Getting started

“You’d better find a surgeon”.

But how exactly do I go about finding a surgeon?
And how can any physician send off a patient with that cold, brusque advice?

I go to my office and get on the phone. I talk to Giuseppe, a doctor friend of mine. He says I should call the Gemelli hospital, one of Rome’s best, and make a ‘semi-private’ appointment with a surgeon. He explains that it works like this: if you need an operation, first you pay for a private appointment. Then, after the surgeon examines you, you get put on the waiting list of the public system, so that you can be admitted to the hospital for the operation … Is he kidding me? I had no idea. Never having gone through a similar experience, it all seems rather ridiculous. You have to pay to get in. Or so it would appear.

Francesca, my family doctor, tells me that she’ll check with some of her colleagues to find out exactly whom I should contact.

But Anna Maria, another friend who’s a doctor, tells me to stop right there. She says there’s no one in Rome whom she’d let anywhere near her pancreas. No way. She’ll put me in touch with the Borgo Roma hospital of Verona that’s the very best in the field. She serves as my go-between with her fellow doctors (many of whom work in Verona but are originally from Rome, like us), and they give me an appointment for a biopsy. I go to have it done on 21 November 2017: a cytology exam by fine needle aspiration.

But given that I have to travel all the way to Verona, I figure I might as well enjoy the trip, so instead of reserving some depressing Bnb in the centre of town, I decide to spoil myself, taking a room at a spa hotel in the nearby Valpolicella district (the Villa Quaranta Tommasi Wine Hotel & SPA) and bringing my friend Adelaide with me. Adelaide and I have shared countless adventures and other moments in our lives, and I have no intention of spending the entire trip on a train with my mother giving me sad looks, trying to stay strong, for my sake, but suffering every minute of the way. I don’t consider this a trip to hell and back, or a journey to the gallows. I’m going in a two-day vacation with my friend, with a brief interlude to get a needle inserted in my sternum.

I can’t wait to get into the spa water; I’d recently become a great fan of hot water. We hurry to get there, in order to enjoy the spa for as long as possible before it closes for the day (the next day I won’t be able to go in, because hot baths are not recommended when you’ve just done a biopsy). The photos we’ve seen make the spa look absolutely terrific.

But …. it’s a shame it’s also being used for an introductory swimming class for new-born babies, with at least ten couples and their screaming little ones in the water when we get there (the site said ‘Nobody under 16 in the spa’). We wait patiently, knowing that sooner or later they’ll have to go home, the kids will get hungry. And indeed, for a full 15-20 minutes we get to relax in the spa all by ourselves, until: boom, boom…. ONE, TWO, THREE, FOUR, ONE, TWO, THREE, FOUR … music cranked up to full blast comes over the loudspeakers for a very well attended course of aqua-gym exercise. An absolute nightmare. Never again: the next time I’ll call ahead and double check. Fortunately we make up for it with a meal centred around a delightful risotto all’Amarone. I can still taste it.

RESULTS of the biopsy: “Despite the sparse amount of material, the cytological outlook is in keeping with pancreatic ductal adenocarcinoma.”

In Verona they tell me that, given the position of the tumour, it would be better to do neoadjuvant chemotherapy as a preliminary step: 3-4 months of chemo to make the operation itself simpler and less risky. The latest research points to a few months of chemotherapy before an operation on the pancreas increase the chances for success. But they suggest that I do the chemo in Rome, so that I don’t have to commute back and forth. They recommend Michele Milella. He’s an oncologist who works at the National Tumour Institute, also known as the IFO.

I’m slowly catching on: when you have a tumour of the pancreas, you have to move quickly, faster than the tumour. If it can be operated on, then the key figure is the surgeon. If it can’t be operated on, or at least not yet, then you’re dealing with the oncologist. I find out that, if there are only a few surgeons who are skilled at operating on the pancreas, there aren’t many oncologists who know it well either. But now that they’ve stuck a needle in me, at least I know where the pancreas is. So I start browsing through images on the web.