Visual cut: the jughandle

When Laura went back to work in March 2009 because Avastin had shrunk the tumor, she had a slight cut to her right side vision.  That is, she couldn’t see her doctor’s fingers moving if he held his hand near her right shoulder. The tumor was pressing more and more on the parts of the central nervous system processing signals from the eyes.

Beyond an initial peak from Avastin, Laura did not progress functionally. Then we both began to sense that progress was slipping away.  Laura became much more frail, losing as much weight from the time Avastin began as she had lost during the terrible months of the first radiation treatment.  In all, she had lost about a quarter of her body weight in the nine months since diagnosis.  She was constantly fatigued, prone to headaches and colds.  As Avastin worked less and less, the cut to Laura’s vision also grew worse.

Yet she kept going to work 4-5 days a week … until the day my assistant interrupted a meeting to say that she was on the phone.  Laura had called through the switchboard because her aphasia and limited eyesight made it difficult to find my direct line or cell phone in her contacts.  She was also distraught.  Janie had tried to help her, but Laura needed to talk with me.  She was calling from the fire station on Harrison Street in Princeton.  She had been coming home on Route 1 from her office in Trenton and had taken the jughandle at Harrison Street where she hit her right front tire hard against the curb.  She had made it about a mile and a half to the other side of Route 27 before her tire went flat. Fortunately, a Good Samaritan stopped and changed the tire for her.

Now she was desperate about driving on the spare and about getting to Anne Mei’s camp in time to pick her up.  When I offered to come there to drive her, she calmed down and said that she would pick up Anne Mei and then go to the Honda dealer to get a new tire.

During the 18 months of her GBM, this was the only time I heard real fright in Laura’s voice.Laura’s immediate fear arose from the surprise and shock of hitting the curb because she couldn’t see well enough to judge her speed around the jughandle or to estimate where the curb was.  Then she felt the fear of realizing that her tire was going flat, not knowing how she would be strong enough to change the tire, nor how she was going to get to Anne Mei before closing time at the camp.

The strong emotions of this incident affected either Laura’s speech or my listening or both. For years after I was bothered that I could date this flat tire incident precisely in relation to the progress of Laura’s disease, but I could not find its date on the calendar.  I did not report it on the Caringbridge blog because that would have upset Laura.  I didn’t mention it in my personal journal either.  Like Laura I was having a difficult time facing the implications of her flat tire.  As best as I can figure, this incident happened on June 22nd or 23rd, 2009.  I remember very clearly that Laura was anxious to and in fact did pick up Anne Mei at a camp.  The kitchen wall calendar shows a drawing camp at the Princeton Arts Council beginning on Monday, June 22, with no other camps between the close of school on June 5 and that week.  My memory is that Laura said she had to pick up Anne Mei at the music camp at Westminster Choir College, but on the wall calendar the music camp doesn’t start until the following week.  (I’ll explain why the flat tire happened before June 24 shortly.)  The drawing camp was at the Princeton Arts Council.  It would not have made sense for Laura to get off at Harrison if she was on her way from Trenton to the Arts Council.  But she did. That’s where she would get off to get to Westminster College.

What I remember her telling me is consistent with where she drove.  Neither is consistent with the wall calendar or with what happened on June 24th. I could, of course, ask the Honda dealer the date when Laura bought this tire.  But that’s not the point.

Friday, June 5, 2009 was not only Anne Mei’s last day at school that year, it was also the day that the oncologist finally conceded that the mass in Laura’s head was growing, even though he continued to argue that Avastin was killing cancer cells.  When we asked him whether surgery could reduce the mass, he said we would discuss this option when Laura came for her next Avastin infusion on June 24. On June 24, the oncologist cancelled the Avastin infusion and referred Laura back to the surgeon to discuss an operation to reduce the mass in her brain.  As best I can recall, Laura did not go back to work after that and, therefore, would not have been driving home from Trenton after that either.

Laura had another MRI before meeting the surgeon, but we did not need an MRI to tell us about the advance of her tumor.   By the time of the flat tire, the cut to her vision had extended far enough that she couldn’t judge the right side of the road very well.  An ophthalmologist’s evaluation just before her surgery on July 7 measured the cut at one-third of her vision in both eyes coming from the right.

Laura could see (by not seeing) what was happening and how fast.  Of course, she was afraid.

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