metastatic carcinoma unspecified

That's the diagnosis on his discharge papers. What that means is that the cancer is rampant in his body, in every organ and bones and they haven't been able to determine where it originated from. They will eventually be able to determine that but it takes time consuming and difficult staining of the cells to examine the insides of the cells which is why the results from the bone biopsy were/are taking so long. Without the test results to back them up, they can't say it positively but they are as positive as they can be without those results that it originated in his lungs. Which stands to reason since he smoked two packs a day for 50 years, starting when he was 10 and only quitting about three years ago.

I left here Tuesday to head up to the hospital so my sister could go home to get a good night's sleep and start the arrangements for the hospice care. She came back to the hospital Wednesday morning to consult with the doctors for the final diagnosis and sign the necessary paperwork. They decided to go ahead and discharge him without the results of the bone biopsy which they still did not have conclusively. When we questioned the need for this final test result since there was no treatment that could save him, they told us they needed it for the death certificate. They gave him three days to three weeks.

I asked how the death process would go. The doctor told me that once home the calcium levels in his blood would start to go up again and he would start to exhibit the same confusion he was experiencing when we brought him in. He would probably go through a period of irritability and then as his organs started to shut down, he would go into a sleep from which he would not wake up. His breathing would gradually become slower until he finally just never breathed in again.

My sister left, while I stayed, to go home again so they could deliver the bed and the other equipment they would need. Unfortunately, they forgot to get her to sign the DNR-in-transit paper so as an 'authorized family member' (one of the options) I signed it. They ordered the ambulance, disconnected him from the monitors, took out his IV and dosed him up with morphine. The ambulance arrived about 6 PM and then I had a long two hour drive home. I was met by my husband with a glass of wine, a good dinner and a blanket on the couch while he did the dishes, a reception made all the more poignant by the knowledge that my sister is losing her partner.

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Family members are coming in. Both my children visited him last Sunday in the hospital. His step-daughter (whom he fathered longer than their natural father) was with her mom and helped get the house ready. His other step daughter who lives in Albuquerque is coming in on Saturday. His son from a previous marriage is due in on Monday. There are other family members from whom he is estranged, all his blood relatives and his daughter (twin to his son), who are not coming and, in fact, have not even been notified. That can wait til it's done.

We are hoping Michael lasts and with some of his mental capacity intact until his son can get here. The hospice nurse who was there last night to receive him from the ambulance service thinks the process has already started. He is losing circulation in his feet and circulation to the extremities is the first thing to go so that the body can put it's energy and resources into protecting the torso and brain but even the brain will be sacrificed for the heart, lungs, kidneys. Hence the confusion of his mental faculties. My sister thinks he is waiting for his son whom he knows is coming. She thinks he won't last past that.