Guest Post: A List Of To-Do’s from a Pancreatic Cancer Patient

My life has had to turn on a dime. A bellyache led to a CT scan, the results of which sent me to upper GI specialists, who got me if for an MRI, that lead to a biopsy and pancreatic stent. The diagnosis: pancreatic cancer, albeit of a type less deadly than other varieties.

Surgery is scheduled for the end of the month, a six to eight hour affair where they will be performing a “Whipple procedure.” I’ve drawn a very skilled surgeon—and have access to resources able to confirm his batting average of 800 of these procedures with five deaths on the table—but still found myself having a month to confront my mortality or possible long term disability, all while devising an overall battle plan. What follows are some of the elements I’ve been sorting through while contending with the variables in a narrow time frame. Hopefully these musing will inspire others to confront the inevitable in a less compressed time-frame than I’m facing:

• Outlook. Stoicism has emerged as the only sensible philosophical framework from which to view the current lift. Folks like the proprietor of this page and others in my hit/grapple/stab/shoot circles have already launched me on that path, and indeed I seem to have naturally embraced that outlook, but find myself being much more intentional in my embrace of stoicism now that death or protracted recovery loom. I’ve a wife and adult kids that would be served poorly were I to wig out, launch a pity party, or otherwise fall apart. I’ll be damned if I’ll do so, particularly should I be headed out the door and hence am being as dispassionate as I’m able to. There are lapses—it was hard sitting down with my family and communicating my end of life desires should things go sideways or I end up in a drooling state among other outcome planning—but embrace of the most dispassionate affect I can muster has emerged as the only sensible choice.
• Estate planning. Folks, do it now so you don’t have to jam it all into a month. There are a lot of lists of what all needs doing, such as this one: https://www.legalzoom.com/articles/estate-planning-checklist In my instance a trust makes sense for various reasons and so is another element I’m seeking to set up on the fly. A will is something else I’m knocking out. I’ve a lot of knives and firearms of intermediate to somewhat high value, for instance, I need a plan for. Coming up with a way of dealing with items only I know the history of quickly is less than optimum. I imagine my wife opening the toolboxes I store my blades in and trying to figure out their value and where to sell them; someone could easily take advantage of her. Bottom line, think about this stuff now so that you too don’t have to sort it out within a 30 day window.
• Disability. Should my recovery prove protracted how can I best prepare for it now? I’m fortunate in a lot of ways, particularly as I’m a state college employee with a ton of medical and other leave banked, as well as long term disability insurance. However, before the latter can kick in I have to be on a non-paid status for 60 days. Don’t know about you, but not getting a paycheck for two months kinda gums up the ol’ cashflow. Again, I’m lucky as I have a couple options I can exercise to bridge things with some ill effects, but it’s a lot to game out in 30 days. What’s your plan if you find yourself unable to work for a couple months, and what can you do now to deal with the possibility? Note also the deck is stacked as, in a lot of ways, it’d be easier on my family were I to die then end up disabled. Readying yourself to confront those sorts of perverse incentives would be easier, I imagine, in a less compressed framework. 
• Debt. I’ve more than enough life insurance to cover outstanding debt including mortgage et al should I die, though a long term disability scenario is far less debt friendly. I got a degree later in life, but my remaining student loans are tied to me and any assets I drop in the trust ought to be out of reach there, meaning that won’t land on my wife. I cop to an impulsive nature—ooh, check out that fine looking blade—and have been working for a bit to pay down stabby shooty stuff, particularly items purchased when I assumed an anti-gun presidential candidate would win. Still, I’ll leave behind some issues for my wife to contend with should I die or become disabled and regret that I might be handing that stuff off to others to sort through.
• Pain management I. Don’t care how stoic you are, having what feels like a couple small rodents wrestling in and gnawing on your innards makes sleep elusive and me cranky. The latest bit of War on Drugs folly (and I challenge any Drug Warrior out there to name a single criteria by which the WOD can be measured a success) involves making it difficult for folks to easily obtain effective pain relief. Doctors are hesitant to risk federal or state entanglements by prescribing effective pain relief, meaning opioids, while my experience suggests that seeking out pain specialists is most likely to bear fruit, albeit with a lot of hoops to jump through. For instance as I understand it opioid prescriptions must be hard copies dropped off and picked up by the person the medicine is prescribed for, a task that will likely prove a, ah, pain once I’m released from the hospital and hobbling about. Speaking with your doctors about pain management in advance of need is likely a smart move, and finding one with some pain management stones will likely serve you well should you find yourself facing protracted pain.
• Pain management II. Before my pancreatic stent went in its main duct was likely occluded, which turned me what my daughter described as “highlighter yellow,” while sapping my energy and causing a good deal of pain. My martial pursuits used to leave me eating NSAIDs by the fistful until kidney function was impacted, leaving them off the table. As such while I waited for the stent to go in and then take effect I cast about for effective pain relief, with a friend donating some CBD oil from a jurisdiction with liberal THC rules to the cause. It worked, but I noted psychoactive effects. Meanwhile pain management specialists contend with federal and state opioid entanglements by demonstrating due diligence via tinkle tests, ones that THC could gum up, particularly as the data sharing emerging as part of Obamacare leaves open to question what all the feds et al can see where medical records are concerned. Another consideration with few winning options to consider when confronting a sudden acute illness, particularly one known for being painful.
• Religion. A drunk and abusive father and schizophrenic mother with MS left me little scent any benevolent deities while growing up. Moreover, nasty pieces of work my siblings and I dubbed “church ladies” regularly took us to task for failing to emulate a 50’s nuclear family and guising all the dysfunction we found ourselves immersed in, further driving me away from lairs of self righteous nitwits found at church. Alas, as word of my diagnosis has spread A LOT of well meaning folks offering prayer and other religious counsel have emerged. Perhaps I’ve mellowed in my old age, or maybe I’m not arrogant enough to pretend I know how metaphysical wheels spin, but I’ve been unable to tell these folks to pound sand. I’ll be damned if I’ll mutter under my breath asking for supernatural intervention by anything actually heeding those sorts of petitions, though I have asked a time or two that any comfort that can be provided my loved ones please flow their way, and would count myself as a major hypocrite if these circumstances drove me into thumping the bible or whatever. I mention this because a major health issue will bring all flavors of religion your way as word spreads across your social circles. Whether you are a believer or figure as I do this stuff either won’t matter or will reveal itself after the lights go out, understand matters of faith come at you from all sides should a serious health issue comes your way.

Those are the big things that have jumped out since my diagnosis. Doubtless there are other considerations that have yet to either emerge or register among all the that needs attention. And hey, though my DX, disease, and to do list are all daunting, I’m far more fortunate than many slapped by similar circumstances. I’ve a lawyer sister willing to jump in where legal needs are concerned; health policy experts in the family that have helped me sort through myriad choices and considerations in short order with a focus on optimized outcomes; a decent boss willing to cut all sorts of slack; coworkers in key positions willing to help me sort through HR requirements, benefit permutations, and other complicated matters; resources enough that I’m not forced to embrace lowest rent options; and a loving family able to endure straight talk and willing to schlepp me around when it’s a bad idea to try to do so by myself. I am both blessed and fucked. Within that crucible we’ll see what cooks up.