Pancreatic Cancer Part 7: Discouraging News: the Horrors of Chemo

As most of you know, my wife, Peggy, has pancreatic cancer. Among her oncologist's first words were: “It would be reasonable for you to choose palliative care only. If you go that route, you will probably die within six months.” Had she chosen palliative care only, she would have now exhausted a third of her remaining time on earth. (Our photo dates from 1973.)

 

Peggy has now received five radiation treatments to her right hip and two chemotherapy treatments through a port on her upper chest. With her first chemo infusion, she also received a bone strengthener. As we left the clinic, she said she had a bad taste in her mouth and felt like heat was coursing through her body. She later complained that her supper tasted bad, but at least she could eat, which was more than she could do after 3:00 a.m. when fatigue, nausea, joint soreness, stomach cramps, abdominal bloating, and diarrhea (which changed to constipation), hit so hard that she spent much of the next four days in bed. We should have taken her chemo nurse's advice and started her on Smooth Move Tea sooner, because by the time we did, she was so desperate that she took a second dose hours later and ended up screaming on the floor while I hugged her. 

 

She had her second chemo on Thursday, July 10th, and her hair started falling out the next day. I told her that I would abandon her and the cats and move to Indiana (the first faraway state that came to mind), if she loses her good looks, but the truth is that I'm honored to be with her. I only I wish I could die when she does. I'm not the first man to feel this about his wife, and I know of one man (Robert E. Howard, the author of Conan the Barbarian), who shot himself in the head when his mother died. You can interpret the fact that men appear to need women more than women need me to mean that men are weaker or that they're more sensitive. (Peggy is in chemo in the second photo.)

 

Yesterday, I stayed in bed because I was too depressed to get up. Today, I cried throughout mass at my Episcopal church because I was touched by the beauty of the ancient music and the chanted liturgy; because I was sad for Peggy; and because I was terrified for myself. My life has become like a bad drug trip except that drug trips end while what I'm facing will frame my existence until I die. I can only escape my grief and terror when I'm asleep, but even then it's the first thing I think of when I get up to use the bathroom, and it keeps me from going back to sleep. I so want to die that it scares me, because I don't know how much sorrow I can take before something within me breaks. (The third photo was made after her second chemo when Peggy was in bed with our five cats.)

I don't want that to happen, but if I can scarcely trust myself now, what will my life be like when, after 54-years together, Peggy is no longer here to share my life cuddling; shopping; cleaning house; watching birds; enjoying our cats; doing home improvement projects; taking walks on Mt. Pisgah; watching old movies; going to doctor and veterinary appointments; sharing good times and bad; and, most of all, listening to one another talk about his or her day. Since she retired, I'm almost never alone, but if she dies before I do, the house will remain silent and the loneliness constant.

 

It would be unconscionable for me to kill myself because Peggy needs me now, and our cats will need me when she's gone (other people would mourn my passing, but only our cats' would lose their home, their human family, and their cat family). I'm reading a book entitled A Matter of Death and Life, by Irvin and Marilyn Yalom, a couple who had been married 65-years when Marilyn was diagnosed with terminal cancer. They wrote together until she died, and he finished the book when she was gone. So much of what they experienced, Peggy and I are experiencing. 

 

For instance, Irvin and Marilyn didn't believe in an afterlife; like Peggy, Marilyn considered the option of a medically-assisted death from the outset; and like I, Irvin seemed more upset by his wife's approaching death than she did. He and I are also alike in that he too considered killing himself when she died, but rejected it for the effect it would have on others. Yet, I'm afraid that, even if I attempt to live, my body might weaken and die, which is common for men my age. Clearly, men need their wives more than wives need their husbands.  As to why this is, I suspect that men feel some emotions more deeply than women. I say this based upon my marriage and upon the writings of the Yaloms.

 

Peggy gets chemo and blood tests every two weeks, and she also visits with Mark (her oncologist) or Betty, his PA (physician’s assistant) every two weeks. Several days after her first chemo, we had our first visit with Betty. We were having a bad day already, and it was worsened by the three hours that we spent at the cancer clinic, most of it waiting for Betty. It seemed like every bruised, shrunken, and emaciated cancer patient in Eugene was there that day, and this led Peggy to ask Betty if she would come to look like that. She also asked if she would get less ill when her body was used to chemo; and how often she would be able to take a break from it. 

 

Betty said that Peggy could expect to lose weight; that each successive chemo treatment would make her sicker than the last; and that she would have to take chemo every two weeks for as long as she lives unless every drug fails or she refuses treatment. Peggy then asked Betty through her tears if there was truly no hope whatsoever of beating the disease, and Betty answered that she would have to fight it for as long as she lives. Betty might have been wrong about this. Here is a relevant quotation from the Onco Library site (https://oncodaily.com/oncolibrary/pancreatic-cancer-remission-rate):

“Long-term remission in advanced disease is still rare but not impossible, particularly for fit patients treated at high-volume centers with access to clinical trials and personalized therapy... Although traditionally seen as incurable, a small but growing number of patients with metastatic pancreatic cancer are achieving partial or even complete remission with modern systemic therapies.”

As for how these characteristics apply to Peggy, prior to her disagnosis, she ate well, kept her weight down, lifted dumbbells three days a week, and took a strenuous uphill hike three days a week. She is also receiving treatment from a the Southern Willamette Valley's busiest cancer center, which offers access to personalized therapy. If anyone can tolerate the misery of chemo, Peggy is that person thanks to a strength and fortitude that have often left me in awe. (My friend, Hollis Shostrom, loaned Peggy a wheelchair, but in the photo, she is shopping for the walker that she already needs.)

 

It was impolitic of my mother to say that I married a better person than myself, but she was in some ways right. Even so, Peggy's life is now such that, as she looked at her once strong body in the mirror the other day, she said, "How low the mighty have fallen." Indeed, within two months, she went from being a the epitome of good health to being a cancer patient who groans, grimaces, limps, tires easily, sleeps a lot, can only walk slowly, and has moments of despair. Her radiation oncologist thinks she might have already broken her hip, and then there's that troubling lesion on her spine. Fortunately, she is a woman of courage and self-discipline who, to my embarrassment, is handling this crisis better than I. 

 

Peggy has received so much support from friends that thanking everyone has taken many hours over many days. They've emailed; called from far and near; offered to visit; offered to drive her to appointments; and sent cards, books, flowers, cookies, candies, tea bags, and the Pooh Bear in the third photo. Many have asked, "What can I do to help?" and a college friend from Houston invited Peggy to stay in her home so she could receive treatment from the nearby M.D. Anderson Cancer Center. Many of those who reached out to Peggy have also expressed support to me. Sadly, the people whom we thought would give the most have offered the least. I speak of her sisters who have never called, never sent a card, never sent a gift, never asked to visit, and never offered to help. What they have done was to accuse me of being weak when I asked that they support both of us. Aside from that, their contribution has been limited to  brief texts and heart emojis.

 

Betty speculated that Peggy might have a relatively good year left, but after that year, her health will decline so precipitously that she will need to ask herself if the cancer has taken away so much of what she loves that she no longer wants to live. Betty was wrong about this too, because another factor that will influence Peggy’s decision is her obligation to her loved ones. I just hope she won't allow her love for the cats and me to keep her here beyond the time that she should go. I have already begun schooling myself for the day that she says she needs to die. When, and if, that day comes, the man in me will pick up her lethal prescription and grind the numerous pills with which she will end her life, but the child in me will silently scream, “NO! NO! NO! PLEASE DON’T LEAVE ME!” But perhaps I overestimate myself. Marilyn Yalom talked about ending her life many times, and each time thus far (I haven't finished the book), her husband, Irvin, threw himself into talking her out of it. 

 

Peggy's illness offers me the potential of becoming ever more wise, brave, and honorable. I want to care for Peggy so exquisitely that it atones for every way I've ever failed and for every bad thing I've ever done. So much of what I do and what I think also finds voice in the words of Irving Yalom:

 

“I stay constantly by her side. I hold her hand as we fall asleep. I take care of her in every possible way... When I shall be facing death, there shall be no Marilyn hovering, always available, always beside me. There will be on one holding my hand.”

 

I so wish I were more than I am, but I must at least believe that I have the capacity to become more.  Then again, perhaps I overestimate myself about this also.

Today, though, I am not just afraid or in grief. I am angry, angry that our internist of 34-years didn't catch this cancer when Peggy lost nine pounds in December (he attributed her loss to changes in her diabetes medication), and angry at the universe for pissing on a woman who took such good care of herself. I'm angry like Job when he railed against God for treating him unfairly, and I'm angry like Moses when he accused God of demanding more than he could give. Only I have no God to curse and to spit upon. Still, what these men felt speaks to me, none moreso than Jonah when he said:

 

Therefore now, O Lord, please take my life from me, for it is better for me to die than to live.” And the Lord said, “Do you do well to be angry?” And Jonah said, “Yes, I do well to be angry, angry enough to die.”