After taking a punch to the gut, it is almost instinctive to recoil, to curl up in a ball, to regress to the fetal position. But my post-Whipple rebirth demands that I stand up and move.

People don’t often stop to think how exactly cancer kills; they are aware of its mortal ultimatum without knowing the means to its ends. It is rare that the primary tumor grows so large that its size alone is fatal, although such a direct outcome is certainly possible in, say, a case of a colon cancer obstructing the bowel. More often the cause of death is not mass effect but downstream derangement of physiology. The malignant epiphenomenon of clotting has claimed many lives, if not silently then at least less visibly than hemorrhage. The notion of bleeding to death, be it through external or internal losses, invokes the vivid horrors of slasher films but we should be just as scared of our blood congealing. Once it solidifies, it might not be long before we’re rigid ourselves.

The towering German pathologist Rudolf Virchow identified the key ingredients in the recipe for a clot. The human body is not exempt from the rules of fluid mechanics. Picture a river where muddy effluence, rather than traveling in a straight line, is forced to swirl past a bend; the water will eddy and thicken next to the curved bank.

Virchow’s triad unites a chemical predisposition to thrombosis with damaged vessel linings and sluggish flow. These three risk factors explain why an otherwise healthy woman with a family history of DVT and varicose veins might develop a clot after the relative immobility of a trans-Atlantic flight (airlines are understandably resistant to labelling this scenario “economy class syndrome”).

A body at rest tends to stay at rest, so, even though this operation has enfeebled me, I am galvanized to keep going. My surgeon is my cheerleader in this exercise, encouraging me to walk circuits around the nursing unit. Having gotten me through six and a half hours in the OR, he is now protecting me against the threat of stasis.

Inertia is proving to be a mighty temptress, coquettishly coaxing me to bed. But I will stagger onward, rejoicing one step at a time.

Mark Lewis