Hi everyone,

I have more test results for you. Because John's tumor marker readings were so low last month, the oncologist wanted to double-check the results by other means. John took a P.E.T. scan Thursday. Positron Emission Tomography measures cell activity, specifically the rate that cells consume radionuclide-laced sugar. Because cancer cells grow (and eat) faster than other cells, they appear as "hot spots" on the scan. This is an important measure, because CT scans and ultrasounds measure tumor size by viewing them, however, they do not tell you anything about the amount of cancerous activity in the tumors. Because adenocarcenoma tends to leave fibrous, non-cancerous tissue behind in the shape of the tumor, tumor-size becomes a less reliable measure as it shrinks. It is difficult to determine how much of the tumor is still cancerous. That makes the results of a P.E.T. scan that much more important. We got the preliminary results of this scan while in the oncologist's office yesterday. It was early for the results, which take days, but the nurse called in to the nuclear medicine center in the hospital to get what information she could. She just poked her head into the examining room and said, "The results were negative." I asked the doctor, "So there was no measurable cancer activity?" He answered, "Yes, that's right, but you have to understand that it does not guarantee that there is no cancer. Cancer cells could exist at less than detectable levels." I respect this oncologist for how detailed he is, and how disinclined he is to read anything into results. In my research this morning, I see that P.E.T. scans can not measure small clusters of malignant cells, for example, tumors under 1cm in size. Nonetheless, this is strikingly good news after already strikingly good news. The doctor and we agreed that it was good news and that we needed to continue with vigilance. We went on to talk about other technical details, and plans for response.

We discovered that John's varicies and enlarged spleen that concerned us on the last CT scan were already present in July previous to the start of chemotherapy. We looked back on the CT scans from the time of diagnosis and found the varicies there all along. We (including the oncologist) were so preoccupied with the cancer, that we paid no attention to them until they showed up in October and again in December. As it turns out, Pancreatic Cancer can cause varicies of this sort just as liver cirrhosis can. Unlike alcoholics and Hepatitis patients, John's cirrhosis was caused by the varicies rather than the other way around. Therefore, the presence of varicies does not indicate advanced cirrhosis. This explains why his liver function numbers have all been good. John's is early-stage cirrhosis. This complex of conditions, though still potentially serious in the future, will not affect his ability to take the chemotherapy that seems to be helping. So, we needed to decide whether to take a break from chemotherapy while John's cancer was so much smaller, or to continue on with treatment. The oncologist even considered whether John could take treatment options (radiation or surgery) usually only reserved for Stage I Pancreatic Cancer patients. He had already informed us that he had discussed these options with his partners in the office, and that they had convinced him not to consider the early-stage treatments. John's cancer has already metasticised, so there could be small amounts of cancer cells anywhere in his body. They did not think, and our doctor agreed, that John should be exposed to the toxic or stressful effects of these treatments without an obvious potential gain. Now, he mentioned that he had communicated with the specialist in San Francisco and outlined the treatment options he was considering. She suggested that John take the same chemotherapy at the same dose as before but every other week rather than every week. That is what John decided to do. The local oncologist also recommended that John take another tumor marker blood test as well as some other blood tests. John agreed.

Then, as I parted with John at the chemotherapy infusion room, and walked out toward the elevator I began to smile, then take little jumps. At first, I was thrilled that John will be taking chemo every-other week rather than every week. "What a civilized schedule," I thought. "We might be able to predict our schedule from week to week and maybe even a month ahead." However, as the information about the P.E.T. scan began to sink in, my thinking began to shift. By the time I pulled out of the parking lot, I realized the ramifications of such a result. Wait a minute, if John's cancer continues to respond the way it has been, we might look back years from now and think, "Wow, what a difficult time." Perhaps there will be no widow, no orphans, none of it. I had always hoped, held out the possibility, but it did not seem like a very realistic thing to hope. Now, I had external, measurable support for my hope. I cried and laughed, and then swerved back into my own lane on the freeway.

With the shock of such a dramatic realization, I momentarily lost my grasp on reality. This has been happening to me regularly for a couple of months. I have been trying on self-images like clothing as the news of John's illness changes, and I think I have lost the ability to reliably see the world as I have always seen it. I don't think this is an entirely bad thing, as reality is overrated anyway, but it is uncomfortable and frightening (and when driving, potentially dangerous). My thought process over the previous months unfolded such that every time I shifted my perspective, and as I more fully accepted the unacceptable, the less firm my grasp on reality became. In July I wondered, "How can I live without John?" I didn't want to be left behind. "We have been together all of our adult lives, what will become of me if he dies?" "I don't have any choice, somebody has to take care of the children." "I can do this if I have to. I will miss him, of course, but I can do this." Some time while living with this particular perspective, I had a Bliss experience (it felt like the direct presence of the Holy Spirit) that made everything seem OK, not by force of will but really OK. I felt my existence and that of everything else at a molecular level. I could feel myself sharing molecules/energy with everything else. I knew, really knew that he and I would always be connected. I could feel the truth of that connection. In the succeeding weeks, I also understood that some day, I would move on and that the children would recover. "Would I be attracted to other people?" "What is single parenting like?" "How do I provide for everyone by myself?" "What is dating with children like?" "What sort of person will attract me? What will sex be like with someone else?" Then, we returned from San Francisco with the idea that John might stay alive but sick for years and years. " Can I go on like this indefinitely?" "Will he live long enough for the little ones to remember?" "What sort of memories does a sick daddy make?" "Will I be able to stand it if he keeps offering to kill himself to relieve us of that burden?" During that time, I was able to recall the Bliss in therapy (using a Shamanic journeying technique) or while meditating and did so many times in order to relieve myself of the terrible burden that my life presented to me. Later, I could recall it, by simply choosing to. I chose to more and more often. In November, I began to have the experience unbidden. I had concisely let my emotional guard down. I intentionally thought about how I hated my situation, not allowing my natural positiveness (read denial) to overcome my sad and angry feelings. In the process, I became like walking Swiss cheese. I had exposed my weak spots to the air. I never knew when something would happen or someone would make a statement that would send me into an emotional breakdown. Strangely, though, at the bottom of the abyss I found the Bliss. This happened to me so often in late November and in December, that I felt more like a roller coaster than a person. I was fine when in normal reality, and loved the Bliss state, but excruciating emotional pain accompanied the process of moving from one state to the other. Now, I found myself on the freeway with reality not quite all there. This time, the transition caused no pain, but I recognized it. Reality simply slid in and out of conscious view for an instant, something like going over a speed bump. I made it to the kids' Shakespeare class, and a few moments of talking with other moms, and playing with the children settled life back into place.

An hour later, I picked John up from Chemo and asked him how the news sat with him. He was not sure what I meant. The doctor is so careful to keep us off of a roller coaster, that John had not even seen the ramifications of this test result. John, living with me, gets much less practice reading subtle communication than I do living with him. Also, in his world, very little had changed. He had, after all, just sat for three hours getting toxic chemicals dripped slowly into his veins. And faced the same prospect of a week sick in bed as he had faced when he had cancer over most of his abdomen. What difference, at the moment, was there really? Nonetheless, I could not resist giving him a taste of the future-tripping I had enjoyed. "John," I emphasized, "You are getting better, your P.E.T. scan was negative." "I guess that's positive," he replied. We both laughed.