other types of brain cancers, and through that forum I made contact with some people who had outlasted the prognosis of their disease, a few of whom had been diagnosed with GBM and had not only made it past the predicted two-year "maximum" survival time but for years or even decades longer.  While my dad was sick, I was desperate to find out what these people's secret to survival was so that I could find a way to try to make that same set of circumstances happen for Dad.  After he died, I still felt a need to know: What had these people done that we hadn't?  How had they made it, when Dad couldn't?  I'm still signed up on one of those chat boards, Cancer Compass; I don't post anymore, but I always read the new comments about long-term survival of GBM.  It might seem like I would see that as a point of sadness, or frustration, or injustice, but for me it serves more as a point of scientific curiosity - and of hope.  

In the summer after my dad died, a friend of mine who had been combatting cancer found out that her cancer had relapsed again and that she needed radiation treatment.  I offered to drive her to some of her radiation appointments.  The hospital where she had to go daily for several weeks was about a 45-minute drive from her house, and she and I commented several times during those weeks and afterwards that we had enjoyed having that time to talk to each other on the way to and from the appointments.  

I admired this friend a lot; I had always thought that she was full of great advice and, since she'd been diagnosed with cancer about five years before, of tenacity and true grit.  She was one of those people who is so easy to talk to, a great listener, someone whom I'd always felt like I wish I'd had more time with so I could get to know better.  On one of our commutes that summer, she and I had a conversation about how we both had a hard time asking for and accepting help from others.  I commented that I was much better at giving help than at receiving it, and my friend thought for a minute and then said, "I guess in a way it's helpful to let someone help you, if you think about it," words on which I would end up reflecting back countless times since then and that later inspired a perspective shift and this post about my perspective about gratitude, blessings, and philanthropy: A Gift Received.

In another conversation during one of our drives, I asked her and she told me about the timeline of her illness.  She filled me in on details that I hadn't known from along the way, including the fact that when she was first diagnosed she had been told that her cancer wasn't curable.  "How do you deal with that?" I asked her, and she responded in a voice that conveyed unlimited courage and conviction, "You just do.  For me, I just keep hoping and believing that if I can stick around long enough, somebody will find a cure. I am fighting to stay alive not because I fear death, but because I love life.  I am thankful for every day that I have in this life, but at the same time I want more, and I hope that that's what I will be given."  

Through those words and through the words of my dad's friend and those of other long-term survivors, I've started thinking of hope as good, necessary, supportive, even power-inducing; I guess my perspective about hope had changed so much that, despite what actually happened with my dad, I now don't regret carrying that hope.  I now deeply believe that there’s no such thing as false hope: I think that all hope is valid, even for people who have been given an awful prognosis like we were, even when hope would no longer appear to be sensible.  Because as far as I'm concerned, sensibility went out the window the second we heard that my dad had brain cancer. 

"I believe that imagination is stronger than knowledge - myth is more potent than history - dreams are more powerful than facts - hope always triumphs over experience - laughter is the cure for grief - love is stronger than death." ~Robert Fulghum

No Answers - Part 4: In The End

Continued from No Answers - Part 3: Doctors and Death

Another thing that I find disturbing from during the time that my dad was sick is that we never found out what really caused his rapid decline or his death, as I touched on in this post as well.  The medical record from his second and final hospital stay - and his death certificate - list his primary diagnosis as brain cancer ("GBM"), which is of course accurate, but here's the confusing part: his death certificate lists a secondary cause of death as "pancytopenia," or low blood count, while the records kept by the hospice nurses during the final days of his life list only GBM.  Although a low blood count is an expected side effect of some types of chemotherapy, it is not one that is typically seen from the type Dad was getting.

However, for an undermined reason, Dad's blood count was low when he was admitted to the hospital the second time, but that was aggressively treated with transfusions, platelets, and medications and had resolved over the time he was in the hospital.  Still, though, his condition continued to decline, and the host of physicians on the case said over and over that they didn't understand why he wasn't getting better.  Several times towards the end of that last hospital stay, the oncologist said, "On paper, he should be getting better."  Not better from the cancer - although the scan did show that there was less of a blood supply going to (or "feeding") the tumor which was the goal of the treatment with Avastin - but better from the horrible infection which we can only assume he got from a compromised immune system.  The oncologist expressed lots of confusion about why Dad's immunity was so low, too.  I didn't think about it then, but I have many times since: what does lower immunity is steroids, and Dad was on a HUGE dose of them, for an extended period of time.  That was never mentioned by the team of doctors as a possible reason for the infection or the problems he was having; in fact, a severely compromised immune system wasn't ever mentioned to us as a possible side effect of that medication.  We were given reams of paperwork about the possible risks and side effects of the Avastin and the chemo, but nothing on the side effects or the risks of the steroids (or the seizure medication he was on).  Dad hated the steroids, and we did too, because of the side effects they caused that we knew about, like insomnia and blood-sugar level spikes; the oncologist insisted that Dad needed to stay on a very high dose of steroids throughout the course of his illness though because he continued to suffer from severe headaches.  Someone later asked me why the doctors never considered whether or not placing a shunt could have helped with the headaches.  I don't know, and, unfortunately, that's just one of many things that was never discussed with us and that we will never know.

I guess second-guessing like that probably happens a lot when a patient doesn't make it, at least on the part of the family.  I wonder if it happens on the part of the oncologist too, though, or if he just crosses that patient's name off on his list and moves on.  I hope there is a review of some kind, perhaps so that something could be learned that could help the next patient.

I would venture to guess that it's not uncommon that not knowing the actual cause of death is unsettling to those left behind.  

I don't understand why no one was able to explain to my family what was going on medically with my dad; I'm not sure if they didn't care to figure it out because they didn't think it mattered since they felt he was obviously terminal anyway, if they couldn't figure it out due to their inadequacies or problems with the medical testing [one doctor told us that scans like CT's and MRI's "just can't really be trusted," whatever the HELL that means], or if they couldn't figure it out because it was truly a medical mystery.  I realize that all of the problems stemmed from the unpredictable nature of neurological disease, but all of the unknown just exacerbates my emotions - anger, sadness, frustration, all of it - even more because it feels like someone, somewhere, failed - failed to figure things out, failed to fix things, failed my dad and my family.

I've always been a right-brain thinker. I like logic and consistency. I don't mind following rules that make sense.  I like sticky notes (like my dad) and flow charts (unlike my dad - he didn't feel the obsession need to visualize the steps or the details like that).  On the flip side and to the point of this post, I have trouble tolerating things that don't make sense, that don't seem fair or logical, and that haven't been explained.

I know that knowing wouldn't change anything and that it probably wouldn't make me feel one iota better if I knew the answers to the questions with which we've been left, but still somehow not knowing disturbs me.  I guess having it remain a mystery just further adds to the shock of the whole thing having happened in such a relatively sudden manner - the diagnosis in an otherwise very healthy person, the lack of improvement despite following the prescribed course of treatment including surgery, rehab, and participation in a clinical trial, and then the rapid decline from which he could not recover.  I think I will always be stuck questioning why the things that weren't supposed to happen happened and why the things that were supposed to happen didn't.  

The Chemo Room: What's Going On With THAT?

Here's something I've been wondering about lately ...

Why are cancer patients forced to get their treatment in a crowded room?  I don't know of any other diagnosis that results in patients being forced to sit in a room together while each of them, one by one, gets stuck with a needle and then filled with toxins, all while they sit there in a circle, like they are hanging out around a campfire getting ready to sing Kumbaya and roast marshmallows.

Is it an attempt to mask the fact that each person is really fighting alone, no matter how much we love them and no matter how much we support them and want (need) them to get better, no matter how much we wish we could take away their pain or how hard we would fight to take their place?  

Is it supposed to be like a Cancer Club, with their cushy recliners and (if you're really "lucky,") flat screen TV's?  Because it's really not. Or at least it wasn't when I was in there with my dad.  For us, it was an environment of extreme stress, pain, and fear, tempered with just a little bit of hope and the belief that what was happening would be worth it.  But it didn't take having other Cancer patients in the room with us for that to be true. In the first chemo room we were in, the one at Duke, there were curtains between the recliners.  (Prior to then I'd read that only the newbies use them, but I didn't care - I pulled ours closed anyway so Dad would have some semblance of privacy.)  I'd heard that after the first few visits in the Chemo Room most patients prefer to keep the curtains open and chat with each other.  That sounds great.  And maybe for some people it is.  But I didn't see it, and I really can't imagine it seeming like anything other than an invasion privacy.  

For what I think were purely logistical reasons, our second visit to the Chemo Room was far worse than the first one. Neither one, of course, was a walk in the park for Dad, and, as you know if you've read our Behind The Scene Story, neither one ended up being worthwhile.  Both times, though, I remember feeling the breach of confidentiality and the urgent need for privacy and peace and comfort for Dad, all of which were not to be found in that type of a setting for him.

Is it an attempt on the part of the medical staff to keep people from showing their emotions?  We all know that peer pressure can be a very powerful thing.  I know there are lots of times in my life when I was hurt or scared and I wanted to cry but didn't because other people were around.  That just doesn't seem very nice, though, does it - using someone's pride against them, humiliating them into shutting down their fear, their pain, their anxiety, when they're battling for their lives?

Is it a cold hard dose of reality (like HEY YOU!  YOU REALLY DO HAVE REAL CANCER, and soon you'll be pale, bald, and sick-looking just like the other people in here!)?  OR, to shame them into not crying when they have to be stuck for the IV, when the chemo burns their veins, when terror hits them in the gut harder than any boxer ever could.  

I guess the most likely reason, though, and one that's in some way actually even sadder than those reason, is that it's a way to save money.  

Just one more thing about stupid Cancer that I don't understand.

Sick Days

During the time that my dad was on chemo and therefore immunocompromised, I became acutely aware (read: completely paranoid) about being exposed to germs.  I’ve always been a little bit of a germaphobe, and, armed with the knowledge that it was entirely possible that something to which I was exposed could result in (1) my not being able to be around him once I realized I was getting sick, or – worse – (2) my accidentally contaminating him if I went to see him and didn’t realize I was getting sick, I was on perpetual high guard about germs and illness at that time.

All of that got me started thinking about sick day policies at work and at school.  Every school that I know of has an award for Perfect Attendance.  Many offer rewards for not missing school ranging from getting to choose one’s teachers for the next school year, getting to go to a party, getting vouchers for free stuff like ice cream and pizza (that seems at least a little counter-intuitive, doesn’t it?), and – the one I don’t understand at all because it’s something that would never have motivated me as a kid – getting to wear a hat to school.  At my kids’ school, students can earn the privilege of getting exempt from the final exam in any class if they end up with an yearly average of at least a 90 and have come to school sick amassed less than three absences ALL YEAR. 

Isn’t it a proven fact that a quicker recovery is much more probable if a person who is sick gets extra rest and takes in extra fluids, both of which are impossible if that person is on-the-job as a student or an employee?  If that sick person does come to work or school, it is a sure thing that he or she is not performing up to his or her full potential.  Oh, and, if that sick person has something that is contagious like a cold, isn’t it a certainty that he or she is spreading those germs all around, which could potentially result in a greater loss of productivity when others in the office or school catch the illness??

One of my kids did a science fair project once to determine which public place was the most germ-infested.  Samples from ten different locations around our town were put into petri dishes.  The one that grew the most grossness was the sample from the front door of City Hall.  I’ll leave that discussion for another time.  Second place went to the front door of the school building.  Yep, people are getting sick at school as often as they coming to school sick.

I don’t think that colleges care if kids have Perfect Attendance Awards listed on their high school resumes, and I doubt prospective employers do, either.  If I were in charge of hiring someone for a job, I would NOT hire someone who had a record of never missing work.  From my perspective, Perfect Attendance implies a person has almost undoubtably come to school or work sick and carelessly spread their germs around at some point.  I’m not advocating playing hooky or skipping school or being a slacker when there’s no legitimate reason; I just think it’s better to take a sick day when one is, well, sick!

Some of the funding for schools is based on the average number of students who are present at school each day, a figure that they call the Average Daily Attendance.  So school administrators are highly motivated to do their best to highly motivate their students to show up every day.  I think schools are, in general, also focused on the fact that kids who miss a lot of school aren’t likely to be learning as much as they could be.  That said, though, I think it’s a bad idea to have a Perfect Attendance Award that is so enticing that the consequences of coming to school sick outweigh the benefits of staying home to recover.  School employees typically get one sick-day off per month; why do kids, in cases like my children’s school, only get a few day off per year, or – worse – none if they want whatever Perfect Attendance carrot that is being dangled in front of them??

And don’t get me started on the value of mental health days.  What about an employee who takes a day off to go on a field trip with their child or to attend an awards program at their child’s school?  I think that’s commendable, much more so than it would be if that person missed the chance to be present for such an event. (Wouldn’t it be ironic if the employee missed work to go to see their child get a Perfect Attendance Award at school?)

Something I’ve learned since my dad got sick is that time is a finite resource and making time to be present in the lives of your loved ones should trump everything else – money, recognition, and awards for Perfect Attendance.  When I think about missing out on taking care of a loved one in their time of need (including oneself) just to avoid not missing work, Perfect Attendance seems anything BUT perfect.  I missed work whenever I felt I needed to be there with my dad while he was sick, and sometimes even when I wasn’t really needed but I just wanted to be with him.  From my perspective, there is so much more of a risk from not missing work or school in cases like that, and, I’m sure, Regret from something like that is a tough pill to swallow.

After my dad went on ahead on the Wednesday after the Christmas Break, my kids missed the next two days of school.  If ever there was a good reason for them to take a sick day, that was it.  We were all heartsick and heartbroken, but we were together, and that was the only thing that helped any of us at all.   After the memorial service, we packed up and headed back home on that Sunday, feeling obligated to get back to school and work on that Monday.  I wasn’t sure any of us would be able to wake up that next morning and go about our lives like things were normal.  And, thankfully, we didn’t have to.  I like to think that Dad had some pull Upstairs because we ended up getting the next two days out of school for snow, and so we had two extra days to grieve as a family unit, still not nearly enough but, as Dad would say, “Better than nothing!”

In China, health officials use a thermometer that looks like a gun to take people’s temperatures to limit the spread of germs for things like the Swine Flu.  I’m only half-kidding when I say maybe we need something like that to check people for fevers when they are coming into the school building or employees in a large company as they get to work.

I’m honestly not sure what the solution is for keeping kids or employees from not missing school or work when they aren’t sick or keeping the ones who are sick from coming, but I do know what is currently being done is not a good idea.  The fact that we obviously can’t rely solely on human decency and honesty and internal motivation makes me sick.

The Fight Against Cancer

When I was in college, my grandmother (my mother’s mother) was diagnosed with breast cancer.  She had surgery, went through chemo, and made it into remission for awhile.

After I graduated from college, I lived with her and my grandfather for a few months while I did one of my internships at a hospital near their house.  At the time, my grandmother, then out of remission, was struggling through her second course of chemo, which did not do its job that time around.  She held on long enough to give her input during the planning of my wedding and to hold her youngest grandchild in her arms for the first time, and then she went on ahead, two weeks before I got married.  And thus begun my membership in the I Hate Cancer Club!

Spurred on by this over the years, I’ve participated in at least 25 runs benefiting organizations involved in the fight against cancer, including the Race for the Cure, the St. Jude Marathon and Half-Marathon, and various other races.  Each time, I was proud and humbled to be part of the effort and excited to be part of the extended cheering squad for those involved in this war.

Last August, I participated in the Avenue of Hope 5K benefiting the American Cancer Society in honor of Cindy, a friend of mine battling cancer.  It was a small, local charity race, my favorite kind, full of meaning and spirit and camaraderie.  A group of my friends also completed the race in honor of Cindy as well as many other loved ones who are fighting or have fought this terrible disease.

Cindy with her "team" at the ACS race, August 2010

 Only eleven weeks later, taking part in the fight against cancer took on a whole new meaning for me and the rest of my family. 

Last weekend, I ran the Avenue of Hope 5K again, this time with my younger daughter Molly, who proudly wore her grandfather’s racing shirt in his memory and who won her age division.

While my dad was sick, one thing that irritated him was, as he termed it, “too much talking.”  I could never figure out if it was because of the fatigue from which he suffered because of the incessant insomnia caused by the medications he was taking, because of the tumor in his brain, because of the emotional stress he was under, or because of something else that he couldn’t tolerate chaos or noise during that time.  Many times he asked us to be quiet, even though oftentimes he himself would later break into the silence by asking a question or making a comment.  Most of the time, he just couldn’t tolerate someone talking about the same thing for too long or asking him too many questions, and he particularly disliked it when several people around him were having a conversation and when other people were taking what he considered to be too long to figure something out.  He just didn’t see the need for inefficiency, something to which I can certainly relate.  As we talked about schedules and plans and details that we felt needed to be ironed out, Dad often chimed in by saying, “Don’t worry – just hurry!” meaning he thought there should be less discussion and more action.  One of my nieces even paraphrased Dad at one point when we were talking about something we were going to do later in the day and said, “Let’s quit talking about it and just do this thing!”

As much as I am honored and motivated to continue to participate in events to raise money and to promote awareness for this worthy cause, though, and as much as I take notice of the bumper stickers and related paraphernalia for awareness of different types of cancers, I’m pretty sure everyone is aware of cancer and the devastation it leaves in its wake at this point.  What I want - what we really need in this fight - are prevention and a cure.  Now let’s quit talking about it and just do this thing!

The Difference

I recently came across a story about a 54 year-old man from Turkey who was diagnosed with a brain tumor around the same time my dad was.  Like my dad, this guy had surgery during which it was determined that not all of the tumor could safely be removed.  He had his life turned upside down for awhile, but at least in the case of this man, he still had his life and he got to go on working towards his goals.  In fact, this man, who already held 11 world records for breaking concrete blocks with his bare hands, earned the title of World Champion in the sport of taekwondo only seven months after his diagnosis, and now he is trying to better his own record by using his bare hands to shatter 1145 concrete blocks in under 60 seconds (his previous record was 1135 blocks).

Click here to read the story

After the competition, the man attributed his victory to "faith and perseverance," and the report describes him as being "high spirited and determined despite his age and his serious health condition."

 

While I’m impressed by his skill and fortitude and glad that he had a “good outcome” after his diagnosis, what I’m really thinking after reading his story is why we couldn’t have had that “outcome;” in other words, what’s the Difference?

In all the research I did about brain tumors and brain cancer after Dad’s diagnosis, the one commonality that I noted in the stories about people who achieved long-term survival was having a belief that they would survive.  But we had that!!!  The words uttered by and the description of this guy could have been my dad's!!!  So, back to Square One – what’s the Difference??

At the beginning of Dad’s treatment, we explored the idea of using vitamin and supplements as part of his treatment.  We read lots of books and journal articles and corresponded by email with a few physicians and even one man who, as a 20-year brain cancer survivor, had forgone traditional medical treatment and had instead used a model of nutritional and dietary changes.  This man has written a book about less frequently considered treatment routes for brain cancer, and he was kind enough to answer our questions and provide specific advice via email.  When we asked Dad's team of oncologists about adding supplements and looking at dietary changes or even the possibility of using a few off-label uses of medications, we were told they felt it was necessary to wait until the Dad had completed chemotherapy to consider starting any of them because of possible interactions.

I eventually persuaded them to agree to Dad’s taking 15 mg of melatonin per day by pointing out that melatonin is often used to address sleep problems and the obvious health risks from the utter lack of sleep he was getting due to the crazy-high doses of steroids they felt was necessary.  We had seen research that indicated that melatonin could also function as a powerful anti-oxidant when added to conventional therapies (chemo and radiation); one clinical trial showed significant reduction in tumor size with years added to the average survival time with this as part of the treatment regiment.  But I kept that part of what I knew to myself at that point; as long as they agreed with adding it to his Pill Box, I was satisfied for the time being.

The team of oncologists also agreed that Dad could take a multi-vitamin to address our concerns about his immunity from the steroids and the chemo.

We kept charts and logs of Dad’s daily food intake, paying careful attention to the amount of nutritional value of what he was eating.  Because of the medications he was taking, his appetite was literally feast or famine; he either said he was “zero hungry” or he requested foods that had little or no nutritional value, like Diet Cokes and, the food he asked for the most, “just a little piece of chocolate.”  Dad would normally never have eaten the junk food he did while he was sick, but either he wasn’t in a place cognitively or emotionally to consider it as he usually would have or he just figured what the hell – I’ve got brain cancer; I should at least be able to eat whatever I want for a change!

After his first dose of chemo, I printed out lots of recipes for things that I thought would be good for him to eat.  We made a plea to the oncologist around that time for a consult with a registered nutritionist, and the one that met with us provided Dad with some samples of calorie supplements and encouraged him to drink Ensure, whole milk, and milkshakes to further boost his intake because she said his daily calorie count was too low.  Dad balked at those suggestions; his pre-diagnosis personality kicked in and he said he would never drink something “fatty” like that.  When we tried to talk to him about how he needed to increase his intake of healthy foods, he usually said, “I don’t really see how I need to eat more since my exercise program now consists of leg and arm raises and walking around in the house on a walker.”  Further discussion and reminders about what the doctors and nutritionist had said resulted in his saying “Riiiiight!” and then tuning us out.

I did talk him into drinking smoothies, though; I named off all the fruits and vegetables blended into the concoction, and I guess he thought that seemed to be reasonable as part of his Recovery Plan.  I didn’t mention the calorie-boosting things I added to the mix, and he didn’t notice.  A few times I mixed in things like spinach to give even more Vitamin Value; each time, he chugged down those smoothies with a grimace like a big shot of liquor and then requested a beer as a chaser to reward his Good Behavior.

Despite all of the charts, recipes, fruits, vegetables, and supplements and all of the effort it took especially on Dad’s part to try to comply and to move forward with our Recovery Plan, we found out that it just didn’t make a Difference because, before he could even get a third dose of chemo in his system, he was took weak and too sick for any of it to matter.

Like probably every other person whose loved one has lost the battle to the side effects of the treatment of cancer, I wonder every day if the route we should have chosen was an alternate one.   Would that have let him sleep, and, if so, would that have helped him?  Would he have had more energy for doing things he wanted to do, even if it didn't increase his length of survival?  He certainly would have avoided the pain of needle sticks and some of the uncomfortable side effects of the chemo and steroids, even if he didn’t get better physically.  Could we have gotten him to a beach, which is where he really wanted to go? Would another treatment or even none at all have made a Difference?

There are many questions I would like to have answered that probably never will be.  I have been considering writing a letter to Dad’s doctors, not necessarily to ask those questions because, even if they were answered, it wouldn’t really matter because it wouldn’t bring him back.  I wonder, though, how it would be received if I shared some of my thoughts about what else could have been considered or done in a situation like ours.  Maybe the doctor or whoever opened and read the letter on his behalf would toss it straight into the trash.  Maybe the letter would be read but disregarded because I don’t have an M.D. behind my name.  But maybe, just maybe, it would spur an original perspective, shed a new light, bring about a changed view, and, “best case scenario,” as my dad liked to say, maybe it would make a Difference.