What Is It Like to Die? (Pt.2)

February 1, 2020
Ok, back from a failed Whipple Procedure surgery, which was an amazing failure at so many levels. It began with finding myself on the way back to the Geriatric Ward from whence I wandered earlier, racked with severe pain and deposited there without instructions for pain treatment to anyone. Even Darlene was gone. But an angel of mercy came floating into view named Kathy Murray, with her hair all done up in a pretty blue bun.
Dar came in, then Kyle, and then we quickly found ourselves at odds with the whole Geriatric Ward nursing staff (and a few more popping in and out from Oncology, upstairs). The nurses gave me the same dose of watered-down morphine they were giving me presurgery, which was tremendous, if only it was still presurgery! Later, after the excitement leveled off, they discovered the I.V. they injected the morphine in leaked anyway, so they could have given me an overdose without any worry.
I will say I did a tremendous job of arguing uselessly with the nurses. They took turns making me re-explain the problem from the beginning, and then repeat it for the next nurse in line. There were four (sometimes five) neatly lined up in a row at the foot of my bed. If one left, the vacancy was magically filled by another. I also had to explain why their counterarguments were so utterly facile. (Have you ever tried to disprove a facile argument? I have. Repeated four times per facile argument.) Then the banality would be reworded and dished up as a novel insight by the next nurse, and I would argue against that one four times. Is this exaggeration? Perhaps so, but since the arguing persisted for hours, something like this did occur.
Finally, they brought in the floor doctor, who made me go through the whole exercise with her virtually from scratch. She was oriental, and I thought at one point it would be useful to point out that her counterargument was as far away from reality as China was from the USA. Kyle later told me that was racist. I thought it would be helpful. So that's how that went.
Darlene at one point pointed at a nurse and said, in a firm but calm voice, "You can leave. You're adding nothing to this." She was the mouthiest, loudest, most hackneyed one. Good eye Dar! The hack nurse stalked off quite literally in a cliché huff saying, "I can tell when I'm not appreciated," or something just as predictable and bland. (There was a perceptible smile and sign of relief among the other nurses when she left, so was I arguing against her the whole time, and she was moving down the line?)
Poor Kathy was throwing herself at the problem in her quieter Kathy way, one-on-one with this or that nurse, and Kyle tracked down the floor doctor to fasten his mouth onto her ear with his bulldog grip. Sean sat there covering his ears and shaking his head. Beyond her big pronouncement against the hack nurse, Darlene mostly looked on, horrified. I, meanwhile, treated my pain by unleashing it on the poor nurses. I am proud to say, however, that during the whole 6 or 7 hours I never once yelled. I must admit that was only because I was hold my intestines in-place.

The Whipple Cut

I guess they opened up my poor potbelly guided by the long and ugly, vertical path of an incision made in 2011 by an Intestinal Bisection (they cut a slice out of my small intestines because my guts nearly exploded when they got blocked by an "adhesion" apparently caused by a traumatic 1991 appendix removal). I have rarely shown my ugly potbelly to the public ever since because that incision was so gnarly and long (plus I was a bit plump). That 6" scar became useful after all for my 2020 Whipple Cut! (OK Millennials: it's not a "nipple cut", which is often used today to hold jewelry!) The new and improved scar is about 12" long and yet too long because they abandoned plans to remove the duodenum (below pancreas, see Fig. 2, below), and part of the stomach. Instead they removed my gall bladder, as planned, and cut some adhesions around (inside?) my pancreas (we still do not understand what part of the pancreas was cut, but they did not cut off the pancreas  head containing the cancer as planned). So it ended up being, mostly, Gall Bladder removal, which is usually outpatient surgery with a little bikini-cut. This, however, created a bikini-cut for an elephant.
The surgery was abandoned because the Hepato-Billary Whipple Surgeon discovered the "mass" inside the pancreas was abutting the SMA and IVC (which will be explained shortly). This he told me the next morning at 6 AM, so he said I had to go to Oncology now and get chemo—which meant like I was being sent to the principal's office.
I said, "The SRC? PVC? Veins? Ducts? Lymphs? Nodes?" He waved a hand, almost chuckles, said "veins" (or arteries?). He acted like I should-a known. Later I contacted my biggest bro, John Bruce McCallum (Th.D.), who eats such terms for snacks and worked in medical research at UM for decades. (UM is "One of the top 10 in national research spending every year since 1972," they boast, which probably explains why JB lives in Milwaukee?) And they do more than spend money, since they also produced 19 Nobel Prize Laureates, which I'm guessing is at least 19 more than ever graduated from Summa Nursing School. I digress… JB agreed to stand ready by the phone when Dr. Acula would surely spring on me in his usual pre-dawn solitary raids, looming over my bed in the dark. (My surgeon comes from Transylvania or Moldavia and has the accent to prove it, and I swear he introduced himself as, "I'm Dracu…I mean, Dr. Acula, pleased to meet you." Or, it could've been one of Connor's or Kyle's jokes the night they first came to the hospital to hear the cancer facts, it's all a blur.)
Sure enough, when I asked Dr. Acula to hold one sec at 6:11 AM and dialed Bruce, who answered on ring two sounding like he'd already eaten a country breakfast of acronyms, and Dr. Acula literally plopped down in a chair like he'd fainted, asking if I was recording this. (Ha! The first time he'd ever bothered to sit down near me! Or, my loose gown revealed a patch of bare neckline when I grabbed the phone and when I turned back, he pretended he was sitting down? Either way, he was rattled, because he stopped waving dismissively at me.
So JB and Acula swapped acronyms and meaningful, "ahhhh, yes, but of course, indubitably," nods only these types can translate, and later Bruce told me the cancer mass was abutted to the SMA (Superior Mesenteric Aorta) and IVC (Inferior Vena Cava), which sounds benign until you look at the heart/pancreas diagrams, below. This artery and vein are the body's major conduits between the heart and the digestive system. The blood pressures in these regions are incredible, and the tiniest nick or bump means instant death—can't stitch, can't even clamp them shut.

The Prognosis

It is stage 3 because the cancer did not escape the pancreas, nor has it visibly spread to other organs, so it is still a localized Stage 1b cancer. That was the good news after Tuesday's endoscopy probe into the pancreas and the common bile duct where my poor liver dumps bile into the stomach. Lately the common bile duct was blocked from within the pancreas by the cancer, causing a backup of bile in the liver, and the liver dumped it in the Gall Bladder and blood stream, which caused jaundice—which means yellow (and orange!) skin, yellow eyes, black pee and white poop. (As an aside: Cholerics are so mean from too much bile, Greek doctors once thought. I still think so.)
After Wednesday's Whipple Cut failure, they considered it local advanced, Stage 3 cancer. It means there may be some kind of "connective tissue" between these highways of the heart and my cancerous blob. Nobody knows right now, since the relationships are not visible from the entry door to the pancreas. I proposed sticking Dr. Mahdi's scope in there, or his ultrasound wire he used for probing things (he did, after all, make three attempts the day before, so he knew my pancreatic side roads well). My proposal drew gasps and sucked all the oxygen from the air between Akron and Milwaukee. Apparently it was an exceptionally dumb proposal.What Is It Like to Die? (Pt.2)
As Fig.1 clearly shows, the IVC is where blue blood flows straight into the heart atrium. The SMA is one of two splits from the Aorta carrying red, oxygen-rich blood into the pancreas and digestive system. (For simplicity, the diagram doesn't show arteries in the pancreas.)
Whether the cancer is connected to one or both or neither of these two blood superhighways is the big question that will only be answered by more probing. I am still Stage 1 (not likely) or Stage 3, depending on the organic nature of that abutment. I could also be Stage 4 if there is any kind of DNA breakthrough into the IVC or SMA between now and the minute they begin aggressive chemo, which will immediately freeze its growth and begin to shrink the filthy growth. If the DNA passes through the abutment (especially in significant quantities) my life of Remonstrance will be quick curtains. Time scale is three to 18 months, and maybe three years. The Oncology Surgeon told me he sees three to 18 months, and he's mid-50s.
Of course, the Almighty Creator also is the Almighty Surgeon, so He might change that time frame, as needed, as it would best serve us all. He says he's seen it go from one minute to complete deletion-without-pain. So what does He say? I'll write about that next, because I'm outta this hospital, thank God!