Chronic pancreatitis. I was only vaguely aware of the pancreas. If you have no problem, you don’t know it’s there. But if you get a problem, you damn well know it’s there. The pain is excruciating, and nothing helps. Morphine maybe. But I can’t really say. I only know it from secondary observation. Eva ‘developed’ – wrong word, but what else? You can’t ‘contract’ or ‘catch’ pancreatitis. Eva developed pancreatitis, and I saw what it did to her. I should have known more about the pancreas as my father used to tease us kids with quiz questions about where the Islets of Langerhans were.
The first attack was at one o’clock in the morning. She woke me up, calmly as ever, not screaming in pain – in fact she never said much about her pain, ever. She would calmly describe it, but I could see from physical reactions how much pain she was in. Even in her dying, she characteristically underplayed her pain – I wonder if the medical staff then felt she wasn’t in pain. On the 10-point pain scale the nurses used, Eva usually rated her pain as 3-4; only once can I recall her giving a 7. Now, however, she explained how the pain radiated across her back up to her shoulder, how even the slightest movement, the slightest breath, exacerbated the pain. I called the doctor urgently. I thought she was having a heart attack. I can still recall the anxiety I felt: ‘Oh no, not again, she’s only just recovered from the splenectomy!’ Somehow I did not want Eva to know how worried I was. But this was to become permanent for the next decade.
The doctor had no idea, but could see she was in serious pain, and called the ambulance. It was an extremely cold January night, around minus 10. The ambulance had been sitting out in the cold all evening – this was its first call. The paramedics wrapped Eva in a special blanket and manoeuvred her downstairs and into the ambulance. Eva was giving me instructions about what to bring to the hospital, especially her blanket – she had always found the hospital so cold.
The junior doctors in the emergency room also had no idea. The tests were uncertain, and the ultrasound unclear. Finally by about 7 am, they decided to admit Eva with a lung embolism. I’m sure they knew that wasn’t the real reason, but it was strong enough to get her admitted. Eventually a scan revealed the cause. Eva had to lie still for a couple of days, scarcely eating, and finally the pain subsided. The same procedure happened again with another emergency nighttime ambulance shortly afterwards, but gradually Eva learned to cope with the attacks, by simply going on a null-by-mouth diet and lying as still as possible for as long as it took. Attacks varied in length from an hour to more than a day or two.
Now we began to learn about pancreatitis from our specialist and from other medical sources. The fact that the pancreas has two functions, an endocrine function whereby the islets of Langerhans excrete insulin hormones, and an exocrine function, secreting the digestive juices. In Eva’s case it was exocrine function that was impaired by calcification. ‘Can’t you operate, take out the bad bit?’ we asked. Ah, no, came the answer, and our specialist described in great detail the anatomical structure of the pancreas, comparing it to butter. ‘We can cut the pancreas, but we can’t sew it up again. It’s like sewing butter,’ he said. ‘You will just pull the thread through the tissue.’
So Eva lived with pancreatitis. ‘What causes the attacks? Do I have to cut things out of my diet?’ she asked. ‘We don’t know. You will have to find out what you eat and what causes the attacks. Each attack can increase the calcification.’
For ever after I had to remind myself that whatever Eva was doing, she could be in severe pain.
To be continued.