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September 16, 2009

母親の入院

 9/5、うちの母が亡くなりまして、以下はその備忘録。

 4月に入り、まともに食事がとれない(食べると腹痛で戻してしまう)状態が続いていました。4/20頃、腹痛で救急へ。35年前に、腸の手術をして以来、腸が弱く、詰まりやすかったので、本人は腸閉塞ではないかとの懸念していたそうですが、わずかながら便通があり、X線検査の結果でも腸は詰まっていなかったそうで、点滴で症状回復し帰宅。5/4、再び腹痛激しくなり救急へ。今回は便に血が混ざっていたため(4/20は無し)内視鏡検査をしたところ、胃潰瘍で即入院となりました。

 組織検査を行ったところ癌細胞が発見されました。すでに腹腔内に癌がちらばっており、癌性腹膜炎で腹水がたまっているとのこと。 癌としては低分化腺癌 por、印環細胞癌 sig とのことで、かつ、スキルス性の胃癌なのだそうな。

 難しい言葉はすぐ当然ググるです♪

スキルス癌
...スキルス胃がんは、他の胃がんと同じように粘膜から発生します。
そしてあまり粘膜面の変化をおこさないまま胃壁の中を広く浸潤していきます。
スキルス胃がんは胃の粘膜表面の異常が少ないため内視鏡検査では見つけにくくなっています。
スキルス胃がんに特徴的な転移が腹膜播腫です。
この腹膜播腫とは、簡単にいえば内臓を包む腹膜にがんが散らばって転移した状態のことを言います。
がん細胞が胃壁を貫いていちばん外側の漿膜を越えて外に出てしまい、バラバラと腹膜にこぼれ落ちていきます...

低分化腺癌
もともと分裂する能力のある幼若な(小さくてN/C比の高い、ほとんど分化していない)細胞が、どんどん増えていってしまいます。 低分化な癌ほど、ばらばらになりやすく(転移もしやすく)、手強い相手となります。

印鑑細胞癌
低分化腺癌のうちの粘液産生型であって、腺腔形成能は乏しいが、この癌細胞はその細胞質内に粘液を産生・充満し、その結果、核を一側に押しやるために印環細胞型を呈する癌です。

...この種類の細胞からなるがんとしては“スキルス胃がん(硬がん)”が有名です。印環細胞が見つかったとしてもすべてがスキルス胃がんとは限りませんが、スキルス胃がんへ進展する(あるいはすでに進展している)ことが多いといえます。スキルス胃がんにおいては、印環細胞が間質(繊維質)を伴って、胃の壁にびまん性に浸潤し、結果として硬くなります。また、悪性度が高いので、腹膜への転移、リンパ節への転移、骨などの血行性の転移を起こしやすいといわれています。

※細胞診については子宮癌についてのページだけれど、とてもわかりやすかったので参考に。
細胞診について

...と、いちばんやっかいな癌で、

 ・すでに腹膜に癌が散らばっている。
 ・手術、抗がん剤治療に耐えうるだけの体力がない。

ということで、余命1~2ヶ月だろうと宣告でした。

 面談の二日前、病院から「組織検査の結果、よくないものが見つかった」という連絡があり、夜も眠れなかったのですが、いざ宣告されると、暗い洞窟の向こうに光がみえたような、何か憑き物が落ちたような気分でした。「もしや、悟りを開くっていうのはこんな気分なのでは」と思ったりして(多分違うでしょうけど)。 不思議と"悲しさ"や"悔しさ"はなく、ただ「お疲れ様」という気持ちだけが生じてきました。
 これはどういう作用なのか、精神分析学的に考察してほしいところ。

 先生と話し合って、以下のように決定。

  ・本人には告知はしない。
  ・できるだけ苦しまないようしてあげたい。


 入院してからは絶食&点滴治療(治療といっても癌の治療ではなく胃潰瘍の治療なのですが)
潰瘍は治ってきたのですが、癌性腹膜炎で腸の通りが悪く、本来は便となって出てゆく分泌液が胃に逆流してくるため、吐き気がひどい。吐けば一時おさまるのですが、その間隔が短くなり、頻繁に吐き気が起きるようになりました。

 鼻から管を入れると、吐き気はおさまるとのこと、自由に動けなくなるのがいやで本人は拒んでいましたが、あまりに吐き気がひどいので、本人を説得し、鼻から管を入れました。すると、吐き気がウソのようにおさまり、また、潰瘍の痛みもなくなってきたこともあって、本を読んだり音楽を聴いたりする余裕がでてきました。

 6月末には、特に治療をしているわけでもないのに腹水が消滅(先生も不思議がっていた)。家に帰るとなればいましかないとのこと。
本人は、「いま家に戻っても家事も炊事も何もできない。完治してから帰りたい。」と考えていたようです(本人には告知していませんでしたから)。そこで、私が家にいる土日のみ自宅外泊することにしました。
 最初は不安がっていましたが、久しぶりに自宅の風呂にはいることができ喜んでいました。その後、流動食なら食べられるようになり、体力も若干ながら回復、週末は家で掃除・洗濯・庭いじりしてました(もともと家の仕事をするのが好きな人でしたから)。

 8月になり「お盆は一週間外泊かな」なんて話をしていたのですが、8/2に病状が悪化、吐き気がはげしくなり、ふたたび鼻から管を入れました。外泊は中止になりました。「せっかくよくなってきたのに振り出しに戻ってしまった」と、本人かなり意気消沈。

 8/12に腹部に激しい痛み。「腸閉塞で腸が詰まってしまったか、あるいは癌が神経に達しての痛みと思われる」とのこと。
 点滴に痛み止めを入れるようになりました。息をするのがつらいようでした。夜間は、痛みで眠れないため、睡眠導入剤を使用。

 8/20には、不安のせいなのか薬のせいなのかはわかりませんが、精神が非常に不安定に。幻覚を見るようになりました。
家に帰ろうとして管を外そうとしたり、ベッドから降りて転んだり。危険な行動を示したときは、睡眠導入剤を使って眠らせてもらうようにしました(睡眠導入剤は呼吸をおさえてしまうので危険を伴うとの説明を受けましたが、どっちにしろ先は長くないのだし、もし眠ったまま苦しまずに亡くなったとしたら、本人にとっては幸せかなと思いましたから)
 この日から、夜は病院に泊まるようにしました。簡易ベッドも馴れると結構快適でした。

 9月、激しく動く体力もなくなってきたのか、ベッドから降りたり...という危険はなくなりました。発する言葉は、ほとんど聞き取れない。一日中、朦朧としている感じ。
 血圧が80-50まで下がる。動脈血酸素飽和度も70%を示してかなり危ない状況。いつ亡くなってもおかしくない状態だが、まだもっているとうのは、かなり心臓が丈夫だからだろうとのこと。

 9/5、午後の定期巡回で看護士さんが血圧測定したところ脈がかなり弱い様子。「親戚呼んだほうがよい」と言われ、電話連絡。病室に戻ると、明らかに呼吸が弱くなっていました。間も無く、眠るように亡くなりました。私が病院に居るときに亡くなってくれて、子孝行な親ですね。

 病院に寝泊りするようになってから、暇つぶしにポータブルメディアプレイヤーに映画や芝居を落としてみていたのですが、9/4に見ていたのが、宝塚舞台の2本「アパルトマンシネマ」と「イーハトーヴ 夢」。前者は、余命わずかの殺し屋の話、後者は宮沢賢治が亡くなるまでの話と、死にまつわる2本を見てしまったのは偶然じゃないかも。

 結局、4ヶ月間の入院となりました。当初は、余命1ヶ月の覚悟でしたから、残り3ヶ月は、最後の親孝行をするために神様がくれた時間ではなかったかと思います。(ここでいう神様は、特定の宗教の神様ではないことを言っておく)

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