Ruth, Randy and Pancreatic Cancer

News that Justice Ruth Bader Ginsburg had surgery for a one centimeter malignant tumor in her pancreas was particularly dismal for me. My wife and I were happy when she was named to the court close to the time when our first daughter was born in Brooklyn in 1993 because Justice Ginsburg herself is a native of the Borough. She has also been a model of what a jurist should be: firm in conviction, willing to listen, integrity beyond reproach.

Not very many pay close attention to the pancreas because it is such a quiet organ. We take for granted its endocrine and exocrine functions, responsible for the metabolism of sugar as well as having a critical role in digestion. Not to trivialize the obvious but insulin-dependent diabetics and patients with chronic pancreatitis are obliged to perform life-changing modifications if they want to continue to live. Imagine having to take 6-8 capsules with each meal for the rest of your life or strictly adhering to a meticulous diet and exercise regimen along with insulin shots and never-ending blood tests.

Pancreatic cancer is a whole different matter however. Because there are hardly any established risk factors and there are no specific signs and symptoms, the tumor is often discovered incidentally, in an advanced stage. Perhaps Justice Ginsburg’s history of colon cancer in 1999 prodded her physicians to be extra vigilant in ordering abdominal CT scans, nevertheless the over-all survival rate for 5 years is still 5%.

First time I became conscious of this cancer was when Michael Landon of Little House on the Prairie fame was stricken and died shortly. Cardinal Joseph Bernardin and Luciano Pavarotti did not last a year. Steve Jobs and Patrick Swayze are fighting for their lives.

Before Randy Pausch delivered his “last lecture” in September 2007, I had already been back in the Philippines for more than a year, partly because of what I learned from my patients with pancreatic cancer. Two were farmers, one was a veterinarian, another one was a 45 year old high school teacher. Next to this disease, all physical complaints pale. The brevity of our lives takes on an embossed and immediate character.

Pausch, 47, a professor of computer science and design at Carnegie Mellon University in Pittsburgh was invited to participate in a lecture series where top academics, usually those about to retire were asked to reflect upon what truly mattered in their lives and then deliver a “final talk”, about "what wisdom would you try to impart to the world if you knew it was your last chance?" Randy Pausch died 10 months later.

To live a more fulfilling life Pausch recommended we try our best in achieving our childhood dreams. What makes his lecture priceless though is it cogently reminds each of us that while we are not yet dying from a terminal illness we all have this incredible chance to transform our lives, find meaning, help others and leave the world a better place.