Coping With Cancer: Note From Dr. Abrams

Ross Abrams, MD, a radiation oncologist at Rush University Medical Center in Chicago, Illinois

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. Continue reading

Coping With Cancer: Eulogy for W. Nathan Nyman

By Linnea Nyman Curington
Read at the funeral by Nate’s four sons

Youth

Willard Nathan Nyman, who we have always called Papa, was born in Galesburg, Illinois, on August 18, 1945, to Willard and Lois Nyman. Four years later his brother Kenneth entered the family. Their father, a jewelry store owner, and mother, an elementary school teacher, instilled in their boys a strong work ethic and taught them the value of education. Papa loved being a student. In high school he was captain of the debate team and editor of the school newspaper.

From there he went on to Northwestern University, majoring in history with a minor in Russian, graduating in 1967. But Papa didn’t just get his degree. The things he learned became part of his identity. He was called by many friends a “walking encyclopedia,” able to recite historical dates and facts quickly off the top of his head. As for his Russian, he continued to practice the language, going through flashcards in his spare time and often announcing at the dinner table the Russian word for “peas” and “chicken” and anything else on the family menu that night.

Education and Career

After earning his undergraduate degree, my dad entered law school at the University of Illinois. The Vietnam War held America’s attention at that point, and Papa joined the military ROTC, entering officer’s candidate school as well. He also served in the active Army Reserve for eight years.

After graduating from the U of I in 1972, Papa began his career in the trust department at a Chicago bank before moving into a law practice with several other lawyers. He went on to develop his own law firm, which evolved into a real estate investment firm. For the past twenty years, my dad practiced law independently in the Loop, working alongside his brother-in-law Tom and a group of lawyers he came to know and love. He also served as a Police Commissioner in Prospect Heights from 1988 to 2009.

Marriage

Papa loved to work, but his life was so much more than that. He was forever changed the day he met Margaret Johnson during his senior year at Northwestern. From their first meeting (on a blind date!), he knew she was the one he wanted for his wife. They were married at Moody Church on November 29, 1969, and for the rest of his life our dad was devoted to his Margaret, our mom. Over the years he brought her countless bouquets of flowers, and it was a Nyman family joke that when it was time to buy something for her, he would do it in multiples. Whether it was a camera for Christmas or birthday jewelry, Papa would always give my mom at least two versions. Even when it came to milk from the grocery store, a request for one gallon always meant Papa would arrive home with two or three. He loved providing for her and taught by example that a husband should treasure his wife. Continue reading

Coping With Cancer: The Funeral

By Margaret Nyman

November 8, 2009

What makes a perfect funeral? Strong attendance, beautiful weather, meaningful music, a powerful program, an abundance of flowers and good food. Today we had every bit of that.

As with any pre-planned event, there were moments of quiet drama leading up to it. For example, Louisa struggled to find something of her dad’s she could wear or display throughout the day as a testimony of her love for him. We didn’t accomplish that, much to her frustration.

As people entered the room at the funeral home, they could track Nate’s life on 14 poster boards full of photographs, arranged in chronological order. All of us were greeted with the scent of many flowers, and sunshine streamed through the windows. Crowds began arriving well before the start of the service, and at the stroke of noon, music filled the large room.

Family members sat in the first several rows of seats, and I took one last look toward the back of the room just before we sat down. It was standing room only with extra chairs in the hallway, and as we began the service, folks were still arriving. Later they told us nearly 300 people had attended.

As the service started, all seven children plus our two children-in-law stood side-by-side facing the audience. Adam prayed, and the four girls welcomed everyone with thank yous for the unending loving care so many had shown us during the last whirlwind weeks. Then the four boys read the eulogy, written by our daughter Linnea. Several had difficulty but all pushed through their readings with courage. Nate would have loved it. Continue reading

Coping With Cancer: The Wake

By Margaret Nyman

November 7, 2009

Walking into a funeral home is never easy. Walking into one with your husband in the casket is excruciating. Although Nate always said I would one day bury him rather than him burying me, the picture of that never formed in my mind’s eye. Today I saw what that looked like and felt the pain of it.

After driving the 90 minutes from Michigan, several of us entered the room together. Not wanting to arrive at the front too soon, we lingered to read the cards attached to beautiful floral arrangements. Waiting for us at the end of that line was the casket with Nate lying in it, cold as ice and still as stone. As we approached, I could feel myself getting nervous, shaking as if a shaft of cold air had whooshed into the room.

I remember seeing my dad in his casket, looking as if he was taking a nap. Mom looked natural, too, outfitted in a silk dress like she was on her way to a party. Today Nate didn’t look good. Although I’ve always thought he was handsome, today he looked worn, like a warrior who’d fought a battle and lost. And of course he had. The angle of his chin and set of his mouth made him look like somebody else. Only by standing to the side and looking from the top of his head did he resemble my Nate.

But what did I expect? The cancer had eaten him up, and he hadn’t looked good for several weeks. How would dying of a ravenous disease and being placed in a casket ever improve his appearance? Even so, something in me wanted him to look handsome for his public. Continue reading

Coping With Cancer: Mom Was Right

By Margaret Nyman

November 6, 2009

Years ago, when Nate and I were in our 20s, we were invited to a slew of weddings back-to-back. For a couple of months straight we were attending a wedding every weekend. I complained to Mom at the time, saying, “I’m constantly shopping for wedding gifts, and it’s expensive. Besides, we’re so busy, we’re neglecting our weekend work around the house.”

Mom answered in a strange way. “Weddings are happy. Just wait till your calendar is full of funerals.”

Tomorrow we attend the wake planned in Nate’s honor. The next day is his funeral, and we haven’t been to a wedding in quite a while. Mom was right. These occasions aren’t happy.

The girls and I shopped for clothes today, having nothing appropriate for the wake and funeral of our husband/father. Shopping for clothes is usually fun, but this time the fun had been sucked out of it like air from a balloon. The guidelines for what to buy were based on the sad realities of a family in mourning. We tried on dark colors, mostly black, and fought sadness even in the dressing rooms. None of us are “happy” with our purchases.

Each of us has been peppered by thoughts of Nate being in the next room or on his way home. Even as I tried on my black dress I thought, “Nate will like this when he sees it.” That’s probably the hardest part of beginning the mourning process. The reality of his absence takes time to sink in. One minute we know it, and the next we’ve forgotten. Each disappointing “oh … that’s right … he’s gone” is a sledgehammer to the heart. Continue reading

Coping With Cancer: Counting Blessings

By Margaret Nyman

November 5, 2009

Our first day without Nate has been jam-packed with wake and funeral preparations, trips to the cemetery and funeral home, eulogy writing, and shopping for proper funeral clothes. All of it reminds us that Nate’s death is the only reason for today’s checklist.

The low point of the day was when Van’s Medical Supply arrived to pick up the hospital bed and related equipment. As the man stepped into our front door he looked me in the eye and said, “I’m so sorry for your loss.”

I started to tear up and said, “It seems like you just brought the bed in.”

He looked at the ground and quietly said, “It went so fast for you.”

Watching him break apart the sturdy automatic bed was a symbol of my breaking heart. I could hardly stand it. Last night after everyone was finally in bed, at 4:45 a.m., I was longing to get my pajamas on and go to sleep but was drawn to the little room where Nate died. The hospital bed was still set up then, although the sheets had gone out the door wrapped around Nate. I climbed onto the bed with my face in his pillows and cried and cried. The plugged-in mattress gently rose and fell as it had when Nate had been lying on it, coming to life with the weight of my body. Oh how I missed Nate, even the Nate in the hospital bed.

As long as he’d been alive, even if breathing ever so slightly, I still had my husband. I was still a married woman. We were still a team, working together to keep him alive. Now he was gone, and his absence was completely final for the rest of my life. I began to understand why people can make decisions to keep their debilitated loved ones on life support, even though brain-dead. A person can still hug, kiss and hold a warm, living body. Caressing the dead is unthinkable. Continue reading

Coping With Cancer: Precious in God’s Sight

By Margaret Nyman

November 3, 2009

Today was a holy day as Nate stepped out of this world and into the next. The members of our family (as well as Mary and several hospice staff) had kept a vigil around his bed for three days, not leaving him alone for one minute. Pancreatic cancer is one of the most painful cancers that exists, but the nurses had taught us how to manage his pain with helpful drugs. We learned to read Nate’s body language carefully, even while he was unconscious, watching for signs of discomfort and anguish. If he paddled his feet, pinched his shoulders together, furrowed his brow or shifted in his sleep we knew he was struggling and needed help.

Yesterday morning Nate hit a new low. He was in tremendous pain, which yanked the rest of us into it with him. A nurse guided us by phone on how to escalate the meds, finally arriving in person to help us. Nothing we did seemed to settle him. The combination of drugs had gotten complicated, and we were keeping a desktop record of what we gave him, when we did it and a schedule of next doses, but even with that it was becoming more and more difficult to keep everything straight. When the drugs weren’t “getting” his pain, we were devastated.

Hospice offered to send a nurse who would stay with us through the evening and overnight. Her main function would be to manage the complicated medicine, although she would also be there to help if he passed away on her watch. We gratefully agreed.

By 5 p.m. yesterday, Nate’s pain began to subside. The added pain patches wouldn’t kick in until morning, but the increased morphine worked its magic, and he began to settle. We learned later that the orange-sized tumor in his lung had ruptured during this time, causing tremendous pain he could not tell us about in words. Later that evening fresh blood would flow from his nose, and brown fluid would spill from his mouth. Both seemed mysterious at the time, but later the puzzle pieces fit together, when the rupture was identified. From that point on, he was breathing with one lung.

Tears, love and gratitude

Nate could no longer talk to us with his voice but spoke volumes with small facial expressions we carefully looked for. All 11 of us squeezed around the bed in his tiny room once again to express love, each one taking a turn with their father/father-in-law. Tears flowed and great things were accomplished. Gratitude poured from the hearts and mouths of each person. I, too, spoke love and thanks to Nate. We repeated Scripture to him, sure of his hearing. Mary and I sang all three verses of his favorite hymn: “Blessed Assurance.”

Nurse Sonia arrived at 6 p.m. and made an assessment of his condition, concluding he probably wouldn’t live till midnight. We braced ourselves and spent every minute with him. His makeshift bedroom was filled: the hospital bed, the big oxygen-making machine, extra oxygen tanks, a desk covered with medical supplies and as many chairs and stools as could be wedged around the bed.

At about 10 p.m. it looked like he was slipping away. His breathing became more shallow with long pauses between breaths. He was in a deep unconscious state but was, at long last, resting without any signs of pain or even discomfort. His hand was relaxed as I held it. I sat on the edge of the bed and put his warm hand on my knee, a gesture very familiar to both of us. For a flash it was just like old times, before pancreatic cancer.

I began singing quietly again, and Mary joined in. Nate, a non-musical person (except for Elvis Presley songs), had often mentioned his favorite hymns: “Blessed Assurance”, “Fairest Lord Jesus” and “A Mighty Fortress”. We sang them all, and gradually each of the kids drifted back into the room, lit by a dim green lamp. Some of us were softly crying. We quoted Nate’s favorite Scripture passage, Hebrews 12:1-3, about running life’s race. I told him, nose to nose, that his race was almost over, and he was close to the finish line. He was worn out and would soon be able to rest. We told him how proud we were of him in his strong perseverance.

‘No more pain’

Despite the click-click of an oxygen machine, the little room became a sanctuary of worship. We lovingly spoke to him, caressed him, loved him. I talked right into his ear and said, “The Bible tells us an angel will escort you to Jesus. Do you see the angel yet? It’s time to stop running the race. Just walk right into heaven. No more pain. No more work pressures. No more trouble. You can leave us any time now. You’re ready to go, and we are ready to let you go.”

These words were difficult to say, but God kept my voice strong despite tears plopping on Nate’s t-shirt. The kids moved forward and said more nourishing things to their dad. Many of them broke into spontaneous prayer. The Holy Spirit was hovering over our little group, working his wonders in every heart and mind. Continue reading