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The Choice

Last night, not for the first time and probably not for the last, we made our five-year-old choose between drinking poison and having us force it down her throat.  We did so calmly, patiently, quietly, never raising our voices or becoming angry.  We’ve had too much practice at this to make the mistakes of the early days.  Perhaps with more practice we can somehow find a way to make it a game, some way of making it all easier.  For now, we simply let her know, with quiet patience and love, that this is not optional, and if she doesn’t take the poison herself, we will make sure it gets into her.

It isn’t always a long struggle.  Some days she poisons herself without complaint, getting it over with in order to get on with life.  But not very much, of late.

The poison in question is temozolomide, a chemotherapy agent that’s specifically used to treat brain tumors.  I once read the label, with its biohazard trefoil, and stopped when I saw the word “cytotoxin”.  That means “cell poison”; it attacks cells that are dividing, as cancer cells always are.  But it attacks all dividing cells, not just malignant ones.  A growing five-year-old has a lot of dividing cells, and we are poisoning them all.  We just hope that we’re poisoning the cancerous brain cells more than other cells.

But her brain is trying to grow, too.

Temozolomide is an oral medication, usually in capsule form.  However, for kids who haven’t learned the trick of swallowing four large capsules in quick succession, its toxins are suspended in a gooey liquid compound that tastes vile.  I know; I tasted it, so that I could better understand her struggle.  Worse still, it can’t be flavored.  We’ve asked—begged—more than one pharmacist, but it cannot be combined with flavoring agents.  So she takes her poison straight.  At home.  For days at a time.

When she asks why she has to take something that’s “too icky”, we remind her (even though we know she knows why, just as we know why she asks) that it’s to keep the “bad rocks” from coming back.  That term is a holdover from when Rebecca was three and Kat had to have some masses removed from her abdomen, and “bad rocks” was the best way to explain to Rebecca what was being taken out of her mommy.  We thought she was too little to have to worry about cancerous growths, so we simplified things to make sense to her.  We still think she’s too little to have to worry about cancerous growths, but we can’t be euphemistic any more.

And if we ask her what will happen if the bad rocks come back, she says, “Not telling” in a small, scared voice.  This is actually a common reply from her, but usually it’s said with a smirk and a gleam in her eye, the one that kids get when they think they’re getting away with something and it seems like the biggest joke in the world.  When she refuses to tell us what will happen if the bad rocks come back, it’s because she understands all too well.  She understands better than we can bear.

We know she understands because when we were home between her surgeries and the radiation treatments, twelve days of having the family together in the midst of everything, Rebecca got very mad at her sister for not letting her play with a toy.  “It’s for kids eight and up,” Carolyn said, reasonably.  Rebecca, of course, found this line of reasoning lacking, and came storming into the kitchen.  “Carolyn won’t let me play with that toy and I have to play with that toy!” she shouted.  We explained that it was in fact for older children, and that she certainly might want to play with it, but that wasn’t the same as having to play with it.  “I have to!” she shouted again, her voice rising almost to a scream, breaking with angry, anguished sobs, “I have to play with it now because it’s for kids who are eight years old AND I’M NEVER GONNA BE EIGHT!!!

I can think back to the first days of her illness, lying almost unconscious with so many tubes leading into and away from her, with relative dispassion, as if analyzing a movie.  It might even seem like I’m doing that right now.  But that moment of anger and fear erupting from our five-year-old daughter brings me to tears every time I remember it.  I’m typing this part with tears streaming down my face; it’s taken me this long to be able to come to a place where I can write about it at all.  Even now, I want to throw up.  I want to die, if that could somehow save her.

Instead, I have to, we have to, make her poison cells all throughout her body and especially all throughout her brain in the hopes of killing off the cells that might kill her.  All the other cells that die in the process, the good cells that are trying to grow more curly hair and develop her brain and lengthen her bones and help her grow up, are collateral damage.  We tell ourselves that those innocent, beneficial cells are acceptable losses, and hope that it’s true.  We hope that the damage we do trying to save her doesn’t end up killing her later.

In the end, she took the medicine herself, as she always does, choosing to be in control of how things happen to her.  It took several false starts; for each, she calmed herself by sitting up straight, closing her eyes, and taking a deep breath.  And then, as soon as the syringe touched her lips, she crumbled back into sobs, her body shaking with visceral rejection and misery.  Not anger, even though it would be easier for us if she hated us for what we keep doing to her.  If she blamed us for making her do this.  It would be easier to be targets of her anger than witnesses to her hopeless, knowing, abject misery.

Finally, after all those tries and stalling tactics, she made her choice.  She squared her shoulders, slowly put the syringe to her lips, and pushed the plunger, drinking it all down in two audible swallows.  She then immediately drank half a cup of Gatorade in an effort to mask the taste.  She doesn’t usually like Gatorade, but it’s what she asks for to go with her chemotherapy.  So we give it to her.

But only after she’s poisoned herself.

People ask us how we’re holding up, and when we say we’re doing pretty good, we’re being honest.  We know that we’re lucky to have to poison her, just like we were lucky to have to irradiate her.  We’re beyond grateful for those opportunities.  We are.  But we’re also painfully aware of the nature of what we’re doing.  We feel every last drop of the horror it is to be grateful to be damaging our baby; to have the good fortune to force her to choose, day after day, whether she will poison herself or we will do it for her.

57 Responses»

    • #1
    • Comment
    • Sat 4 Jan 2014
    • 1144
    Emme wrote in to say...

    It’s heartbreaking.

    • #2
    • Comment
    • Sat 4 Jan 2014
    • 1156
    Sophie wrote in to say...

    Poor Rebecca. Strong Rebecca.
    Wishing her to be old enough to get blasé about 8 years and up toys.

    So sorry to read that. For what it’s worth, you are in my thoughts.

    • #3
    • Comment
    • Sat 4 Jan 2014
    • 1214
    Stephanie wrote in to say...

    Sending your family all the hugs. All of them.

    • #4
    • Comment
    • Sat 4 Jan 2014
    • 1216
    Jeff Jones wrote in to say...

    Thanks for sharing your lives with us through all of this – as horribly difficult it must be to write. You have many of us out there in the web community thinking of and praying for you guys.

    • #5
    • Comment
    • Sat 4 Jan 2014
    • 1216
    Prisca wrote in to say...

    Eric,
    thank you for carrying on with your writing, I hope it helps a little knowing that there are many of us thinking of you all, wishing you well—and indeed, wondering how you’re holding up, how you are coping with this struggle. No one can fathom your situation.

    Rebecca sounds like an amazing, strong and spirited girl – may the future bring healing and recovery.
    Sending you, Rebecca and all your family the warmest wishes, and lots of love x

    • #6
    • Comment
    • Sat 4 Jan 2014
    • 1232
    Cliff Tyllick wrote in to say...

    Eric, if it were possible for friends to take this burden from you, even for just a minute, I would. As you we’ll know, I’m not alone in feeling so. You and Kat and Rebecca, too—especially Rebecca—are showing incredible strength.

    I imagine that at times it seems that your reserves are exhausted. When you feel that way, do the best you can to trust that the strength you need will come to you.

    Just as the resolve to drink the poison and trust that it could help her came to Rebecca, even in your most desperate moments the strength you need to do the best for her will come to you.

    I’m not usually one to pray, but lately I have been saying a small prayer each day for Rebecca, and Kat, and you.

    • #7
    • Comment
    • Sat 4 Jan 2014
    • 1235
    andrezero wrote in to say...

    All the best for you and your family.

    Stay strong.

    Be brave.

    • #8
    • Comment
    • Sat 4 Jan 2014
    • 1237
    Patrick wrote in to say...

    I simply cannot fathom your struggle in dealing with this. I will pray right now for healing for your daughter and a little peace for you and your wife. Prayer changes things. Don’t give up!

    • #9
    • Comment
    • Sat 4 Jan 2014
    • 1417
    Tracey Adams wrote in to say...

    My heart and prayers go out to you and your family.

    • #10
    • Comment
    • Sat 4 Jan 2014
    • 1443
    Ric Fink wrote in to say...

    I’m sorry Eric, I’m sorry Eric, I’m so so sorry. Stay strong for dear Rebecca, and God- bless this beautiful, innocent child. Return her to good health and a happy life.

    -Ric

    • #11
    • Comment
    • Sat 4 Jan 2014
    • 1626
    Hal B. Rager wrote in to say...

    I’m so sorry to hear this. Our thoughts are with you all…

    • #12
    • Comment
    • Sat 4 Jan 2014
    • 1648
    Pablo wrote in to say...

    Hi Eric,

    Someone said that being a father is having your heart out of your body, running and jumping on the streets.

    Please keep your heart strong for her, and never loose faith.

    -Pablo

    • #13
    • Comment
    • Sat 4 Jan 2014
    • 1744
    Alex Morales wrote in to say...

    I’ve been following and learning from you for years. I know that you’ve invested your time and efforts towards helping others even if it’s just in a professional manner. Nothing you do for others will ever go unpaid. I’m praying for you and your family and I hope you know that you are due for something good. I pray you all grow stronger from this and that she will be able to fulfill all the dreams you have as her parents and she has for herself. Please let us know how this continues and thank you for sharing. You are never alone in this.

    • #14
    • Comment
    • Sat 4 Jan 2014
    • 1750
    Kel Smith wrote in to say...

    If there’s anything I can’t stand, it’s the suffering of children. My thoughts are with you all.

    • #15
    • Comment
    • Sat 4 Jan 2014
    • 1827
    Than Tibbetts wrote in to say...

    Crushing. Strength to your family, Eric.

    • #16
    • Comment
    • Sat 4 Jan 2014
    • 1857
    Adam wrote in to say...

    My thoughts are with your family and you.

    • #17
    • Comment
    • Sat 4 Jan 2014
    • 1939
    Ashutosh wrote in to say...

    Being a father to a 6 year old daughter, I can understand your pain when you see your daughter sob while taking her medication. I might have shed a tear or two visualising your young princess taking those injections and capsules.

    Sitting thousands of miles away from Rebecca, I can do much except probably put in a word or two to God for her speedy recovery.

    God bless her. She will grow strong, healthy and old is all I can wish for, Eric.

    • #18
    • Comment
    • Sat 4 Jan 2014
    • 2050
    Jesse Gardner wrote in to say...

    Writing about it isn’t easy. Going through it is even worse. But keep writing…

    It helps those of us who can’t be there every day for you understand your journey and in some small way feel closer to you. And even though it may be the furthest thing from your mind, these posts have helped me appreciate my children in a much deeper way, embracing them just a bit tighter, reminding myself that the fleeting annoyance are fleeting and their lives are precious.

    • #19
    • Comment
    • Sat 4 Jan 2014
    • 2202
    Ruth wrote in to say...

    My thoughts are with you and the family.

    • #20
    • Comment
    • Sat 4 Jan 2014
    • 2305
    Steve Fisher wrote in to say...

    Eric, this is beautifully written and heartbreaking. Thank you for sharing a hard piece of your family’s journey. I can’t imagine what you must be going through and my thoughts are with you and your family.

    • #21
    • Comment
    • Sat 4 Jan 2014
    • 2317
    Jono wrote in to say...

    Years from now, when you & Rebecca are looking back at all of this, the pain & sorrow will have been replaced with many newer memories of triumph, happiness & exploration.

    When the going gets tough, the tough redefine what it means.

    • #22
    • Comment
    • Sat 4 Jan 2014
    • 2338
    Tiff wrote in to say...

    Thank you, as always, for sharing your family’s story. You each continue to be in my thoughts.

    • #23
    • Comment
    • Sun 5 Jan 2014
    • 0008
    David Weinraub wrote in to say...

    I have no words, just hopeful and supportive thoughts for you and your family.

    • #24
    • Comment
    • Sun 5 Jan 2014
    • 0052
    Matt Heerema wrote in to say...

    Through tears, my heart goes out to you and your family.

    • #25
    • Comment
    • Sun 5 Jan 2014
    • 0101
    Aly wrote in to say...

    We poisoned our 13 year old son so he could live. He’s 19 so the poison worked, but the collateral damage is immeasureable. Thank you for the brutal honesty of this post. Sending you light.

    • #26
    • Comment
    • Sun 5 Jan 2014
    • 0105
    EllenHS wrote in to say...

    Beautifully written, and so painfully sad – but with hope.

    I pray for Rebecca, that her cries can be proven wrong, that she makes it to eight and beyond – and sending hugs and strength to your family.

    -Ellen (a stranger from the internet, linked here through the magic of Facebook).

    • #27
    • Comment
    • Sun 5 Jan 2014
    • 0152
    Josh L wrote in to say...

    Thank you for sharing, my best wishes for your family.

    I reply here because it sounds like the capsules might be preferable to the liquid. We needed our almost-4 year old daughter to take some large pills (I think around 16-18mm?). It took some practice, but on the off chance you haven’t heard of this technique she learned it by first swallowing a single tictac with water (putting the pill in the mouth first, then adding water and swallowing). Practicing with various head tilt angles with varying amounts of water. Then 2 at a time. Then 3, 4, 5, and then 6. More head tilts and water amounts. She was then easily able to swallow some not-important medium sized pills no problem. Then the big ones. Took a couple boxes of tictacs IIRC.

    • #28
    • Comment
    • Sun 5 Jan 2014
    • 0513
    Petra Gregorova wrote in to say...

    Eric, I can’t even imagine what you are going through but thank you for sharing it. Seems like Rebecca is a little fighter, just like the rest of you, and she will overcome this. You all will. Thinking of you with hopes that 2014 will bring you nothing but great news.

    • #29
    • Comment
    • Sun 5 Jan 2014
    • 0523
    Mariusz wrote in to say...

    Speechless. Hold tight.

    • #30
    • Comment
    • Sun 5 Jan 2014
    • 0850
    a touched and chastened father wrote in to say...

    Eric, thanks for your intimacy.

    I will, this very moment, stop resenting my 4 under 8 year olds disturbing me whilst I try and catch up on my rss feeds, asking me to play with them.

    I will stop now and hug them all and tell them all how much I love them.

    But first, please let me say a prayer and ask for healing, support and peace for all of your family, but particularly Rebecca in the name of Jesus, through whom all things are possible.

    Thank you for reminding me how blessed I am.

    • #31
    • Comment
    • Sun 5 Jan 2014
    • 0925
    Yiannis wrote in to say...

    I hope this year will be a significantly better than the last one. I hope Rebecca will make it. I hope you will remain strong to help her.

    My best wishes and my warmest hopes.

    • #32
    • Comment
    • Sun 5 Jan 2014
    • 1019
    Barbara Gavin wrote in to say...

    Becca’s awareness of her battle and its consequences is so very sad. Which is only partially mitigated by how bravely and maturely she is behaving. Blessings and peace for you all.

    • #33
    • Comment
    • Sun 5 Jan 2014
    • 1049
    Kari wrote in to say...

    Oh Eric, I had no idea.
    I went to school with you in Lexington.
    I am so very sorry.
    Praying HARD for Rebecca.

    • #34
    • Comment
    • Sun 5 Jan 2014
    • 1328
    Faruk Ates wrote in to say...

    Eric, thank you for sharing this, heartbreaking and powerful. I continue to keep you and your family in my thoughts.

    • #35
    • Comment
    • Sun 5 Jan 2014
    • 1514
    Marya wrote in to say...

    My love and thoughts to your family. Eric — your writing is beautiful. I’m sorry your family has to go through this.

    • #36
    • Comment
    • Sun 5 Jan 2014
    • 1836
    Jackie wrote in to say...

    Wow. Feeling like you took the words right out of my mouth (and then said them better). Currently in the hospital room with my 2.5 year old who is on day 4 of 6 inpatient with ifosfomide +etopside pouring into his port from his friend “ivy” (whom I refrain from calling “poison ivy”) . Week 11 of 54 for relapsed rhabdomyosarcoma. Preparing for a trip in 2 weeks to New Jersey (from Israel) for proton radiation, which will hopefully result in less permanent damage to his neck vertebrae, teeth, thyroid…
    Thx for sharing your story. I’m with you every step of the way. Sounds like you are doing everything and looking at everything so much like I do (or try to). Your daughter is lucky to have you!

    • #37
    • Comment
    • Mon 6 Jan 2014
    • 0130
    Mike Reiser wrote in to say...

    You all are definitely in my thoughts. My grandma died of cancer, can’t imagine having a child with it.

    • #38
    • Comment
    • Mon 6 Jan 2014
    • 0702
    Jason Robinson wrote in to say...

    Can’t thank you enough for writing-out-loud about this.

    Rebecca is amazing. You are all amazing. Peace & Blessings.

    • #39
    • Comment
    • Mon 6 Jan 2014
    • 1935
    Doug Pascover wrote in to say...

    Good heavens, friend. I should have been following your news better. I can’t tell you how sorry I am that your family is going through this and how much I admire all of you for facing this and dealing with it. My prayers will be with you all. But, damn.

    • #40
    • Comment
    • Wed 8 Jan 2014
    • 1105
    Harald Hollmann wrote in to say...

    Too touching to comment on.
    Your daughter and you are too brave to imagine.

    • #41
    • Comment
    • Wed 8 Jan 2014
    • 1717
    Irene wrote in to say...

    I am so sorry for your family. I am being treated for cancer but as I realized with the diagnosis, while filled with terror, and initially executing to die soon, I am a grandmother, I am 62 (then…I had a birthday the next week). I have reared my children and seen all of them get married, and two of them have their own kids now. My death would not be so terrible as the death of a younger person. I hope you daughter grows up to remember the terrible tasting medicine as a blessing. I hope your family has much joy ahead of you.

    • #42
    • Comment
    • Thu 9 Jan 2014
    • 1231
    jennielf wrote in to say...

    As a first time mom of a 10 month old, I am in tears. I cannot fathom having to go through this with our happy, active baby, even though I know parents do everyday.

    Thank you for your honesty and intimacy. Much love and good energy is coming your way. As Irene says above, I, too, hope your family has much joy ahead of you.

    • #43
    • Comment
    • Sat 11 Jan 2014
    • 1355
    Mark wrote in to say...

    I didn’t know your family was struggling with this. Praying!

    • #44
    • Comment
    • Sat 11 Jan 2014
    • 1947
    dj wrote in to say...

    Let (suggest) she stuff toilet paper in her nose (or hold it) for a minute before she swallows, swallow fast, follow immediately (if not sooner) with desired pleasant stuff, eat bread… or just chew and spit it out… wait a minute; then, take out the paper.

    Something in all that, possibly the loss of olefactory receptors, or the distraction from the procedure, makes it better than it would have been.

    (Truly, children can swallow pills long before they (or their parents) realize that they can. For some, that’s the only saving grace – better than an NG tube.)

    • #45
    • Comment
    • Mon 13 Jan 2014
    • 0650
    Andreas wrote in to say...

    Came here quite by accident and cried big manly tears reading this.
    For what it’s worth my heart and best wishes go out to Rebecca and your Family.

    • #46
    • Comment
    • Mon 13 Jan 2014
    • 0704
    kathy wrote in to say...

    I cannot tell you how very sorry i am that your family is going through this nightmare .I know how you feel how helpless things can seem because i am going through the same my youngest daughter at the age of 40 was diagnosed with stage four pons glia blastoma.August 19 2012 will always be burned in my brain.She is holding her own and has lived two months longer than the doctors has said she would never give up hope will keep you and your family in my thoughts and prayers

    • #47
    • Comment
    • Mon 13 Jan 2014
    • 0922
    Peter Krefting wrote in to say...

    Wow. I am trying to stop crying, but I can’t.

    • #48
    • Comment
    • Mon 13 Jan 2014
    • 1324
    Dan Hathy wrote in to say...

    My heart goes out to you and your family. I truly have an understanding of this. I take the same drug for the same thing. 90+ % of my tumor was removed on JUly 5th.

    This terrible thing has had a positive affect, however. I have a renewed faith in humanity and my family has been blessed by many people, some of whom we do not even know.

    If you or your family need anything, please feel free to conact me via my email.

    Regards and Bless all of you.

    • #49
    • Comment
    • Tue 14 Jan 2014
    • 0526
    kathy wrote in to say...

    Do you have pons glioblastoma? Have you ever heard of Dr. Bookvar at Weill Cornell in New York?

    • #50
    • Comment
    • Tue 14 Jan 2014
    • 1100
    Dan Hathy wrote in to say...

    Prayers will go out every day to Rebecca and your family from me and my family

    • #51
    • Comment
    • Wed 15 Jan 2014
    • 1725
    Sam wrote in to say...

    Eric, please investigate ketogenic diets and gliomas, the research is still in its early days however the studies done so far are extremely promising. These diets were once the mainstay treatment for epilepsy for children in the early 20th Century but went out of fashion when the pharmaceutical age hit. It is now making a revival where drugs fail, and it’s being discovered that it has many other beneficial properties, including neurological disorders, and especially brain tumours (and perhaps other types of cancer).

    The good thing about the diet is that it can be followed concurrently with other treatments, as it aims to strengthen healthy cells and weaken cancer cells. The crux of it is severe carbohydrate restriction and just adequate protein intake to maintain muscle tissue. The rest of the calories come from fats (healthy fats – no refined vegetable oils). This places the body in a state of ketosis where the primary source of fuel for cells, including brain cells, is ketones, not glucose. Cancer cells, the theory goes, are highly dependent on glucose and have not developed the metabolic flexibility to use ketones like other cells. You are basically starving and weakening them.

    As it is a proven treatment for epilepsy, there are many resources and recipes on the internet for this type of diet, especially for children. There are very few side effects. It is sometimes referred to as the “cream cheese” diet, as cream cheese provides the required macro-nutrients in the correct ratios for the diet. Long water only fasts are an alternate method, but this is pretty tough, especially on children.

    Just so you know, I am also taking temazolomide at the moment for a GBM I had removed a few months ago, I can’t say I’ve found it too bad compared to other chemo treatments I’ve seen friends go through, although I can’t imagine what it must be like for a child. Like you mention, it’s basically poisoning your body, although of course the benefit is judged to outweigh the harm. It doesn’t make it any easier though.

    I am following this type of diet myself during my chemo and radio, and have seen a lot of side benefits. As for its effect on the GBM, time will tell. Of course I am by no means a doctor nor nutritionist, nor can I guarantee my own fate let alone anyone else. Having said that, should you research it and feel there may be benefit in it, please feel free to contact me and I will be happy to share whatever information I have, if even a little.

    Praying for the best of outcomes for you and your family.

    • #52
    • Comment
    • Thu 16 Jan 2014
    • 1155
    Tim wrote in to say...

    I’ve been reading your blog for about fourteen years. Like I tweeted at Zeldman back in October when he wrote about his mother, I came for the tech but I stayed because you had a voice. Reading this as a parent is devastating and hopeful at the same time. Thank you for continuing to share with us.

    • #53
    • Comment
    • Fri 17 Jan 2014
    • 1222
    Marc Ardizzone wrote in to say...

    Eric:

    You have always been an inspiration to me as a web developer – add “as a fellow parent” to list. Sending best thoughts, wishes and good vibes your way.

    • #54
    • Comment
    • Tue 28 Jan 2014
    • 1710
    Donald Oji wrote in to say...

    I just came your site for the first time to read about CSS and was deeply touched by Rebecca’s story. I pray that God gives her the strength to make it through this difficult times. Nothing is impossible to God. Stay strong!

    • #55
    • Comment
    • Wed 12 Feb 2014
    • 1801
    Steve wrote in to say...

    Words. They fail to adequately express the pain I feel reading this.

    • #56
    • Comment
    • Wed 12 Feb 2014
    • 2058
    Gary Howard wrote in to say...

    Eric, much like the others I came here for your CSS abilities. But I have to admit, I cried as well. I have an 11 year-old and I could NEVER imagine life without his presence. I truly wish Rebecca good health and a long beautiful life. Strength to your family!

    • #57
    • Comment
    • Mon 24 Feb 2014
    • 1611
    ben wrote in to say...

    Okay, I’m late to this party, but…

    So. At any given time, like anyone who’s experienced CHF, COPD, or diabetes at length, there’s a non-zero chance that I’ll be asked to pop pee pills, since that’s the most convenient way to relieve edema and the (relative) sodium overload that causes it. It’s that, or maybe you drown a fair distance from the nearest large body of water. Fun times, that.

    What laymen and non-patients don’t realize is that you also need to keep your potassium in balance, so you get clobbered with KCl doses, dispensed as either awful horse pills, or a rather vile solute. I’ve declared with a straight face that I’ll accept an intramuscular injection more readily than a dose of potassium.

    …But after reading this, I’ve seen confirmed my original suspicion that my right to complain is a mote next to others’ stories.

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