There are many foundations on which we build our lives; assumptions that guide our actions. Once in a while, we are reminded that change is the most reliable assumption of all. Unfortunately, while maybe reliable, change is not very predictable.

A few years ago, Sherri’s health was one change we didn’t think would hit us this drastically, or this soon. We’ve had some runway to deal with Sherri’s cancer, and she’s acted bravely, pragmatically, and with focus on what really matters. It’s a precarious balance between being hopeful while shooting for positive outcomes on the one hand, and preparing for the inevitable on the other hand. Of course, it’s just a matter of time for all of us. We’ve been focused on positive action and trying to make the best of Sherri’s time, carefully building our house of cards. We do not regret that. But when the first card pops out of place the rest of the house starts to waver.

Sherri has been on a biological treatment called Herceptin for the past few months. This is an approved breast cancer drug that addresses a gene mutation that was found in her pancreas tumor. Her oncology team speculated that some of the same mechanisms may be at work in both types of cancer. For a while, it seemed like this treatment was keeping things stable (which is a noble goal for anyone in this predicament). Recently though, Sherri has been a little worse for the wear.

Medically speaking, Sherri’s pancreas is not her main worry. The panceatic tumors had already spread to other organs (which is what defines a cancer as Stage 4) when it was first detected in August 2013. The biggest problem is her liver, which has tumors encroaching from one direction and has been damaged by the chemotherapy from the other direction. Slow the chemo, and the tumors accelerate. Speed up the chemo, and the liver damage accelerates. That’s why the immunotherapy trials have been important; we needed something to slow the tumors without toxic chemicals. Dodging back and forth between chemo and immunotherapy trials has been a balancing act, but slowly we’ve been noting the progression of pseudocirrhosis. In this scenario, eventually you lose your body’s filter and other toxins start to make it into your bloodstream. There are signs that we have hit the point of convergence where there is very little left to balance. For example, a recent check of her ammonia levels showed 4 times higher than normal. That would make you really, really tired.

We are having ongoing discussions with our primary oncology team at Fox Chase Cancer Center to consider whether there are any treatments that might still work, how well they are likely to actually work, and what the cost in time and comfort might add up to. There is no obvious course of action. Either way, we’ve decided to start looking at how this fight might come gracefully to a close, whatever the timeframe might be. That first card is bending…