Until recently, I was following an eighty-three-year-old man who has pancreas cancer. I don’t
think he was ever in the road construction business, though I know he’s done his fair share of
driving over the years. We had a lovely exchange about roads a few months back that I would
like to share.
Bill (not his actual name) was diagnosed with pancreas cancer over a year ago. At initial
diagnosis, his cancer was still localized which afforded the opportunity for potentially curable
surgically resection – not a common situation with this deadly disease. As a healthy octogenarian,
he consented to surgery. Thereafter, he struggled a little to get back his stamina.
I met him for the first time while he was recovering from surgery. We discussed the possibility
of utilizing chemotherapy to improve his chance of cure by a few percentage points. He decided
against this. I discharged him to be followed by his surgeon and family doctor.
A short time later he was back in my clinic. A CT showed quick cancer recurrence in his liver.
Bill still felt pretty good, with limited symptoms from his cancer. A second conversation about
the potential utility of chemotherapy ensued, this time for palliation. I explained the pros and
cons: the possibility of longer life, the risk of toxicity, uncertainly in quality of life depending on
how he tolerated treatment. He took a few weeks to talk to his family and come to some comfort
that his decision would be the right move.
About a month later, we started down the road of weekly treatments. I have to say, from the
outside looking in, he was driving smoothly. He was always cheerful and eager when he came to
clinic. He seemed to tolerate his chemo better than a lot of people twenty-years his junior. But,
for him, a toll was being taken with each dose. His white blood cell recovery was lagging. He
started looking more tired. He reported his tank was out of gas.
Several months into chemotherapy, Bill and I met to discuss the results of a monitoring CT
performed to check if his cancer was still being controlled with his treatment. The news was
good – his cancer was stable. Continuation of chemotherapy was discussed. This was when Bill
explained there was something to be said about the benefits of pavement.
He explained the roads he chooses are important to him. He wanted to drive for a while longer,
but he needed a smoother ride. He explained that for him, being on chemo was like driving on an
old gravel road – bumpy and windy, leaving him clenching the steering wheel too tightly with
uncertainty and discomfort. He wanted a smoother drive, even if it ended up being a shorter one.
He wanted to get back on pavement. We stopped chemotherapy that day.
Bill is in the driver’s seat. He knows the road ahead is short. He made a beautiful choice for
himself. I hope he sets the cruise control at a comfortable speed and can sit back and relax now
as he rolls on to his horizon.
Author Notes:
Bill’s story reminds me of an experience I had with my best friend last spring. We took a road
trip south of the border to the state of Washington for a concert. Right around the Canada-US
border we did a quick map check to see what the shortest route to a border crossing would be. A
map appeared with a route that was supposed to be about forty-five minutes shorter than the
route that kept us on the main highway. What a stroke of luck, we thought! We pushed “go” on
the map app to save time.
We followed the map app voice which had us turn off the main highway. At first, we thought
nothing ill of the suggested direction. But, when that road turned from smooth pavement to
gravel less than ten minutes later, we looked at each other with a “does this seem right?” look. A
quick “what do you think?” conversation had us deciding to trust the map app. We had places to
go and wonderful things to see. If this route was to save us almost an hour, we were full steam
ahead.
There had been a constant drizzle for much of our drive that day. The road was wet. The rain
continued as we drove ever-so-slightly uphill, into an increasingly remote and muddy, winding
road. Our pace trickled to fifty kilometers per hour, needing to slow even more around most
turns. The gravel was wash-boarded; the further we went, the worse it got. By thirty minutes in,
our teeth were chattering from the rumbling beneath us and our enthusiasm for the short-cut
dwindled. We hadn’t seen another vehicle. We drove on another fifteen minutes. Then, we lost
GPS signal, losing our aberrant map along with it. We pulled over, frustrated, talked about our
options, then turned our bus around, defeated.
We added an extra two hours to our drive with our detour but eventually made it back to smooth
pavement and to our destination for the night. Clearly our experience was not at all life
threatening, but it does speak to finding oneself on a bumpy road that was thought the be able to
buy time and though that buying of time was very much hoped for, the decision to change one’s
mind to try to get back on a better path was the best decision in the end.
Like Bill, we learned a lesson about trusting our gut, and each other. Bumps can be good. We
learn perseverance and grit from bumps. Not everything is easy, nor should it be. But measured
decision making based in self-knowledge and self-care can be a great compass to help us find the
road we wish to travel.
I am curious to know reader, what bumps in your roads have you encountered? Did you roll over
them, full steam ahead, or turn around? Why? What lesson(s) did you learn?
