This post contains no information. This post contains no answers. It’s just me howling at the universe. Feel free to move on for now; I’ll be back to generating writing-relevant content soon, I promise.
But I’m not thinking about writing right now. I’m thinking about pancreatic cancer.
It’s because we think one of my patients might have pancreatic adenocarcinoma.
That’s one of those diagnoses that just punches me in the gut and makes me feel like I’ve just been shoved off the top floor of a skyscraper by someone I trusted with my life.
Seeing those words in a patient’s chart drops the bottom out of my universe.
Pancreatic cancer is nasty. And sneaky. By the time it causes symptoms so you’d actually think to look for it, it’s already metastasized. And the prognosis is like 6 months to a year. Five years tops. Barring miracles.
As a med student, I had a patient whose life was basically saved because instead of developing one pancreatic cancer hidden quietly in the body or tail of the pancreas like people normally do, he actually grew TWO. And one of them was in the head of the pancreas, where it could actually cause early symptoms. They found the two tumors before either one of them metastasized, because the symptoms that the head tumor caused made the patient go for a CT. We took his pancreas out, and his life was saved. (Of course, he’s a brittle diabetic who has to take a pill with digestive enzymes before he eats anything…..but at least he’s alive…..) I can still see his nonchalant shrug at his follow-up appointment, (yeah, it’s hard getting used to the medication regimen,) and his fingers intertwined with his wife’s.
The residents I’m working with assure me that they have had mean and unpleasant patients with pancreatic cancer, and that assholes with pancreatic cancer actually do exist. But all of my patients have been the nicest people you could possibly imagine. It’s like all the meanness they never put out into the world gets concentrated into a little ball in the core center of their bodies and eats them alive from the inside out.
My current patient has three kids, she’s smart and kind and in her fifties and she may be dead in a year, and she spends her time teasing me about how awful “my cooking” (ie: the hospital food) is. And her husband works at my hospital.
She knows she has a “tumor in the pancreas”. I don’t think she knows exactly what that entails. And I dread the moment that understanding dawns on her face.
Today one of my med students looked me in the eye at the nurse’s station, and said “So what you’re telling me is, don’t get attached.”
I wanted to pat her shoulder and assure her that either (a) all was right in the world and that such an evil, nasty thing couldn’t possibly exist or (b) that as a “seasoned” physician, I have developed a healthy detachment from the fates of my patients, that nonetheless does not mar the veneer of my compassionate interactions.
Neither one is the case. I don’t think you ever stop deeply giving a damn. And the amount of damn you give seems to be directly correlated with the direness of the situation the patient is facing.
I have a small glimmer of hope; we did an MRI today, and the appearance of the mass in her pancreas was “atypical for pancreatic adenocarcinoma”. It recommended a biopsy to see what kind of cells are actually in the mass, and suggested it might be one of a number of less aggressive tumors.
And I have to wait until tomorrow to schedule the biopsy. And then I have to wait a day (at the least) for it to actually happen. And then I have to wait three days (at the very least) to get the results.
And she will have to wait. Terrified and in pain.
If my burning hatred could kill, it would kill pancreatic cancer.
And I have to say this, because 30% of pancreatic cancers are associated with tobacco use:
Don’t smoke, okay? Please? Just don’t smoke.