Early yesterday morning, my brother-in-law died of pancreatic cancer. He was only 44 years old. As is so often the case with this insidious and horrible disease, he was diagnosed with the condition at a time when it was already too late to do anything about it except chemotherapy – in otherwords, the tumor could not be removed surgically.
Darrek lived with us for 6 months after he found out he had pancreatic cancer while he underwent an experimental form of therapy in our cancer center. In all, he lived about 24 months after his diagnosis, time it is very unlikely he would have had without the experimental treatment. In fact, he did very well for about a year after completing the therapy with stabilization of the tumor growth, but over the past several months, as the tumor regained its momentum, he rapidly deteriorated and finally succumbed following several weeks of the pain that usually accompanies the end-stages of this disease. His passing has left me very sad and contemplative. Although we were not very close, we had very different interests and very different outlooks on life, it was a pleasure to get to know him during the time he spent with us, an opportunity we would never have had if it had not been for his medical condition.
Personally, pancreatic cancer is one of those diseases that terrifies me. When I was in medical school, the very first patient I helped to care for during my second-year surgery rotation was a young, 37 year old man who came to the local Veteran’s Hospital because “my stomach has been swelling for the past couple of weeks and I can barely breathe and now it’s hurting,” he said with a heavy southern drawl between chain-smoking drags on his cigarettes! He was a thin man who had a massively protuberant abdomen that obviously contained fluid. Back then, students were expected to actively participate in the evaluation and management of all new patients and the first thing I did with the surgery intern was to stick a needle into the man’s abdomen to draw off some of the fluid and send it down to the hospital laboratory for analysis.
Knowing that it would take days before the results would be available, I remember taking a small amount of the fluid (we always saved ‘extra tubes’ of everything!) to the little laboratory we used on the surgical ward to look at some of it myself under the microscope. I did a quick stain on the fluid and clearly remember to this day the bizarre looking cells that were present under even low power of the microscope. Neither I nor the junior resident to whom I showed this would understand the significance of our findings until later that night.
Within a few hours after admission, the patient developed severe abdominal pain. The chief resident saw the patient, felt he had developed bowel obstruction for some inexplicable reason (we had shown him the microscope slide but he had just brushed that off as irrelevant), and scheduled him for an emergency exploratory laparotomy that night. Upon incision of the abdomen, what seemed like an endless flow of fluid poured out onto the operating room table and the floor. When the flood ceased, the attending physician looked inside, shook his head, reached his hand in to explore the abdomen, took one last look at the peritoneal cavity and turned away saying, “Close him up. There is nothing we can do for this man.” He left and we all then looked as well to see the entire bowel and peritoneal surfaces studded with little white spots – metastatic implants form the cancer in his pancreas which was enlarged and hard as a rock. It was only then that we realized we had made the diagnosis by microscopy just hours before.
The incision was closed and our patient spent the last two weeks of his life in the hospital dying from his painful, metastatic disease. He never again ate a meal or smoked a beloved cigarette. I was alone at his bedside in the small, stark, VA hospital beige, dimly lit room, window cracked, the hot breeze of summer rustling the window shade and stirring what I have come to recognize as the characteristic ‘smell of cancer’ in the air, no one else present, holding his hand when he deeply sighed his last breath. I held his limp hand a few moments afterwards, then checked his pulse and left to tell the charge nurse with a tear in my eye for a man I didn’t even really know, who had served his country in the Viet Nam war, and who died by himself with no family or friends in attendance – just a second year medical student who had eagerly attacked his abdomen with a long needle at the time of his admission and had never before confronted death. Along with the sadness I recall experiencing a sense of the surreal and an almost overwhelming sense of loneliness as I tried for the first time in my own life to understand the reality of the brevity of our existence in relationship to the vastness and infinity of the universe into which we are all born…a journey I have not yet completed.
In memory of John Darrek Offutt (October 5, 1963 – April 9, 2008), I am signing off for a few days to attend his funeral in Athens, Tennessee.