One of Our Own Faces Down Colon Cancer

Jeffrey Fudin, PharmD, co-editor-at-large of Practical Pain Management (PPM) was recently diagnosed with stage 4 colon cancer. What follows is the first in a series of essays chronicaling his experience. As clinician turned patient he hopes his training and knowlege helps to educate and inspire fellow cancer patients and their loved ones. 

Recently diagnosed with stage 4 colon cancer, PPM co-editor-at-large Jeffrey Fudin, PharmD, hopes to inspire and educate his fellow patients with a series of personal essays chronicling his fight.

Unchartered Territory...Sort Of  

I started my career as a clinical oncology/hematology pharmacist in Albany, New York. It was 1982 and I was in my mid-20s. My task was to integrate direct care pharmacist to  care—a unique opportunity at the time.

A large part of my day was spent prescribing comfort—in the form of anti-nausea medications, opioids, and other pain-relieving drugs—to patients enduring the pain of chemotherapy treatments and the cancer itself. It was an incredible learning opportunity for me as well as the pharmacy and medical interns and residents working alongside me.

Most importantly, patients received the best therapeutic regimens that were prefably scientifcally based, but in some cases prescribed based on prior experience gleaned treating palliative care patients and taking into consideration what we knew about pharmacology and drug interactions at the time.

There were some unfortunate bumps in the road—a story for another day—but if you like horror stories, see the 2005 New York Times article, "Abuses Endangered Veterans in Cancer Drug Experiements".

A Symptom Not to Ignore

Severe and painful cramping in the lower left side of my abdomen led to a CAT scan that revealed a problem. Four days later I met with a colorectal surgeon (still not knowing if it was a tumor). A week after that I had an unsuccessful colonoscopy. 

Unsuccessful, how?  Everyone dreads the pre-colonoscopy cocktail cleanout and all that toilet time, right? Well, I drank it all down and waited for it to do its dirty job but guess what? After three hours...no response. 

I was instructed to do it again—I did half of it and looked nine months pregnant. It wasn't pretty.

By this time, my lovely wife Robin called the doctor on call because with a possible tumor, at least in my mind, I was afraid I’d perforate my bowel—an outcome potentially worse than the alleged cancer itself.

So, into the hospital I went—by ambulance—and the colonoscopy was switched to a sigmoidoscopy because the newly-discovered tumor was blocking the exit of the fluid from my rectum. 

Too Big to Scope

That tumor continued to impede the diagnostic progress. It was large and blocked the scope. I woke up in a bit of a post-scope drug stupor and recall being told I was being taken back to surgery, "so we can insert a stent”. Thank you Robin for making that decision. 

The stent, basically a small cage, was embedded into the colorectal wall to open the rectum and allow fecal matter to pass through. I’m was fine with the plan. My response: "Shoot me up with some more meds and let’s get this done."

In an attempt to shrink the tumor—prior to surgically removing it along with the adjacent lymph nodes outside the colon wall—I endured five days of intense but targeted radiation.

Thanks to the multiple scans obtained during my hospital stay, we learned that the cancer had not metastizied to the lungs or liver—both of which are the most common sites for colorectal cancer. How did I know this? That knowledge came via my previous life as an oncology pharmacist (see paragraph one, above).

Forty plus years ago I had daily conversations with patients and their families about the advantages and disadvantages of chemo. What to consider in terms of opting in or out of treatment; defining confusing terms and statistics for them regarding benefits versus risks; reviewing survival percentages and helping them consider the personal costs associated with chemo or investigational drugs with potential expanded life expectancy versus no chemo and perhaps most importantly, their quality of life with or without treatments, side effects, combined radiation, diminished blood counts, etc., etc.

An Unfortunate Discovery

The intention was to find a way to create a temporary poop pipe (aka ileostomy) by cuting the colon and reconnecting it above my large intestine. Then, they'd go after that nasty colorectal tumor and lymph nodes. Get them the hell out of there! Once the colon healed, surgeons would reverse the plumbing back to normal. 

But that surgery was ended abruptly when multiple tumors were discovered throughout my peritoneal (abdominal) cavity even though imaging indicated all other organs were free of disease. 

What we all thought (or were hoping) was early stage 3 cancer, now became non-curative stage 4 cancer. So, when I woke up to a large-capacity central line catheter instead of the ileostomy bag I expected, I knew things had gone arwy and that the stage was set for chemotherapy to be administered. 

Before the surgeon came in, I hoped it was all just a drug-induced dream, and that my new fate wasn't going from a 90% cure rate to palliative chemo. But unfortunately it the nightmare was real.

Truth be told, I still wake up hoping it's all a bad dream—and so do the many people I love.

So here I sit...writing this on the first day of chemo in my cozy recliner surrounded by many others (socially distant of course). We all have our own stories of fate. Different cancers, variable family/friend support systems, different financial access, and different outcomes in terms of cure versus palliation.

Why Am I Sharing All of This with All of You?

That’s a good question. It’s because in some ways my life has come full circle. I've gone from a young oncology pharmacist to a middle-aged pain doctor, to a patient in a chemo chair. 

I hope my experiences and feelings over the last few weeks will help clinicians—young and old—pause and reflect on their lives and how they care for their patients.

And I hope my perspective—as a clinician and now patient in the chemo chair—will benefit other patients. My ability to speak from the other side (no, not my grave!) will undoubtedly be shaped by my knowledge and training. Any gems of wisdom I glean will be shared in future posts.

In The Meantime...Squeeze the Day

My mantra in life has always been, "when life throws you lemons, get off your a** and make lemonade".

Although treatments and clinic visits have become a large part of my life, I still continue to work, teach, and write. Over the last several weeks as all of this unraveled, I reaped the benefits of spending time with all of my 4 children who are planted all over the US (except one who lives nearby) and their spouses.

All of them have generously put their lives on hold to support daddy, papa, life partner in good and bad times, sickness and health, just like the vows I made with my wife nearly  40 years ago. They flew in  and/or drove multiple times to Albany. 

My neighbors, friends (really my extended family), professional colleagues (also extended family) have called, texted, just showed up, sent cards, jokes, and all kinds of encouragement, and for that I am eternally (possibly a bit shorter these days) grateful. The outpouring from people I haven’t heard from in decades was equally endearing and heartwarming, both to me and to my wife.

As a patient, I am so grateful. And considering the circumstances, I do consider myself one of the luckiest men in the world that got dealt one really bad hand of cards.

As a professional I feel badly for my patients that may not have this support, and as clinicians we all have to be better at understanding their misfortune, listening intently, and referring them to behavioral health and clergy experts that can help soften that void.

*Adopted from "Pain, Lemons, and Lemonade". First published June 22, 2021 on PainDr.com, Dr. Fudin's website. You can follow Dr. Fudin's journey through his lemonade blog series and clinician lessons at https://paindr.com/category/pain-lemons-lemonade/.

Updated on: 09/22/21
Continue Reading:
My Colon Cancer: The Awkward Question Everyone Asks
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