As recorded previously, Mom had been in poor health for some time. Thus, after I began my residency at UCLA, it seemed reasonable to have her undergo a thorough medical workup at the hands of some of the outstanding physicians who practiced there. Accordingly, this was arranged, in December 1965. She was admitted by one of my professors, Joseph J. Kaufman, M.D., who initiated a thorough hypertensive evaluation. Concomitantly, Mom was seen and evaluated by Dr. Morton Maxwell, of the internal medicine department, as well. Excerpts from Dr. Kaufman’s summary now follow:
Mrs. Christenson gave a history of having had labile hypertension for approximately 30 years and having first been noted during her second pregnancy. For the past several months she has had fatigability, occipital headaches and occasional blurred vision…. Her blood pressure has been found to be in the range of 240 systolic and 120 diastolic…. The isotope renograms with hydration and dehydration both showed evidence of impaired renal function on the right…. The intravenous urogram however showed equal appearance time and concentration…. A renal arteriogram…showed a slight stenosis of the origin of the right renal artery and slight irregularities of its two major branches; on the left side the vasculature appeared normal…. In summary then, we have proven that Mrs. Christenson has a renal artery stenosis on the right side of doubtful clinical significance. She has mild diabetes and moderate hypertension. I believe that she should be managed on combination antihypertensive therapy…and should have her diabetes regulated [locally]. 168
Although this evaluation in 1965 included extensive blood and urine screening plus thorough physical examination, it was primarily geared towards evaluating the cause of Mom’s high blood pressure. Hence, other than the mild diabetes and moderate hypertension, no other diagnostic impressions were forthcoming at that time. All the same, despite compliance with the above medical recommendations, coupled with significant improvements in their spousal relationships as noted heretofore, Mom continued to have a number of physical complaints.
In any event, with exacerbation of her high blood pressure, along with new gastrointestinal complaints, she was readmitted to UCLA Hospital in April 1970, for further evaluation. Dr. Kaufman sent a letter informing me of the findings, parts of which now follow:
This is some follow-up information on your mother who was hospitalized…to investigate an exacerbation of her hypertension apparently with poor response to medication. Except for her diabetes and tendency to obesity, we found no significant abnormalities. Her blood pressure in the hospital was within respectable limits with diastolic blood pressures between 90 and 100 and systolic levels between 150 and 160. Repeat intravenous pyelogram and arteriogram studies showed no new findings, but because of some additional complaints of meteorism—“the presence of gas in the abdomen or intestine”—and gastric distress…we performed an upper GI series and gallbladder series both of which were negative. She is being seen again by Maxwell’s group and they are placing her on a trial of propanolol and apresoline. As soon as they feel that they have her hypertension better regulated, she will be discharged. I am pleased that we found no additional problems. I think that she must continue to try to lose weight and if she takes the new medication, I think that her blood pressure will be easily managed…. It was a pleasure to see your mother again and I am happy we found no serious problem. 169
Obviously, however, as subsequent events would demonstrate, there were significant medical problems developing that could not be fully appreciated or elucidated at the time. Indeed, by the early spring of 1971, she was having so much gastric distress that a tentative diagnosis of chronic gallbladder disease was made, and she was operated.
At surgery, an inoperable adenocarcinoma of the bile ducts and gallbladder was identified. She was essentially told that she had two years to live 170, and was referred to the Stanford University Oncology Department for further evaluation and treatment.
Subsequently, in a letter dated 3 March 1971, from Mom’s oncology consultant at Stanford University to her attending physician in San Mateo, the following was recorded:
We have completed our evaluation of Mrs. Christenson… On physical examination she had no abnormalities, save those of residual scleral icterus [yellow discoloration of the eyes] and her T [drainage] tube. [The liver function blood tests were still high, but decreasing from previous elevated levels.] We have repeated her cholangiogram in an effort to define the extent of her disease. In this study the ductile system of the right, middle, and left lobes [of the liver] completely filled, revealing involvement of the entire right and middle lobe ductile systems. Based on these findings, we did not pursue liver scan or search for evidence of distant metastasis, for with this amount of involvement in the liver the radiotherapists were not willing to treat her at this time. As you know, this is most often an aggressive tumor for which there is no established form of effective chemotherapy. However, since this is basically a gastrointestinal carcinoma, I would recommend one of two drug programs to be used to provide palliation for pain or for increasing liver function derangement…given on an outpatient basis. [He then recommended either 5-fluorouricil be given alone, or in combination with several other drugs.] At this time, however, I would not begin therapy, since she feels relatively well and is able to do most of the things she wishes. I would begin therapy at the first indication that her bilirubin begins to rise [a liver enzyme, which if rising, would indicate increased ductile obstruction] or her liver enlarges. 171
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On watching her own aged mother suffer and become progressively enfeebled and forgetful, Mom had once mentioned in a letter to me: I don’t think I want to live to be very old. 172 Now, her desires were being realized. And yet, viewing her incurable condition from today’s perspective, it might well be considered to have been a blessing in disguise.
For, besides the soul-healing that had already taken place in Mom and Dad via the multiple avenues referred to previously, I’m convinced that learning to deal with and adjust to Mom’s terminal illness also played a major role in completing full resolution.
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