Andy Segal, a former senior producer in CNN's documentary unit, says he didn't think at first he would need help from others when he was diagnosed with pancreatic cancer. Credit: courtesy of Andy Segal
(CNN) -- There was no way to stop the tears.
Five and a half months after I was diagnosed with pancreatic cancer, six weeks after the last of seven chemotherapy infusions, and four days after major surgery, the doctor was ready to discharge me.
The only thing I needed was to defecate to show that my digestive system was working. That afternoon, I was alone in my hospital room with a nurse of Iranian origin who, at 37, was my son's age. We had become friends, a Muslim and a Jew, exchanging stories about our childhoods, careers and children.
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As I updated my history on the computer, I started sobbing. After months of stoicism, the time had finally come for my emotional catharsis. The nurse immediately came to my side. Soon after, he would be by my side again, with a suppository, for an equally important intestinal catharsis.
I figured I could fight cancer on my own.
I'm not cut out to cry, and it's not just because I'm a man. It is a legacy of my parents, who always conjured the strength to combat their challenges. My mother had no choice. His father, a Russian immigrant, abandoned the family a few years before the Great Depression. Later, his mother lost her sight to glaucoma and then also her hearing. After such a traumatic childhood, my mother was not dependent on anyone at all.
My soft-spoken father was tough in his own way. He tolerated hard work without limits and never complained. He preached that the strong should take care of the weak and, despite his modest income, he assumed his responsibility.
Based on my lineage, when I faced cancer I didn't think I was one of those weak people who would need help. I figured my superpowers would beat the debilitating side effects of chemotherapy. I was very wrong. Pre-operative chemotherapy assaulted me with incessant nausea, diarrhea, dehydration fatigue, hair loss, hypoincessant, blood-tinged mucus, and painful tingling when I touched something cold.
The full meaning of being a patient, vulnerable and dependent, would eventually become clear: I would be the beneficiary not only of my caregivers' skills, but also of their determined loyalty. He would discover a sacred relationship, but, like many men, he would learn it lesson by lesson.
I didn't want to accept help.
I had resisted the role of patient in part because my early diagnosis was encouraging. When my GP called me to communicate the results of the CT scan, which first revealed the pancreatic tumour, he started the conversation with "What good news!"
Relatively speaking, he was right. The stage I tumor did not touch nearby blood vessels and there was no evidence of metastasis. I was apprehensive, but never anxious about my treatment.
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My wife of 40 years, Ellen, wasn't so calm. I imagined coming home from the hospital like a zombie, tubes oozing slime as red as fruit punch. He arrived at his catastrophic vision after consulting Dr. Google about the high mortality rate of pancreatic cancer (true) and the surgery that would eviscerate me like a fish (hyperbole). She was sure she would need extensive care from herself and an army of friends, neighbors, cooks, visiting nurses and physical therapists.
Segal married Ellen Mazer in 1982. His cancer diagnosis, four decades later, strained their relationship, generating so much friction that they tried couples therapy. Credit: Courtesy of Andy Segal
But I insisted that I wanted nothing to do with any of them. I planned to take care of meals, exercise, and what professionals call "activities of daily living" myself.
A friend of mine, psychologist Avrum Weiss, said that my brain was doing what it had been socialized for: processing thoughts and emotions according to traditional roles. "Men think of masculinity as a standard, something they have to earn. Something they have to prove," said Weiss, author of "Hidden in Plain Sight: How Men's Fears of Women Shape Their Intimate Relationships."
My manual didn't work well at home
Ellen and I even argued about where she would wait during my operation. Why would it make sense for me to go to the hospital at 5:15 in the morning to wait uncomfortably for several hours until the operation was over? I reasoned that it was better for her to come later, fully rested, when I left the recovery room. What seemed logical to me, hurt Ellen deeply. (The surgeon settled the matter. He said Ellen should be there.)
Our conflicting forecasts led to a cold war. Under the iron curtain of frowning and sulking was the question of control or, more accurately, lack of control. For Ellen, there was a double problem: the cancer was out of her control and so was her ability to influence the way I dealt with it.
The conflicts generated enough friction for us to attempt couples therapy. It didn't work. After four sessions, the psychologist dismissed us, saying he didn't want to waste our time and money listening to us argue.
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A turning point in my healing
It protected my privacy as much as my independence. I've always been the class clown and I love to get attention. But starring in my own medical soap opera? No thanks. I didn't want to be seen as damaged merchandise. We only tell our inner circle. But the support we received made me realize that my people were helping me, and not telling friends seemed as dishonest as lying. So we told more people.
Sometimes, the frankness turned against me. Some blurted out comments like "Oh, my relative died of pancreatic cancer!" but, usually, the emails and phone calls were encouraging. A high school classmate broke a 54-year-old silence to cheer me up. My group was forming, whether I wanted it or not.
Friends who had battled cancer offered advice, shopping, respite care, and a ride to doctor's appointments. Some were people I hadn't called when they were sick. At the time, I thought I was too far away from their lives and didn't want to intrude. I regret my immaturity and it won't happen again.
Connection with my surgeon
After chemotherapy came the operation, performed by a doctor who radiates the confidence of an NFL quarterback and enough warmth to be approachable. He says he has performed several hundred pancreaticoduodenectomies, known as the Whipple procedure, in honor of Dr. Allen Oldfather Whipple, who developed the protocol in the mid-1930s. In addition to removing the tumor, the Whipple procedure also removes parts of the stomach and intestine, as well as the entire gallbladder. This requires new surgical connections between the organs, making the operation complex.
After the operation, in my hospital room, physical intimacy with the hospital staff was immediate, with the hospital gown, urinary catheter and two surgical drains in the abdomen.
Preoperative chemotherapy left Segal with nausea, diarrhea, hair loss and other side effects. He hopes to have five more sessions of chemotherapy after the operation. Credit: Courtesy of Andy Segal
Everyone I met, not only the doctors and nurses, but also the physician assistants, physical therapists, quartermaster staff, and waiters, was committed to my well-being. The friends strengthened my spirit. And Ellen oversaw everything. I no longer argued. Together, they created a healing environment that I thought I didn't need.
My surgeon soon abandoned the formality of calling me "Mr. Segal" in favor of the shorter, friendlier "Segal."
"Segal, I have heard that you want to leave the hospital." During his rounds on the night before my discharge, I took my new casual nickname as a sign to promote male bonding with a vulgar joke about a genie in a magic lantern. After laughing out loud, he started calling a few people "idiots" and even let out an expletive.
The connections that matter
Ellen's brother, a retired intensive care physician, had offered to come to Atlanta from Annapolis, Maryland, when I was discharged. Although I thought it was an exaggeration, she appreciated his moral support and the extra pair of hands in case something terrible happened at home.
Segal says he and his wife, Ellen, have now discovered where they connect as caregiver and patient.
Credit: Courtesy of Andy Segal
As we walked away from the hospital, she told us of her fantasies of taking revenge on her "enemies," including the body parts that distinguish men from women. It was hilarious. And something magical happened. In the days that followed, he became more of a friend than family.
Lifelong friends gave new meaning to "comfort food" with meals for Ellen and meals that fit my restricted diet. There were also phone calls, text messages and cheesy greeting cards. A friend's husband became my walking companion. I had never realized how many people had my (and Ellen's) backs.
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Finding the connection with my wife
My prognosis is reasonably good. The pathologist's report says the removed tumor has clean margins, meaning the surgeon removed everything. There was no cancer in the 34 lymph nodes that were removed, meaning there is little chance it has spread.
Even so, in case there are undetectable stray cancer cells left, I will undergo five more sessions of chemotherapy. At this time, I appreciate all the help I can get through those 10 exhausting weeks.
Fortunately, Ellen and I are better prepared now. We've discovered places where we connect as caregiver and patient. One example: When I first walked after the operation, I hunched over unconsciously and unnecessarily to protect myself from what I feared was abdominal pain.
To improve my posture, Ellen used a slogan from the hit TV series "The Wonderful Mrs. Maisel," which she will invoke again during the final hard phase of my chemotherapy treatment: "Up the tits!" instead of the bossy "Stand up straight," it helps my posture and my attitude in general. At this point, I sincerely appreciate that.
-- As a senior producer in CNN's Documentary Unit, Andy Segal won Emmy, Peabody and DuPont awards. He is currently a freelance writer, producer and director in Atlanta.