Current literature on pancreatic cancer outlines the stages of the illness and treatment strategies for the disease. There are also websites available to help patients and loved ones cope with receiving the news of a terminal diagnosis. However, few pancreatic cancer websites reveal what to expect as a patient with untreated pancreatic cancer declines and eventually passes. Since I watched my beloved grandmother decline from this disease, it is my wish to tell her story so that others know what to expect from death from pancreatic cancer. Allow me to share Marietta’s story.
2007-2008
Marietta is an 87 year-old vibrant grandmother who has only struggled with thyroid disease since the 1980s. Marietta is now expressing that she is constantly nauseous, weak, she is having insomnia and is experiencing pain in her lower back. Marietta’s primary care physician runs some tests and prescribes medication to alleviate the nausea. No cause of the symptoms is revealed.
October 2008
Marietta is experiencing shortness of breath and chest pain. She is hospitalized for three days. After many tests, no cause for her symptoms is found but she is diagnosed with hyperthyroidism and Type 2 diabetes. She begins to take Actos to control her blood sugar levels.
April 2009
Marietta is hospitalized again. This time it was a result of her blood sugar being too high. She is transitioned to a nursing home for thirty days for therapy and is then discharged. No cause has been determined as to why Marietta’s blood sugar will not stabilize.
August 2009
Marietta is now admitted to the nursing home as a resident after being hospitalized again. Her nausea, fatigue, insomnia and back pain are getting worse, and she has now fallen a few times at home. Marietta is weak and has extremely low potassium levels. No cause for her symptoms is determined.
August 2009-April 2010
Marietta’s thyroid and diabetes are under control. By April, she begins to look more and more yellow in the face. She is also complaining of stomach cramps at night. The nurses at the nursing home urge Marietta to go to the hospital for tests. An endoscopy is scheduled but is then cancelled during the procedure. A tumor has been found growing off of Marietta’s pancreas. The tumor is so big that it has rotated all of the organs in Marietta’s stomach. Marietta is diagnosed with late stage pancreatic cancer. Due to her age, she does not qualify for chemotherapy or surgery to remove the pancreatic tumor. The family is told she has six months to one year to live.
Marietta visits an oncologist and he runs some tests. The oncologist finds high levels of cancer in Marietta’s blood. The family is told to not tell Marietta about her terminal illness. The oncologist schedules Endoscopic Retrograde Cholangiopancreatography (ERCP). In May, Marietta has balloon dilation, but a few weeks later the balloon becomes infected. In June, Marietta has a stent inserted to unblock the bile tube that was causing the jaundice. The family is now told that the stent will fail in six to nine months, and Marietta will then pass. A family friend, who is a nurse, says, “Marietta will now have good and bad days, but when she begins to decline, it will be quick.
June 2010-January 2011
Marietta has been doing well throughout the last seven months. She is loving life and only rarely complains about stomach cramps and nausea. When she does, she constantly questions why she has these symptoms. The family tells Marietta that she is having trouble with her pancreas and her symptoms should subside with medication. By January, she has lost forty pounds and is experiencing severe abdominal pains at night. Around the middle of January, Marietta contracts a stomach flu that has been going around the nursing home. The flu lasts for a week. After the flu has passed, Marietta begins to complain of extreme weakness, fatigue, diarrhea, chest pains, hand tremors and stomach cramps. Her face then begins to turn yellow again and she requires around the clock oxygen. Marietta’s doctor prescribes medication to relieve the stomach cramps.
February 6, 2011
Marietta has been bedridden with fatigue since mid-January. Today is her 90th birthday and she is well enough to come to her surprise party that is being held at the nursing home. Marietta’s face is clearly displaying signs of jaundice and her face is now sunken in from the weight loss.
Marietta’s nurses advise the family to consider Hospice, as Marietta’s weakness, fatigue and stomach pain are getting worse. Marietta is scheduled for an oncologist appointment for February 21st and the nurses draw blood and run tests. The tests confirm that Marietta’s cancer is “now off the charts.”
February 14, 2011
Marietta’s first day under the care of Hospice. She is given Roxanol, which Drugs.com state is morphine prescribed to relieve pain. Marietta expresses that she has no pain and she is feeling “high.” The nurses continue to give Marietta Roxanol every four hours.
February 16, 2011
Marietta loses her ability to speak and is now confined to bed all day. She is experiencing hand tremors, muscle spasms and sleeps most of the day. While sleeping, Marietta moans the entire time. Marietta’s legs, arms, and hand are slowly filling up with fluid. The nurses state these are common symptoms that present when a patient is starting to decline. Marietta is barely eating, but at 10 pm, she does request a bowl of cereal and she feeds herself. Marietta’s daughters decide to start taking 24 hour shifts and stay at her bedside to take care of her.
Marietta eats a banana for breakfast. She immediately regurgitates it and the vomit is all black. This will be the last time she eats. Marietta cannot get out of bed to use the bathroom and a catheter is inserted. Marietta continues to sleep all day, loudly moaning and is constantly experiencing muscle spasms.
February 21, 2011
Marietta continues to sleep all day and her urine is now the color of tea. She is still moaning, so morphine patches are placed on her arm to ensure that she is comfortable. Around 6pm, she opens her eyes and stares into the corner of the room. I approach her and her eyes light up, acknowledging my presence. I give her a kiss, tell her I love her and tearfully tell her to go be with my grandfather. She gently shakes her head and goes to sleep. Marietta will never wake up again.
Marietta has been asleep all day and is snoring peacefully. She looks comfortable but she is developing a fever. Around 10pm, a nurse’s aid informs the family that Marietta now has the death rattle, which is a rumbling noise that is heard with each breath. Marietta’s breathing then starts to labor, and she experiences pauses between her breaths that last up to three seconds. By 12 am on Wednesday, February 23, 2011, Marietta now has a fever of over 100 degrees Fahrenheit and the nurses give her Tylenol to try to make her more comfortable. By 12:15 am, Marietta’s Cheyne-Strokes are now five seconds apart. At 12:25 am, Marietta’s breathing stops for a minute, but then she takes three more breaths. A nurse confirms her death from pancreatic cancer at 12:30am.
It is my wish to share Marietta’s story about her death from pancreatic cancer because I had trouble finding literature on what to expect as she declined. Although some of Hospice’s literature outlined what to look for when a patient dies from a terminal illness, I realized that every patient’s departure will be unique. As was Marietta’s, who went from winning four out of five rounds of bingo to succumbing to pancreatic cancer in ten days.
In loving memory of my angel, Marietta T. Pollio. February 6, 1921- February 23, 2011.
Pancreatic Cancer Center, “Endoscopic Retrograde Cholangiopancreatography: About the procedure,” http://www.pancreaticcancercenter.com/about-procedure.html.
