Pancreatic cancer

I got the call yesterday as I was pulling into the driveway after running an errand. I sat their in the car and listened and talked with a brand-new widow who called to inform me of the death of her husband. I used to get those calls more often. People call the minister right away when a death occurs. There is a funeral to plan and ministers are kept in the loop. However, this call wasn’t made to me as a minister. It came as a friend who had just lost a friend. As is often the case with the finality of death, I sat in the car a bit immobilized. There was nothing I could do. I can’t make the loss hurt any less for the widow. I know the children. I watched them grow up. I can easily imagine them gathered together and talking about their father. He was human. He made mistakes in his life. He said and did things that he regretted. Sometimes they couldn’t understand him or why he made the decisions that he made. But they loved him and they knew that he loved them. They aren’t talking about the bad times as they sit around the house wondering what the next steps might be. They are remembering the good times.

Three times in recent years, I have been invited into the inside of a friend’s journey with pancreatic cancer. The diagnosis is devastating. The survival rates are low from this particular form of cancer. Doctors measure success in terms of days and weeks, not years. The chemotherapy is nasty. The surgery is grueling and recovery from the surgery is filled with all kinds of ups and downs. The risk of infection and complications is high. Pancreatic cancer victims learn to spend a lot of time in the hospital as medications are adjusted.

Cancer is not the only disease that involves the pancreas. The pancreas produces insulin, a critical hormone that controls the metabolization of carbohydrates. It sits near the first part of the small intestine, right next to the bile duct that drains waste from the liver into the bowel. Tumors on the head of the pancreas tend to squeeze the bile duct and can interfere with the normal operation of the liver. Surgery to remove tumors or parts of tumors is extremely complex with all of the different tubes and ducts that intersect in a small part of the body. Removing any part of the pancreas means re-routing tubes and reconnecting ducts.

Pancreatic cancer is difficult to diagnose. Often sufferers have symptoms that confuse their doctors and make it especially challenging to figure out what is going on. Treatments of symptoms can result in significant disruption of routines. Not being able to get far from the bathroom can make life unpleasant and social connections challenging. Add to that the compromised immune system in the midst of a global pandemic and he necessary isolation to reduce the risk of infection and sufferers become isolated and lonely.

One of the great honors of my life is that these people have trusted me with some of their most intimate thoughts, hopes and fears as they journeyed through the odyssey of pancreatic cancer. I’ve learned a lot more about the human body than I expected to learn. I’ve learned even more about the human spirit.

Pancreatic cancer patients come face to face with a reality that is true of all of us. We are mortal. We all will one day die. After the diagnosis, death seems a lot closer and its reality cannot be ignored. In the absence of life-threatening illness, we age at a measured pace, losing our abilities so slowly that we hardly notice. I’ve watched friends seem to age in front of my eyes, losing their balance and ability to walk and form clear thoughts and ideas in a matter of days and weeks. I’ve seen their frustration first hand. I’ve heard them speak of learning to live with nearly constant thoughts of life and death and the meaning or lack of meaning of it all.

Hope rises and falls with dramatic shifts in the pancreatic cancer journey. The big surgery, called a Whipple Resection after the Columbia University surgeon who developed the procedure, is a highly complex operation. Usually before that procedure is undertaken there is a simpler, laparoscopic procedure in which a stent is inserted in the bile duct to improve liver function. Chemotherapy is also prescribed to shrink the tumor in advance of the surgery. There can be months of feeling really bad while the patient is waiting for and preparing for surgery. Some days seem almost normal. Then another round of chemo leaves the patient in bed with no energy at all. Hope is renewed when doctors proclaim that the tumor is shrinking. A surgery date gets set and, frequently needs to be rescheduled over and over. Hope rises and falls with each visit to the doctor’s office. When the procedure is performed, usually at a University or advanced medical center far from home, there are weeks and weeks of recovery. Hope rises as falls as the patient gains a few pounds then loses them. Appetite seems to be recovering and then nothing tastes good. Pills are taken to replace hormones that used to be automatically produced. The doctors pronounce the procedure a success, but nobody thinks that the success will result in the end of cancer or medical treatments.

Knowing that death is nearer rather than farther away, however, makes people wrestle with deep spiritual truths. I’ve had some amazing conversations as I listened to the stark honesty of people who know that they will soon die. Each visit with a child or grandchild becomes a precious treasure. Each conversation with a friend an opportunity. Time takes on a new meaning.

I wish that experience would make the process easier, but for me it has not. Grief triggers memories of other grief. Each loss is painful. Each phone call a unique emotional challenge. I would not, however, trade the experience. I am blessed to have known these people. They have taught me much about courage and struggle, pain and joy, faith, hope and love. They are not forgotten. None of them has been conquered by cancer. Even though they have died, the disease did not win. Their generosity of sharing their journey has made me more confident of resurrection than ever. Though tears cloud my vision, I know I am among the most fortunate of people to have been invited into the intimacy of their journeys.

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