I remember leaving the doctor's office. It was 2:14 pm. I don't know why that sticks in my mind. But for some insane reason I looked at my watch as we reached the van and I stopped, as always so that Richard could open my car door, and it was 2;14 pm and for some reason that hardwired in my brain. I thought to offer to drive and immediately realized that such an offer would be wrong on at least three different levels.
There was a long pause between the snap of two seat belts being securely fastened and the start of the engine. A long silent pause. There were no words for that patch of time. Somehow I knew that we were both trying to comprehend, digest and … breathe. I was thinking of him, knowing he was thinking of me
I was searching desperately for words that would comfort, and there were none. I'm Irish, so if there are words to be had, I WILL find them. Something in my heart knew that his first thoughts were of us as well. “How will we get through this, what will happen to her, this will be so very hard for her.”
I don't know what to say.

It would not be a long drive from the doctor's office back to home—fifteen minutes max. When the engine started I felt light-headed, and when the vehicle began to move I felt the sensation of entering a tight, glass tunnel. Like a transparent vacuum tube that was pulling me to my destination, and at the same time I was looking out the window at the end of winter, and the trees, the trees, the trees.... the sap must be rising, and what did that feel like for the trees? And holy shit I'm losing my mind. We reached for each others hand at the same moment, which was normal for us.

My first thought when we got home was that I had to call work and let them know I wouldn't be back in that day. I had worked through lunch so I could leave for this appointment—something I had never done before. I called the direct line of a co-worker, and when she answered I said in a clear voice “Katie, it's me. I'm not going to make it back there this afternoon.” She asked if everything was okay. I said “Rich has stage four pancreatic cancer.” I heard her gasp. I heard her say “oh my god”. It was like someone pulling the blanket away while sticking a pin in a balloon. I was instantly awake, alert and this was my new reality.

Next I called the surgeon who had removed the 22 lb tumor from my brother's abdomen the year before. “We just left the doctor's office,” I'm explaining to the pleasant woman on the phone, “and he has stage four pancreatic cancer and the doctor said we have to have a surgical consult before we can proceed...” We were given an appointment for the following morning. Wow... pancreatic cancer kicks ass. We were less than an hour into this and I had accomplished something. Rich was standing on the back patio looking out over our beautiful garden when I got off the phone. It was hard to know what to say to him. We stood there together, wrapped in each other's arms looking out at the end of winter and beginning of spring. The daffodils were barely up.
“Who's going to take care of my garden?” was all he said.

The next morning we saw the surgeon. Fifteen minutes that accomplished nothing other than providing an opportunity to bill the insurance company. How long does it take to explain it's inoperable? Eighty-five dollars. I felt we had just purchased a ticket for two to the Cancer Carnival. Little did I know how right I was.

It took me less than fifteen minutes to choose an oncologist. It helps to know people who know people. Less than 48 hours from diagnosis we were sitting in a small room filled with a round table and four chairs. We were sitting across from Dr McGee and he was explaining what we were facing as near as he could tell at this point. He was speaking in large, open statements like he knew exactly where Rich and I were mentally and emotionally; aware that details were more than we could digest.

There was a box of tissues on the table. I felt they had been strategically placed for me, like there was a note on the bottom of the test results “have tissues ready, spouse is a weeper.” Or as my father would say, “she's not a Cryer, but her eyes sure do leak”.

The diagnostic powers of CATscans are limited so the next step would be a liver biopsy. He was admitted immediately. They had to give him three bags of plasma and Vitamin K injections because he'd been on coumadin for atrial fibrillation, and because his liver was not functioning at full capacity, his INR was way too high—16.8. (therapeutic is 2.0 to 4.0)

They do his biopsy and that was a level of pain I've never witnessed before. They don't have pain meds in radiology so it was a really long commute from Floor one to his room on the fifth floor. After two pushes of morphine he's still delirious with pain, but 4 mg of dilaudid flick a switch and he's in fifth grade again and telling me about every single student in his class...name, address and general point of interest. CAT scan shows the liver hemorrhaged into the membrane surrounding the liver, hence the pain. He has the ghost of a mottled bruise on his right side.

The next day he's discharged. We wait for results. The results come back but they don't make any sense—not a direct quote, I'm paraphrasing. He comes home March 14th and on March 16th I'm calling Dr McGee because Rich is having difficulty eating due to pressure in his abdomen, his skin is itching terribly, he appears almost imperceptibly swollen and his skin is yellowing before my eyes like a ripening pumpkin. They direct us back to ER.

The difference between ER and a really exclusive nightclub is that ER has to let everyone in. Once admitted, however, ER is exactly like an exclusive night club—your treatment is directly related to the names you can drop. If you say “Dr McGee” and “pancreatic cancer” you are on the fast track to IV fluids, all the pain meds you desire, and not too long a wait for admission to a bed.
A GI doctor is called in and he places a stent in the common bile duct, which has been surrounded and squeezed by the main tumor in the pancreas. The stent will allow bile to flow from the gall bladder, and within 24 hours there is amazing improvement overall. But they still can't tell us what they're dealing with. More tests. I begin to suspect that tests are the crack cocaine of the medical profession.

So they run the tests, mostly the same tests again because they couldn't conclude anything from the first round of tests. Because the second round of tests are the same as the first, the results are also the same so imagine my surprise at their surprise that we still don't know what we're dealing with...exactly. So they add some new tests; a 24 hour urine test. And those results come back, and more results come back, and eventually we learn that this is not the typical Stage Four Pancreatic Cancer. This is neuroendocrine cancer. Somehow I sense that this is good news, but NO one is going to endanger their malpractice premiums by offering any measure of Hope. Upon my own research I learn that in the world of cancers, neuroendocrine is the hybrid of a Fox and an Owl. When was the last time you saw a fox or an owl in the wild, or even as road kill? See what I mean?

On the positive side, and I am always looking for the positive side... this is really, truly, fucking with their heads. It is the small measure of enjoyment I find for reasons I will explain later. Richard has now been asked 103 times if he is having any pain. Anywhere. 103 times he tells them “nope. No pain.” (With the exception of having his liver roto-rooted by a 16 gauge needle.) He has been grilled repeatedly on symptoms. No symptoms. We are both becoming weary of recounting the events that brought us to the doorstep of Western Medicine. Routine cholesterol check,→ elevated liver enzymes→ abdominal CAT scan→ diagnosis→ skin itching→abdominal bloating, In That Order, and here we are. It has become a mantra.

We go home. On March 30th he has an appointment with another surgeon. On April 6th they do another liver biopsy just in case the first two liver biopsies were …. wrong? Another opportunity to put the man through hell to obtain more cells from the SAME damn tumors? Lord, please don't let this be about BMW payments.

On May 6th they attempt a whipple. Rich is positive and amazingly hopeful of the outcome. Dr A prepares us for the procedure. If he can do what he hopes it will take 10-12 hours. If not, he'll be out in less than four hours. I sit in the surgical waiting area and knit. When my restaurant-style buzzer goes off in my lap I know it's way too soon and I try not to cry. Dr A takes us into a little room...the same little room they took us into after my brother's 22 lb tumor removal. Dr A explains the results. He was not able to dissect any of the tumor in the pancreas because it was intertwined with the main artery and vein, and he couldn't address the two in the liver because there were little tumors EVERYWHERE. He resected the common bile duct outside of the pancreas and closed him up. All I could think of is “how am I going to tell Rich?” Dr A assured me that as soon as Rich woke up he would know without being told.

He was in a regular room and I was with him when he woke up. The first thing he said to me was “they weren't able to get it, were they.” Thirty minutes later I am flirting with jail time...