Alan, a regulatory economist and consultant, was diagnosed with pancreatic cancer at age 65. Thanks to early detection and swift treatment, his prognosis is good. And, he resiliently believes that he will beat cancer and continue to work into his 70s.
The first symptoms showed up earlier in the year, basically a complete lack of hunger. I was full all the time. I’ve fought a life-long battle with weight and have always been a foodie, so I was surprised to not be hungry. My suspicion was that it was a gall bladder problem and I went for testing without any real concerns. The initial diagnosis was high-grade dysplasia, but results from a blood test showed a marker that was off the charts, so I was sent for scans that showed it was pancreatic cancer.
What Me Worry?
I never suspected cancer, especially not in my 60s. I always had an Alfred E. Newman outlook on life, “What me worry?” and I’ve enjoyed incredibly good health, only a couple of minor nuisances like strep and high cholesterol, for 64.75 years, so my initial reaction was denial, denial, denial. “OK, I have cancer, so big deal.” Once I knew I had a tumor and that there would be surgery and chemo, everyone else did the research for me—ignorance was bliss. My other thoughts were that “I’m strong, I can beat this,” an attitude that’s stayed with me the entire time. There were some tears in my kitchen, and me thinking “oh my God, this could be fatal,” but my rational mind started kicking in, and within a couple of weeks I could say I wasn’t afraid of dying; there was too much to live for.
Treatment began with three, two-week cycles of chemo, then surgery, then three clean-up rounds of chemo. I’m not certain if I’ll go through radiation; that will depend on additional tests. The self-righteous “I can beat this puppy” mindset stuck with me through treatment. I wasn’t felled by chemo. Instead I got kudos for my resilience and attitude. My cancer doctor said, “you made the cancer fit into your life, not life fit into cancer.”
In Denial
I think it’s good to have walls within your mind—my professional approach to economics is research, but that never invaded my approach to cancer. In the past, I’ve always thought if I found a health problem, I just need to figure it out and fix it; I want all systems to be working in top order. But this time, I used denial in order to survive. It was an effective tool to deal with the ordinary fears most cancer patients have; like saying “cancer, you picked the wrong person,” even though I pride myself on being a realist.
After my diagnosis, my sister and I went for genetic counseling and found out we are BRCA-2 carriers. It means I have a genetic mutation that makes me susceptible to prostate, pancreatic, male breast cancer, and melanoma. Our family also has an extensive history with cancer, among other illnesses. My mother, her maternal grandfather and paternal aunt, and three of my uncles on my father’s side all had cancer, and except for my mother everyone died from it. My father had a tumor nearly identical to mine, in size and location, but he was diagnosed at age 87 and didn’t get treatment.
When I was younger, my grandparents took me to synagogue all the time, and I ended up with simple blind faith, which has stayed with me. My father and I used to say that we either have a guardian angel or a personal representative; it feels like God protected me all the time—that is probably linked to my denial—I never felt like I needed to worry. But I have a lot of moments of tears and just bewilderment as to why I was so lucky; cancer killed my father in six months’ time; I thought this could have been my end, but it wasn’t.
Neural Impact
Chemo brain is quite real. If I am told something and don’t have a chance to write it down, it’s irretrievable. I struggle for words; I feel as if it has exaggerated the natural aging process. My wife will tell me something and I’ll forget it in 60 seconds. Chemo had another neural impact: I’ve always had hearing issues on my left side, but chemo and surgery affected hearing on my right side. My palate also went wacko: coffee and chocolate weren’t tasty and peanut butter lost its appeal. I was struggling with what to eat for breakfast as my perceptions of sweetness were so exaggerated.
I’m so lucky to have had my wife of 40 years; she was my primary caregiver and took great care of me on a daily basis. She did the cooking, using cancer recipes, and worried about my diet. A lot of people offered to come over, but I had so much to take care of, and doctor appointments and testing kept me busy. Post-surgery, the cantor and my best buddy from choir were around a lot, and people checked up on me via email. My male ego liked all of the attention. The male ego never ends, it dies when you die.
Low Level Anxiety
I think I am done; the denial helps keep the worry away, but due to my BRCA-2 status I sometimes worry about having an unrelated cancer or this cancer coming back without symptoms. Pancreatic cancer can be a very fast killer, so that fear is still there, but it’s not in my conscious mind 24/7and not paralyzing. I should probably deal with the fear directly, but I feel like I am done.
There’s no clear trigger to this anxiety, but I suspect that fear is the root of my irritability. I think: I’m not ready to give up, I’m from a family whose members have lived comfortably into their mid-80s or longer, so why should I quit now? I should have 20–30 years left, but that’s not so certain now.
Recently, I’ve been preparing for a professional symposium, and was asked to write a paper for a client; I’m thinking about getting more active in soliciting clients; I see myself working into my 70s, for the joy of the experience…and a little bit about the economics.
Grateful to Be Alive
My resilience, both emotional and physical, has surprised me. I never thought I would be this strong. Rather, I thought I would go to pieces with anxiety ruling every moment. But my family is much more openly anxious than I am. They were far more worried than I allowed myself to feel. I have a good attitude about life and have always rolled with the punches, but it was a surprise to me how well I handled things. Part of it is just being so grateful to be alive, especially after having seen my father die. I’m struck every day with gratitude; I had a lot of that gratitude before, but now it’s more pronounced.
As a Postscript Alan adds:
In early September, imaging and blood work revealed a “local recurrence” somewhere in my abdomen. I finished 28 daily radiation treatments in November and my prognosis has changed to “treatable, not curable.” My intense desire to keep fighting, and my other resources are keeping me in good spirits. Even though the statistics are pessimistic about remaining lifespan (less than 5 years), I know that estimate is based on historic data, not currently diagnosed patients receiving modern immunotherapies. I continue to believe the statistics don’t apply to me. Denial?