A TOUGH HAND FOR PARTNER

My father-in-law is in his 80's, and lives by himself out on 5 acres in the adjoining countryside. He's a self-made man with little formal education, but wide life experience and high intelligence, especially of the spatial kind involved in construction. He has few passions, other than raising goats and playing cards, especially pinochle. I have whiled away quite a few hours playing with 'the old goat', as his family affectionately deems him.

He beats me more often than not, and when he gets the cards, he beats me like a drum when we play three-handed (a cutthroat game). Disconcertingly, when he's trying to crush me he refers to me as 'Partner', since I'm typically paired with him when we play four-handed (partnerships). This is such a running joke that his grandkids have taken to referring to the old man as 'Partner', as well.

Well, 'Partner's' latest hand is a rough deal. Previously, he'd had a spot on his lung about two months back that might have been cancerous. A few days ago, following a CAT scan involving iodine (to which he is allergic), he had a respiratory episode and was admitted into Kaiser. While there, the results of the scan came back. While not conclusive, they suggested that whatever it is (now almost certainly cancer) had metastisized to the other lung. Provisionally, he's been diagnosed with Stage IV non-small cell lung cancer (NSCLC).

The only option known to improve survival rates for NSCLC is surgery to remove the offending tissue. With both lungs apparently affected and in his ninth decade, 'Partner' is obviously not a candidate for such a procedure. Chemotherapy based upon cisplatin offers a modest survival benefit (perhaps as much as a year, on average) in patients in good physical condition, but I don't think the latter describes my 'Partner'. And, even if it did, it's unclear that he would have greater quality of life due to the toxicity. The cure, over the long haul, might be worse that the disease.

So, the focus for treatment is not so much in terms of a cure or in terms of survival, but in terms of managing the quality of life. As I said, it's a tough hand. He's survived open-heart surgery nearly 30 years ago back when it was a far riskier procedure than it is now, and as recently as seven years ago he was sharp enough to master-mind home construction and still strong enough, in his late 70's, to swing a mean hammer. For him, quality of life has always been about his first joy, physical labor. As with everything else, what constitutes 'quality of life' must now change.

In this time of transition, we appreciate your thoughts or, if you're so inclined, your prayers.