By JAMES ASHER, D.O.
It seemed like a normal day. Over the past two months I had engaged in vigorous physical activities, including a month before climbing to the Ranger Station at Half-Dome in Yosemite — a 14-mile hike mostly up then mostly down. I felt well but noticed strange symptoms. It was the 29th of October 2017.
On that day there was dark urine, and I determined it wasn’t due to dehydration. On the 30th colorless stools. As a physician I knew to start looking at the sclera — the whites of my eyes — and sure enough, on the 31st there it was: jaundice. There is nothing good that causes these symptoms. “I’m a dead man,” I thought, and began ruminating over the wonderful life I’d had.
I embraced what seemed impending death. Just the same, I figured it would be prudent to see what medical science had to offer. I called up the gastroenterologist who had done my colonoscopy 18 months previously. His office, upon being told I was jaundiced got me right in. In the meantime I got the CT scan and lab work I knew he would want.
I got to the appointment, with my wife and one of my sons. By then I knew I had the commonest type of cancer of the pancreas. I told Dr. Honan I thought I’d had a good life and felt at ease with my situation. “I don’t think it’s over for you,” he said. Looking through the data. “I’m going to send you to a surgeon, Dr. Brink.”
My son piped up, “Jeff Brink?” “Yes, do you know him?” asked the doctor. “We were in high school together at Bourgade Catholic.” Well, that was interesting, and since Jeff had played football at Bourgade, it meant that whereas I had once been his team doctor, he was now mine. But I was a bit disappointed. I thought I would soon be meeting the Lord, and no, it wasn’t going to be that easy for me and it would just be Jeff I was meeting. Still I looked forward, and he did not disappoint.
A Prolonged Experience
I was got into the hospital expeditiously, scheduled for a Whipple surgery November 15. I still remembered the lecture on the Whipple as a medical student, thinking, “Oh my God, I hope nothing like that ever happens to me,” or equivalent thoughts. Think of the operation as a giant cookie-cutter that takes out the lower 10 percent of the stomach, the upper part of the small intestine, the cancerous part of the pancreas, the gall bladder and common bile duct, then reconnects everything as best they can.
Before the operation, Dr. Brink was a bit grim with the family, but real: “If I’m back out here in less than two hours, I won’t have good news. If I’m in there for five hours or so, I may have good news.” It turns out that only 15 percent of surgical cases are candidates for the full Whipple — for the rest there is no point in operating and they close things back up and go home. My surgery took over five hours.
Recovery was a prolonged experience. No pain, but extreme weakness, no appetite, and having to get up and go to the toilet in what seemed every half hour. And weight loss — to my joy I went effortlessly (compared to dieting) from an overweight 214 to near-normal 168 pounds.
The outstanding nurses at Banner University Medical Center cajoled me to get up and take hikes around their station several times daily, which seemed like a terrific chore but no one wanted me keeling over from a nasty blood clot after all they’d been through to try and save me.
The path report returned, and Jeff gave me a copy. Particularly troublesome was that the superior mesenteric artery, which had been scraped to near-dangerous thinness, showed a microscopic tumor margin of “0.1 millimeter” — about the thickness of this sheet of paper. I asked if this had been a kindness on the part of the pathologist and was told, “They are never kind.”
Recovery from major surgery is about a year, and it was at least that long before I was starting to feel more normal. Getting back to normal was complicated by institution of chemotherapy some two months after completing the surgery, which then went on for six months. My oncologist, Dr. David Paul, it turns out had married a girl — also a Bourgade graduate and well-known to our family — one of my other sons used to date. Bourgade, from which all my children graduated, was surely figuring prominently in my present experience.
In spite of expert surgery and chemotherapy, the tumor recurred, and beginning in March of 2020 I began five weeks of radiation combined with more chemotherapy, amidst all the CCP virus hoopla, under the capable, lovely hands of radiation oncologist Dr. Arti Sanvay. Although no one told me radiation would be easy, I think I was unprepared for the wallop it gave me, and it took many weeks to get back to feeling more or less normal again.
At the conclusion and follow-up, results looked good, but they were temporary, and in October there was definite recurrence, with tumor showing also in the lungs and liver. Not really so surprising, therefore not so disappointing. If you read anything medical about adenocarcinoma of the pancreas, the prognostic parts of the text are shot through with words like “dismal,” “disappointing,” “unfortunate,” and “unhappy.”
November 15 was my three-year anniversary of surgery, which put me in a small category of pancreatic adenocarcinoma survivors — median survival time after the Whipple is 15.5 months. So, I had clearly received my summons, after a rather generous time to enjoy life after all the treatment.
Treatment, however, is still not over. I had another port placed for another round of chemotherapy, which may prolong my life but won’t save it. Chemotherapy will stop when the effects are no longer tolerable.
Thoughts that pass through one’s brain: Earlier in 2020, I had undergone an in-depth Confession with Fr. John Lankeit at my Cathedral parish. The last thing I wanted to hear Jesus say was “How about the unconfessed, forgotten sin(s) of. . . ?” Psalm 19:13: Who can detect trespasses? Cleanse me from my inadvertent sins. Not that I could think of any, but I surely wanted to make good and sure.
Then, OK, God’s will be done but isn’t almost 79 years old, too old to be praying for a miracle? I mean you have to die of something, sometime — how terrible it would be to live to old age as I have, then die of nothing. Dear God, please use your miracles on young people. Which is silly, because God’s abundance is not limited.
People say to me, “You are handling this so well.” What am I supposed to do, go hide under the bed and not answer the door? Spartan soldiers used to have a maxim that applies: It doesn’t matter if the water is hot or cold if you have to march through it anyway. The Marines would like that too.
OK, I admit to some anxiety about the process — stuff like pain, nausea, no appetite, weight loss, maybe more jaundice, generally not feeling good, perhaps social isolation. But I think, hey, I’ve been through tough stuff before: USMC Boot Camp and subsequent officer training were no slouch courses. Neither was medical school nor residency. My marriage into its 57th year is as good as it gets, but the first two years were an ordeal for both of us. We made it.
Then there was the Whipple and what came after that. At least I don’t have weeks of getting my slovenly body into tip-top physical condition like it or not. I don’t have to carry 40 pounds of stuff, exhausted already, further up slippery, muddy hills in the Virginia heat, rain, and humidity with somebody yelling at me while simulating being a platoon commander. At least there are no rounds every morning about patients I’ve not grasped the full magnitude of the disease processes I’m supposed to manage with hostile chiefs of departments glaring at me for my breathtaking ignorance — which went on for three unrelenting years.
All I’ve got to do is lay there, do what I want, go where I want, eat what I want — or don’t want — for any of it. I don’t even have to go to Mass if I don’t feel up to it, although if I can’t I’ll miss that. It would be nice if I could see a priest every once in a while. And I hope my curmudgeonly qualities don’t surface too much and I’m up to a few visitors as I decline.
People tell me, “I don’t want you to die.” Yeah, I get it. I don’t want to leave them either — although somehow I feel I will remain in contact even though they won’t be as aware of my presence as I am of theirs.
In the movies they always show the dying person talking to everyone around the bed, then gradually dying — like in the space of five minutes. Not been my experience with patients like me. More like dying by millimeters. Little by little by c’mon let’s get this over with. Gradual entry into coma with possible brief periods of lucidity, more coma, more death watch, on and on. Eventually and finally it happens, and everyone is relieved. Suicide or euthanasia are real temptations.
Talking To The Angels
I’m encouraged by two Jesuits. Fr. Robert Spitzer, SJ, talks about a dying relative who was in a semicoma, but obviously engaged in an animated conversation. When he opened his eyes and was asked whom he was talking to, he responded, “Why, the angels.” Sometime later he opened his eyes again and asked, “Is it OK if I go now?”
Everyone assured him that it was fine if that was what he wanted. He smiled, closed his eyes, and died shortly after.
Fr. Marc Calegari, SJ, died of pancreatic cancer years ago. I went to see him in the hospital just before he died. I expected a bed-fast guy, grim, bleak, doing his best to be sociable. No, Father was positively mirthful, like a little kid anxious to get on the bus to someplace really fun.
I pray to him daily for guidance.
One thing bothers me ever so slightly. I’ve now had general anesthesia a number of times. In every instance, I last remember being in the OR or procedure room, then nothing else but waking up in recovery. No out of body experiences, as reported by many people. Nothing weird. I’m OK with God’s will for me, and I’m not asking for any Divine favors. But are other people’s out of body experiences their imagination? Am I lacking something they have? What if the lights go out and that’s it?
I’m reassured by knowing if I’ve not done the best I can, I’ve at least made the best amends I can discern, and am as ready for my summons as I know how to be . . . but what if. . . .
I meditate too, on the English martyrs, the sublimely innocent and good people who were hanged, drawn, and quartered for High Treason — the charge for no more than being Catholic. I pray for their assistance. Hanged, drawn, and quartered is way worse than a Whipple. If they could take it, I can take it: Lord, don’t make it easier, make me tougher.
O Mary, pray for us sinners now and at the hour of our death. St. Joseph be with me at the hour of my death to guard me against the foe.
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