Dad would often state that the hardest aspect of getting old was seeing his friends become ill. He would arrive home from visiting someone in the hospital and shake his head, whining about the unfairness of life. I never gave those comments too much thought until one day, on March 15th, he called me from his truck in the parking lot of the doctor's office.

"They want to refer me to a specialist," he said. When he said this, he sounded smaller than usual. "It's about a spot on my chest X-ray."

That call took place eight months ago. Since then, my knowledge of lung cancer has far surpassed what I ever wanted to know. I have sat in waiting rooms that smell like disinfectant and anxiety, and I have Googled medical terms at 3 in the morning only to regret what I had just read. I have been a witness to my strong-willed father being transformed into a patient—a word that never seemed to fit him prior to this experience.

This isn't a medical textbook; this is our story of what happened to our family when cancer decided to move in without an invitation, and what I eventually learned about fighting back.

The Day We Learned

The appointment with the pulmonologist was on a Thursday. Mom and I went with Dad because we had heard too many stories about people walking out of doctor's offices with no recollection of what they had been told. This came in handy, as soon after the doctor said "non-small cell lung cancer", everything else became white noise for all of us.

I remember focusing on the most peculiar details when the doctor was speaking.The way the pen sounded when he pointed to the X-ray. The ink stain left on his tie from his coffee. The motivational poster behind him that read "Every day is a gift" in cheery yellow letters was not lost on me. He was showing and telling us about things like" it was tumor staging", or about "the treatment options" and my brain was just constantly screaming "This is not happening."

Dad took it better than mom and I did. He was asking the practical questions about timing and what do we do next, while we sat there trying to process the word "cancer". Later he mentioned how he knew something was wrong for a few weeks but didn't want to worry us. Typical dad. Looking out for everyone else while his world was coming undone.

The hardest moment from that day was not the diagnosis. It was leaving the office and going outside to the parking lot and everything looked exactly the same as it did two hours ago. Same people, same cars, same overcast sky....but our lives had just been through a measure of "before and after" and we weren't ever going back.

Learning a New Language

Cancer has its own lexicon, and we would need to learn it quickly. Adenocarcinoma. Staging. Oncology. CT scan. PET scan. Pulmonary function tests. Each term carried us further into a realm that we had never consented to enter.

The staging process lasted two full weeks, which felt excruciating. The results from each test would dictate what we would have to do after the results came in, but for now when asked the doctors had zero answers until they could visibly construct the whole staging picture.Dad remained unfazed by the constant appointments and procedures, but I noticed worry in his eyes during the calm periods. When we finally received all the reports, some of the details were good and some were not so good. The cancer was present in what was referred to as stage II, so it had not metastasized to distant areas in his body; it was only in some of the nearby lymph nodes. Not the best possible scenario, but not horrible either. The oncologist, Dr. Peterson, explained that even at this stage, it is possible for the cancer to be cured with treatment.

Dr. Peterson was our translator during those first few weeks. She was good at describing complicated medical concepts in a way that was easy to understand, but not condescending. More importantly, she didn't tell us everything was fine, but didn't make the situation seem hopeless either. She layed out the facts, probabilities, and options - the information we needed to make educated decisions.

The Surgical Decision

The first major decision was deciding whether or not Dad was a surgical candidate. The tumor was located in the right lung and removing it would involve removing almost the entire upper lobe (about 25% of lung capacity). Dad was 67 years old and a lifetime habitual smoker (quitted ten years ago), so surgery wasn't a given. The thoracic surgeon, Dr. Martinez, was blunt about the risks and information provided during the procedure. Surgery produced the best chance for cure, but it was major surgery and there would be an extended recovery period. Whatever happened, Dad would not be able to breathe like before, and there were inherent risks of post operation complications, pneumonia, or surgical blood clots.We had also sought a second professional opinion, which was probably a good idea. The second surgeon, while recommending the same procedure with surgery as the most effective option, had a slightly different approach that could conserve some lung function. Two expert opinions gave us that peace of mind that we were on the right path.

All of this ultimately came down to Dad's philosophy about life: he would rather fight and suffer the complications than play it safe and wish he had fought. "I'm not ready to start making accommodations for this thing," he told Dr. Martinez. "Let's get it out of me."

The day of the surgery and everything that followed

The surgery would take place on a Tuesday morning in early May. Again, Dad remained surprisingly calm for the occasion, joking with the nurses and assuring Mom not to worry. I was a complete wreck. Five hours later, Dr. Martinez came out and reported that everything had gone well—they removed the tumor, removed several lymph nodes, and the margins looked clean.

Recovery was much harder than any of us imagined. Dad was in the hospital for four days, most of which he was dealing with chest tubes and managing pain. The first time I saw him try to walk to the bathroom, hunched over and moving like he was 90 years old, I had to step outside the room to not cry.

But Dad was a sight to see. Every day he tried to push himself a little harder with his breathing exercises. Every day he walked a little further down the halls of the hospital.The respiratory therapist told us he had never seen a man his age work so hard on his recovery.

Once home, it was actually just as scary as being in the hospital. We were now responsible for monitoring Dad's incision, managing his medications, and keeping the right balance of monitoring activity to keep him engaged while preventing him from overdoing it. In the first week home, Mom could hardly sleep because she kept checking on him, worried about whether he was breathing normally.

It took two weeks after surgery for us to get the pathology results. Good news and bad news. Good news was they got all the visible tumor. Bad news: two of the lymph nodes removed did indeed have cancer cells, which meant Dad would need additional treatment to be sure all cancer cells had been eliminated in case they were hiding in other areas.

Chemotherapy: Facing the Unknown

When most people hear the word chemotherapy, they think of movie scenes—people losing all their hair, being sick to the stomach and wasting away in a hospital bed. For us, it was difficult but manageable in ways we didn't expect.

The treatment included two drugs, given through an IV once every three weeks over the course of four cycles. The oncology nurses explained the process as a whole, but in reality, there was simply no way to prepare for what was going to happen until you actually went through chemotherapy.

The first infusion took about four hours. Dad sat in a big recliner, reading magazines and chatting with other patients while slow-dripped the IV. After a lot of anxiety about Dad starting chemotherapy, it seemed almost anticlimactic.

The side effects began approximately 48 hours after receiving the chemotherapy treatment.It wasn't the extreme nausea we dreaded but rather a deep-seated fatigue that Dad had never known before, which he remarked was like trudging through thick mud at all times. Even getting dressed or pouring himself a cup of coffee took a toll on him, and afterward, he would need to rest and regain strength.

What especially surprised us was how much the fatigue impacted his mood. Dad was always active and self-sufficient, so needing assistance with simple tasks was more difficult than unacceptable symptoms. Mom needed to learn how to approach Dad and offer help that he didn't perceive as demeaning.

The medical team was great about managing side effects. They prescribed medications that effectively prevented nausea, scheduled blood counts selectively, and adjusted his treatment plan if he was not able to adequately recover between cycles. The team also provided us with a great nutritionist, which was critical in helping Dad manage his weight and energy during treatment.

The Emotional Whirlwind

No one prepares you for how much the treatment for cancer messes with your emotions. Not just the patient, but the entire family. One day you are hopeful for test results, and the next day you freak out over a seemingly insignificant symptom. Hope and fear take turns infiltrating the mind and heart, and at times they each seem viable.

Dad managed his emotions through a lengthy search for knowledge and reading, which he did in many different ways. He read cancer journals, joined online forums for lung cancer survivors, and even kept elaborate notes on his symptoms and side effects from chemotherapy. The search and knowledge is what helped Dad make sense of the random and unfortunate situation that was ultimately chaotic.Mom took care of it all—focused on everyone, focused on everything. She got Dad's medications in order, scheduled his appointments, analyzed viable nutrition plans, and even tried to establish at least a little normalcy for the rest of the family. She was exhausted but couldn't admit it, even if she felt that Dad was depending on her to be strong.

I would venture between anger and sadness—sometimes within the same hour. Initially outraged by the sheer unfairness of the situation, sad to witness my parents navigate through this gut wrenching experience, and frustrated with my utter helplessness. I began seeing a counselor which really helped more than I thought it would. Cancer is not just about the person with the illness, it is about the family.

The cancer treatment center had support groups, but my dad didn't want to talk about feelings for his disease with a bunch of strangers. Yet, he enjoyed connecting with other patients during infusions. There was something about shared experiences that automatically jump started a mutual understanding that is almost instinctual.

The Treatment Options World

As Dad was treated, we learned of treatment options that were not even something we had conversations about before the diagnosis. Targeted therapy, immunotherapy, precision medicine—the world of lung cancer treatment options has changed so much in the last few years—it is showing up with treatment options that didn't exist 10 years ago.

Dad's tumor was tested for specific genetic mutations that could indicate that his cancer might respond to targeted therapy options. These newer therapies are proving to be very effective for patients who have certain molecular properties of their cancer.Sadly, Dad's cancer didn't have any of the currently targetable mutations, so traditional chemotherapy remained the best option for him.

We also learned about some immunotherapy, which helps the patient's immune system recognize and attack cancer cells. These treatments have dramatically changed care for some lung cancer patients, including offering long-term control of the cancer while the side effects were manageable. Again, Dad's specific cancer characteristics made him unlikely to receive any benefit at this time from available immunotherapy options, but it was encouraging to know that they were available, should he need them in the future.

The speed of research regarding treatments of lung cancer was both hopeful and frustrating. Hopeful because a constant stream of promising new options being developed and tested. Frustrating because, you never know if there is something even better to wait for.

Dr. Peterson helped us to understand that treatment decisions should be based upon what is proven to be effective and available now, not a potential future treatment. She likewise reassured us that Dad's standard treatment plan was sound, and while not thrilling like the newer experimental types, there was better science behind it for patients like Dad than some of the newer options.

Trial Research and Second-guessing

Throughout Dad's treatment, we kept hearing about trials, mostly clinical trials—research studies of testing new treatments, or new combinations of existing treatments. Part of me wondered if we should be trying to get Dad enrolled in a trial as opposed to standard treatment.

We researched several trials that may be appropriate for Dad's case. Some were alternatives through new drug combinations. Others were trials testing if changing the sequences of the standard treatments made any difference. The problem was most trials have specific eligibility criteria that Dad simply did not meet to access what seemed like the most promising trials in the listing.

Dr. Peterson explained to us that trials aren't necessarily better than standard treatment, they are simply different. Sometimes trials ended up being state-of-the-art improved care over the previous standard care, but sometimes the trial treatment could be less effective or could have worse side effects! This uncertainty from trial research is why trial research is necessary.

We took the position that we would stick with Dad's standard treatment while carefully keeping a clinical trial as a backup plan if Dad's cancer began to progress, or if trials became very relevant or applicable to Dad's case.

The decision-making process also taught me that there is no best choice in treating cancer—there are only reasonable choices made based upon the best available information, and the patient's personal values in terms of preferences.

Radiation Therapy: The Final Phase

After chemotherapy, the next step in Dad's treatment plan was radiation therapy to the specified area of his tumor. This was an additional precaution against local recurrence and targeted therapy since Dad had developed some cancer cells into his lymph nodes.

Compared to what they used to be, modern radiation is extremely precise. The radiation oncologist showed us some computer-generated modeling that demonstrated how they'd shape the beams to focus on the area designated for treatment while minimizing impact to the surrounding healthy tissues.

A lot went into planning! Dad had several scans that mapped out his anatomy with relative precision, and the radiation therapy team had to spend numerous days calculating and figuring out what angles and doses would be the best fit in Dad's situation. They even created a positioning fixture so that he could be accurately configured for treatment every time.

The actual process was surprisingly short. Roughly 15 minutes total, and it was done 5 days a week for 3 weeks. In fact, he was able to drive himself to most of his appointments, and almost always stopped for coffee with his friend Frank afterward. Overall, the severity of his side effects was remarkably minor, consisting of fatigue and some mildly irritated skin that healed well after he finished treatment.

What stood out regarding the radiation therapy team was a balance of high-tech precision combined with a personal approach in care. As you would expect, the team members were intimately familiar with their complex equipment, yet they took added time to discuss things at the end of each treatment with Dad, checking in to make sure he was ok and encouraging questions.

Life During Treatment

One thing that no one shares during the cancer treatment process is how cancer takes over not only the patient's life, but the lives of everyone in the family; the entire family revolves around cycles of treatment, appointments, and recovery time.Dad had to learn to manage time differently. Stuff, that by now was pretty routine, needed to be planned and paced. Grocery shopping was a half-day project, and he would be off his feet afterward. Luckily, some things which had previously been enjoyment and a way he could mentally unwind, such as working in his garden, became manageable again even if only for short stretches.

But there were also some surprises. Consider that our friends and neighbors stepped up to help us in ways we couldn't even have expected. Dad's poker group re-arranged their weekly meetup around his chemo schedule. His old fire department buddies organized a rotating plan for yard work help. Our church family provided us with meals and rides to appointments.

Overall, we learned how to graciously accept help; that is not easy for a proud, independent family like ours. Dad had the most difficult time letting others do the things he had always done for himself. We understood that accepting help was not just about getting something else done—it was about letting people show their love and concern for you in tangible ways.

Financially

Cancer treatments are expensive, even with good insurance. The medications alone cost thousands of dollars monthly, not to mention the scans, procedures, and supportive care. Even with our insurance covering a good percentage, the co-pays and deductibles added up fast.

We were very lucky that Dad had good insurance through his retired firefighter benefits. Nonetheless, we had to navigate pre-authorizations, networks, and limits in coverage even after care began. We had to work closely with the cancer center's financial advisor, who was incredibly helpful in understanding coverage and linking up with patient assistance programs.The hidden expenses were usually the hardest to deal with. The cost of parking at the medical center, the gas money to get to appointments, the special food that was suggested to manage side effects, the medications at the drug store that were not covered by insurance. Although these items did not seem like big deals one at a time, they added up pretty quickly when the treatment extended over months.

What bothered me the most was how much time and energy we wasted dealing with insurance and billing issues when we should have been focused on Dad's health and recovery. The paperwork of a serious illness is something that no one warns you about.

Scan Days and the Anticipatory Anxiety

Si every third month, Dad has a follow-up scan to see if there are any signs of cancer reoccurrence. As these appointments approach on the calendar, they come to be associated with greater and greater anxiety. Scan days have become a significant "marker" in our family's emotional landscape.

The routine is pretty much the same: labs in the morning, ct scan in the afternoon, results with Dr. Peterson a few days later. However, despite the routine, the process does not get old or less anxiety producing. We have all learned to notice and recognize the signs of how each of us is feeling before the scan, and are good about offering addition support during this process.

The worst part is the in-between time after the scan, but before results are presenting back to Dad. Dad kept busy doing "normal" things, but I saw him analyzing every symptom and wondered if his symptom meant something significant. Mom was hypervigilant about Dad's health, always on the lookout for signs that something could be wrong.

To this point, all of Dad's scans have been clear.Each good scan brings a huge sense of relief and renewed hope. But anxiety returns as we prepare for the next scan because, as we all learned, cancer can be unpredictable and scans indicating no disease doesn't mean future scans won't show disease. The New Normal, Dad finished active treatment four months ago, and we are all still trying to adjust to what the medical team calls "survivorship". Survivorship is an odd term because it makes it sound like the hard part is over, when in fact that is not the case. Physically, Dad is doing well. His energy levels have been slowly returning, and he is back to doing most of the things he enjoyed doing prior to treatment. His breathing capacity isn't what it was prior to surgery, but he has learned to manage the limitations and rarely feels limited by his limitations. Emotionally, the shift from treatment to survivorship has been hard for Dad in ways we never expected. When dad was in treatment, there was always something to do. An appointment to attend, side effects to manage, a concrete sense of actively fighting the disease. Now the fighting seems much less active, and feels more like just waiting and watching. Dad said the hard part has been not knowing if every little ache or pain is something to worry about or not. Before cancer, dad never paid any attention to minor changes. A cough didn't warrant an inquiry, or a moment of fatigue wasn't met with any analysis. Now he finds himself analyzing every cough or moment of fatigue thinking that it might mean something big is going on. The oncology team has assured us that this anxiety is normal and generally lowers over time.They've also made it clear that the vast majority of these symptoms are not a sign of cancer recurrence and helped us understand which symptoms to report via telephone and which cases we need to see immediately.

What we have learned about hope

When Dad was first diagnosed, I think we felt hope was fragile and a little desperate—a sense that we needed to create it out of positive thinking and determination. Now, eight months later, I think hope feels a little more solid and realistic—more so than wishful thinking and based on evidence.

The evidence comprises successful surgery, completed chemotherapy and radiation, clean follow-up scans, and the fact Dad is gradually returning to normal activity. It includes knowledge that many people are able to successfully complete treatment for non-small cell lung cancer and go on to live full, meaningful lives.

But we have also learned that hope does not mean denial. We know that cancer can recur, and there is still vigilance to pay, and Dad's future includes uncertainty that wasn't there prior to diagnosis. Hope means being realistic about challenges but feeling confident that we can endure what comes next.

The experience of cancer has altered our family's relationship with the future: we are more intentional about spending time together, we are more present to ordinary moments, and we are more aware of what really matters in life. Though, while we wouldn't have chosen these circumstances, these changes feel like gifts.Recommendations for Families

If I could share a drink with a family who has just received a new lung cancer diagnosis, my main message would be this; even if the road is long, it is navigable provided that you have the right people and information supporting you.

First, I would recommend you get organized early. Establish systems for recording appointments, medications, and important documents. The logistical components of cancer treatment can be daunting, but being organized will help bring some order to the chaos.

Second, I would stress the need to establish your support team. Your support team consists of not only your medical team but your family, friends, neighbors, and community support. If you need help—ask—don't feel guilty. You should not be a superhero and try to handle every situation on your own.

Third, don't hesitate to ask questions or advocate for yourself. The medical professionals that are working with you appreciate and respect patients/families who are engaged and inquisitive. Write down your questions before an appointment, take notes while you are with the doctors, and ask for another opinion if you are struggling to comprehend or have any doubts.

Fourth, take care of the caregiver. Cancer not only affects the patient, but it affects the whole family. Caregivers need their own help, rest, and strategies to cope. Don't sacrifice your own physical and emotional wellbeing in the process of showing love and support to the patient.

Finally, see if you can find habitual moments of normalcy and joy amongst the treatment. On the serious side, cancer is serious and it will demand a lot of your attention, but that doesn't mean it has to occupy all of your moments of every day. It is important for all of us, as a human beings, to engage in, and maintain, connections to activities, interests, and relationships that have meaning and bring us happiness.

The Next Steps

Dad is still on his cancer journey, although it looks a little different now than it did during active therapy. Follow-ups are less frequent, worries about the unknown have dissipated, and normal life has come back in small ways that, in those early weeks post-diagnosis, felt inconceivable.

He is back in his garden, but working out how to manage his energy expenditure differently. He is back to his weekly poker game, and back to volunteering at the local food bank. He talks about the future—home projects, vacations, plans for next years garden—in a way that demonstrates moving from just surviving to living again.

He has changed. Some of these changes are subtle, but they are nonetheless significant. He seems to be a little more accepting or patient with inconsequential frustrations, a little more appreciative of good health when it is present, and a little more forthright about telling those who matter to him that he loves them and that he is grateful to have them in his life.

Our family has been permanently affected by the experience, in ways that I would consider mainly positive changes given the traumatic beginning. We've learned that we can handle more than we thought possible, that support comes from places we didn't expect, and that hope can exist with uncertainty.

The landscape of lung cancer therapy continues to change rapidly with new treatments and new strategies throughout the country. Patients diagnosed today have better options than the options available to Dad, and patients diagnosed in the future will have even more. This progress provides hope—hope not just for each family, but for everyone impacted by the disease.

To families commencing the journey, know that while the journey may be daunting, many adults have journeyed successfully before you. Each year the medical community makes the journey easier to navigate and more hopeful, and you do not have to make the journey alone.