Let Us Begin

[Why I hate the pancreas and you should too.]

The pancreas is the crybaby of organs.

Take its neighbor the liver, for instance. You can beat the hell out of the liver (“Bottoms up!”), but if you ask for forgiveness early enough and pinky swear to be nice, it will sometimes give you a do-over and actually regenerate its own cells. How polite is that?

Colon cancer is bad, but you can detect it early, and it progresses slowly (good), and they can cut out a chunk of your six-foot long intestine and you’ll still be fine. Hodgkin lymphoma, prostate, testicular, melanoma, breast and thyroid cancer—I wouldn’t wish those diseases on anyone, but most people survive with the proper treatment.

But the pancreas is a little asshole of an organ. Most of us don’t know what it does and where it exists in our bodies. So it’s burdened with resentment that manifests as bad behavior. If you asked someone to tell you where the pancreas was, it would be like watching an American trying to find Ukraine on a map. If you asked someone to tell you what it does, it’d be like asking them to explain what this contraption is. The pancreas is not one of the popular kids, so it pouts in the corner of the schoolyard plotting its violent revenge. (“It was such a quiet organ. We never saw this coming.”)

The pancreas is very important. It secretes enzymes that allow the body to absorb nutrients. So technically, you could find pancreatic cancer very early. Losing weight unintentionally, especially muscle mass, could be a sign of pancreatic problems. In fact, the weight loss can sometimes emerge years before other symptoms. But who connects weight loss to emerging pancreatic cancer? No one. And the asshole pancreas hides its cancer cells so well that when you eventually find them, it’s already angrily shaking its fist at you. 

The pancreas is such an asshole, when it gets angry, it can unleash a sudden torrent of pain that reaches an 11 on the hospital “how-would-you-rate-your-pain” scale. If you like morphine or Dilaudid, show up at an ER with pancreatitis and they will fix you right up. Three times my pancreas has swelled up, laying me low in a matter of minutes. Twice I went to the ER; the third time, I curled up on the floor of my office and waited an hour for the Tylenol to kick in. The thought of it returning haunts me.

The pancreas is such an asshole that its pain will sometimes trick doctors into first thinking you have gallstones (I wish) or liver problems (I sort of wish). The pancreas is such an asshole that it will sometimes hide its tumor behind other organs—the harder to find you, my little dearie.

The pancreas is such an asshole, it even makes it hard for us to fix. Its head sits near critical blood vessels that can block the surgeon’s scalpel. And when you can do surgery on the pancreas, it’s so squishy and pudding-like that the surgical stitches sometimes slip apart. This was such a problem decades ago that one in five pancreas surgeries was unsuccessful. 

To be fair to the pancreas, when it works, it does its job quietly and efficiently. Without it, you’d have diabetes. But I’ve got nothing nice to say about my crybaby pancreas and its defective little bastard cells. Just the two words that title this post.

[Fuck you, by Lily Allen]

I’ll be honest. I didn’t really want a steel wire threaded up from my wrist to the inside of my heart. Abundant anxiety as my brother and I tried to find our way through the maze of hallways at Kaiser Walnut Creek. No one seemed to know where I was supposed to be for my angiogram, which didn’t instill a lot of confidence in the whole Walnut Creek operation (as opposed to my Mother Ship, Kaiser Oakland, which is somehow chaotically functional and professional). We make a joke about Igor and a basement “operating room.”

But…after 90 minutes of prep and pep talks by wonderful nurses, it took no more than 10 minutes for them to feed the catheter up my arm and into my heart, inject some dye, look around, and call it a day—all of which I endured wide awake with just a smidge of fentanyl.

“OK, we’re done. Everything looks good,” says the doctor. Good as in no heart disease. Good as in no blood clots or other blockages. Good as in no stent required. And good as in “you can go home in a few hours.”

Good as in a good day.

PS: Nurse Nancy told me that I had to be very careful with the incision where they put in the catheter so that it doesn’t start bleeding. It’s an artery, and if it were to break open, I could “bleed out in two minutes.” I guess that would qualify as a bad day.

[Good Day Sunshine, The Beatles]

Some merciful good news last night. I had an echocardiogram yesterday (that’s an ultrasound of the heart), and it showed no damage and my heart working normally. The aorta is slightly dilated (hmm, Dr. Google has a lot to say about that), but the cardiologist is not concerned, at least for now.

Big exhale.

Nonetheless, we had these shortness-of-breath episodes, so we will go ahead with an angioplasty tomorrow morning to see what’s what.

Fingers crossed and all that, and hopefully back to chemo next week.

[Heart of Gold, Neil Young]

We’re calling it the Great Pumpkin (thank you, Kim!). It’s starts off as a grapefruit-sized ball of chemo chemical attached to my port in my chest. I wear it for two days as the chemicals drip slowly into my body. When the ball is empty, I get it disconnected, and then I am free from chemicals for 12 days.

So far, the day after my first treatment is going well. No major side effects as of yet. Just a little fatigue and light-headedness. I know it will get worse as time passes, so I’m cherishing every non-horrible moment.

Onward.

Mixed feelings today. Excited to finally be attacking this bastard tumor. Anxious about the experience.

The injection clinic is nothing like I imagined. I had conjured up an image of a serene, quiet and low-lit (if sterile and institutional) room with rows of patients in recliners. Some reading, some resting, others on their phones or laptops.

Hah. How about a big kind-of-noisy clinic with rows of nurses stations and patients in hospital-like rooms or curtained off spaces. I get a room that feels like every Kaiser doctor’s office I have ever been in, except for the red $5,000 recliner in the corner, pillows, and a chemo IV machine.

Lisa is my nurse and I get almost all of her attention for the morning. She went into oncology nursing after watching her father deal with cancer nearly 30 years ago and realizing it was something she could handle. She explains everything in excruciating detail; another information bomb, but today it’s especially useful because it allows me to set my expectations for what is to come.

Here is the anti-nausea medicine for today.
This is the first drug you’ll be taking.
Have you picked all your prescriptions?
Let’s talk about nausea and diarrhea.
The cold sensitivity sometimes starts right away.
How do you feel about cannabis? Sativa can help a lot with nausea. It’s stupid that it’s still stigmatized; Big Pharma and the feds are the problem.
Here is the what the pump that you will be taking home looks like. You get a fanny pack that looks like it came from a dollar store.
We had a guy once almost rip out his pump from his chemo port because he went to play basketball. Don’t do that.
OK, let’s start the second medicine. If you start to feel flushed or have a grumbly stomach, summon Zabeda immediately and we’ll give you atropine. (I did, and they did.)
Here’s the deal with your platelets and neutrophils. If they get too low, we’ll need to skip a cycle until you recover.
You might not lose much hair. Don’t shave your head just yet.
Do you want a granola bar? We have four kinds.

Bridgette comes in with good news. Instead of giving myself five white blood cell shots each cycle, they will give me one “super shot” when I get my pump disconnected. Praise be. She got permission to do this because I mentioned at one point not liking needles. In fact, Bridgette has put the whole nursing staff on alert that I hate needles. An overreaction, but they are all gentle with me now.

Also good: Lisa tells me that I can come in to get the pump disconnected whenever it runs dry. No need to wait two full days.

The chemo port makes sense now. It’s painless and less squeamy (new word) than an IV in the arm. Still weird to have a lump in my chest and a catheter going to my heart.

Biggest takeaway today: The wifi here sucks.

{Title from Lewis Carroll, Alice in Wonderland]