A Month of Questions

How we got here...

On the last Saturday afternoon of November, while Kim was away volunteering at the school bazaar, I had the kids to myself and took advantage of a lovely fall afternoon by taking the youngsters on a short hike around Spencer's Creek at Christie Lake Conservation Area. The enthusiasm of the girls, who would much rather have been at home and watching a movie or playing Prodigy, faltered as Noah - eyes ever on trees and skies rather than the path - tripped on some prominent roots, fell and began crying. It was a predictable scene.

But when we arrived at the bridge crossing the creek at the far end of the trail, creation began working its mysteries on children and the joy and energy built. Noah became silly.

The rest of the hike was a mad scramble and dash up and down hills, tumbling into leaf piles and a semi-terrified father chasing after a toddler so as to save a the rambunctious tike from tumbling down an embankment or sliding into cold November waters. As usual, Noah's joy found its way into the day and made it a wonderful one.

This is the last day I remember Noah living without pain.

Constipation

Since coming to our family last July, we have been schooled in the world of toddler boys. Attitudes and ailments that were both novel and perplexing have become normal and when, the following day Noah became irritable we chalked it up to the usual explanation which was there is probably no explanation.

A day or two later, however, the irritability and growing discomfort Noah displayed began to grow and, more obviously, he had stopped pooping. To us and everyone else this seemed unfortunate but normal. He is a stubborn three year old boy in the middle of toilet training and he would rather not go at all than to humour us by learning how to use the potty. We started with "special" (read "prune") juice then called the doctor who got Noah put on a laxative.

And Noah started pooping again.

But something else was going on. The pain which initially seemed to be resolved came back to Noah in agonizing and crippling waves. He couldn't and wouldn't jump and he cried in frustration when he could not do somersaults. He wanted to dance with his sisters but, because when you are three years old, dancing means jumping he cried once again because pain held him back. So Noah went to the emergency room to find out why the relief from constipation wasn't enough.

After ultrasounds and bloodwork what came back was a reasonable diagnosis of inflammation in the lymph nodes around the appendix, probably caused by a viral infection. This explained the pain and constipation but would take time to resolve so we took some comfort in that and waited again.

But the pain continued and we went back to the doctor and to the emergency room and began doing google diagnosing from our living rooms because Noah wasn't just feeling crampy or pointing to "owies" in his tummy. He arched his back and pointed to his chest, he took a knee when he bent over, he couldn't lay on his back without being propped up by a pillow and he woke up during the night in a pain that Advil and Tylenol didn't have any affect on.

Yet he had good days. Some mornings, he would climb out of bed and wake me up by calling "daddy" and then asked "Noah on?" before going to plug in the Christmas tree lights. On Christmas morning he joyfully opened presents with his sisters and played determinedly with his new toys. He ran though the lights of Spencer Smith Park, chasing his sisters through the displays and seemed genuinely better. The pain, however, always came back and after several agonizing nights, one last family doctor appointment and - by the grace of God - some stern words from a friend, Kim took him back to the Emergency room determined to get answers.

And on the evening of the 30th of December, we got our answers. An x-ray revealed a large mass growing on and around Noah's spine, behind his right lung.

What we've learned since

A day after being admitted into the pediatric unit at McMaster Children's Hospital, Noah endured a barrage of scans and tests. The afternoon started off with a MRI of Noah's head and spine. Fortunately, doctors coordinated other procedures to align with anesthetization and intubation and immediately following the MRI Noah was sent off to radiology where, after being injected with a fluid, a samples for a biopsy were taken from the growth. A port which is not actually called a port but, which my foggy memory and the internet tells me is something called a Hickman catheter was placed on his right chest. Finally, the oncologist switched places with the radiologist and took bone marrow samples from each of Noah's hips. Though it was a horrible ordeal, it was good to have all of the big tests done at once.

What is known now is not known with certainty as results from the biopsies and other assorted tests will take some time to start trickling in. Here, though, is what we have so far.

The oncologist believes, fairly confidently, that Noah has a childhood cancer known as neuroblastoma. This belief is based on the site and characteristics of the cancer seen in imaging. Beyond the larger mass there are also smaller masses up and down Noah's spine. The cancer is affecting Noah's bones and there are signs of this on his spine and skull. How far the cancer has spread we won't know until further testing is done.

Beyond this, there is liquid around Noah's right lung, most likely caused by the pressure of the mass on his spine. This is monitored and affects his breathing and heart rate when he gets excited or upset.

And as for a plan of treatment, things are still up in the air. The oncologist is confident enough in her assessments to start chemotherapy for neuroblastoma immediately if Noah experiences a sudden decline but the doctor would rather wait for further biopsy results before starting a course of treatment that, once begun, cannot be interrupted or changed.

So, for now, Noah rests. Being moved to the oncology ward after his procedures, he is given a steady stream of morphine so that he does not the pain and discomfort that slowly became his normal over the last month. Though encouraged to move and play, he is content enough now to watch more Paw Patrol and Wiggles than he could ever ask for (and he asks a lot!). Kim stays at the hospital with Noah and I stay at home with the girls and we intersect whenever possible.

And, every and always, we pray and ask for prayers and place our trust in God during this time. We pray for Noah's rest and peace. We pray that he will regain some strength before he begins his treatments in the coming days and weeks. We trust that our God is good. We trust that, while we live through our own "Babylonian exile" that we can see the plans for the future and for prospering that God holds for us, even if they are well beyond a horizon we or anyone else can currently see.