Ken Rybicki was about to go under the surgeon's knife.
And he was afraid.
"If I woke up in intensive care, it meant they did the surgery and I had a chance," the Belleville physician said. "If I woke up in a regular room ... the doctor told me to start getting my affairs in order."
There was a good chance he wouldn't wake up at all.
He had pancreatic cancer and was having surgery at Barnes-Jewish Hospital in St. Louis in February 2002. Patients with this form of the disease usually have a less than a 1 percent chance for survival.
Thirteen hours later, Ken opened his eyes. Still groggy, he heard the beeping of machines and the mumble of voices. He knew immediately he was in ICU.
Wife Susie squeezed his hand.
"I was hopeful. I wasn't out of the woods yet, but I had a chance," said Ken, 52, who lives in Belleville with Susie. They have four grown children, two of whom are in college.
"Now I feel so blessed. But I also feel guilty because a lot of people go through this disease and don't do so well and don't make it."
The 6-foot 2-inch physician weighed 220 pounds before he was diagnosed with cancer Feb. 18, 2002. He had joked with patients that it was time for him to drop a few pounds.
Side effects from chemotherapy and radiation caused him to lose 80 pounds. He has gained back 30 pounds and now weighs 170.
"He's thinner but he looks good," said patient Bob Collins as he shook Ken's hand during a visit to the doctor's Swansea office for a checkup.
"We worried about him, and we kept going to him even when he was over in St. Louis," said Bob's wife Ellen.
Ken continues to be cancer-free nearly seven years after his diagnosis and now runs half-marathons. He's an internist at Barnes-Jewish Hospital and recently reopened an office in Swansea. Rising costs for medical malpractice insurance caused him to close it four years ago, he said.
The diagnosis
In early 2002, Dr. Rybicki was bothered by an ongoing upset stomach, but considered himself healthy.
He turned his attention to business interests.
In early February 2002, he and a small group of investors purchased The Orchards golf course in Bellville and the undeveloped lots around it. Daughter Mary was a senior at Althoff Catholic High School, and Ken enjoyed watching her soccer games as well as getting involved in all his kids' activities.
"I had indigestion. I thought I had some gallbladder problems, so I ordered some tests."
On Feb. 18, he diagnosed himself with pancreatic cancer.
The doctor read the results himself with his personal physician, which revealed his worst nightmare -- a cancerous mass the size of a golf ball on his pancreas, the organ responsible for making insulin to regulate blood sugar levels.
Ken knew his future was grim.
"It was a strange feeling. Pancreatic cancer is often a death sentence." Susie was stunned.
"I was supposed to have lunch with his mother. I had to call her and tell her I couldn't make it, but I couldn't say why," she recalled.
She listened as Ken's doctor explained.
"I think he quit listening after he heard 'cancer.' I didn't know if I should get a power of attorney or what, and we had to keep things normal for the kids."
Both were stoic.
Ken told their children, then ages 11 to 19. Mary, the second oldest, was first to get home from school that day, then Tommy, and Sarah, the youngest. Jennifer was away at college. "We knew something was wrong. There's not a whole lot of thought. You just listen," said Mary, now 24, who works in marketing in St. Louis.
Ken remembers wanting to ask Mary not to go away to school and Jennifer to come home for a semester. But he couldn't do it.
"I wanted people around, but I didn't want people sitting around feeling sorry for me, and I didn't want them to give up their lives."
'I might never come home'
The question was: Had the cancer spread?
His surgeon, Dr. Steven Strasberg, would know the answer after performing exploratory surgery. If the cancer had spread, surgery would be useless. If it did not, he would perform the Whipple procedure, a surgery that removes part of the stomach, pancreas and small intestine.
The risky surgery, if successful, can help pancreatic cancer patients live longer.
"There was a real chance I might never come home," said Ken.
He was scared but tried not to let his family know. His family assembled in the waiting room Feb. 20, 2002, during the 13-hour surgery.
"The minister from church kept coming in and out, and our friends did the same thing. All of kids played euchre the whole time," said Mary.
Word came from the surgeon after about two hours. The cancer had contained itself in the head of the pancreas, leaving the tail (the part that produces insulin) unaffected. They could proceed with the Whipple procedure.
After surgery, Ken was extremely sore but thankful to be alive. Family members came into ICU one by one to check on him. Within 12 hours, he was moved to a regular hospital room and started drinking liquid, then eating soft foods.
"I still have problems digesting carbonated beverages and I have to eat meats slowly."
Fighting back
Five weeks after surgery, Ken started aggressive treatment to kill any remaining cancer cells. For the next six weeks, he received radiation treatments five days a week in addition to three different chemotherapy treatments.
After that six-week regimen, he received another round of chemotherapy for nine weeks.
"I haven't had a chemo treatment since then," said Ken.
Now, he understands what cancer patients go through.
Besides nausea and weakness, he developed mouth sores and neuropathy, a burning and tingling sensation in his arms and legs.
"As a doctor, you tell patients what they might experience. You go through it, and you know what it means to go through all the waiting and have the treatments."
Treatment left him unable to do basic household chores.
"For a guy who had never been sick, I was too weak to take out the trash."
He made it to his kids' sporting events, but often had to leave early.
"I think I stayed at Mary's graduation party for all of five minutes. I was so weak," said Ken.
Susie packed the family car and got two of the Rybicki kids moved in to college that year.
Road to recovery
Getting on with life also meant returning to an active lifestyle. He began walking, then light weight training to rebuild strength in abdominal muscles after surgery, Chest exercises also helped him loosen tight skin and muscle tissue damaged during radiation.
In 2006, Mary was planning to run in a half-marathon for the Pancreatic Cancer Action Network (PanCAN) in San Diego.
Dad was going to cheer from the sidelines.
"She said, 'Why don't you run it?' I thought I could at least walk. I ended up walking and running."
Ken has been running since to keep fit, 2 or 3 miles a couple times a week.
He likes the track at Kings Point in Belleville and jogging in St. Louis' Forest Park. When he gets off late, he and Mary sometimes jog in the parking lot near his office.
In January, he and Mary ran for PanCAN in Miami.
Moving forward with life also has meant moving into his new office, a former oncology center. He's there on Tuesday and Thursday afternoons.
He has learned not to worry about the small things. He has minor aches and pains and needs to have a knee replaced, but he isn't complaining.
""If someone cuts me off in traffic, it doesn't bother me. I have bigger things to concentrate on, like helping other people fight cancer, and helping with funding for research. Someday, I want other people not to have to go through what I went through." To see more of the Belleville News-Democrat, Ill., or to subscribe, visit http://www.belleville.com. Copyright (c) 2008, Belleville News-Democrat, Ill. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
Copyright (C) 2008, Belleville News-Democrat, Ill.