Be aware: deadline ahead.

The doctors that I saw in Fall 2021 were pretty clear: pancreatic cancer is deadly. Two different oncologists explained that without surgery, the outlook for this cancer is usually less than a year. In my experience, most doctors aren’t so forthcoming with prognostic pronouncements, but the research seems consistent. Information extracted from the clinical trial consent form listed two other parameters. One criterion for participating in the trial is that the “patient must have a life expectancy of >= 3 months.” ✔ Check. I’m not quite sure when my countdown timer started, but it’s been over three months since diagnosis. An outcome measure listed is Overall Survival (OS); that time frame is 2 years. So, the likelihood is that the time remaining I’m looking at something less than 2 years (a range that doesn’t take into account how I’ll feel during that time — the difference between vital signs, routinely tracked by medical personnel, and vitality signs, an individual, qualitative measure).

Most humans realize that bodies are subject to biological obsolescence. We may have expectations for how long we’ll live, but we’re vulnerable to accidents or illnesses. In the US, life expectancy is approximately 79 years, a number that has declined during Covid. (Those interested in a more specific figure can use the Social Security Administration’s Life Expectancy calculator.) As I was registering for Medicare, I discovered that Social Security has an initiative designed to expedite the processing of new disability claims. Under Compassionate Allowances, certain presumptive conditions qualify for disability as soon as the diagnosis is confirmed. The examples included acute leukemia, Lou Gehrig’s disease (ALS), and pancreatic cancer. Yet another indicator that time is precious… 

While it’s good to remember that we’re individuals, not statistics, it’s simple math to know every day we’re closer to the end. Things will fall apart. Most of us just don’t know when, where, or how. Knowing how much time we have remaining can rattle the psyche or jolt you into working on your bucket list.

I’ve always thought that end-of-life (EOL) is like an open-book test. We know the questions we’ll be asked ahead of time. We can use whatever resource materials we want. The only tricky thing – the date. We don’t know when we’ll sit the exam. But the EOL test isn’t multiple choice about varying amounts of time. It’s more about the essay questions: Who matters most? What matters most? What will my legacy be? But, because of fear, denial, or procrastination, we don’t ask about what’s ahead, until we’re in an ER or getting admitted to an ICU, when the focus is more about next steps rather than big picture.

When I was researching my thesis and analyzing the statistics, I realized that forecasting the future is like spinning a wheel of fortune. It’s not like roulette where a ball stops in one discrete slot with limited possible outcomes. With diseases and deaths at age 65+, there are also finite selections. But, a person can start with cancer, but succumb to an infection, stroke, or heart attack. Oh, my!

With no family history of cancer, I didn’t expect my ball to land where it did. Luck of the draw. But, barring a miracle, it’s likely this will eventually kill me. Usually, based on personal habits, family history, and an individual’s health weak link, the process isn’t completely random. But ultimately, failure of vital organs—heart, lungs, and/or brain—results in death. Among Americans over the age of sixty-five, more than a third (34%) will die from heart ailments while another 28% succumb to cancer and its side-effects. Six chronic diseases (congestive heart failure 34%, cancer 28%, chronic obstructive pulmonary disease 9%, stroke 8%, dementia 6%, and diabetes 4%) account for around 90 percent of the deaths for this age cohort. There is usually no single cause for death. For example, obesity can cause multiple, serious health complications such as heart disease, diabetes, and/or cancer. In a New Yorker article, Dr. Atul Gawande explained: “As the defects in a complex system increase, the time comes when just one more defect is enough to impair the whole.”^[1]

The writing is not on the walls, but appears in written form or sometimes spoken words. It’s a numbers game based on bi-weekly labs, bi-monthly scans, and oncologists’ predictions. Is the tumor growing or shrinking? Will I become eligible for surgery? How long do I have? My bottom line is clear — No time to waste.

© Joan S Grey, 26 JAN 2022 ∞
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^[1] http://www.newyorker.com/magazine/2007/04/30/the-way-we-age-now