I would like to share a story about a woman named Diana. I have known Diana since March of 2017. Diana has incurable pancreas cancer.
The opportunity to have lengthy relationships with my pancreas cancer patients occurs infrequently. The sad fact of the matter with pancreas cancer is that it is often a quick killer. Most people diagnosed with this deadly disease will die and die fast.
Diana’s journey could be that of any number of pancreas cancer patients that have come through my door – except it is not. It’s her journey. Each patient has their own shoes to walk in. I think this is so crucial to understand for a patient and as a caregiver.
In walking in her own shoes, Diana has inadvertently helped me walk more in mine. She has been a teacher whose lesson plan focuses on helping me continue to learn, and live in, the beautiful saying “be where your feet are”. Let me explain:
I met a sixty-year-old Diana five years ago, after she had a large surgery to remove her pancreas cancer. The surgery she had is called a Whipple’s procedure. During her surgery, a liver surgeon removed her pancreas, part of the liver, part of her small intestines, her spleen, and some of the tissue around these organs. Her surgery left her diabetic because almost all her pancreas was removed. With removal of the pancreas, our ability to produce insulin disappears and diabetes results.
Diana was considered “lucky” to be able to undergo this surgery. Her cancer was caught early enough that it had not yet spread to other organs, as best as could be seen from CT images at the time. Her surgeon felt that he would be able to remove all her cancer and so under the knife she went. This was her chance for cure.
A few weeks later, Diana was sitting across from me with her husband to discuss how chemotherapy improves the cure rate after such a surgery. The extra cure rate afforded by this chemotherapy is patient specific; in Diana’s case, that number was between ten and fifteen percent over an expected cure with surgery alone of less than ten percent. As I told her these bleak numbers, I remember she got teary – rightfully so.
Diana wanted to proceed with chemotherapy. She valiantly got through six months of treatment. Her CT after chemo was clear of cancer. There were a few tears of joy.
I discharged her from my care at that time and told her, jokingly but with all seriousness, that I never wanted to see her again. If she was to see me again, it would mean her cancer was not cured by surgery and chemo. If that happened, she would die much, much earlier than she should.
Almost three years later, I received a request from her surgeon to see her again. Her pancreas cancer was now growing in her liver. I saw her back in my clinic to tell her that her cancer was no longer curable. There were naturally more tears. The whole meeting was very sad.
Diana was still very well at sixty-three. She, her husband, and I discussed palliative chemotherapy which would likely extend her life. I shared the average data that chemotherapy could almost double her length of life, and in doing so, perhaps keep her quality of life as good as it could be for the longest possible time. Sadly though, this still only left her with an average length of life of about one year. As usual, I qualified this statement with “no one has a crystal ball”, and we never know what will happen. Half the people do better than this average and half do worse; we can always have hope that we will land in the better half.
Diana opted for chemotherapy again. There were two decent options that we talked about. The intention would be to use one of these options until it stopped working and then switch to the other chemotherapy grouping. This is exactly what we did.
Almost two years later, this is exactly what we are still doing. It has turned out that Diana was in the better half. She is beating the odds.
Like most people in her situation, Diana’s journey has been packed with ups and downs. She’s been on a windy road juggling medical appointments and side effects of treatment while trying to live life, travel, and spend time with the people she loves. I know she has understandable anxiety around her diagnosis and mortality, but she deals with this well from what I can tell. I’ve been impressed with her grace while dealing with her terminal diagnosis. I’ve also been impressed with how she presents this grace.
I acknowledge I only see the parts of my patients that they reveal to me. Sometimes that viewpoint is of narrow scope. But from where I sit, Diana is tough lady – physically and mentally strong. She looks hip and fit when she comes to clinic, as if ready for her golf game or a long hike in the river valley. She appears centered within herself, even when hurting, tired, or anxious. And, over the years, I have seen her wearing a few fancy pairs of shoes. Not only does Diana know the importance of making bigger plans for herself than her cancer has, she does this in fabulous footwear.
Last fall I noticed a pair of reddish-orange patent leather, ankle high boots she was wearing. These boots looked amazing. They made the bland clinic room I was seeing her in pop. I complimented her on her fancy boots. She could have just said thanks. Instead, she offered that her boots were purchased in a quaint little shoe store on the main street of Canmore, a town about four hours away from our city. The arrival of this welcomed information had impeccable timing. I just so happened to be heading that way a few weeks later to do some hiking with my best friend. I made a mental note of the name of the store and thanked her.
Canmore is a favourite place of mine, where the foothills meet the giants of the Rocky Mountains right before the boundary of Banff National Park in Southern Alberta. It’s a small mountain community that bustles in both the summer and the winter months with those looking for peaceful escapes for skiing or hiking or camping or the majestic magic of nature.
On the second day of our hiking trip, my best friend and I went to the highly recommended shoe store – Shoes t’ Boot. We found ourselves in the store by ourselves for over an hour. Between the two of us, we must have tried on over twenty pairs of shoes and boots. We laughed and giggled and showed off our runway feet to the more than helpful staff who played right along with us. It was one of the most memorable shopping experiences of my life. We were both so very much in the moment. There was nothing else on our minds. It was the two of us and the lovely ladies at the store and a hundred pairs of shoes. We were having a blast. Nothing else mattered. We were where our feet were.
My best friend and I walked out of that store with a few purchases. More importantly, we had an experience and a memory to last a lifetime. So much joy came out of that short time on Canmore’s Main Street. That joy was courtesy of Diana.
For the next couple of visits that Diana had with me in my clinic, I wore a pair of newly purchased shoes to show her. I told her about the experience my person and I had in the store she recommended. I told her of the impact it had on us. I hope I impressed upon her how much we appreciated her recommendation and what that time being where our feet were meant to us.
As I write this, Diana is still where her feet are. I choose to trust I’ll see Diana’s shoes in my clinic for many months to come. When her feet are finished moving, I will try to keep Diana’s teaching alive in my heart and mind, with fancy-footed steps, being present in as many moments, exactly where my feet happen to be.
Author notes:
I don’t know where the saying “be where your feet are” came from. I learned it from my best friend. It’s a beautiful saying. Diana and her shoes are a great example of this. When Diana was given a cancer death sentence, she laced up her fancy, big girl shoes and continued to live, with cool shoes t’ boot!!! When I see her in her amazing shoes, I see someone who wants to be walking solidly in the moments of her today. I admire her for this.
Diana sharing her shoes and shoe store with me was an ultimate connector – for her and I, for me and my best friend, and then for me with another patient. A few weeks after my Canmore trip, I wore the new pair of Fluevog boots I purchased at Shoes t’ Boots seen in the picture attached to this story on my busy clinic day. I walked into a room to see a seventy-nine-year-old rectal cancer patient who also loves brilliant shoes, many of which are Fluevogs. She and I have often admired each other’s collection. That day we were both miraculously wearing Fluevogs with ribbons for laces. Ribbons as shoelaces make me so joyful. I yelled in excitement when I saw we both had ribbon laces. She and her daughter and I had a lovely moment laughing about this.
I believe mastering living in the moments of each day is challenging. It is certainly a struggle for me. People like Diana remind me to try to 1) not worry too much about what’s in the past, for it cannot be changed, and 2) not stress about what’s in the future, for it cannot be predicted. Sometimes I am good at this, sometimes not. It is definitely a work in progress for me.
I thank Diana for helping me make my shoes a reminder to be in the moments of today. I don’t know how many more I am going to get, after all. I will try to walk in my shoes with awareness. I’ll scuff them up. I’ll dance with them on when I get the chance. Mostly, I will try to be where my feet are while I wear them.
What does “be where your feet are” mean to you? Do you have a pair of shoes that help you feel joy with where your feet are today? I’d like to hear about them.
