One woman's courageous choice while dealing with pancreas cancer

I was in my second year of residency and in charge of the medicine service. I had two interns and two medical students on the team. Our job was to admit all the non-surgical patients who came into the hospital through the emergency room.

It was 4 a.m. and all of us had been taking care of patients since 8 a.m. the day before. The service was extremely busy and we were all suffering from lack of sleep.

Olga was a 68-year-old African American woman who was being admitted for chest pain. She was quiet, serene and somehow regal, yet the signs of poverty and hard work showed on her callused hands and her lined face. She held my hand as she looked at me. "Thank you so much for taking such good care of me."

She came from the emergency room with only her initial labs, chest X-ray and EKG. As the rest of her labs started to come in, her liver tests were markedly elevated in a pattern that showed her bile duct was obstructed, most likely by gallstones. The interns and I were certain the ER diagnosis was not the right one and that only we were getting the right story. Giddy from lack of sleep, we were moonwalking backward and high-fiving each other in the hallway. The next step was to get an ultrasound of her abdomen to verify her gallstones.

The radiologist paged me with bad news. She did not have gallstones, but her pancreas was full of masses that had spread to her liver and other parts of her abdomen. A CT scan confirmed the diagnosis of pancreatic cancer with spread to other organs. This was a terminal diagnosis at this point and nothing could be done to cure her cancer since it had spread outside the pancreas itself.

We consulted the on-call gastroenterologist as there is a procedure called an ERCP (endoscopic retrograde cholangiopancreatography) that could go in and open her bile and pancreatic ducts to relieve some of her pain. She declined. "The good Lord only gave me so much time here. All I need is my faith and my family." I urged her to have the ERCP done as it could relieve her pain.

"Will it make me live longer?"

"No."

"Will it make the cancer go away?"

"No."

"Then why do I need it? The Lord will provide for me."

It was now 8 a.m. and time to sign out our patients to the oncoming medicine service and finish up our work for the morning. I wasn't able to get back to Olga until about 10 a.m. One of her sons was with her. He was dressed in a worn, threadbare dark suit and tie and was as calm and serene as his mother. Surely he would be able to reason with her and convince her to get the ERCP. I carefully explained his mother's diagnosis to him.

"Is it terminal?"

"Yes."

"Will the procedure change that?"

"No, but it will make her more comfortable."

"If she doesn't want it, we don't need it. The Lord will provide for us."

I couldn't believe it. I so desperately wanted to do something to help her and they weren't accepting what we had to offer.

"Olga, won't you please reconsider?"

She took both of my hands in hers and looked straight into my eyes. I could see the strength and resolve of many hard years looking back at me.

"Young man, Dr. Vainio. You have been so kind to me and I know you just want to help, but I have everything I need. I'm going to a better place, so don't you worry about me."

I had to leave the room at that point and went out to the top of the parking ramp. I looked out over the new day with the sun sparkling on the Puget Sound and the Olympic mountain range in the background. The birds were singing and the sky was a rare and brilliant blue.

How could something so terrible be happening on such a perfect day? Every time I tried to turn around and go back into the hospital, I started to cry. Not silently, but sobs that wracked me so hard I had to hold myself up by leaning against a concrete pillar.

I was finally able to go back into the hospital and into Olga's room. She was dressed and ready to go home. She refused pain medicines, but I wrote a prescription for her in case she changed her mind. I gave her my pager number and my home phone number and told her to call me any time she needed me. I was not in the habit of giving that information to anyone.

What hardships can someone endure in a lifetime that makes death OK? She would have been 27 when Rosa Parks refused to sit in the back of the bus and when Emmett Till was beaten to death for whistling at a white woman. She was 35 when she heard Martin Luther King's "I Have a Dream" speech in Washington, DC. She was 40 when he was shot and killed on April 4, 1968.

Her faith was not my faith. My beliefs were different than hers. Yet her faith was so strong that she was comforting me when I should have been comforting her. Even though our beliefs were different, we weren't actually any different at all. She understood this and I understood it, too.

Daniel Nikcevich, MD, PhD is a hematologist/oncologist (blood and cancer specialist) at the SMDC Cancer Center in Duluth and he and I have had patients with cancer in common. This is what he wants you to know about pancreatic cancer: "Pancreas cancer often does not cause symptoms until the disease is very advanced. Some warning signs can include painless jaundice (yellowing of the skin), unexplained weight loss, hard to control blood sugar levels in patients with diabetes, or a change in bowel habits with light-colored stools.

"The best chance for treatment is if surgery can be performed, but with new changes in chemotherapy, there is always hope. Similar to Olga, our goal is always to treat the patient and not to focus on treating a disease per se as sometimes the best treatment does not always involve something prescribed by a doctor."

I never saw Olga again. She didn't call and I never really expected she would. She called on a more qualified and experienced healer than me.

Arne Vainio, M.D., is a family practice physician at the Min No Aya Win Human Services Clinic on the Fond du Lac Reservation. He can be reached at a-vainio@hotmail.com .