Last Updated: Aug 16, 2018
By Ira Sharp, MD
“Unfortunately, you know you can’t be cured and you will eventually die from this.”
These are the words I heard that day several years ago as I was leaving my oncologist's office. They may have been true, but were certainly not therapeutic. Driving home from this specialist’s office, I stared into the abyss of death and these words became a source of despair to me and my wife.
My saga is as follows:
In November 2013, after developing late-in-life diabetes, altered bowel habits and fatigue, I was found to have a large complex cyst in the body and tail of my pancreas.
I saw a surgeon. After seeing my CT scan, he appeared in the exam room surrounded by an entourage of fellows, residents and medical students. In the cold, stark environment of a small exam room, he stated, " I'm sorry. You have adenocarcinoma of the pancreas."
The last thing you want to hear from your own doctor is "I'm sorry." Disbelief was followed by terror and panic, as I envisioned some of my late stage cancer patients and what my future might hold.
Work up including EUS biopsy showed adenocarcinoma of the pancreas, locally invasive. I began a clinical trial of chemotherapy followed by radiation treatment for seven weeks. In June 2014, I underwent surgery which included tumor resection (R0), splenectomy, cholecystectomy, and a vascular surgeon to remove the celiac axis and reconstruct the circulation.
My CA19-9 (which is a tumor marker for pancreatic cancer) dropped to less than ten (from initial level over 10,000), and no metastasis was detected on scans. For the next six months, I recovered from this surgery, until December 2014 when the CA 19-9 rose once more, and a palpable lymph node was felt in the left supraclavicular fossa.
CT confirmed this node and a left adrenal metastasis. Again, panic and anxiety!!
That was the moment that the oncologist deemed appropriate to tell me of my coming demise from cancer.
After several consultations , I elected to start another clinical chemotherapy trial, under the guidance of a new oncologist, who offered me hope and a meaningful chance of success. Within a few months, the lesions melted away on CT scan and my CA 19-9 normalized from 2,000 down to about 20. For over three and a half years I have continued this regimen, with good results.
After 31 years of practicing internal medicine, I must admit I was never prepared for such a devastating blow as this diagnosis has had on my life. Being both a doctor and a patient with pancreatic cancer can be a terrible combination.
It is only with the help of my wife, my family, friends and wider community, and my medical teams, that I have had the courage and stamina to soldier on. While realizing the statistics, the notion that there are survivors (even if not many) has given me hope.
Hope is a valuable commodity when dealing with the raw emotion of this disease reality. While a physician should not give false hope to his patients, sustaining a positive outlook is both humane and therapeutic. Some days after treatment, when I felt physically as if I wanted to die, only the hope that tomorrow could be better kept me going.
Words have power. They can cut like daggers, or assist healing. What severe illness has taught me is that perception of a doctor's caring or lack thereof can make all the difference in how a patient fares.
What you say to your patients and how you say it must be carefully weighed and measured, almost in the way you would titrate a dose of critical medication, because the side effects of misplaced words could be just as devastating to a patient's hope as a medication error.
Conversely, the right words, at the appropriate time, can be a source of hope and inspiration to even the sickest patient.
Ira Sharp, MD, a 62-year-old graduate of Jefferson Medical College (now Sidney Kimmel Medical School), Class Of 1979. He practiced internal medicine and geriatrics for 31 years until his retirement from illness in 2013. He is currently still undergoing treatment in a clinical trial and is doing well, with his time spent studying and part-time teaching.