Sibling Rivalry, Moonshine, and Abundance

Mayo visit from June 1&2 2016

My brother Steve was with me at Mayo this trip. Deb was all out of “family illness leave” and Steve was ready to help. Steve is always ready to help. Right away. He’s amazing that way, and I would call it a gift. He has the gift of “helps”. This is a powerful gift that many don’t have, certainly to the degree or in the way that he has it. He has a soft spot for the downtrodden, the disadvantaged, the needy, the disabled, the sick, his family, his friends, his students (Steve teaches earth science at Jim Hill), and those who honestly need help. Beyond that, Steve and I have many of the same interests, backpacking, mtn biking, road biking, climbing, and science/geology, so we end up spending a fair amount of time together. I am blessed to have a brother like Steve, but that’s the thing with my family, my brother Bob is amazing as well, and so is my sister Eleanor Erickson. Help is only a phone call away and oftentimes it’s them calling me to check how I’m doing, to offer help, or to pray together. There are many families who are like that, but there’s also many more who are not. How did I end up with the family I’m in?  A chance meeting on a train in Chicago. That’s how. Mom and her girlfriend were on their way to see a Minot College boyfriend in Tennessee, when she bumped into a very handsome soldier on the train. The chance meeting led to letter writing, and eventually a wedding.

My father passed away a number of years ago from lung cancer caused by asbestos. As a young teenager, he had a job cleaning out blast furnaces in the steel mills in Detroit. They used asbestos in furnaces at that time. This was just before he lied about his age, joined the army-air force, and spent part of WWII in the Philippines, and later Korea carrying a Browning Automatic Rifle (BAR). He and my mother, who’s still doing well, would always emphasize how important it was to stick together, and to watch after my brothers (each of us are just 1 year apart) and my sister (who came years later). Some of this emphasis, I’m sure, was due in large part to my father’s early life.

My father grew up in Detroit. His father was a fireman. Both dad’s father and mother were severe alcoholics, to the point of completely neglecting the children. As you might assume, the children oftentimes had to fend for themselves, that is until social services became aware, intervened, and the children were split up between a grandparent, an aunt, a family who moved east, and an unfamiliar family, who it seems, unbeknown to social services, simply wanted another child to help with the work around their place. I never remember seeing or talking to my grandfather on my dad’s side, but I did get a congratulatory card from him when I graduated from college. I was the first Fogarty with a college degree. He said he was proud of me. He has since passed away. I still have that card. My grandmother? I remember meeting my dad’s mother once when I was in junior high. We were total strangers at that time. Still are, although I’m sure she has passed away by now. If you asked, I couldn’t tell you her first name.

When I was in my early years at the beginning of grade school, people would ask me who my grandparents were, and I’d name my mother’s parents and stop. They’d ask who my other grandparents were, and I told them I didn’t have any more. I thought it was strange that most of my friends had more than two grandparents. In my world, at six years old, the ‘normal’ amount of grandparents was two. As we grew older we understood the concept of ‘grandparents’ and we’d ask dad about his dad. He would tell two stories about him. There were only two stories. In one story, dad would tell about a time when he lit the garage on fire, so he could see his father, and yes, he saw him for sure when the firetruck came roaring up. And another story he would tell is about a fire truck he received as a gift for Christmas one year. I don’t know if these stories were true or not. It’s entirely possible that Dad simply had no stories to tell, so he came up with some. There were no stories about his mother, ever. These are the complete and totalI memories I have about my grandparents on my father’s side.  It took a while, but as time went on, we got to meet all of dad’s siblings. They are great people, and my life has been enriched just getting to know them. It’s no wonder though, that a strong family was important to Dad, because his family was broken, split up, and scattered. Watching out for and protecting one another, and the liberal application of forgiveness, were strategies promoted in our house in order to keep bonds strong.

Anyway, Steve and I have a great time together. Steve can find humor in many situations. Sometimes by connecting two seemingly unrelated things in ways that are funny (a good skill if you’re a teacher ... connecting things for students is important). Not irreverent or sarcastic humor, but legitimately funny stuff. Off the cuff stuff. I remember one of our trips to Banff to do some hiking, this time with my daughter Heather, and a boy friend of her’s at the time. At the end of one day’s outing, on our way in the car back to our campsite, Steve started singing to the radio, but made up his own lyrics based on our visit to the Columbia ice fields and the Athabasca Glacier that day. It was hilarious! We all ended up taking turns and also singing together for the next couple of hours, making up lyrics as we went. The amazing thing was how often our lyrics matched! Well, that’s Steve for you. 

So, here he was at Mayo with me. He accompanied me into pre-op (and was there when I returned from surgery. “Mike, he said, you came back from surgery and they were asking you questions... the trouble is, it didn’t look like you’d checked back in yet. I was amazed when you answered them. Do you remember?”  “No. I don’t”, I said.) I’ve had fun in pre-op before, but this time it was even more fun. We were having lots of laughs. At one point the nurse said,

“OK, now we need to get serious. I have to ask you some very important questions.” Questions were carefully answered, the IV was inserted flawlessly, monitoring equipment was attached, the anesthesiologist came in, she asked some important questions, I answered them seriously, then we joked around with her some more. At one point another nurse from down the hall poked her head in to see what all the laughter was about. I saw her look in, smile and quickly leave. I don’t know if Steve noticed.

Finally the Dr came in. You know what he said if you saw my facebook post. Yes, he was amazed at what the scan showed. Never before had he seen this. The tumor on the head of the pancreas was coming apart. The tumor on the tail was shrinking. He explained, 

“Typically what we see (meaning the doctors he knows who performs the EUS technique with kidney cancer on the pancreas (3 in the US, 1 in Europe), is the tumor stops growing. Never have we seen them come apart, nor have we seen them shrink. 

“We will do one more EUS procedure with alcohol, and I want to be aggressive with the treatment if you’re ok with that. The downsides are we can’t control where the alcohol goes, once it’s injected, same as before, and it’s possible it could burn a hole in your pancreas. There’s also a risk of pancreatitis as usual (1 in 4-5 chance). So what do you think Mr. Fogarty?”

“Yes,” I said. “Use your best judgement. I’m good with that.”  (By the way. All this doctor does is EUS procedures, all day long, all the time. That’s his ‘thing’.)

The Dr. went on. “ This will be your last procedure at this time. I will not schedule a follow-up procedure. We originally started out planning for a maximum of 3.  This will be our 5th. From here on out, you will be seeing Dr. Truty, your original surgeon. He will monitor the growth of the lesion, and we will treat as we deem appropriate. I may see you again in the future, but this will be our last for now. I have one patient, who is now going on 10 years past diagnosis. He comes back periodically, we do a procedure, and it takes care of it for a while. Since the alcohol is working, this might be something for you, but right now we don’t know how much the tumor will shrink, or if it starts growing again how fast it might grow, etc. It’s just watch and see after today. Are you good with that Mr. Fogarty?”

“Yes, I answered thankfully.

“OK, I’ll see you in OR in just a few minutes.”

------------

So let’s just take a step back and review the sequence of events. (very general timeline)

        September 2016
Diagnosed with renal cell metastases (kidney cancer) on the pancreas. This is unusual, and somewhat rare, but not unheard of. This is complicated by the fact that I have a pancreas that is fatty. Something that is very difficult to operate on (very risky). At the time of diagnosis, my doctor said,

“ You have a few choices; 

Remove the whole pancreas. You will be a brittle diabetic who can’t digest food very easily. 

Chemo or targeted therapies. You will have people along your journey who suggest this. I’m going to make sure that doesn’t happen here. This is not curative.

A Whipple, where we section the pancreas to remove the part with the tumor, then we put your pancreas back together and re-plumb it. You are not a good candidate for this procedure.

Try to surgically remove just the tumor.”

October 2016
a. Appt at MD Anderson in Houston, Tx. Oncologist (who has done research concerning renal mets on the pancreas) suggests surgery as curative

b. The surgeon there said he would not do surgery. It was too risky. “Maybe 100% chance of complications,” he said. He suggested chemo or “targeted therapies”. He suggested I talk to the oncologist again and he’d see me in January.

November 2016

I saw several doctors in Minot, some who had expertise in the areas of concern, some who didn’t have anything to do with my area of concern, but who helped pave the way for appointments with experts, one of which was an oncologist. The oncologist suggested I go the surgery route if at all possible. 

December 2016

I decide to go to Mayo for surgery. “I”m 100% certain I should do to Mayo”, I said. The day before surgery I show up for my appointment with the surgeon (there were 4 doctors in the room) The surgeon says, 

“I can do surgery if you’d like. The surgery will go ok. You’ll make it through. You’re young. You’re strong, but there are risks of complications afterwards. We have a doctor here who is pioneering a technique at Mayo. It’s less invasive. It’s less risky. If you’d like I can contact him and you can visit with him. He’s on vacation right now, but he just happens to be in the building as we speak.”  We talk to Dr Levy and decide to go with this new procedure (because of the way he folds a piece of note paper... very anal about it).

February 2016

I have my first procedure. The Dr uses radio frequency waves to heat, and hopefully kill the tumor. 

March 2016

Second procedure. Dr says, “Mr Fogarty, we haven’t seen any progress. Hopefully we’ll see some after the next scan. 

April 2016

Third scan, third procedure.

Dr. Says, “Mr Fogarty, I’m very sorry to have to tell you this, but but we see no improvement. This is not working. However, I’ve been on the phone to the worlds greatest expert in this technique (some Dr. in Europe) and I’m going to get more aggressive. We are going to turn up the heat. We are going to go longer, and when we are done, I’m going to go back in and put some alcohol in the tumor. We will schedule a scan for next month. As soon as your scan is done, they will let me know. I’ll have one of my team read the scan. If there is still no progress there’s no use doing another procedure. I’m sorry. 

May 2016

Fourth scan. I was unaware that the radiology department did NOT let the Dr know when the scan was done. So I showed up for the procedure the next day assuming they had, and that the scan showed there was progress. The Dr. said, 

“I’m very sorry Mr. Fogarty. There has been no progress. But you’re here, I suppose we have two choices. You can go home. Or as long as the surgical team is already assembled I suppose we can do an alcohol treatment (down the throat, poke a hole through the stomach, into the tumor on the pancreas with the alcohol. ( The nurse tells me because I asked;  98% pure alcohol ... like the moonshiners strive for except if you drank 98% pure alcohol it would kill you. We have to be very careful when we use this stuff she says, then... holds up a small vile of pure ‘moonshine’. Real moonshine is about 50% alcohol I guess, which is 100 proof. Look it up. ) Obviously we did a procedure. 

The Dr said, “I put in a lot of alcohol”.

June 2016

“I am amazed” the Dr said, ,... and now you know the rest of the story.

So let’s put this together even more succinctly. 

I opt for Mayo because the referring dr said don’t do chemo/targeted therapies, and that’s what they wanted to do in Houston. The Mayo Dr initially said he could cut the tumor out, and he said it with confidence (yes there were risks... but). When I showed up to do that,  the Dr said the risks were quite high, he’d rather not, but would if that’s what I wanted. He went on to explain that they had someone pioneering an esophageal ultrasound radio frequency ablation technique they had some success with, so I decide to go that route. That doesn’t work. In May, Radiology was supposed to tell the Dr about the scan results, showing no progress. That didn’t happen so I showed up in pre-op the next morning. My two legitimate choices were; go home, or do alcohol. I chose alcohol. 

What if, in May, Radiology had given the Dr the scan results when they were supposed to?  The Dr would not have assembled his team the next morning (at 6:am-ish), and I would not have had the procedure that worked. Secondly, what if “I” had decided to forgo the additional treatment that day because, “it was not working”.Thats what I had been told earlier, and because of that I had the name of a doctor at Johns Hopkins in Baltimore who had some surgical experience with this kind of thing. I was ready to make an appointment with him. What if? 

I remind myself that this cancer is still inside me, but wow. A last minute - you can go home or as long as you’re here we can do an alcohol “hail mary” procedure, and this was successful? How did this come about? By mistake? There certainly was one. It was a communication error..... or was there an error? Who was in control here anyway? 

Like the Dr, I too am amazed. I’m actually ecstatic, but I have no illusions that I’m out of the woods. God’s goodness is not defined by the length of my earthly lifespan. Even if I am healed now, all things end; galaxies, stars, and worlds are born, and implode, mountains rise, but eventually crumble, rivers form but can dry up, countries and civilizations begin and disappear, kingdoms come and fade away, cities spring up and die out or are destroyed. Earthly rulers come and go. It’s all part of the fabric of the universe, the laws of nature, and the effects of the selfish nature of man. It’s how things work here. You and I my friend will also one day pass away. That moment can come totally unannounced. I’m fortunate that I’ve been given a possible head’s up. I’m ready no matter what happens next.

John 10:10b says, “I came that they may have life, and have it abundantly.”  This does not mean that God will bless me with abundant things, money, wealth, property & possessions, although I certainly have nothing to complain about in that regard. Real abundance, however, does not reside in possessions that get old, rust away, require repair, upkeep etc, nor is it about the amount of money in my bank account. Real abundance has to do with eternal hope and life, peace, contentment, and joy in everyday life, even in the midst some difficult situations.  I’m in one, but strangely, once I was able to deal with the initial realization, and a down moment or two, I honestly can’t say that this is a ‘bad’ thing. Yes, I do realize that trouble, like death and taxes, are certain. But the ‘abundance’ that christ brought is real. On the other side of this earthly life, I look forward to eternity in heaven. Not only that, while I’m here, I’ve experienced many joys, some of which are a direct result of having cancer. Figure that one out! Now that’s an abundant life! 

------------

My next Mayo visit has not yet been scheduled. I suspect I’ll see a Dr some time in mid to late July. I also suspect I’ll have scans periodically, and as mentioned previously, check to see how the tumor continues to respond. My goal for the rest of the summer is to get back into shape. I want to be ready in case we end up needing risky surgery down the road. I’ve also got some projects around the house to finish; remodel the basement, replace a deck. Presently, I feel pretty good. Some days I take long naps, or go to bed right after supper. Other days I work on my basement, ride bike, help at church, stay up late, normal stuff. Everyday I give thanks.

Thanks for your prayers. Thanks for being a partner with Deb and I on this journey. Both make a difference!

Love

Mike & Deb