The End of Your Life Book Club

by Will Schwalbe

at about page twenty or so, the magical thing occurred that happens only with the very best books: I became absorbed and obsessed and entered the “Can’t you see I’m reading?” mode.

you have pancreatic cancer that’s diagnosed after it’s spread, there isn’t likely to be a surprise ending. You can be fairly certain of what fate has in store.

“Little did she know her life was about to change forever.” Many authors adopt something like this when they want to create suspense. The truth is that people never realize their lives are about to change in unforeseen ways—that’s just the nature of unforeseen ways. We were no different.

“I don’t know,” Mom answered. “Maybe not. But maybe the characters think that things could have turned out differently. Maybe that’s why you found it so sad.”

Mom was suffering; I was going on with my life.

Every year pancreatic cancer kills more than 35,000 people in America—it’s the fourth leading cause of cancer death. It gets only 2 percent of the National Cancer Institute’s budget; maybe that’s because it has so few survivors.

Most people don’t know they have pancreatic cancer until it has spread, because the symptoms usually come late, often as a result of the cancer affecting other organs, and they are common to many different illnesses. Weight loss, back pain, nausea, and loss of appetite can have hundreds of causes. The yellowing eyes and skin of jaundice is another symptom but is far more likely to be caused by viral hepatitis than anything else, so it’s usually chalked up to that.

The pancreas is the gland that makes hormones like insulin and also the enzymes that help us digest food. The bile duct links it to the liver and the gallbladder. Cancer cells easily spread from the pancreas to other parts of the body, hitching a ride on the blood that courses from the pancreas through the lymphatic system.

Fewer than five percent of all people diagnosed with all kinds of pancreatic cancer, including those who have the Whipple, will live five more years. For those, like Mom, who are diagnosed after the cancer has spread, the average life expectancy is three to six months, but that’s just an average. Some people, we were told, are dead within a month; others will live for two years or even longer.

One of the many things I love about bound books is their sheer physicality. Electronic books live out of sight and out of mind. But printed books have body, presence. Sure, sometimes they’ll elude you by hiding in improbable places: in a box full of old picture frames, say, or in the laundry basket, wrapped in a sweatshirt. But at other times they’ll confront you, and you’ll literally stumble over some tomes you hadn’t thought about in weeks or years. I often seek electronic books, but they never come after me. They may make me feel, but I can’t feel them. They are all soul with no flesh, no texture, and no weight. They can get in your head but can’t whack you upside it.

The prognosis for people with Stage Four pancreatic cancer was, as my siblings and I had read on the Internet, usually three to six months. That didn’t leave much room for hope. But there was no clear prognosis for people with “cancer that has spread.” Stage Four is the end of the line. There is no Stage Five—though

Treating a disease that isn’t curable is, in essence, palliative—the goal is both to slow the progress of the tumors and to make life worth living while you do.

It helped you remember that people aren’t here for you; everyone is here for one another.

Of course, we are all dying and none of us knows the hour, which could be decades away or tomorrow; and we know that we need to live our lives to the fullest every day.

She paused to consider the question. “Well, I don’t think it’s any sadder to die from cancer than from a heart attack or another disease or an accident or anything else. It’s all just part of life, real life. If we ruled out books with death in them, we wouldn’t have much to read.”

What’s odd about commencement is that so many people think of it as the end of something, the end of high school or college—but that’s not what the word means at all. It means the beginning, the start of something new.

“loneliness can kill people—in different ways can actually make you die.

And I knew I would start to cry and didn’t want to. Not then. Maybe I didn’t want Mom to have to comfort me. Or maybe I was scared that once I started, I wouldn’t be able to stop.

she would choose quality of life over quantity;

You should tell your family every day that you love them. And make sure they know that you’re proud of them too.

now, I looked to books to help me make sense of my life.

There is no place more perfectly lonely than an airport at night when you fear someone you love is dying and you’re rushing to see that person.