How much time do I have left?

When I was first diagnosed with pancreatic cancer, I was given a terrifying number: 10. On average, someone diagnosed with Stage 4 pancreatic cancer has ten months to live.

And what sounds scary is the fact that I was given this statistic a little over seven months ago, which makes it sound like I have only about three months left to live.

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But this logic isn’t right. I have survived the last seven months (actually, I’ve lived the last seven months intensely), and so the number I should be concerned with is not

  • “How many months, on average, does the diagnosed Stage 4 pancreatic cancer patient, who has just been diagnosed, have?”

But

  • “How many months, on average, does the Stage 4 pancreatic cancer patient, who is still alive after seven months, have?”

The answers to these two questions are different, because they take their averages from two different sets of people. To answer the first question, your set would include everyone who’s been diagnosed with Stage 4 pancreatic cancer. And that means including all the people who did not make it to seven months: those who died within one month after their diagnosis, two months after their diagnosis, and so on.

But to answer the second question, you would not include everyone. You would exclude all those people who died within seven months of their diagnosis. And so the average number of months this group of stage 4 pancreatic cancer should be higher. In other words, the answer to the question “how many months do I have left?” should be more than three months.

The difficult thing is that I have no idea what the answer to the second question is or how many more months I actually do have.

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But I’ve recently got on good terms with uncertainty, which is a good thing, since uncertainty — about life and death no less — has forced its way to become my constant companion.

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Changes to my body

My body has undergone many physical changes over the last 6 months, since my cancer diagnosis and my chemo began. I used to have hair on my head.

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Now I do not.

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All this from the chemotherapy.

I’ve also had a plastic triangular disc placed under the skin on my chest which allows for easier intravenous access for chemo drugs. I’ve also lot some weight. And those are just the changes one can see.

My treatment has also given me peripheral neuropathy, which means my fingers and toes tingle all the time.

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And the fatigue is persistent, and even as it wanes the further from my last treatment, it pops up unpredictably, causing me to end social engagements early, to leave my friends before I finish my coffee or tea, to leave parties well before the end, just so I can go home and sleep.

In all of this I have been fortunate—my body is continuing to respond well to treatment (relatively speaking). The cancer itself is having less effect on my body than it once did, despite still remaining my probable and eventual killer.

It’s difficult to deal with change, even if you recognize its inevitability and its pervasiveness. If you change one thing, and deal with that, that’s still hard but okay, especially if you are the change’s agent rather than its plaything.

A large, unshakeable, change will come to me swiftly at some point. The chemo will stop working, and the cancer will overtake my body and me. It will be fast—a matter of months. But it will also be slow—months are long. The cancer will bring fatigue down on me like rain. I will not burn out or end with a bang. Instead, I will whimper and fade away. My death will be pathetic.

I don’t want to die, but I will

The sadness I sometimes feel is just a result of this straightforward problem. I want something that I can’t have. The simplicity of this frustration is almost immature.

I’m hardly alone with this problem. The tension between what we want and what is going to happen is universal. It’s not just me. Almost all of don’t want to die, and all of us are going to (probably). There’s just an immediacy to my situation – I’m going to die sooner than most, and I don’t want to that to happen.

The wise advise against wanting something you can’t have – Buddhists, Stoics, whoever else. We must accept what is inevitable in order to live peacefully, with equanimity and calm. What good would it do, they ask, to want something impossible? What good would it do to resist change? How fruitful is it to rebel against nature?

And death, if it is anything at all, is natural. All living things die. That is about as universal a truth as you can get, without stepping into the abstract. It is a concrete reality, unfailing in its comprehensiveness.

But that death applies to all is only a statistical reality. It is a claim about how things have been thus far. There’s a tree, the Great Basin Bristlecone Pine, that is said to be over 5000 years old. Is it mortal? It can certainly die, from natural disaster or human ill will. But if it’s left alone, will it die at all?

Some might say that death is written in the laws of nature, but that, of course, is not literally true. The laws of nature are not written anywhere, not on any stone tablet, not in the holy books, not on the side of a mountain, not in the stars, not anywhere. And those who think they know the laws of nature are, I say, fools – fools for thinking they can rest assured in their supposed wisdom, fools for accepting ideologies as facts, fools for stifling their own curiosity with cliches. And yes, here I am, calling the Buddha a fool, Marcus Aurelius a fool, Yoda a fool, and all other holy men fools.

But I too am a fool. I want never to die; I want to live forever. This is about as foolish a wish that one could have. Nobody lives forever. Fact number one.

Repetitiveness

My illness is repetitive. Or more accurately, my treatment is repetitive. And dull. This is the part of the movie where they show the scene once, and then we watch the pages of a wall calendar flip and fly away, or watch a time-lapse segment of seasons changing, or a montage of small moments, until we come back to the same scene but with a significant and meaningful change.

But there’s none of that. Not yet at least, and I don’t know, maybe not ever. And even the change I’m supposedly hoping for (and sometimes I am hoping for)—for this illness to go from terminal to chronic—is not the kind that play well in movies. “Yay! It’s now chronic, instead of terminal”. Chronic illness is probably repetitive and dull too.

It’s not just the days that are repetitive. I often think the same things over and over again: how tired I am, how tired I am of being tired, and of course, “didn’t I think all this last week?” and “the week before that too?”

I want to acknowledge though that I am getting better. My tumours have shrunk substantially, and so I guess my illness is on its way from being terminal to being chronic. But what do we call this distance, this space, between the two?1

Maybe there is no space between these two places at all. Maybe terminal and chronic are two neighbouring countries with a only width-less border between them. (And to complete the metaphor: full recovery is across an ocean, and it’s decades before we have the technology and know-how to get there.)

I guess I’m getting closer to the other country without yet having left this one.


  1. There seems to be no word for it, and so it’s hard to feel grateful for something I cannot even name. Plus, even though I am getting better, I don’t feel better. It’s the chemotherapy, not the cancer, that exhausts me. But I am lucky. Not everyone gets to be here and move in the direction of better. 

How could I be angry?

Time seems to slip away from me. Days and hours seem to go missing. Fatigue seems to be the most common culprit. Sleepiness and exhaustion take me down at unpredictable times.

I used up four days in the hospital last week, due to a fever. Fevers, if you are in chemotherapy, require going to emergency. You are given saline and a lot of antibiotics. It probably saved my life, and I should probably feel grateful. But it’s hard.

Before cancer, I would spend most of almost any day reading and thinking, but now it seems that I have to spend the hours I have on errands, in hospitals, going to and coming back from hospitals, leaving little energy and time for what matters to me.

But as often as it comes to the fore of my mind, I find that I cannot sustain my anger and my feeling of unfairness.

I am often grateful. When I heard about the earthquake in Japan mid-April, I felt sad for the victims, and grateful that I did not suffer their awful misfortune.

I think about all the people who have died in car accidents every year and about who will die this year and the next. Over 32,000 people die every year in car accidents in the U.S., and over 2000 in Canada.

I think about how sudden their deaths were and are — how they had no time to contemplate the rest of their lives.

I think about the 3 million children who die every year due to starvation. These children didn’t get to do what I have been able to: grow up, read books, make friends and lose a few, find love and experience heartbreak, to struggle and learn about the world and what it means to be human.

One should not think about fairness without thinking about the context. That is what fairness is, after all – what we have in the context of others. But real fairness, ultimate fairness, isn’t about how much you get compared to your brother or your sister, or how much you get compared to your friends, your co-workers, your neighbours, or even your fellow citizens. It’s about how much you have, and how much anyone has, in comparison to everyone in the world.

And by keeping that in mind, how could I, a man lucky enough to be born and raised in Canada, a country with socialized medicine and a stable economy, think himself the recipient of worldly unfairness? How could I — who have such loving parents and brother and sister, wonderful and devoted friends, a decent education, time to reflect, and the most wonderful partner — be angry with what I’ve been given?

How could I be angry in the face of all this? I’m not sure, but I do manage it from time to time.

Is this a fight?

We often talk about fighting diseases. We say, “I’m fighting a cold.” And people talk about “fighting cancer”. They might say, “she won the battle against cancer”, or “he fought bravely, but ultimately lost his fight against cancer.”

Having cancer sometimes feels like I’m in a fight. I try to maintain an even temper, find solace and peace, and not cry out too often. I try to do what I can to be a good patient, take the prescribed medicine, ask the right questions, find out what more can be done, all without being a nuisance. I try to make the right moves in this fight.

But it is not really a fight at all. A “fight” suggests some kind of fairness to being in the ring. Like, I somehow qualified to be there squaring off with Mike Tyson or Manny Pacquiao.

Can a single human being be in a fight with a tornado, a flood, an earthquake? Can you be in a fight against a force of nature? A cold, maybe. We can fight a cold, because everyone gets a cold from time to time, and it goes away.

But this cancer, this stage 4 pancreatic cancer, is not like that. It is a force of a nature, unremitting in its brutality. I am not qualified to be in this fight, nor do I think is anyone else. One cannot beat this thing; one can only live longer.

If there is a fight being fought, it’s the medical community who’s doing it, who’s working on new medicines and clinical trials to see what can be done. I believe these doctors and researchers will eventually, in the next few decades perhaps, find a cure and beat pancreatic cancer. But I will not be here when they do so.

It is funny how it stills feels like a fight sometimes. If I die from this disease, which is likely, it feels like I will have lost. But if I win, it would feel like it was luck alone that let me win. I guess if I were in a fight with Tyson or Pacquiao, it would be much the same.