Dammit Janet

There is cancer.  And then there is CANCER.  The first refers to the ones we discover early, excise completely and move on—a tiny rent in the whole fabric of a life, easily mended or patched but never quite forgotten.  But the second, CANCER in capital letters—these are the ones that can never be discovered early enough, the ones that cause gaping holes in the hulls of unsinkable ships and the whole ocean falls in after the vessel goes under.  This kind kills, and kills so quickly that there are very few survivors left to mount the political assault necessary to raise millions for research and a cure.  These are the cancers that have no armies in pink T shirts walking or running for the Holy Grail.  Highest on my list of evil enemies these days is cancer of the pancreas.

In the early spring of 2011, my friend Janet Porter, President of the Scottish Deerhound Club of America, developed abdominal pain that she initially thought was gallstones or an upset stomach from food poisoning.  Her discomfort progressed rapidly and then, almost overnight she became jaundiced, with a yellow cast to the whites of her eyes, tea colored urine and light colored stools, because the blocked bile duct at the head of the pancreas cannot empty into the duodenum as usual, and the bile backs up into the blood stream and leaches into the skin.  She was diagnosed quickly, worked up well, and pronounced a good candidate for a Whipple procedure, one of the most difficult operations that a skilled surgeon can perform, involving removal of most of the pancreas, gall bladder and common bile duct with considerable rearrangement of the indoor plumbing. Janet was “lucky”.  Most patients diagnosed with cancer of the pancreas are inoperable and incurable from the minute they are diagnosed.  Janet was a smart cheerful optimistic person.  She underwent this difficult surgery, and then took months of chemotherapy and radiation, finishing late in 2011.  In the spring of 2012, she was able to attend the National Scottish Deerhound Specialty show which was held in Michigan. A week later she was told that the cancer had recurred in her liver and despite additional treatment she passed away on August 20.  She was 59 years old—we were born the same year. From the time she was diagnosed she lived every minute to the fullest—she saw her family, took care of her friends, and when it became clear that she was not going to survive she did what every good dog person does—she found homes for her beloved hounds.  I wrote something on the Deerhound List to try to describe her courage, and people liked what I wrote, but all I could think of, quite inappropriately, was title of that old song from The Rocky Horror Picture Show where Brad sings to Janet, in front of a cemetery—“Dammit Janet”.

Today in clinic I saw another patient with pancreatic cancer—this time a lovely woman who is 87 years old.  One of the best surgeons in the country had deemed her operable when she was diagnosed in May, but she hesitated, knowing that complications from such radical surgery could abruptly end her life, or at the least, affect the quality of her remaining days.  She was started on chemotherapy and did well initially, at least well enough to be considered for definitive radiation therapy, which is used when surgery is not desired or possible. Last week, a scan done for treatment planning showed that, like my friend Janet, the cancer had already spread to her liver.  Today I explained to her and five of her visibly distraught middle aged children that there would be no point to pursuing radiation therapy to the pancreas.  I said it would be like closing the barn door after the horse had gone.

Is an 87 year old dying of cancer less sad than a 59 year old?  How do you compare the life well lived for all those years which should have ended quietly, rewarded with a peaceful passing with the life that ended early, devastating friends and family?  Sitting in my exam room with that family today, I certainly could not say.  But tonight I am still thinking, damn it.  Janet.

11 thoughts on “Dammit Janet

  1. Okay so now you have me crying dammit. We loved Janet. She totally lived her life without abandon (I suppose we all should all the time) in the last 1 plus years she was granted and was an incredibly responsible breeder. Cancer sucks but I agree this cancer sucks. There is a certain level of tragedy when someone young dies although I think Cancer is a tragedy at any age, especially when one has vigour and life force which are so ruthlessly taken away from them. Knowing ‘when’ and ‘how’ (using those terms loosely) is the tough part – going in a heap isn’t something you can be prepared for, nor is knowing what you will lose. I don’t envy you your job but I am so glad there are Doctors out there like you who witness the most painful aspects of people’s lives.

  2. I agree, cancer of the pancreas is one of the worst, so insidious and undetectable and then bang–it takes you. The youngest patient I saw with it was a Chinese-American woman of 35 with three young children. She had about three months from first symptoms (painless jaundice) to death. My grandmother was 72 and had less than two months. It is a cancer that cheats and doesn’t play fair though some have cheated back and borrowed time, like Steve Jobs.

    I’m enjoying every piece you write. Send more to kevinmd!

    Emily

  3. Miranda – I would surely like to meet you someday. You speak volumes about this cancer. I have been feeling so MAD at this CANCER. And you are right, why isn’t anyone running with purple t-shirts on, raising money for pancreatic cancer? I’ve been talking to my sister, Carolyn, about this and she is going to try to start an annual Janet Porter Memorial Walk for pancreatic cancer. She wants to grow it to become as big as the Susan B Komen Foundation, which was started by her sister after she died of breast cancer. We need to do SOMETHING to find a way for early detection of this deadly cancer.

    I have a lady that has come to me for scrapbook classes over the past year. She was diagnosed with pancreatic cancer just 3 months after Janet’s diagnosis. I followed her progress as it also spread to her liver. Sadly, Linda just passed away on Monday, just 2 months after Janet left us.

    Your words are comforting to me because I know you “get it” on this cancer. Please keep them coming!

    Janet’s sister, Cheryl.

  4. Oh great, start my breakfast off with tears.

    I lost my sister to breast cancer in 2001. I’d already made life changes 8 years earlier after losing two good friends but Katharine’s death was what truly made me stop, take a look around, and start living every day here and now instead of looking toward the future.

    That’s what we have: Right now.

    There’s a lot we can learn from our dogs in that regard.

  5. Since 2007 with the death of my husband to complications of lymphoma treatment, I have lost more dear friends & family of dear friends than I care to count. Janet’s passing last summer left me speechless, unusual for me. Now, another dear, dear friend who has fought valiantly for a year with what we thought was good success, has been found full of metastases . He and his wife are cheerfully preparing his bucket list. With any luck at all, his final months will be as full as his first 63 years. Thank you for providing this forum, Miranda! Your eloquence shines a ray of light in the darkness.

  6. Janet was my sister. Her passing has left such a huge hole in my life and the lives of my other two sisters. She was the best sister you could ever hope for. We flew to Michigan this past weekend to bury her ashes alongside my Grandmother and Grandfather.

    I love what you say about the pink armies. We need to take up the cause and make purple the new pink. We need Janet L Porter to become the fund raising machine Susan G Komen has become. We need to give hope to those given the horrible diagnosis of pancreatic cancer. Before I flew to Michigan I decided I want to make all those things happen. I need to start small with the hope that it can become big. I am hoping Janet’s friends will help me make that wish a reality. I am thinking of working with PanCan and organize a walk next year in VA to raise funds. I am hoping I can name it the “Janet L Porter walk with your pooch” walk. Right now this is my dream. So I need to talk it up so I don’t loose the courage to make it happen. I hope I can enlist the friends of Janet to help me make it happen too. And who knows…..it just maybe the start of creating a Janet L Porter foundation and making purple the new pink.

  7. Thank you all for your comments about this piece. To support pancreatic cancer research, I highly recommend the Lustgarten Foundation http://lustgarten.org/home and their CurePC campaign. So many people have been affected by this terrible disease that I am certain that progress will be made soon. M

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