Epilogue

NOTE: This is the unabridged/unedited Epilogue that is much more complete than the version in my book, “Fighting Times”.

AGAINST ALL ODDS – BEATING TERMINAL

PANCREATIC CANCER

Little did I realize that the choice I made then -- to take factory jobs to help workers in those plants get the justice they deserved -- might end up killing me decades later. 

Introduction

I never gave much thought to writing a memoir. I’m experienced at publishing an in-shop rank and file newsletter. I can deliver a rousing speech, and I write a damn good grievance; but a memoir talking about myself - not on my agenda. 

If you read a bit further, you'll understand why questions posed by my sons Eli and Noah launched this decades-long project following a 2004 diagnosis of terminal pancreatic cancer; a life altering event that called much into question.   

After I received my diagnosis, when no one knew how much time I had left, my sons asked me why I had spent my life the way I did. Why had I exposed myself to life-endangering chemical toxins that might now be killing me? 

Throughout their childhoods, Eli and Noah had listened to many of my stories, some of which you now know, but were curious why I had gone to work in a factory after graduating college. The transition from college student to factory worker struck them as counterintuitive.

Fearing I might not live long enough to answer their questions, I set out to memorialize the story. I stopped and started many times, deciding in the end that Fighting to Win offered worthwhile lessons for Eli and Noah, but also for a new generation of young political activists who have chosen a similar path as I did and are taking jobs in workplaces to organize workers to bring about anti-capitalist transitional change with socialism as the goal.

After writing about many of my life’s experiences as an activist, I would be remiss in not concluding with a description of the life-and-death battle I waged with pancreatic cancer which was a direct consequence of the decision I made at twenty-one to enter the industrial workforce. 

I felt little enthusiasm as June 10, 2000, approached, the day of my fiftieth birthday. Being a charter member of the generation that coined the phrase anyone over thirty can’t be trusted, turning fifty didn’t call out to me. Thankfully, Susan, my wife at the time, agreed to a low-key dinner in our neighborhood. We never made it out the door. 

I knew something was very wrong when the toilet filled with blood. When my doctor’s office opened Monday morning at 9:01a.m., I speed dialed. “You need to see the best colonoscopy man in town—Dr. Abel.”, my doctor recommended without a moment’s hesitation. 

“The good news is that you have twenty-five feet of intestines.” Dr. Abel noted. “The bad news is that I need to remove a sizable portion of the large and small intestines, including the sphincter. Unfortunately, you may have to wear a colostomy bag.” Apparently, I suffered from “a carpet of … polyps” that would soon be cancerous if not surgically removed.

For three days I lay immobile, hoping for the punishing pain to abate, living on ice chips and drip morphine. Dr. Abel visited my hospital room to examine the incision stretching across my belly. “This fucking damn infection stinks!” In an angry outburst at the nurses responsible for dressing and cleaning the wound, he both chastised and demanded surgical tools in a single exasperated outburst. Without warning, and with nothing to deaden the pain, he ripped out six metal staples, each followed by a blood curdling yell.  

A week later, I walked unsteadily out of the California Pacific Medical Center (CPMC) with a gaping, deep slit running through my belly button and beyond. I cringed with each footstep, recoiling from a knife-like stabbing pain, wondering if there might be a nerve running from my foot to my belly button. Despite heavy antibiotics, my rehabilitation progressed slowly as staph, contracted at the hospital, stubbornly resisted healing.  

A semblance of normalcy returned, and life went on despite repeated hospitalizations for blockages caused by scar tissue closing off passage through my intestines. Hospitalizations followed a predictable pattern. I’d feel a wave of nausea, hoping it would soon pass. When it didn’t, shooting pain commenced. Soon, I repeatedly vomited, clutching my guts as my intestines cramped and twisted with incapacitating spasms. 

The inevitable next stop - the closest emergency room. On occasion, I’d lose consciousness. The moment I made it to triage, I’d plead with true pathos - “Morphine, please I need morphine!”

When morphine no longer relieved the pain, I begged for the more potent opioid Dilaudid. If the blockage persisted, a team of nurses forcefully jammed a stiff plastic tube down my nostril to drain my stomach. As the nurses forced the tube down my nasal passage, breaking cartilage as it passed, they commanded, “Swallow, swallow, swallow …” till the tube bottomed out in my stomach. 

The Diagnosis  

Spring 2004 we planned a family trip abroad. I crossed my fingers, hoping I wouldn't suffer a blockage while visiting a bucolic French village without a hospital or any English speakers available for translation. I didn’t want to live life in a cocoon, afraid to leave San Francisco, but worried about being too far from doctors and hospitals familiar with my precarious health condition. 

Weeks prior to departure, I experienced a nagging ache in my abdomen, noticeable but not debilitating. “Ignore it and it will go away” I assured myself. The next day, sharp stabs, a bit more intense. I kept myself distracted with music deals I was negotiating for my employer Rock River Music. 

My face flushed, although the office wasn’t particularly warm. I threw open the wood frame window welcoming the chilly San Francisco summer air. The cool air refreshed; maybe I was being a hypochondriac?

Dr. Abel had explained that blockages occurred when scar tissue formed adhesions where the diseased portion of my colon had been removed. The scar tissue narrowed the intestinal passage. When the bowels blocked, the intestines twisted like a knotted, tangled garden hose. 

Gnawing pain persisted. For hours, I laid my head on my desk. I tried to conduct business, but incessant spasms of pain dominated my every thought and recurrent nausea necessitated frequent sprints to the bathroom. 

I lost my appetite and grew steadily thinner. At night, I lay awake, taking deep breaths to remain calm, waiting for the bliss of sleep to relieve my fears. Try as I might to hide the discomfort, my face betrayed me. I wore a perpetual wince—the corners of my mouth pulled back; my face contorted. 

Just days before departure, fear that the pain might worsen forced me to visit Dr. Abel. Typically, we chatted for a bit. Today we cut it short. He poked and probed, eliciting painful winces. He listened with a stethoscope for sounds of movement, even a slight gurgle would indicate the absence of a blockage. His expression betrayed concern:

Jonathan, I recommend we immediately schedule a CT scan. This is likely a passing partial blockage or at worst pancreatitis. Most surgeons would consider a CT scan to be radical, but your condition concerns me. Intuitively, something feels different. By the way, are you Ashkenazi Jewish? 

The question caught me by surprise. “I am, but why do you ask?”

There is a small propensity, 10% or 15%, for Ashkenazi Jews to develop both colon and pancreatic cancer. You very narrowly averted colon cancer. I want to rule out pancreatic cancer.

What lousy luck. For centuries my European Ashkenazi ancestors had been forced to live in ghettos where we all married other Jews living within a few-blocks. We weren’t even allowed to wear shoes when we left the ghetto, making it easy to identify us. For centuries, our gene pool was too insular, as relatives married relatives. If we hadn’t gotten out of those damn ghettos, they’d have made a movie like Deliverance about in-bred Jews.

“Dr. Abel, we’re about to take a family vacation. How about we wait a few weeks till we return and then schedule the scan?” 

“Jonathan - let’s talk after the scan results. In all probability its pancreatitis, not pancreatic cancer. We’ll take it one step at a time.”

That night, I called my brother Joey, “I’m going in for a CT scan. The doctor thinks I may have pancreatitis, or maybe pancreatic cancer. Please let the family know.” 

“There’s no way you have pancreatic cancer” Joey interjected. “My friend Joel’s father died of pancreatic cancer. Only 40,000 people a year get it. You’re not one of those 40,000! You’re too healthy. At worst, you’ve got pancreatitis. Believe me, you’ll see.”

July 14, I reported for a CT scan. That evening, my cell rang unusually late. 

“Jonathan, the results of your scan are in,” Dr. Abel said in a solemn tone. “I’d like to schedule an appointment tomorrow to discuss your situation.”

“Why don’t we go over the results now?” I asked, not wanting to wait overnight for the dreaded news I suspected. 

“Well, O.K. I have shitty news. The scan indicates a cancerous tumor on the tail of your pancreas. We need to decide on a course of action. Unfortunately, it’s the aggressive type of pancreatic cancer.” 

His words struck like a gut punch. I had received the phone call that no one expects, but everyone dreads. I desperately wanted to be told that everything would be O.K., like a child begging a parent for comfort. 

Each word he had spoken magnified in my mind, seeming ever more ominous: tumor, aggressive, tail of pancreas, pancreatic cancer. I turned to Google:

The prognosis for pancreatic cancer is not good: pancreatic cancer has the highest mortality rate of any cancer; one-half die within six months; 35,000 of 40,000 die each year; survival rate for five years is less than 5%. 

I did the math: 5% of 35,000 = 2,750. Only 2,750 people with pancreatic cancer survive five years. No data detailed what happened to the 2,750 after the five years. 

I called Joey. “I've got good news and bad news. Which first?”

“The good news.”

“The good news is you’re right - I don’t have pancreatitis.”

“See, just like I told you. Everything is fine. You worry too much.”

I managed a slight chuckle before delivering my maudlin punch line. “You haven’t heard the bad news. I have pancreatic cancer.” 

After what seemed an eternity, Joe responded, “Jonny -You still there? Bro, you can beat it. I know you. You have the willpower.” 

“Right,” I said, rather unconvincingly. “Why not?”

Sleep eluded me. Admittedly, I had smoked two packs of Camel non-filters a day when I was twenty, but for only a few years. I had been exposed to noxious industrial chemicals and toxins in the tannery, foundry, steel fabrication, and auto assembly plants. I had always wondered whether my health had suffered. Were the mutations caused by those chemicals now ravishing my pancreas? 

Looking back, reports diagnosing my cancer expressly referenced exposure to toxins – trichloroethylene in particular. Report #00202 Dr. Abel:

IT IS OF NOTE THAT HE DID HAVE A SIGNIFICANT HISTORY OF EXPOSURE TO TOXINS WORKING WITH TRICHLOROETHENE AS A YOUNG MAN. ADDITIONALLY, HE SPENT TIME AS A TANNER WITH MULTIPLE DYE EXPOSURES … [Emphasis added]

I had tempted fate. I might as well have invited the grim reaper through an open door with a “Welcome” mat on my doorstep. 

I adopted an outwardly stoic demeanor, not wanting to alarm Eli and Noah. They were ten and seven at the time, too young and innocent for the unfolding trauma. We sat down for family breakfast, sun shining in from the garden. “Hey guys, Daddy’s not feeling well. I have a doctor’s appointment this morning. Nothing to worry about.”

I lay on the exam table. In walked Dr. Abel, impeccably attired as usual. We skipped the banter and pleasantries. “Jonathan, I’d like to go over initial findings. There is an enlargement of the pancreatic tail— 3.3cm in width and 5.8 cm in length. Let me show you.” Dr. Abel sketched my pancreas. I am looking at that sketch on faded yellow-lined paper, recalling the emotional jolt at the moment he depicted the disease’s profile.

There is a tumor on the tail of your pancreas right here. It is cancerous ... If it progresses further into your pancreas, it will be increasingly difficult to surgically remove as the tumor might become entwined with surrounding veins. I recommend we schedule you for some additional tests… while the condition is still operable. [Emphasis added.]

I drafted lists of all that needed to be put in order. I ensured my will was current and confirmed that my life insurance policies were up to date. I took care of as much paperwork as necessary to protect my family, thinking less of the disease's consequences for me than the possibility of Eli and Noah’s futures without me. 

I again underwent an endoscopy. The pathology report confirmed that the tumor was cancerous. Also detected were abnormal lymph nodes, the largest measuring 9mm. The abnormality raised alarm that the cancer had already spread to the lymph nodes. If so, the disease could readily metastasize elsewhere in the body, most likely the liver. My already slim odds of survival diminished. Stage T3: “Tumor extends beyond the pancreas …” [Emphasis added]

My tumor marker, the severity measure of pancreatic cancer, reached 112; normal being under 37. I grasped for any hint of optimism, yet this felt like a death sentence. Was I deluding myself with false hope that I could beat the disease? Maybe my remaining time would be better spent preparing for my departure, no matter how untimely?

Time for Surgery 

I prepared for adenocarcinoma surgery, arriving at CPMC at 6:00 a.m. 

All around me technicians in hospital garb, faces and hair obscured by surgical masks, busied themselves, checking monitors, setting dials, arranging surgical tools, and shaving my abdominal area. I was about to be sliced open like a fish waiting to be filleted. 

“Jonathan”, said Dr. Abel, “As soon as the anesthesiologist arrives, we’ll get started.”

“Cool. I’m going nowhere.” I thought my joke was funny. No one paid attention. 

My mind drifted. I summoned images of my sons. Noah, sporting a blue tinged mohawk, smiled while he rode his bike adorned with training wheels and multi-colored plastic streamers on the handlebars. (The photo sits on my desk.) In my mind’s eye, Eli swung a baseball bat, hitting balls I pitched to him. The images thwarted my deep foreboding, imparting a sense of joy and purpose. “Yes - I have to beat this fucking disease!”

The anesthesiologist arrived, “Mr. Melrod - we’ll put you under in just a minute. We’ll be applying an epidural patch. I’ll position it so that when you regain consciousness, the pain will be under control. Are you ready?”

“As ready as I’ll ever be,” I responded. 

PAIN, unmitigated, searing, GOD AWFUL PAIN! Somebody help! I’ve never experienced this much pain. Someone please help! This is unbearable! I never knew I could hurt so badly! FUCK!

My mind cried out for help, but anesthesia froze my tongue. I forced my eyes open. All was a blur; a haze obscured my surroundings. Where the fuck was I? What had happened to me? 

The outline of a nurse came into focus. “Nurse, please, I need help. I don’t think I can stand the pain. Please do something. I’m pleading with you.”

She examined the epidural patch. “Oh! I’m very sorry Mr. Melrod. The patch is not properly positioned.”

“You mean I’ve got nothing blocking the pain? The doctor promised the patch would help. I need morphine, please I need a lot of morphine right away.”  

“I’ll get the resident to approve a morphine drip. It’ll take a moment to locate him.” 

“I don’t have a moment!” I barked, unable to maintain civility.  

I closed my eyes. Through the pain I tried to summon images of Eli and Noah again, but nothing broke the spell of the searing, stabbing pain emanating from every sensory receptor in my abdomen. “Nurse, please, I beg you. Hurry with the morphine.” 

Seconds passed interminably slowly. After an eternity, probably only a minute or two, the nurse returned with a syringe of morphine, injecting it into my IV. A warm, tingling wave of relief crept through my body. I focused on the feeling of slowly spreading soothing relief as the morphine performed its miracle. 

I lay back, recalling life before the operation. Would anything ever again seem normal? I so desperately wanted to turn back time. I let the morphine take over, drifting into semi-consciousness. 

Out of the fog - a voice. “Here’s a little red button Mr. Melrod. You’ll be able to self-administer morphine every seven minutes. We don’t want you to suffer. We’ll let you rest now.” I wanted to ask, “Who the fuck came up with the seven-minute rule?” Definitely not a patient in pain. 

I slipped in and out of consciousness as night progressed. Grotesque, maudlin faces stared down at me. More than one, a whole group just staring. A collective, malicious glare. Maybe I could yell loud enough to banish them from my room. I tried to raise my voice. No sound escaped despite my herculean effort. Ghastly, ghoulish faces hovered. Caught in their demonic gaze, I felt unable to move or extricate myself from their spell.

I battled to regain consciousness, trying to determine what was real. Through slow morphine clouded deduction, I realized someone had hung mylar “Get Well” balloons at the foot of my bed. Realizing I must have been hallucinating, I allowed the sleeping meds to shut me down.

Again, I experienced horrible, raging nightmares, as the lines between sleep, hallucinations, and consciousness blurred. The next morning, Susan recounted that I had screamed, terrified that someone was trying to kill me, trying to shoot me. I had been fleeing, too weak to escape. I had thrashed and yelled, unable to evade my tormentor. My dream wasn’t so far off the mark; something was trying to kill me. 

I felt distressed and emasculated, all vestiges of self-respect stripped away. I was a fifty-four-year-old man who couldn’t go to the bathroom to pee, instead being instructed to urinate through the tube inserted in my penis. The very thought of that insertion procedure sent shivers through me.

I couldn’t even move my bowels in privacy, nor at a time of my choosing. I had to notify the nurse so I could be monitored. “By the way, your bowels won’t move for a few days but when they do, please let us know so that we can help.” I pushed the red button, lying back to let the morphine engulf me 

Desperate for water to quench a parched throat, I pushed the buzzer. My dry voice barely audible, I rasped, “Can I please have a cup of water?”

“I’m sorry Mr. Melrod, but water is too much for your system. I’ll bring you a sponge on a stick that you can dip in a bowl of ice cubes to lubricate your mouth and lips. Please make sure you don’t swallow any water.” Even my drinking privileges had been curtailed. 

Post-Surgery Prognosis  

Eli and Noah were coming for their first visit, a few days after surgery. I recalled the first time I had seen my father decimated by liver cancer. To see him so frail had shaken my world, even as an adult. What would it be like for my two young sons to see me with five tubes protruding from every orifice, oxygen being pumped into my nostrils, and morphine reducing my eyelids to half-mast? I resolved to make their visit trauma-free. The disease was mine to own. 

Pulling myself together, I forced my eyelids open; I feigned a cheerful, “Come on in.” Their young faces were filled with trepidation. They entered tentatively, clutching Susan’s hands. Noah, only seven, momentarily glanced at me, lowering his eyes. Expressionless, he asked to watch TV.  How strange I thought, as he toggled through the channels. He sat immobilized, glued to the TV. It seemed unusual as he wasn’t a TV viewer like some children. Not until I was writing this memoir did he confide that he had been too frightened to look at me. 

Eli, at ten, exhibited great fortitude, an internal strength beyond his years. He asked how I was feeling. He maintained a facade of normalcy on his face, even willing to exchange a few sentences. 

“Much better than I look sweetheart. I must look scary with all these tubes; I just came out of surgery. It’ll take a few days for me to recover.” I had decided to await Dr. Abel’s prognosis before saying more. Seeing me in such a frail condition was more than enough to digest. 

I held on for three or four days, suffering mightily through each. In walked Dr. Abel, standing at the foot of my bed like an apparition emerging from my morphine fog. 

His prognosis was brief and unambiguous: 

“Jonathan.” He paused. “We’ve had time to digest the results of the surgery. The good news is that the cancer has not spread to the thirteen lymph nodes we were concerned about.”

A rush of relief washed over me.

“I’m sorry though. The bad news is we weren’t able to get all the cancer. We took samples from the margins of the pancreas tail. We’ve studied those slides; the margins are sticky. In simple terms that means there is still cancer on your pancrea. We have a great oncologist on staff; I suggest you see him in the next few days to discuss treatment. 

Verdict delivered—a death sentence. Dreaded pancreatic cancer cells lived within me, threatening to further invade my body and rob me of my life. I couldn’t shake the damn question - had I signed my own death warrant when I went to work in a factory? “Dr. Abel, please ask the oncologist to see me as soon as possible.” 

“I can get him here this afternoon. Jonathan, I wanted this to turn out differently. I’m truly sorry.” He sincerely meant it. He looked sad but resigned. 

Through morphine laden eyelids, I focused on a figure at the foot of the bed. “Hello Jonathan. I’m the oncologist Dr. Abel mentioned. I’ve reviewed your case and propose an aggressive course of chemotherapy. I have to be honest, however. Despite our best efforts, I don’t expect you will live much more than six months, a year at most.”

“What the fuck are you telling me? Who the fuck are you to tell me that?” I was pissed. 

He continued, “I know this is difficult, but with pancreatic cancer we’ve experienced limited success with chemo. We’ll do our best, but I recommend that you put your affairs in order.”  

“Doctor - you don’t understand. I have two young children. I can’t die right now! I don’t plan to leave them. I’m sorry, but I don’t need your help.” The oncologist looked taken aback. He was the expert, I – only the patient. But I’d taken charge. I had to take charge if I hoped for a better outcome. I had fired my oncologist; he had offered no hope, no encouragement. What now?

Could it really be that my whole life had come down to five brutally stark words? Was it possible that my fifty-four years were reduced to a five-word admonition: “Put your affairs in order”? 

The oncologist’s visit had been all too real. In the aftermath, one particular musing plagued me — would my life ever again be close to normal? If somehow, against all odds, I managed to survive, would I ever be a normal dad? Would I ever travel with my family? Would I ever work again? Would I be around to see Eli and Noah grow up? I had never so deeply craved normalcy. 

The long, protracted night after the oncologist's visit was the toughest yet. My mind swung endlessly between the insufferable agony of physical pain and the irrepressible fear of dying. With each slight movement a tube uncomfortably tugged, reminding me that only medical intervention kept me alive. 

How to Move Forward 

I forced my mindset to reset. Through the pain and the fear of dying, I pondered the historic and turbulent era of my teenage and young adult years. Like a film playing in my mind’s eye, I reviewed the many life-endangering political struggles I repeatedly engaged in – being beaten by police and thrown in jail with a naked, bloodied, crazy man threatening to rape me; joining violent picket lines to defend striking workers and battling scabs who tried to cross the strike line; armed confrontations with motorcycle goons hired to break a rent strike; facing a neo-Nazi who had the barrel of a .38 revolver pressed against my stomach while he threatened to shoot me for being a “Commie Jew;” jeering at a legion of KKK members who slipped white robes over their uniforms before marching out of the Tupelo Police Station. The memories were vivid, so real 

I didn’t sleep. Night in the ICU was unbearably quiet. I heard only the beeping and humming of machines that kept patients alive. The steady hum of monitors, interrupted momentarily by the moan of a patient clinging to life. 

I continued rewinding my life frame-by-frame. Shutting down the University of Wisconsin to demand rights for African American students; battling riot police for days on end after four students were murdered by the National Guard at Kent State; firebombing military recruitment centers and eluding police helicopters as I hid in alleys after Nixon invaded Cambodia; providing armed security with a sawed-off pump shotgun for the Chicago Minister of Defense of the Black Panther Party. 

In the dark of night, in the wee hours of the morning, each political struggle ran through my mind, as if projected on 16mm film. The stream of visuals so engrossed, I confused my cancer-ridden reality with my past political reality. One offered death by cancer; the other had offered hope for an ethical, moral world I had fought to bring into being. 

I pondered, “How much harder, how much more difficult could it be to overcome cancer than it had been to fight those earlier political battles that had marked my life’s path? I overcame fear and adversity in each of those encounters. Any confrontation might have taken my life, but I had survived. Why couldn’t I overcome the threat of death by cancer?

Over that long, endless night, I persuaded myself that I could, and would, summon the inner strength to find a path out of the mess I now found myself in, no matter what the doctors told me. They didn’t know me. I had defied death before, why not again? Certainly, I could muster the tenacity and inner strength to once again fight to win, to beat cancer.

As early morning light bled through the blinds, I pledged to act on my night’s resolve. My first step, regain my physical strength. I broke the morning silence, ringing the buzzer. Every journey, long or short, arduous or easy, begins with a single step. I asked the nurse to help me out of bed and onto my feet. I wanted to begin again, to take that first tenacious step. 

I promised myself I would attend my sons’ Bar Mitzvahs when each turned thirteen. I even dared to hope I’d be around to drop Eli and Noah off at college. If I could only make it till then, I’d feel that I hadn't left my sons without a father till they were old enough to stand on their own. 

My physical state had deteriorated to that of a frail cancer victim. The nurse hesitated before helping me to sit. Raising myself into a sitting position triggered waves of stabbing pain; I was still held together by metal staples. Slowly and gingerly the nurse got me standing, untangling the spider’s web of tubes that ensnared me. I took my first unsteady step, dragging the IV stand. While my body cried out to be left alone, I pushed, “One baby step after another. Don’t give up. Don’t be a baby - cope with the pain. The road to recovery is paved in pain. 

I felt helpless, tubes dangling, as I painfully lifted my leg to take my first steps to recovery. Ever so slowly, barely an inch at a time, I willed myself to venture twenty-five feet. Much to the surprise of the intensive care staff, I repeated my small feat an hour later. Each step triggered new waves of pain, but I summoned the determination to stay positive, pushing myself to continue walking, a little further each time. 

Every hour, I forced myself to walk the stark, white-walled corridors dragging my IV. Progress was slow; I was an old man shuffling along. I avoided peering through open doors. So much suffering and misery in the ICU. With what felt like a Herculean effort, I tested my endurance and challenged myself to venture further: up the corridor, around the corner and back. 

The nurse announced the removal of the catheter. I braced myself, having experienced extraction before. I grabbed the sides of the bed, anticipating the glorious moment I would be able to urinate. A scream escaped as my urinary tract registered every centimeter of the catheter’s withdrawal. My resolve momentarily shaken, I felt relieved to regain a modicum of dignity. 

During one interminable night, I contemplated my plan - a survival strategy - medical and mental. If the margins were cancerous, a surgeon needed to cut out the margins. The thought of the operating table was horrific, but it seemed patently logical that more of the cancer needed to be removed if I hoped to survive. 

Embracing a New Paradigm 

I decided to venture beyond the rigid confines of the western medical paradigm. I contemplated the physiological change in the body that occurs when a person is embarrassed; one’s face reddens and flushes. Fear raises goose bumps, lifting hairs on the back of one’s neck. Sadness can bring tears, as can joy. Surprise can make one jump. In each, the brain produced a physical reaction. Why couldn’t I set my mind to beating cancer? I had heard people opine that stress can cause cancer. Why couldn’t a positive frame of mind boost the immune system to fight cancer? Seeing no reason it couldn’t, I planned to harness the same tenacity I relied on in my prior quest to improve the world. 

Filled with new found energy, I requested Dr. Abel. Before he made it through the door, I blurted out my request that he surgically remove more of the diseased pancreatic tail. My appeal caught him off guard. “Jonathan, it may be possible to remove another five percent. We could cut out about a centimeter that is crushed by one of the staples. Let’s bring Dr. Pinto into the discussion. 

Dr. Pinto, CPMC’s senior surgeon, dropped by. I repeated my request. “How about removing another quarter or half inch?” I asked. “Might that not rid me of the remaining cancer cells?” 

Dr. Pinto paused, “We’ve given your request serious consideration and admire your determination.” I was encouraged. But then, he shook his head, “I don’t feel comfortable with additional surgery. We’ve taken off as much as we can from the margins. I’m sorry.”

A wave crashed over me; the surf sucked me under - deeper and deeper. I was reminded of an incident when I was pulled down by the undertow on Martha’s Vineyard after being battered by a large wave. As hard as I tried to swim to the surface, I couldn’t break free of the undertow. I fought desperately, struggling to get to the surface; eventually I broke free. I felt like the undertow was sucking the life out of me as I mulled over Dr. Pinto’s disappointing rebuff. “I just need to find the right surgeon. I can’t stop now. Damn if I’ll stop now!” 

A week after surgery, an orderly arrived with a wheelchair. My Discharge Summary read, “The final pathology report … show[s] the cut margin to be involved microscopically with carcinoma.” I wasn’t willing for the Discharge Summary to be the last chapter of my life.

Susan had discussed my illness with a family friend who offered to introduce me to the leading pancreatic specialist in the country, if not the world: Dr. Tempero, University of California San Francisco Medical Center (UCSF) Director of the Pancreatic Cancer Program, who was vacationing in Australia. Our friend Laura telephoned Dr. Tempero to set an appointment upon her return. I planned to persuade Dr. Tempero to arrange additional surgery. I didn’t know if my request was medically feasible, but being proactive beat passive acceptance of a death sentence. 

Nights at home offered little respite from my ever-present foreboding. Despite heavy doses of Vicodin for pain and Ambien for sleep, I tossed and turned battling demons that thrived in the still, dark night. Throughout the night I’d wake drenched in sweat; someone was trying to kill me, but I outran my tormentor. 

I anxiously waited for Dr. Tempero, my lap stacked with scans, reports, blood tests, and computer discs logging data about my cancer. I pleaded my case to Dr. Tempero, questioning whether a UCSF surgeon might possess the skill to cut deeper into the deadly cells that threatened my life. Dr. Tempero made no effort to dissuade me. She suggested an appointment with Dr. Way, Vice Chair of the Surgery Faculty. “If anyone has the skills you’re searching for, it’s Dr. Way.” 

August 12, Dr. Way listened to my pitch for additional surgery. He exuded a confidence that comes with age and experience. He recommended I schedule a pancreas protocol CT scan. 

August 19, I returned for my follow-up. “Mr. Melrod - why are you here?” Dr. Way asked. I was taken aback; the question appeared so peculiar. Yet, he seemed to have asked it in all sincerity. Perhaps, he had forgotten who I was and what I had requested seven days ago?

“I’m here to ask you to cut out more of my pancreatic tail, to clean the margins. I’m told you’re the best. I need your hand on the scalpel. Frankly, other surgeons have been unwilling.”

“Yes Mr. Melrod, I could most assuredly cut into the margins despite the severe punishment to your body. There is considerable tissue left which can be resected, but I don’t need to.” 

Gob smacked, “What exactly are you saying Dr. Way?”

“I’m saying that, if necessary, I can resect more of your pancreatic tissue, but I don’t need to.”

“How can that be? Surgeons at CPMC told me the margins are dirty and I have less than a year to live.”

“Mr. Melrod - UCSF pathologists are the best in the world. We train other hospitals like CPMC. Pancreatic margins are challenging to interpret as they are sticky by nature. Our pathologists have concluded that your margins appear clean.”

Awestruck, I queried, “Are you absolutely sure? I’ve spent three weeks coming to terms with death. Now you’re telling me I don’t even need surgery.”

“You don’t need additional surgery. But it’s quite possible that the initial surgery released microscopic cancer cells into your system. I recommend a follow-up with Dr. Tempero to plan a course of chemotherapy.” Dr. Way’s demeanor was disarmingly nonchalant, but his prognosis threw me the lifeline for which I had been searching. 

Dr. Tempero warned that chemo and radiation were accompanied by onerous side effects: nausea, vomiting, fatigue, loss of hair (shit!), loss of appetite, foot and mouth syndrome (like hoof and mouth disease?), diarrhea, sores in the mouth and lips, heightened susceptibility to infection. It seemed like a horrific checklist of all the reasons to not subject oneself to the treatment. I wondered, “What would kill me first: the treatment or the disease?”

Dr. Tempero’s final admonition dispelled any hesitation, “The regimen for treating pancreatic cancer is essential to eliminating any microscopic malignant cells that might metastasize and spread the disease. Cancer cells differ from normal cells because they ignore the body’s signals to stop growing. Diseased cells are erratic and multiply rapidly. Chemotherapy attacks those rapidly multiplying cells.” 

September 16, I headed to the Cancer Center for a year of chemo, with a two-week intermission for radiation over Christmas and New Year’s. The infusion room was filled to capacity. Many were emaciated, a sickly, pallid tone to their skin. Many had lost their hair. I really, really hoped to not lose my hair, but felt stupid, and embarrassed, for entertaining such vain thoughts while fighting for my life. The patients who appeared most sickly were those slumped lifelessly with both eyes closed.

After a particularly grueling five-hour session, I had earned a glass of wine. I set my glass on the kitchen counter. When I returned, Noah and Eli wore mischievous grins. My next sip tasted gritty. I brought the glass to my lips again and swallowed a mouthful of mud. Noah and Eli’s grins became looks of mischievous self-satisfaction. There must be a connection between the grit in my mouth and their impish expressions, I thought. 

“What did you guys do? What’s up with the big grins?” 

“We put magic dirt in your wine to cure you from cancer.” 

 “What magic dirt?”

“The dirt from the church in New Mexico where a miracle happened. We want you to get better.”  

https://www.spiritualtravels.info/spiritual-sites-around-the-world/north-america/the-holy-dirt-of-chimayo-new-mexico/

I smiled, recalling the little whitewashed church. A few years back, we had taken a family trip to Chimayo, New Mexico. We visited a church where a miracle was reputed to have taken place. Pilgrims regularly visited the church to dig soil from under the statue of Virgin Mary. Discarded crutches and abandoned wheelchairs of the healed were strewn around the chapel. I remembered, we had brought back a baggie filled with dirt, some of which now floated in my wine glass.  

“Thanks for helping. I’ve had enough for now,” I said, as I poured out the gritty residue. 

As I pursued my treatment, I learned that most chemo patients engaged in endless discussions of the cancers that ailed them. I fully understood their need to seek solace and commiserate with other patients. That exercise, however, was not something that appealed to me. Susan continually encouraged me to join online ‘pancreatic cancer support groups’, but I explained that I had to fight the battle on my own terms. 

As treatment sessions progressed, I began to recognize my fellow patients. On one occasion, slumped in a nearby chair sat a woman I’d seen several times. She whimpered quietly and sighed in deep distress. Alarmed, I asked if I could get her anything from the waiting area stocked with amenities - tea, coffee, or water. A barely audible “no” escaped her crumpled body. Without looking up, she asked, “What cancer are you here for?”

“Pancreatic.”

Slightly raising her head, “So am I. How bad off are you? How long did they say you have?”

“Not too bad. They removed a tumor from the tail of my pancreas. The surgery may have released some cancer cells that could spread. I’m determined to beat it.”

She raised her head a bit more, eager to discuss our shared affliction. “I’m taking so Goddamn many pills for pain, anxiety, depression, sleeplessness, and nausea, and then this chemo. I don’t know how to survive.”

Her speech was slow and labored, impacted, I assumed, by the shopping list of meds she described. “Well, you’re undergoing chemo so you’re fighting the disease.”

“I can’t sleep. I can’t eat. I always hurt. I take so many pain meds I can’t focus. I’m not sure what it’s all worth. When I hear the statistics, I don’t know how I’ll survive.” 

I thought for a moment, not wanting to offer medical advice, yet wanting to encourage her. “You know, after my surgery the oncologist told me I only had six months or a little longer. I made a decision. Would I resign myself to the surgeon’s prognosis and accept my fate or do my damndest to put up a fight? You’re taking a whole lot of meds and that’s between you and your doctor, but I think your body needs to be able to unleash your own immune system. You need to be clear headed and positive, or the disease will beat you down. There’s no guarantee except that this disease will win if you give up.”

I continued, trying not to sound preachy, “Good luck and feel free to chat. I’m happy to give you my phone number.” She slumped back down without responding. 

Oddly, I gained fortitude from our conversation. In her highly medicated state, she was an unwitting example of how one can succumb to the disease. Because she was so overwhelmed, she was left with little hope and little strength to fight back. She was drowning in an ocean of pain and despair without a life preserver to cling to. I tried my best to throw her one, to encourage her, but it hadn’t seemed to register. 

My goal of beating cancer seemed impossibly distant. To get from A to B to C, I needed short-term advances. I walked in our neighborhood, believing exercise to be critical to strengthen my immune system. I gained fortitude and renewed perseverance from Noah and Eli, who walked the steep neighborhood hills with me. Before I’d been overtaken by cancer, I had held their little hands, making sure they didn’t stumble as we walked together. Now, they held my hands as we painfully, and ever so slowly, inched our way up the same steep San Francisco hills. 

Despite my resolve to stay positive, the steady buildup of Gemcitabine and Cisplatin (two drugs from my chemo cocktail) wreaked havoc. Dr. Tempero had warned that my mouth might suffer because of how rapidly the cells divide. The chemo meds, she explained, didn’t distinguish between rapidly dividing healthy cells and rapidly dividing cancer cells 

My mouth turned bone-dry as a desert, dotted with raw, open sores. The chemo-affected saliva glands were unable to produce enough moisture to lubricate my mouth. The persistent cluster of sores made eating even more distasteful than it already was due to my poor appetite and waves of nausea. 

Week after week of chemo exacted a punishing toll, mentally and physically. Wondering whether the chemo cocktail would destroy the errant cells in my system, an idea dawned on me. If I was going to subject myself to god-awful chemo, damn if I wasn’t going to get the most out of it. My mother had practiced biofeedback during two battles with breast cancer. I didn’t know much about the process except that it was predicated on the mind visualizing and effecting change on the body. Why not? Might as well be open-minded about non-traditional therapies. 

I shut my eyes, imagining chemo drips entering my bloodstream in search of malignant cells. I visualized globules of Gemcitabine and Cisplatin, shaped like round Pac-Men with slit-like mouths, on the hunt. I summoned images of Gemcitabine/Cisplatin Pac-Men gobbling malignant cells just like in the original Pac-Man game that once populated bar tabletops. 

At ensuing chemo sessions, I devoted time to visualizing my Pac-Men. When I lay in bed unable to sleep, I visualized my Pac-Men warriors doing battle throughout my organs and in my bloodstream. I wasn’t convinced my visualizations would impact my health or recovery, nor was I convinced they wouldn’t. 

When I received my initial diagnosis, Warren Kaplan, my father’s law partner and our attorney in the Fighting Times litigation, had urged me to seek treatment at the Pine Street Clinic in San Anselmo, California. A couple of years ago Warren had traveled multiple times from D.C. to California in search of alternative therapies to treat his own cancer. 

I initially refused to entertain the prospect of alternative (non-western) treatment, pooh poohing the very idea as hocus pocus. Over time, however, I reassessed my chauvinist, western-centric view.  

Why limit myself to allopathic or western medicine that has only been practiced for a couple hundred years? Allopathic medicine is limited to treating diseases using pharmaceutical drugs. It fails to analyze the body as an integrated whole, but instead takes a chemical hammer to an illness while often ignoring the root cause of the malady and the impact on the body of the pharmaceutical. Despite initial skepticism, I set out to chart an open-minded course of action. 

On a side street in sleepy San Anselmo, I entered the Pine Street Chinese Benevolent Association. Founded in 1982, the Association “specialized in ... innovative and evidence-based integrative treatment programs for complex medical problems … for which neither an exclusively western nor eastern approach is enough.” Sounded pretty on target. 

I read further, “We aim to offer truly optimal, comprehensive, no-stone-left-unturned, pull-out-all-the-stops strategies that seek to integrate the newest and most promising western therapies, drugs, and supplements with time-tested eastern herbs, acupuncture, and philosophy. We regularly comb through hundreds of international medical articles and maintain contacts throughout the world to be able to recommend the best and most effective options ...”

In a cozy examination room with the atmosphere of a Buddhist meditation center, I met Michael Broffman, who had long studied traditional Chinese Medicine in Taiwan. He asked about my illness and why I had chosen to visit Pine Street.

“I caught a break with pancreatic cancer. I’m lucky to still be here, but I’m searching for a strategy to optimize chemotherapy in conjunction with non-traditional alternative medical therapy to boost my immune system. Chinese medicine has been around for thousands of years. It strikes me as western-chauvinist and arrogant to close the door to alternative approaches.”

“Jon - our philosophy is to integrate time-tested eastern herbs and supplements to boost the immune system. Once I develop a regimen for you, I’ll provide you with supporting documentation, so you’ll understand my recommendations.”

After reviewing my scans, blood tests, and clinical analysis, Michael provided a pages-long regimen of supplements, many wholly unfamiliar. Among the recommendations, he instructed me to take a high dose of curcumin daily. Curcumin, I learned, is commonly known by the flavor it adds as the popular Indian spice from which it is extracted, turmeric. Research indicates, however, that curcumin also inhibits the proliferation of a variety of cancer cell-lines. While people take Tagamet (Cimetidine) to reduce stomach acid, studies Michael provided indicate that high doses of Tagamet act as an adjuvant therapy for pancreatic cancer. Similarly, Omega-3 fatty acids commonly found in fish oil inhibit cancer proliferation and progression. 

Common wisdom dictates - stay out of the sun to avoid harmful rays that cause skin cancer. Many people suffer from a depletion of vitamin D. Michael ordered tests that revealed my levels to be low, so 6000 units of vitamin D3 were added to my daily diet; studies found D3 to be effective against a wide range of cancer cell-lines. In addition, IP6, Resveratrol, Artemisinin, Naltrexone, and Zadaxin, among other unpronounceable substances, all became part of my regimen. I ingested about fifty pills and capsules with breakfast and dinner. Shocked friends watched as I downed handfuls like popcorn and asked whether the pills worked. I’d answer, “I don’t know for sure, but I’m still here.”

While I didn’t want to jinx my chances, I began to hope that maybe, just maybe, I would survive five years. I quoted Robert Frost to myself, “In three words I can sum up everything I’ve learned in life: it goes on.” 

Some days were better, some worse. I discovered no magic bullet to render the sky bluer, make life more enchanting, turn bad into good, unhappy into happy, unpleasant to pleasant, or nightmares into sweet dreams. I relied on Frost, “Life … goes on.” 

Life settled into a tolerable routine: every three months, I reported to UCSF for a CT scan to monitor for disease recurrence. The veins in my arms partially collapsed during chemo, which made insertion of the IV needle challenging, and painful. The ‘needle’ resembled a shaft, much thicker in diameter to accommodate the volume of thick contrast, or dye. 

The first time I experienced the contrast, the sudden blast of prickly heat caught me off-guard. First, the area around the IV warmed. Soon, my whole arm was ablaze. The hot, tingling sensation crept from my arm down my torso. The sensation intensified as the dye penetrated my groin area. I flushed and overheated from head to toe, from inside out, like a baked potato wrapped in tin foil. 

Life took on a near normality. While it was impossible to banish thoughts of disease recurrence, I thought about it less. I returned to work, but on a relaxed schedule. I continued to visit Dr. Tempero quite regularly to review scans and blood tests. Life progressed without any devastating setbacks. I dared to hope for what most thought impossible - a life afterpancreatic cancer.   

Some three years after surgery, I sat in Dr. Tempero’s office for a routine follow-up. I had let go of the anxiety I felt every time I entered her office. With a sharp knock, Dr. Tempero entered the examination room, both arms cradling voluminous medical files. Without any of our usual chit-chat, she explained that three soft tissue nodules had been detected in my upper abdomen near the pancreatic head, and three others in the region of the “hepatic flexure” (near the liver). 

I was floored - six new nodules in close proximity to the resected tumor. Dr. Tempero conveyed what I always knew was possible but thought (hoped) unlikely. Mention of lymph nodes raised a red flag, since there had been concern at the time of surgery that cancer had metastasized to my lymph nodes. Dr. Tempero wrote, “[Melrod’s] CT findings are worrisome” and instructed me to schedule a CT scan in two months. 

The fragility of my survival came into brutally sharp focus. I shuddered as if a bucket of freezing water had been dumped on me. The dismal survival rate flashed like a neon billboard on a dark night. Only 2750 pancreatic cancer patients diagnosed each year survive for five years. I had only three years under my belt. Would I make it to five? The road to full recovery dimmed as I contemplated the overwhelming odds. 

Lying in bed after learning of the nodules, I tossed and turned. I stared out the window into the darkness, barely able to make out the shadow of the gnarled California pepper tree in our backyard. Against my will, I ruminated over my health, sucked slowly into a mortal abyss. I didn’t want to die, but death lurked in the darkness. 

I had felt shitty. Lesions dotted my scalp, painful open fissures on my hands refused to heal, and open sores irritated my gums and mouth. A pervasive malaise tugged at me day and night. During a night of endless trepidation, I suddenly blurted out to Susan - “I feel like I’m dying. My body is signaling me that my health has gone awry.” Momentarily, panic supplanted hope; the grim reaper’s acrid breath engulfed me. 

Two months later, following a new scan, the radiologist’s report noted he had “[a]gain seen … several prominent lymph nodes from the right lower quadrant … which appear to be slowly progressing in size when compared to previous examinations. The largest of these measures 1.1 cm in its greatest diameter. IMPRESSION Section: - results [are] “suspicious for disease recurrence.” [Emphasis added.]

Dr. Tempero’s gaze locked with mine. I studied her facial expression and her eyes behind her glasses. I discerned little from her expression, but she, of course, had played this poker hand hundreds of times with pancreatic cancer patients. 

Our eyes remained locked, “Jonathan, I’m sorry to say, but it appears there is a recurrent pancreatic metastatic adenocarcinoma. You suffer from enlarged lymph nodes combined with … chronic nausea and ... weight loss. Based on the steady growth of the tumors we’ve been observing over the past months, I’m afraid that your cancer has returned.”

The room fell silent, no candy-coating of her prognosis. I sat in stunned silence, unable to respond, unable even to open my mouth. I thought about Noah and Eli. I wondered whether the grains of sand in my hourglass had fully slipped through the funnel leaving the upper chamber empty. 

“Dr. Tempero, may I take a couple Ativan and have a minute to myself?” 

“Of course, Jonathan, as long as you need.”

I slid two Ativan under my tongue and waited for the sweet taste of the dissolving pill to relieve my anxiety. I folded my hands over my eyes, lowered my head into my lap and silently began to sob. Dr. Tempero stood silently, not moving, as my shoulders shook. For the first time since my diagnosis, I allowed myself to cry. 

I didn’t feel sorry for myself; I felt sad that I might be leaving too soon. Eli was only 13 and Noah just 10. Expectations, once embraced, are difficult to dispel. “God damn it,” I thought. “I was doing so well. Now this fucking disease is again poisoning my organs and threatening to rob me of my life.” I was physically fatigued and mentally weary.

After a few more minutes, I wiped away my tears. “Okay Dr. Tempero, what do we do to fight it?” 

“It’s been  a few years since your chemo. That suggests your body was receptive, likely from the Gemcitabine. I suggest we proceed with more tests and insert a port into which we administer Gemcitabine with low-dose Cisplatin.” 

I dreaded the very thought of again pumping poison into my body. Why had the cancer returned? Why wasn’t my immune system powerful enough to fight off the disease? 

I decided on a radical, alternative course of action. I left my job. I needed to leave the overcrowded, treeless city, paved over with cement, and move to my home in the country. I needed to breathe fresh, clean air and jog every morning. I committed myself to a healthy diet, knowing that food can be curative. I needed a change. 

I again visited the Pine Street Clinic. I need to get Michael Broffman on board with the new diagnosis. With Michael’s participation, I pledged to do my damndest to unleash my immune system as my first line of defense without chemo, at least for now. No tears: time had returned to wage all-out war on the illness that threatened to rob me of my remaining years. I embarked on a regimen to beat back the disease.  

Months later, I returned for a follow-up with Dr. Tempero after yet another scan. She reviewed the radiologist’s report. Congratulations Jonathan, no more tumors. The Gemcitabine did its job. 

“Actually Dr. Tempero, I chose not to repeat chemo. I went with an alternative regime, at least to start with. Thanks for all your support. No offense (I said jokingly), but I hope I won’t need to see you again.” 

Dr. Tempero seemed disarmed. I don’t think she really knew quite how to react. The allopathic paradigm to which she was wedded didn’t allow for alternatives to western medicine making it difficult to offer, or accept, an explanation for my changed circumstances. We tacitly decided to leave the definitive analysis for another time.   

I did visit Dr. Tempero once more, ten years after surgery. “Jonathan, I’ve held back saying this, but I believe you’re cancer free. Congratulations. You’re one of the very few.” 

Conclusion 

Before concluding, I return to the initial question posed by my sons - “Dad - after having your intestines cut up and battling pancreatic cancer caused by factory chemicals, would you have made the same choice to work in those factories you’ve told us about?” 

Let me be honest; I’m no Don Quixote. When I made the choice to leave Madison to work in an auto factory in 1972, I was just one amongst thousands whose political roots lay in RYMII, the faction of SDS that believed that the working class possessed the ultimate power to stand up to capitalism and fight for a more humane socialist alternative. I still embrace that same philosophy but realize the goal many of us share isn’t on the immediate horizon as I once, perhaps naively, believed. 

Of course, the millions upon millions of working people who face alienating, insecure, life threatening and toxic working conditions daily aren’t afforded the luxury of contemplating the choice of whether to subject themselves to capitalist exploitation. Survival itself necessitates going to work, despite the inherent consequences and risks. 

As I look back over what I’ve written -- I’d like to think I lived by a worthy creed. In the United States we are not taught our own history, at least the chapters that were written by working class heroes. I’d like to leave my readers with this quote by the famous American socialist who chose jail rather than fight a rich man’s war during WWI. 

“To stir the masses, to appeal to their higher, better selves, to set them thinking for themselves, and to hold ever before them the ideal of mutual kindness and good will, based upon mutual interests, is to render real service to the cause of humanity.”

― Eugene V. Debs

Jonathan Melrod’s new book, “Fighting Times” is available from better bookstores and from PM Press. click here.