I’m Thinking About Pancreatic Cancer Today.

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.

Published in: on September 16, 2010 at 1:02 am  Comments (14)  

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14 CommentsLeave a comment

  1. I’ve said it before: Yours is an occupation that requires a fortitude that I simply do not possess. People who actually give a damn do a lot to help a hopeless situation and it speaks volumes that you have not taken the easy route of emotional inactivity. Take it from someone who has been walking around on a broken ankle for the past two months due to doctor apathy. Even when there is little to make a situation better, it helps when somebody stops long enough to consider someone else’s issue and speak out against the abject cruelty of a universe that does so many things for little reason at all.

    Don’t know if that actually made any sense at all, but maybe got my meaning across despite my inarticulate ways.

  2. Oh, Dr. Grasshopper.

    Please forgive me for contradicting you, but there is a great deal of information in your post. It’s just that only an exceedingly good writer can use it well. Most people won’t have to deal with it at all, thank Heaven.

    My father died of pancreatic cancer nearly thirty years ago. One bright thing that I remember from those dark times is that his doctor cared, and wanted to do more than he or anyone else could do.

    I still don’t know how doctors do that without destroying themselves.

    Take care of yourself, Dr. Grasshopper.

    • Thanks, Jane! Glad you could pull at least a little use out of it.

      I’m so sorry to hear about your father.

      I’ll certainly take care of myself as best I can; please do the same on your side of the screen!

      Thanks for reading, and thanks for writing!

  3. Thank you. I have also been thinking about pancreatic cancer these days. A good friend who has already spent too many years fighting multiple myelomas was just diagnosed with unrelated pancreatic cancer. What you said about all the meanness being concentrated into a little ball that eats them … that describes my friend so very well. I am howling with you.

    • Oh, Krisme, that really, really, REALLY sucks! I hope your friend is doing as well as possible under the circumstances. It always helps people to have good friends around them, and I’ll bet your friend really appreciates your support.

  4. First, I want to say that every time my RSS feed shows a new entry from this blog, I get a smile on my face and sit down to read it. I really love the writing and insights you produce in this blog, and just wanted to thank you for doing it.

    Secondly, both of my grandmothers died from pancreatic cancer (several years apart). They had never met in person and I couldn’t think of two life histories that were more different. What I remember most is how the color drained out of the face of anyone in the medical profession when they mentioned the phrase “pancreatic cancer.” And the bizarre thing is, it’s not like I can alter my behavior (I’ve never smoked) or do anything else preventative, since it seems that there’s very little you can do to catch it ahead of time. I just remember how quickly they slipped away, and how difficult it was. One was at peace with it, and one was not, and it was hard to reconcile the fact that the cancer just appeared one day, just Happened. And that was that. It makes you ask a million questions that can’t ever be answered.

    • Thanks, Nora! I’m so glad you enjoy this blog so much! It’s nice to hear that other people have as much fun with this blog as I do!

      Heredity is a difficult thing, to be sure. I’m so sorry that your grandmothers had pancreatic cancer. It truly is a rough disease, and it shows up in the nicest people. It’s just not fair.

  5. My mother died from pancreatic cancer 5 weeks to the day after she was diagnosed. I felt cast adrift by the medical profession. The only doctor who seemed to care was the poor emergency room doctor that made the initial diagnosis and had to break it to the family. As you stated, pancreatic cancer has no symptoms until it spreads. By the time she was diagnosed there were no treatment options. The hospital gave us a bottle of morphine and sent us home.
    Pancreatic cancer is a painful and horrible death. If I’m ever diagnosed with Stage 4 PC I’m going to drink the entire bottle of morphine in one sitting.

    • TMJ, I have no idea what to say to that. I’m sorry the medical profession didn’t help you guys more.

      Best to you and your family.

  6. My mom got diagnosed with pancreatic cancer almost 7 years ago. She had other health issues that had to be taken care of before having the Whipple. She had no health insurance and some amazing doctors at UMDNJ in NJ went to bat for her. They did pro-bono work and offered to do the whipple. We found a way to get her insurance. She went to the best surgeon in the world at Mass General. She is alive today, despite her 2 percent chance of living past 5 years, in part, because of those amazing doctors. Now she has unrelated stage 1 lung cancer. 7 Years later, she is alive to fight another cancer. The irony stings, but it’s better than the alternative. Never give up hope!! Never give up praying and never give up on finding a wonderful doctor who will fight with you!


    • Wow, a pro-bono Whipple! How bout those folks, huh?

      All the best to you and your family!

  7. hope and change

  8. Dare Dorm account

    I’m Thinking About Pancreatic Cancer Today. | How To Kill Your Imaginary Friends

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