Bruce Whistance

Early in 2022, Bruce again experienced gastrointestinal distress and abdominal pain. Suspecting an ulcer, Bruce called his gastroenterologist, but the doctor was unable to see him for another four months. Not wanting to wait, Bruce instead met with a physician’s assistant who prescribed medication to calm his stomach pains. The medicine failed to help, though, and by April, Bruce and his wife, Gail, sensed something was seriously wrong.

Bruce’s pain had become so severe that the only way he could sleep was upright in a chair at a 90-degree angle. Worrying that the problem was similar to the earlier blockage that ended in surgery, he and Gail decided to forgo another visit to their small, local hospital in favor of getting to the large regional medical center in Albany, New York.

After enduring an eight-hour wait in the emergency room in Albany, Bruce was admitted, and after a day of tests, he and Gail had answers. Bruce had pancreatic ductal adenocarcinoma that had spread to his liver, making the tumor unresectable. Doctors told the pair that Bruce likely had about six months left to live, maybe a few more with chemo. The next step was to see an oncologist. At a large clinic like MSK, he might qualify for a clinical trial.

After finding that local oncologists couldn’t see Bruce for a month, Gail contacted MSK’s Westchester campus and was impressed that they booked an appointment for the following Monday. Bruce and Gail found that the team at MSK had a strong sense of urgency, installing a chemotherapy port the same week of Bruce’s evaluation and starting chemo the following week using FOLFIRINOX. Although his age was at the upper end for this more aggressive chemo option, his overall health was judged to be good enough to tolerate it. The doctor made clear to Bruce that the chemo was palliative only, not curative.

Once Bruce and Gail got home from that first chemo infusion, they were faced with a difficult question:
“How do we best spend the last few months of his life together?” Gail asked.

They decided to spend as much time together as possible and did just that, whether it meant taking walks or scheduling regular date nights. They also had a steady stream of visitors, with friends and neighbors making a point to come through and say goodbye, drop off homemade bread, or otherwise offer up small comforts.

Bruce also began getting his affairs in order, finding new homes for his extensive stamp, vinyl and model train collections. While he’d spent decades amassing them, he didn’t want Gail or their twin sons to have to figure out what to do with them later.

Bruce’s symptoms also continued to worsen. After one particularly difficult night, he and Gail put a call into hospice. As long as chemo treatments are considered palliative only, hospice was able to accept him as a client.

“They arrived faster than Amazon Prime deliveries,” Bruce joked.

The hospice staff helped manage Bruce’s pain and prepare the couple for what everyone assumed would come next.

FOLFIRINOX, as it turns out, has a platinum-based component that works particularly well in people who have a BRCA2 pathogenic mutation, which raises the risk of certain types of cancer. The gene mutation is a bit of a double-edged sword, because while it places those who have it at a heightened risk for cancer, it can also make them more responsive to particular types of treatments, like – in Bruce’s case – the platinum element in FOLFIRINOX.

Bruce didn’t know until after he’d started chemo that he even had the BRCA2 mutation, so his decision to start with the more aggressive FOLFIRINOX was a lucky one, to some extent. However, many people experience severe side effects while taking FOLFIRINOX, and Bruce was among them.

Bruce, who’d long had an aversion to vomiting, found himself doing just that, and he also struggled to eat or drink anything, including the things he used to enjoy.

“Even water tasted like turpentine,” Bruce said. “Even just thinking about food would make me sick.”

Bruce, in a display of positivity for his future, resumed his model train hobby, buying back his favorite rolling stock at auction and building from scratch a long-dreamed-of working train layout in the basement room where static shelves of vinyl used to stand.

Gail, too, played a key role in helping Bruce build back strength, doing everything in her power to keep him healthy, nourished and hydrated while simultaneously managing the emotional toll that often comes with a caregiver role.

“It was tough psychologically and emotionally – I had to face the fact that, imminently, I was going to be alone in this big house on this big property without Bruce,” Gail said.

For Bruce, Gail’s efforts and support were a godsend.

“I would not have made it if Gail hadn’t kept putting food in front of me every day,” he said.

Beyond not wanting to leave Gail alone in a big house, Bruce also had concerns about a degenerative eye disease Gail has and had promised he’d “be her eyes” in the event her vision failed.

“That was a big incentive to continue to rage on,” Bruce said.

Bruce and Gail have also become increasingly well-versed in the value of genetic testing and are recommending that their adult twin sons, who share identical genetics, undergo testing once they get within about 15 years of the typical onset age for pancreatic cancer. They cautioned that it’s important to have life insurance in place before this happens, as known genetic mutations can jeopardize insurance eligibility.

Both Bruce and Gail also hope to see earlier detection methods emerge and surgeons develop less-invasive surgical options than the Whipple, a procedure commonly used to treat pancreatic cancer that involves an extensive replumbing of the digestive system. In particular, they see promise in the “NanoKnife” (IRE – irreversible electroporation) procedure, which can target tumors without damaging nearby arteries, organs or tissue and is used in combination with chemotherapy, immunotherapy or radiation.