Patient Review
by Steve Holmes

I recently read Stephanie Kleine-Ahlbrandt’s latest blog.

“Still here: Five Years with Stage IV Cholangiocarcinoma
How I Stayed Alive and Stayed Myself”

Five years is a long time in our cholangio world. It gets your attention. What matters more, though, is how she got there.

Surviving stage IV cancer of any type is rare. Surviving five years with cholangiocarcinoma sits in a category of its own. That draws attention. And with it comes something else. Responsibility.

Not the kind you think about at the beginning, but the kind that emerges as you move through the challenges. You begin to see what worked, what didn’t, and what actually mattered. At some point, whether you intend to or not, you begin to share it.

As with Stephanie, what stood in front of me once felt like something unbeatable. I came to call it “Cholangio the Beast”. Maybe I had read too many David and Goliath stories as a child, but that is how it looked and felt to me.

What I learned over time is that the obstacle of cancer does not disappear, but how I saw and understood it changed. When that shifts, something else shifts with it.

Goliath is only unbeatable until he isn’t. Over time, Cholangio the Beast began to show its weaknesses, and with that, my possibilities.

Most people think sharing comes at the end, once the challenge is conquered. It doesn’t. It begins much earlier than that. You start to speak, to write, and to make sense of what is happening while you are still inside the battle. That is where clarity begins, not after, but during. For me, writing became both my escape into a parallel world and a way of seeing through this cancer.

If you read Stephanie’s work from the beginning, you can see it forming. It builds layer by layer, step by step, leading to this.

For that, I respect her. Not just for surviving, but for stepping forward and sharing. For taking what she has lived through and using it to help others through her words.

Stephanie has come through this because she was not distracted by the overwhelm of the big, scary picture. She focused up close and saw the small, winnable steps.

She saw clearly and acted on what was in front of her, on what she could control. She was not slowed by what was outside her control. She kept moving, and over time, that movement built momentum.

Momentum, in the end, is what keeps life in motion.

What stands out to me is not just that Stephanie is still here, but how she has written her way through this cholangio challenge.

When you read her story, read it carefully and watch how the patterns begin to change.

Not patterns of emotion, chance or hope, but a sequence.

A sequence in her thinking.
A sequence in who she is.

Stephanie begins with what is real.

“The diagnosis was stage IV intrahepatic cholangiocarcinoma… a tumor 13 by 11 centimeters… wrapped around the portal and hepatic veins, and already spread to distant lymph nodes. I was told immediately: inoperable. Incurable.”

No padding. No softening.
Just the terrain as it is.

But she does not stop there.
She places that reality inside its true context.

“Surgery is the only treatment that offers any chance of cure… For the rest of us, treatment is not curative but palliative, meant to slow the disease and, if you insist on it, preserve a life you still recognize as your own.”

She understands what is possible.
And what is not.

And inside that, she makes a decision.
To preserve a life she still recognises as her own.

From there, her thinking becomes clear.

“Treat the sites of progression locally, and keep going.”

That is the mechanism.
Control what is moving.
Preserve what is working.

That is how time is extended.
And over time, that way of thinking settles into something deeper.

“The goal for me is not the longest possible life.
It is the most alive possible life, for as long as it lasts.”

That line stayed with me.
It was so relatable, something I could understand, hold and carry forward.
Because it holds through those times when decisions become difficult.
When trade-offs are real.
When there are no guarantees.

This is what I noticed.

There were no promises in her path.
In many ways, quite the opposite.

But she did not wait for certainty.

She saw clearly.
She acted on what was in front of her.
And she kept moving.

If you read her full piece, take your time with it, don’t rush to the ending’s, look for the steps. Look for the decisions, the adjustments, and how she keeps moving where others often stop.

There is more there than a story. There is a way of seeing, and a way of responding. Her writing sits within Journeys Within and Beyond, from war zones to hospital rooms, letters on impermanence, compassion, and finding hope amid despair.

Read Stephanie’s full blog here:
By Stephanie Kleine-Ahlbrandt.

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