I checked in for my abdominal ultrasound, already restless. Bariatric surgery was finally scheduled, after years of hesitation and delay. Weight had never been simple for me, but once I said yes to the surgery, I was ready to sign up and move on. The ultrasound was just another box to check.
“Are you sure I need this?” I asked the doctor dubiously. It seemed a bit much. At the age of 35, I was young and healthy. I’d never experienced any associated issues with my weight, though I was worried that if I didn’t address my obesity, problems would eventually develop.
The doctor shrugged. “It’s part of the pre-op testing,” he replied. That left me with no choice but to schedule that nuisance into my calendar.
At the center, I hopped off the exam table and bundled up again. My little ones would be home in 20 minutes, and I dashed for the door. If I’d had some more time, perhaps I would’ve noticed the tech’s wide-eyed concern while staring at the black and white screen.
It was a Friday when a secretary called from the center with a rather unusual question.
“Are you married?” she inquired.
Since when was that a requirement for weight-loss surgery?
I responded in the affirmative. Without furnishing any further details, she requested that both my husband and I come in for a follow-up meeting on Sunday. I thought perhaps they’d discovered a cyst or something like that. I figured that it was just another thing I’d have to resolve before proceeding with the surgery.
Now, there was no way I was going to wait until Sunday, the day my husband was due to travel out of the country for a planned business trip. As soon as my dishes were loaded into the dishwasher on Motzaei Shabbos, we drove over to the center, which was open, serving as an urgent care. It was frigid, and the temperatures had dropped into the teens. The car drove smoothly, the crunch of the ice and salt beneath the wheels an audible soundtrack.
The doctor on call pulled up my ultrasound results. I watched him go still, the computer mouse hovering over the grainy images. The room was silent. Faintly, I heard a young child crying, and the murmured hush of a man’s voice—the father’s?—attempting to calm him.
“There’s a mass on your pancreas,” the doctor broke the quiet. His eyes were still glued to the screen. “Whatever this is, it seems to have spread into your liver.”
He scribbled a number on a Post-It note. “If this is what it is, then you should call them.”
The doctor, a frum Yid, finally swiveled around. His eyes held something I couldn’t decipher, and his voice wobbled a bit.
“Hatzlachah,” he said as we rose. “May Hashem send you a refuah shleimah.”
I stared at the little yellow note nestled in my palm. RCCS. Rofeh Cholim Cancer Society. Cancer? I had cancer? That was for other people, people I’d vaguely read about in books, or whose names I’d overheard in hushed conversations at the bus stop. My family had never been touched by cancer before. Was I the first?
It was only once we were halfway home that I realized that I’d left my coat in the office on the coldest night of the year.
My husband canceled his trip, and the next few days were a blur. While I didn’t know much about cancer, or anything remotely medically related for that matter, I knew that pancreatic cancer was bad. So terrible, in fact, that my head kept playing images of my girls at my own levayah. Pancreatic cancer, I remembered, was particularly vicious, especially in the young.
I didn’t call RCCS. Calling them would be confirming this “thing” was cancer, and the doctor had qualified that ultrasounds weren’t definitive. So long as I didn’t reach out to RCCS, then I could convince myself that this whole episode was a bunch of nothing. Deep down, I doubted my own conclusions.
A CT scan was inconclusive. When I went to hear the results of the MRI, I anticipated good news. Unfortunately, that was not to be. We dialed RCCS.
For the first time since the whole saga began, I felt less alone. My caseworker told me that, yes, pancreatic cancer was survivable, and she’d put me in touch with pancreatic cancer survivors who’d also had metastases. She also reassured me that my weight would not impede treatment, a worry I’d been silently carrying with me, wondering if I’d squandered my only chance at life.
It was over, I thought Monday morning after the kids had all gone off to school. I stared into our backyard, now a winter wonderland with the snow frozen crystal on the branches of our oak tree. O-ver.
I had a biopsy done, and then we settled in for the week-long wait. The only way I survived the week was by remembering that Hashem is good and His judgment is just. We informed our parents, who davened along with us.
In the face of serious illness, my world shrank. I withdrew into myself, attempting to make sense of the incomprehensible. I let the phone ring, the laundry wait and the mail pile up. I have a small home-based business, and I’d always loved working from home at my desk in our sun-lit sefarim room. But the quiet became oppressive, fueling my dark musings. I was never an exercise fan, but I took up running in our quiet suburban neighborhood. With my sneakers pounding the pavement and my breath forming small puffs in the icy, still air, I forced my brain to be absolutely blank. It became my lifeline to sanity.
My diagnosis was stage four pancreatic cancer with metastasis to the liver. Pancreatic cancer is very often discovered when it’s far too late for meaningful treatment. By the time the cancer is symptomatic with liver dysfunction and abdominal pain, it has spread. Additionally, pancreatic cancer can be impervious to chemotherapy.
My caseworker warned me not to check the five-year survival rates. Curiosity got the better of me, and after a quick look, I understood why she’d insisted. I sat in my chair and stared into space. Hashem is good, I told myself fiercely. He has a plan.
It turned out that the path in His plan was a long and protracted battle. And I received the starring role in a drama I’d never asked for.
At the RCCS offices, the team was stumped. Doctors disagreed whether my tumor was of neuroendocrine composition or the far more typical carcinoma. The tissue biopsy revealed both were present, though doctors could not conclude which one was predominant. As my caseworker explained it to me, one was vanilla ice cream and one was chocolate: While they were both frozen treats, they had different characteristics. Chemotherapy treatment was individual for each of them.
Neuroendocrine tumors are rare. RCCS sent me to a doctor specializing in those tumors, and we set up a rough treatment plan. It would involve chemo and surgery, a protocol unchanged for the last three decades.
I arrived for the appointment to find a representative from RCCS already there. From that point onward, whenever there was an appointment of significance, someone was there. My condition overwhelmed me completely, and there was no way I could understand all the jargon doctors were so fond of tossing about. Formulating appropriate questions was likewise beyond me.
The doctor we met that day was nice, but nothing could varnish the bitter reality. When the cancer made its way into the bloodstream, its characteristics changed. She gently told me that there was no way for this cancer to be cured.
“We can try to make the fire smaller,” she offered up an analogy. “Chemo will put up a good fight. But in the end, fire always wins.”
Three months. That’s how long she gave me. It was the week of Chanukah. I thought of the menorah in our window, polished to a high sheen. Would I be gone before Pesach?
My world silently caved in around me, a quiet collapse that nobody but the few souls near me knew of. Without any sons, I wondered who would say Kaddish for me in a decade or two. I imagined my motherless daughters in their white dresses, walking down to the chuppah without me.
The RCCS rep refused to let us give in to despair.
“We are Yidden, and for us there’s always hope,” he insisted. We sat on the hard green waiting room chairs, trying to regain our composure. “Hashem is the Borei Refuos, and I see that every day. No is never our final answer.”
I won’t lie. It was a dark, dark time.
While we were all devastated, my father couldn’t bear it. I found myself comforting him, telling him that some people get into a car and don’t make it home, whereas I had the time and luxury to prepare myself to die. I don’t think it helped him very much, to be honest.
We were almost ready to proceed with treatment when it was determined that the carcinoma cells overwhelmed the neuroendocrine cells, which meant the protocol needed to be revised completely. The new hospital I’d be using wanted to test my tissue again. I always smile when I think of a pathology slide, containing a tiny slice of my pancreas, making its way over from one hospital to another, weaving its way through city traffic.
Meanwhile, my caseworker felt something was missing from the clinical picture. While I felt I’d aged at least three decades in the last two weeks, I was still young. So young, in fact, that the nearest age match in the RCCS pancreatic cancer database was more than 20 years older than me. Additionally, my biopsy findings were unusual: Two protein markers were equivocal, indicating the tumor was being driven by immune system malfunction. In nearly all pancreatic cancer patients, they were not intact. Doctors were not sure if this was good news or not. At this point, it was just another clinical finding.
RCCS got us an NGS, or Next Generation Sequencing blood test. This specialized test would shed more light regarding what was driving the DNA in my cells to divide and multiply out of control. But that test would take at least two weeks to run, and it was time that we likely couldn’t afford. In the interim, we settled on a treatment protocol. The plan was to extend my life for as long as possible.