Guest contributor Margaret Nyman chronicled the 42 days after her husband Nate was diagnosed with pancreatic cancer. This post is from Ross Abrams, MD, a radiation oncologist who treated Nate at Rush University Medical Center.
By Ross Abrams, MD
Over my 37 years as a physician, I have mostly done academic clinical oncology. Sometimes this was medical oncology and hematology, either clinical, clinically focused lab based research, or a combination of both. Later, this was radiation oncology and clinical research related to my patient care and that of my colleagues. The decision to specialize in oncology was driven by observing my mentors when I was a medical student and early resident, by the challenges and opportunities posed by trying to help manage patients with malignant disease, by the excitement of new advances as I was finishing medical school and beginning training, by my mother undergoing surgery for breast cancer and receiving chemotherapy in an early trial of adjuvant chemotherapy shortly after I graduated from medical school, and by the training opportunities available.
However, at the core of all of this, what consistently kept me centered was the human connection. My internal definition of “being a doctor” required being regularly involved in caring for other human beings. When I didn’t have this, there were times when it was “ok.” Particularly in the beginning, when I was immersed intensely in my lab work — trying to get started, develop techniques, prove myself and get results. However, over time, it became clear that being exclusively in the lab was not my calling. Later, I felt I had to choose between one or the other, as doing both at the level of excellence I expected was, for me, too demanding. I chose patient care and left the lab behind.
In the early 1990s, my clinical practice became focused on the nonsurgical care of pancreatic cancer. This assignment found me — almost accidentally, from my perspective. It was a function of the institution where I worked, programmatic needs, and no one else to do the task. This was a hard assignment for lots of reasons, and I had to grow into it. I would say it took me about five or six years before I began to feel truly comfortable in this new role.
When I met you, your husband, and other members of your family at the end of September 2009, it quickly became clear that none of you, as of yet, quite understood what was likely happening. There was a huge disconnect between how “bad” Mr. Nyman’s images appeared and how well Mr. Nyman was feeling and looked that day.
As a physician, I never presume that I really know what will happen to any of my patients. However, I do know what is likely. That doesn’t mean it will necessarily happen, but it does mean that, to the extent possible, I try to avoid letting my patients and their families be “blindsided” by what I think might be coming, especially if it looks like it might be very bad and distressing.
Since I don’t really know what will happen, I can’t and don’t say too much, but I try to provide sufficient “just in case” interventions to be prudent and helpful. My fear was that your husband, and therefore all of you to some extent, were about to fall off the edge of a clinical cliff called “dying from metastatic, pancreatic cancer.” I couldn’t stop the fall, although I wished that the means to do that was available, but I could do some things to try to cushion the fall a little, just in case. So, I did. Unfortunately, it was only a few days later when my fears for your husband and family began to be confirmed all too clearly.
Your husband’s brief period of radiotherapy was a time of medically necessary intervention and also provided “safe haven” during which you and he could learn what was happening, process this most unwelcome reality, and decide how to proceed. These are among the most challenging of times for any person and family. For some patients and families these challenges lead to a place of coming together, intensified love and spiritual enrichment, in addition to severe emotional pain and wrenching loss.
From talking with you since your husband’s death, it seems this growth has happened in your family. You and they came to this unwelcome time and task with intellectual strength, love for each other, psychological determination and spiritual preparation. It wasn’t easy; it’s still not easy. But, you all gained and grew. As much as you lost? Who am I to say? I think that’s the wrong question, really. You lost husband and father; companion, teacher and guide. How does one even measure that loss, much less replace it?
I think the concept is that even given what you lost and lost so irreplaceably, the experience was not exclusively about loss and pain. In fact, I think this is the underlying message of what you write and post. Life can go on: painfully, differently and with adjustment; but also with increased spiritual connection, strengthened family love, and a desire to both grow one’s humanity and share the power of that growth. This is a powerful message for all of us. It’s a message we want and need. It’s not guaranteed, only possible.
My thanks to you, your family, and your departed husband for providing, and modeling, this important message and lesson.