A lifetime of chasing dreams : School, career, relationships, marriage, hobbies and activities, committees and organizations, moving and travel, generational family growth, even rest and retirement, the constantly shifting and expanding components of life have trajectory. The growing, development, searching and explorations define our lives. There is little if any room for drama, sickness or tragedy. Suddenly, we are faced with a shift, sometimes subtle, but often profound. Caring for people at one of the most critical times in their lives has presented me with thousands of opportunities to bear witness, engage and guide.
Even among your friends and family, each of you is independent in your responses. I have seen the range from busy, frenzied, information gathering, multiple opinions, to almost catatonic. I will offer that, as you and loved ones navigate, please also respect each other other’s path. Recognizing that support and love is far greater at a difficult time then demands and direction, which can be intimidating.
As a cancer physician, I want you to be engaged. I want you to now chase the best treatments for your best outcomes. Honestly, not everyone is up for that and respecting their point of view is critical, not just for success, but also for comfort and acceptance.
The family gathered in the exam room, one holding their mother‘s hand while her husband is on the exam table. He had been receiving spinal injections for back pain for almost a year before the jaundice led to a very different diagnosis. A presenting symptom for pancreatic cancer is often back pain. Schedules were made. The chase was on: surgery, chemo, radiation, immunotherapy, a plan was set quickly in motion. Paul is defeated and exhausted. The pain taking its toll, the jaundice and ascites contributing to the weight loss and frailty. At 62 he had not even had a chance to retire. Two children are still in college. The shock is evident in all of their faces. Everyone wants to fight. We will be there for Paul if he wishes to as well, but with this devastating diagnosis, nothing is guaranteed.
We’ve talked here often about how inflammation influences cancer. The development of the disease, the effect or ineffectiveness of treatments, the trajectory, the outcome. It has been found that within a matter of days in pancreatic cancer, elevated inflammation, can spread the disease rapidly cause increasing ascites (fluid) and make successful treatment essentially impossible.. It’s as if the cancer has conspired against us all. New research is looking at attacking inflammation and allow the body’s immune system to battle disease rather than just trying to treat the tumor.
Many patients, and now even friends, are dealing with this difficult new reality and questions arise. Could more have been done? Could the disease be found sooner and curable? Why did the chase for treatment get so derailed? Once again, we are reminded how truly humbling this disease can be. Take heart that research is advancing at very microscopic, nano particle levels for every disease even the toughest to treat. Frankly, this may not benefit all of us now, but therapy for the next generation will be dramatically different. The chase is on to make cancers that do develop, even the worst of the worst, a chronic disease, one that is survivable..
The best hope for Paul now is not to manage the disease, not to chase treatment. It is instead for loved ones to gather and know that it is not a new immunotherapy that will hold his hand, relieve his mind or comfort his heart. It is his knowing that his life well lived will now bring him support and devotion. There will be grieving, but there will be acceptance and memories to honor. Love may not cure but it always heals.