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Context

My mom has been terminally ill for almost a year and my dad has been the primary care taker. I recently moved internationally back to my home country and have been the secondary care taker since the past two months.

We recently settled on a major surgery as the next step for my mom. The surgery would be the only cure for my mom (5-year survival rate >75% vs 15% otherwise). However, it is very expensive - the surgery itself would be 6X of my parents collective annual pensions (they both retired) and post-op medicines required to take for life would take almost half of their pensions annually. However, they owned at least three proprieties in addition to some savings. I don’t know how much exactly. But it doesn’t seem that they don’t have money for the surgery if they want to do it.

My dad was initially very hesitant and very scared of the surgery. He kept talking about the worst case scenario - that we spent all the money on my mom and then what happens if he or I got sick? To resolve his concerns, I invited my dad’s best friends to come over and comfort him. I also offered to give them all my savings, which would cover half of the surgery expense. Also both I and my brother are quite young and healthy; We should be able to make some money in a few years. My dad finally agreed to do the surgery. My mom was initially not certain about it also due to the financial burden, but she was brought on board fairly easily after my dad and I became very affirmative.

Still he had a cancer scare for himself the day after the decision. I went to the ER with him and it was confirmed to be mild infections.

Things have been pretty quiet since then. We admitted my mom for the surgery and were told it should happen in three weeks. My dad also told me that he was a few phone calls away from borrowing the rest half of the surgery money from some relatives.

Problems:

I thought everything was good. Only yesterday did I learn from him that he was still uneasy about his own health and went to do an enhanced CT, which was not what the doctor had suggested.

The result showed he had a small tumor on his liver. The imaging reported “possibly early HCC (hepatic cell carcinoma). Please refer to biopsy“. I immediately took him to a local doctor, who suggested an invasive surgery. I was not very convinced as the doctor didn’t explain why it would be the best option and am looking for further consultation with a bigger hospital. We also did a MRI today and are waiting on the result.

He was understandably very upset. but it appeared to me that he was almost eager to believe it was cancer. He kept talking about the surgery and that he should start informing our relatives. Most importantly, he told me he was not sure if my mom should do her surgery.

I was heart-broken hearing about that, as it would be my mom’s only chance. There is a certain time window before which my mom are eligible for it.

He also changed his words about money, saying that he didn’t even know who to borrow the money from.

It seems to me he is backing off from my mom’s surgery. At the time I’m trying the most - I have been unemployed for the last two months to just take care of my mom. After giving all my savings, I would have tremendous level of financial pressure as well, while balancing care-taking and job search.

I know it’s an emotionally difficult time for him. I have cancelled my flight for my job search event to be with him. But it seems his diagnosis is still unclear. I don’t know the false-positive rate of the CT scan. We haven’t done biopsy. Even if it is cancer, financially there is no problem as he recently received full health care coverage for cancer (upon my insist). The five year survival is very optimistic (>90% based on my research). Given my dad’s otherwise healthy condition, there are a variety of options available for him as less invasive treatments. My brother recently graduated and joined the care taking force, so we should have enough hands as well.

Question:

How do I communicate with my dad to support my mom’s surgery financially and emotionally?

  • you mention their collective salaries: how many years will your mother need to be a healthy worker to earn back the surgery costs? – Kate Gregory Jul 4 at 12:18
  • @KateGregory they are both retired and receiving pension. Based on her pension alone it would be 11 years. – Storm Jul 4 at 12:35
  • I realize this is hard/harsh to hear... but it almost sounds like what your father fears is not just the money aspect of it, but -many more years of caretaking as your mom dies a slower/worse death- when without the surgery perhaps things will be over more quickly and with less suffering. I am sorry for how hard to hear this must be but perhaps worth considering. – Meg Jul 5 at 17:09
  • When you say "it doesn’t seem that they don’t have money for the surgery" I'm a little confused by the double negative. Are you saying "they have the money for the surgery"? Or "they don't have the money for the surgery"? – DaveG Jul 26 at 15:09
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From what I understand is that your dad is under a lot of stress. There is something called an "amygdala hijack" which hinders people to act rationally.

I would use the scientific approach of framing (Kahneman & Tversky).

Give these very simple choices to your dad:

Would you rather choose the path that has an 85% chance of mom dying within 5 years? [negative framing of the likely outcome of not doing the surgery]

Or...?

Would you choose the path that has a 75% chance that mom still lives in 5 years time. [positive framing of the likely outcome of doing the surgery]

Even if people are suffering in decision making from an amygdala hijack, they are still vulnerable to cognitive biases coming from framing, maybe even more so.

Hope this answer is not too late, or at least helpful to others.


I also found this interesting article by Perneger and Agoritsas (2011) in which they suggest to present both relative and absolute risk formats. [I guess that would be the most ethical.]

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This is definitely a situation in which it is important to keep every persons' focus on the "prize": Knowing that your mother has a foreseeable chance of being with all of you, and her presence being priceless, and you won't be wishing you could hold her hand "one last time." This is the position your father needs to see constantly,, and if you can keep any of your own doubts hidden as though they don't exist, it would help. Remind your father how much you admire his strength and determination in doing what's best. Remind him, also, that money won't buy back anyone or any happiness. MY advice comes from a standpoint of knowing how easy it sounds,, while it is not. So you may need someone other than your father to unload on, and it's better to think about that before you get there. Best wishes.

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