RANDY PAUSCH

THE LAST LECTURE: AN EXCERPT

Chapter 12 | The Park Is Open Until 8 p.m.

Dear friends, The Last Lecture is actually a series of lectures organised by the Carnegie Mellon University, which would invite their professors to give a talk assuming this would be their last lecture ever. Except... in this case, Prof Pausch (who was 46 years old then in 2007) was actually diagnosed with terminal pancreatic cancer only a month before the speech. He was given 6 months to live then, so this was to be his real last lecture. The title of Chapter 12, "The Park Is Open Until 8 p.m." was taken from the standard reply given by Disneyland staff if they're asked what time the park closes. This was intended to focus Disneyland visitors not on when it closes, but on what they can do while it is open. My friends, our time is Open for a limited time only. What can we do while it is still Open? Go buy Randys book to read his excellent views on life and living.

The Park Is Open Until 8 p.m.

MY MEDICAL odyssey began in the summer of 2006, when I first felt slight, unexplained pain in my upper abdomen. Later, jaundice set in, and my doctors suspected I had hepatitis. That turned out to be wishful thinking. CT scans revealed I had pancreatic cancer, and it would take me just ten seconds on Google to discover how bad this news was. Pancreatic cancer has the highest mortality rate of any cancer; half of those diagnosed with it die within six months, and 96 percent die within five years. I approached my treatment like I approach so many things, as a scientist. And so I asked lots of dataseeking questions, and found myself hypothesizing along with my doctors. I made audio tapes of my conversations with them, so I could listen more closely to their explanations at home. Id find obscure journal articles and bring them with me to appointments. Doctors didnt seem to be put off by me. In fact, most thought I was a fun patient because I was so engaged in everything. (They even didnt seem to mind when I brought along advocatesmy friend and colleague Jessica Hodgins came to appointments to offer both support and her brilliant research skills in navigating medical information.) I told doctors that Id be willing to endure anything in their surgical arsenal, and Id swallow anything in their medicine cabinet, because I had an objective: I wanted to be alive as long as possible for Jai and the kids. At my first appointment with Pittsburgh surgeon Herb Zeh, I said: Lets be clear. My goal is to be alive and on your brochure in ten years. I turned out to be among the minority of patients who could benefit from what is called the Whipple operation, named for a doctor who in the 1930s conjured up this complicated procedure. Through the 1970s, the surgery itself was killing up to 25 percent of patients who underwent it. By the year 2000, the risk of dying from it was under 5 percent if done by experienced specialists. Still, I knew I was in for a brutal time, especially since the surgery needed to be followed by an extremely toxic regimen of chemotherapy and radiation. As part of the surgery, Dr. Zeh removed not only the tumor, but my gallbladder, a third of my pancreas, a third of my stomach, and several feet of my small intestine. Once I recovered from that, I spent two months at MD Anderson Cancer Center in Houston, receiving those powerful dosages of chemo, plus daily highdose radiation of my abdomen. I went from 182 to 138 pounds and, by the end, could hardly walk. In January, I went home to Pittsburgh and my CT scans showed no cancer. I slowly regained my strength.

In August, it was time for my quarterly check-in back at MD Anderson. Jai and I flew to Houston for the appointment, leaving the kids with a babysitter back home. We treated the trip like something of a romantic getaway. We even went to a giant water park the day beforeI know, my idea of a romantic getawayand I rode the speed slide, grinning all the way down. Then, on August 15, 2007, a Wednesday, Jai and I arrived at MD Anderson to go over the results of my latest CT scans with my oncologist, Robert Wolff. We were ushered into an examining room, where a nurse asked a few routine questions. Any changes in your weight, Randy? Are you still taking the same medications? Jai took note of the nurses happy, singsong voice as she left, how she cheerily said, OK, the doctor will be in to see you soon, as she closed the door behind her. The examining room had a computer in it, and I noticed that the nurse hadnt logged out; my medical records were still up on the screen. I know my way around computers, of course, but this required no hacking at all. My whole chart was right there. Shall we have a look-see? I said to Jai. I felt no qualms at all about what I was about to do. After all, these were my records. I clicked around and found my blood-work report. There were 30 obscure blood values, but I knew the one I was looking for: CA 19-9the tumor marker. When I found it, the number was a horrifying 208. A normal value is under 37. I studied it for just a second. Its over, I said to Jai. My goose is cooked. What do you mean? she asked. I told her the CA 19-9 value. She had educated herself enough about cancer treatment to know that 208 indicated metastasis: a death sentence. Its not funny, she said. Stop joking around. I then pulled up my CT scans on the computer and started counting. One, two, three, four, five, six I could hear the panic in Jais voice. Dont tell me youre counting tumors, she said. I couldnt help myself. I kept counting aloud. Seven, eight, nine, ten I saw it all. The cancer had metastasized to my liver. Jai walked over to the computer, saw everything clearly with her own eyes, and fell into my arms. We cried together. And thats when I realized there was no box of tissues in the room. I had just learned I would soon die, and in my inability to stop being rationally focused, I found myself thinking: Shouldnt a room like this, at a time like this, have a box of Kleenex? Wow, thats a glaring operational flaw. There was a knock on the door. Dr. Wolff entered, a folder in his hand. He looked from Jai to me to the CT scans on the computer, and he knew what had just happened. I decided to just be preemptive. We know, I said. By that point, Jai was almost in shock, crying hysterically. I was sad, too, of course, and yet I was also fascinated by the way in which Dr. Wolff went about the grim task before him. The doctor sat next to Jai to comfort her. Calmly, he explained to her that he would no longer be working to save my life. What were trying to do, he said, is extend the time Randy has left so he can have the highest quality of life. Thats
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because, as things now stand, medical science doesnt have anything to offer him to keep him alive for a normal life span. Wait, wait, wait, Jai said. Youre telling me thats it? Just like that, weve gone from were going to fight this to the battle is over? What about a liver transplant? No, the doctor said, not once the metastasis occurs. He talked about using palliative chemotreatment thats not intended to be curative, but could ease symptoms, possibly buying a few monthsand about finding ways to keep me comfortable and engaged in life as the end approached. The whole horrible exchange was surreal for me. Yes, I felt stunned and bereft for myself and especially for Jai, who couldnt stop crying. But a strong part of me remained in Randy Scientist Mode, collecting facts and quizzing the doctor about options. At the same time, there was another part of me that was utterly engaged in the theater of the moment. I felt incredibly impressedawed reallyby the way Dr. Wolff was giving the news to Jai. I thought to myself: Look at how hes doing this. Hes obviously done this so many times before, and hes good at it. Hes carefully rehearsed, and yet everything is still so heartfelt and spontaneous. I took note of how the doctor rocked back in his chair and closed his eyes before answering a question, almost as if that was helping him think harder. I watched the doctors body posture, the way he sat next to Jai. I found myself almost detached from it all, thinking: He isnt putting his arm around her shoulder. I understand why. That would be too presumptuous. But hes leaning in, his hand on her knee. Boy, hes good at this. I wished every medical student considering oncology could see what I was seeing. I watched Dr. Wolff use semantics to phrase whatever he could in a positive light. When we asked, How long before I die? he answered, You probably have three to six months of good health. That reminded me of my time at Disney. Ask Disney World workers: What time does the park close? Theyre supposed to answer: The park is open until 8 p.m. In a way, I felt an odd sense of relief. For too many tense months, Jai and I had been waiting to see if and when the tumors would return. Now here they were, a full army of them. The wait was over. Now we could move on to dealing with whatever came next. At the end of the meeting, the doctor hugged Jai and shook my hand, and Jai and I walked out together, into our new reality. Leaving the doctors office, I thought about what Id said to Jai in the water park in the afterglow of the speed slide. Even if the scan results are bad tomorrow, I had told her, I just want you to know that it feels great to be alive, and to be here today, alive with you. Whatever news we get about the scans, Im not going to die when we hear it. I wont die the next day, or the day after that, or the day after that. So today, right now, well this is a wonderful day. And I want you to know how much Im enjoying it. I thought about that, and about Jais smile. I knew then. Thats the way the rest of my life would need to be lived.