Matt Batcheldor, Danny Bonvissuto, Jill Clendening, Nancy Humphrey, Tom Wilemon
Photography/Illustration
Sandra Dionisi, Donn Jones, Erin O. Smith, Susan Urmy
Design & Art Direction
Diana Duren
Director of Publications
Kathy Whitney
Executive Director of Digital Publications
Wayne Wood
Cover Photograph
Adobe Stock
Editorial Office
Vanderbilt University Medical Center Office of News and Communications
T-5200 Medical Center North Nashville, TN 37232-2390 (615) 322-4747
Editorial Board
Deb Friedman, MD, Laura Goff, MD, Theresa Sberna, MPH, Scott Hiebert, PhD, Orrin Ingram, Beth Jones, MA, Teresa Knoop, MSN, RN, Ben Ho Park, MD, PhD Sydnie Hochstein, Julie Bulger
In this issue of Momentum, we highlight people who give hope, inspire innovation and improve cancer care. They are the force behind the scientific advancements, breakthrough therapies and treatment protocols at Vanderbilt-Ingram Cancer Center that help our patients achieve longer and better lives.
Our cover story is about the resilience of an 80-year-old woman who underwent the first double robotic colon and liver surgery at Vanderbilt and the medical team who made it a success. Robotic surgery requires a highly skilled surgeon who, from a console, uses a powerful camera to see inside the body and controls miniature surgical instruments that can be rotated in ways beyond the dexterity of the human hand. In this case, two surgeons worked in tandem inside the operating room. Vanderbilt’s surgical oncologists are increasingly utilizing robotic technology, when appropriate, so patients can experience quicker recovery times, shorter hospital stays and less need for pain treatments.
Our care for patients does not end with cancer treatments. We support our patients with programs that lift their spirits and help them cope with challenges. The music therapy program, which you can read about in this issue, is one such initiative. Vanderbilt University Medical Center has offered music therapy to pediatric patients for almost 20 years and recently expanded the program for adult cancer patients. Another support program highlighted in this issue is the clinical care coordinator for women with bladder cancer. These programs were started with donor support. The Esen and Cano Ozgener Fund for the Healing Arts supports the music therapy program, while Gail Kraemer’s gift funds the clinical care coordinator.
People also support our mission through special fundraising events, such as Chic Awear-
From the Director
BEN HO PARK, MD, PHD
ness, an annual fashion show scheduled for Sept. 20 this year, that funds both medical research for ovarian cancer and a mentoring program for women with ovarian cancer. Our photo essay in this issue provides flashbacks to that fun event over the years. Occurring the same month is a different type of event, the Clip In 4 the Cure scheduled for Sept. 14. It’s an annual event that supports cancer initiatives at Vanderbilt-Ingram and at Monroe Carell Jr. Children’s Hospital at Vanderbilt. You can easily register to participate by using the QR code on page 37 of this issue.
We are greatly appreciative of the continuing support from the children of E. Bronson Ingram II and Martha Rivers Ingram. A gift from Orrin Ingram, John Ingram, David Ingram and Robin Ingram Patton has established the Ingram Cancer Innovation Fund. An article in this issue details how it will propel treatment improvements for gastrointestinal oncology and support research into precision oncology for gastrointestinal and urologic cancers.
A person who inspires help by setting an example is Sarah Denger, a cancer survivor who serves on the board of directors for the Young Adults with Cancer Program at Vanderbilt-Ingram. She also works as a trainer for Survivor Fitness, which helps other cancer survivors after treatment. In a personal essay in this issue, she reflects upon the many obstacles she overcame during her cancer journey.
We do more than treat cancer at Vanderbilt-Ingram. We care for people, and we couldn’t do that without the people who support our mission and our patients. Thank you for caring.
“Our care for patients does not end with cancer treatments. We support our patients with programs that lift their spirits and help them cope with challenges.”
THE RESULTS FROM a research partnership between GE HealthCare and Vanderbilt University Medical Center (VUMC) utilizing artificial intelligence to enable safer and more precise cancer immunotherapies show that the models they developed predict patient responses with 70% to 80% accuracy. In the study, published in the Journal of Clinical Oncology Clinical Cancer Informatics, researchers retrospectively analyzed and correlated the immunotherapy responses of thousands of de-identified VUMC cancer patients to predict efficacy outcomes and the likelihood of an individual patient developing an adverse reaction. n
News and Notes
RKimryn Rathmell Named NCI Director
OVARIAN CANCER EARLY DETECTION FOCUS OF STUDY
esearchers at Vanderbilt University Medical Center are investigating whether sonograms of fallopian tubes can be effective for the early detection of ovarian cancer, and their ongoing study shows promise.
Ovarian cancer is the most lethal form of gynecologic cancer because it is most often diagnosed at late stage. A study in WFUMB Ultrasound Open on Dec. 15, 2023 provides an update on their progress.
The investigators shared data from four women who underwent ultrasounds with intraluminal contrast for improved imaging of the fallopian tube lumen, the interior portion of the organ. The women carried the BRCA+ mutation and had scheduled risk reduction surgery for removal of their ovaries and fallopian tubes. Although biopsies after surgery revealed that none of the four women had cancerous lesions, one of the participants did have inflammation of the fallopian tube. The area of inflammation corresponded to the same spot where the ultrasound detected lower luminal circularity values relative to the adjacent segments of the tube and overall high rates of change of lumen diameter.
The finding supports the use of fallopian tube luminal contrast enhancement during ultrasounds to detect abnormalities. The study received support from the Susan Morrow Legacy Foundation. n
Former Vanderbilt chair of Medicine is second woman to hold post
Kimryn Rathmell, MD, PhD, MMHC, the former chair of the Department of Medicine at Vanderbilt University Medical Center (VUMC), became director of the National Cancer Institute (NCI) on Dec. 18, 2023.
Rathmell became the NCI’s 17th director and only the second woman to hold this position leading the nation’s fight against cancer. She was chosen to serve in this role by President Joe Biden.
“I am thrilled with Dr. Rathmell’s appointment as our nation’s leader in the war on cancer — a tremendous honor for her and for Vanderbilt,” said Jeff Balser, MD, PhD, President and Chief Executive Officer of VUMC and Dean of Vanderbilt University School of Medicine. “Her contributions have been extraordinary, advancing cancer research with her colleagues in the Vanderbilt-Ingram Cancer Center and through leadership as the chair of our Department of Medicine. I am confident Dr. Rathmell will have an enormous impact on the NCI and on the lives of millions who are fighting to survive cancer.”
Rathmell, as director of the NCI, leads the National Cancer Program and the National Institutes of Health’s efforts to dramatically reduce the prevalence of cancer and improve the lives of cancer patients and their families through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. With
a fiscal year budget of $7.3 billion and comprised of approximately 3,500 employees, the NCI is the largest funder of cancer research in the world.
“As an oncologist and cancer researcher, the opportunities for cancer right now are incredible. The technology is at a place where we can do more to understand cancer in a way we never, ever could before. The advances, while they may seem slow to some people, are happening at a breakneck pace and continue to go faster. And to have a president who is supportive of cancer research and making a real impact on the burden of cancer, it’s like the stars have aligned,” Rathmell said. “We need more funding for cancer research, but I’m very enthusiastic about what we can do.”
Rathmell joined the faculty of Vanderbilt University and VUMC in 2015 as director of the Division of Hematology and Oncology. After serving in a series of increasingly responsible leadership roles, she was named as the ninth chair of the Department of Medicine in 2020 after serving as interim chair.
She is an internationally recognized physician-scientist whose career has spanned molecular biology research in the pathogenesis of kidney cancer; nationally funded large-scale genomic studies of cancer; clinical investigations bringing new biomarkers, imaging modalities and therapies to patient care; graduate and medical education; and as a national advocate for physician-scientist trainees, ethical treatment of drug shortages, equitable conflict of interest policies in publishing, and rare or heritable forms of kidney cancer.
As a clinician Rathmell has ushered in new lifesaving treatments and is a leader who has ad-
vocated for funding for kidney cancer research, including as a champion for rare subtypes of kidney cancer. She is the author of more than 250 peer-reviewed original articles, review articles, books and chapters and a frequently invited guest speaker on topics ranging from kidney cancer biology and cancer metabolism to academic leadership skills development.
“I think one of the biggest assets I can bring to the NCI is my experience learning from and working with medical scientists and clinicians in areas outside of cancer,” Rathmell said. “The broader perspective, and the range of work we can do to improve human health, is the secret sauce of the Department of Medicine.
“I immensely value working with all aspects of the department and with departments across the Medical Center, and I plan to bring the broad perspective, insatiable curiosity, and strong collaborative culture we have here to the NCI and beyond. I can’t emphasize enough how much I have learned from the incredibly talented people we have here at VUMC, and I will take that with me as I transition to this new role,” she said on accepting the position. n
Obesity & Cancer
Vanderbilt-led team receives 2023 Endeavor Award
A MULTIDISCIPLINARY TEAM of investigators who will probe the connection between obesity and cancer has received a 2023 Endeavor Award from The Mark Foundation for Cancer Research. The three-year, $3 million award will support four closely linked projects exploring the fundamental mechanisms that drive the obesity-cancer connection, taking advantage of a rich collection of matched tumor and adipose tissue samples from patients.
Obesity, which continues to rise in prevalence in the United States and worldwide, increases the risk of multiple diseases including diabetes, cardiovascular disease and cancer. It is a significant risk factor for at least 13 different types of cancer, according to the National Cancer Institute, and may contribute to 1 million new cancers globally each year.
“Obesity is second only to smoking as a modifiable risk factor for cancer, and we really don’t know why that is,” said Jef-
frey Rathmell, PhD, Cornelius Vanderbilt Professor of Immunobiology, director of the Vanderbilt Center for Immunobiology, and team lead for the Endeavor Award. Vanderbilt University Medical Center is the host institution for the award.
“We know that obesity affects inflammation and that many of the comorbidities associated with obesity are inflammation-driven, but we don’t have a good picture of inflammation in tumors in people with obesity,” Rathmell said.
There’s also an “obesity paradox,” he noted, in that obesity can, in some cases, improve responses to cancer immunotherapy.
“It’s a bit of a yin and yang question,” said Alyssa Hasty, PhD, Cornelius Vanderbilt Professor of Molecular Physiology and Biophysics at Vanderbilt University School of Medicine and a co-principal investigator on the team. “You want to have more inflammation to kill tumor cells, so adipose tissue inflammation could be good in that context and improve responses to cancer immunotherapy, but obesity still increases risk of colorectal and other types of cancer. One of
our main questions is: ‘Is there a relationship between adipose tissue inflammation and tumor growth?’”
The team will focus on renal, pancreatic and colorectal cancers, all of which have increased risk with obesity and are associated with visceral adipose — the internal adipose tissue most closely linked with inflammation in metabolic dysfunction.
Kathr yn Wellen, PhD, professor of Cancer Biology at the University of Pennsylvania, and Liza Makowski, PhD, professor of Medicine in Hematology and Oncology at the University of Tennessee Health Science Center, are also co-principal investigators on the Endeavor Award team.
VUMC investigators
Kathryn Beckermann, MD, PhD, assistant professor of Medicine in Hematology and Oncology, and Kamran Idrees, MD, MSCI, Ingram Associate Professor of Cancer Research, associate professor of Surgery and chief of the Division of Surgical Oncology & Endocrine Surgery, will co-lead an initiative to collect matched tumor and adjacent adipose tissues from patients with renal, pancreatic and colorectal cancers, along with blood samples and subcutaneous (not tumor-adjacent) adipose tissue.
The researchers will also collect matched tumor and adipose tissue samples from mouse models. Rathmell will lead efforts to analyze immune and metabolic profiles of the human and mouse samples. The biorepository of samples, database of analyses and de-identified patient information will feed into a shared “Cancer & Adipose Immunometabolism Resource” that all four principal investigators will build and draw on. n
EDEN BILTIBO IS SCHOLAR RECIPIENT
Vanderbilt’s Eden Biltibo, MD, MS, is one of the first recipients of the Multiple Myeloma Research Foundation’s Scholars Program, an initiative launched in 2022.
Biltibo, assistant professor of Medicine, will receive $100,000 per year for four years to support her career development and research in “Identifying Effective and Cost-Conscious Maintenance Daratumumab Dosing”
She is one of two researchers to be the first recipients of the award, which the Multiple Myeloma Research Foundation launched to address health and education initiatives by promoting early career researchers in the research and clinical fields. The other recipient is Joselle Cook, MBBS, assistant professor of Medicine at Mayo Clinic Alix School of Medicine.
Black patients make up 20% of the approximately 35,000 people diagnosed each year in the United States with myeloma. Despite the high incidence of myeloma among Black people, most Black patients are diagnosed at later stages than other patient populations. Survival rates for Black patients have not kept pace with improved rates for other patient populations.
THE NHL STANLEY CUP came to Vanderbilt-Ingram Cancer Center on March 26 courtesy of the National Hockey League in cooperation with the American Cancer Society. Many people posed for photographs with the revered trophy, including Kamyla Christian, left, and her mother, Brittany McAlmont. n
BY THE NUMBERS
GLOBAL CANCER STATISTICS
The American Cancer Society has released Global Cancer Statistics 2024, a report on recent diagnoses, ongoing trends and future projections. The report relies on worldwide estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, a division of the World Health Organization.
20 MILLION
Newly diagnosed cancer cases in 2022
35 MILLION
Number of cancer cases predicted in 2050
2.5 MILLION
Number of lung cancer diagnoses in 2022
1,000
Number of women dying each day from cervical cancer
15%
Percentage of girls who have received the vaccine against HPV, a virus that causes cervical cancer
A physical exam to check for signs of cancer, such as lumps or anything else that seems unusual, along with an assessment of a patient’s health history
Laboratory tests that analyze samples of tissue, blood, urine or other substances in the body
Imaging procedures of areas inside the body
Genetic tests in which cells or tissue are analyzed to look for changes in genes or chromosomes Source:
News and Notes
Powerful Collaboration
Advisory board makes community-informed research possible
VANDERBILT-INGRAM CANCER
Center collaborates with patient and community stakeholders in a bidirectional manner on research, cancer control efforts and quality care.
The Community Advisory Board plays a key role in that mission by helping investigators design initiatives that have the appropriate outreach and engagement. One of the initiatives is the Southern Environmental Health Study. It aims to better understand how exposure to different chemicals might affect the likelihood of developing cancers or other diseases. The study, which is being conducted in 17 states and the District of Columbia, is enrolling adults between the ages of 40 and 70.
Candace Wong, an educator from the Mississippi Delta region of Arkansas, became a member of the Southern Environmental Health Study Community Advisory Board to help with the study.
“My backg round is in biol-
ogy,” Wong said. “Science is one of those very underestimated aspects of our daily lives that we don’t realize affects us in general, especially in the South. Cancer and heart disease are two things that catch all of us, I think, either personally or within our families.
“I’ve always been interested in possible causes from the environment, what we’re exposed to and how it affects our bodies. This was the perfect opportunity to explore that and see how it affects us within our communities as well as others throughout the United States.”
She said she plans to use her communication skills as an educator and her relatability as someone who grew up in the Mississippi Delta to help inform study participants. The study is a long-term cohort investigation, which will last at least 10 to 20 years. After enrollment and an initial questionnaire, up to twice a year participants may be asked follow-up questions about their health. The question-
naires should take about 30 minutes to complete. Some participants may be asked to give saliva, urine or blood samples, but this is an optional decision. People can opt out of that and remain in the study.
“It is my hope to provide the necessar y resources and information for our community to understand the significance of what this study represents for future generations,” Wong said.
Cancer is already a generational experience for her.
“Within the past two years, my mother and I have become breast cancer patients,” she said. “I finished going through treatment this spring. My mother’s is underway. We have been greatly impacted.”
Her interest in the Southern Environmental Health Study led to her serving on the Community Advisory Board.
“I saw an online advertisement for the study,” Wong said. “I just called the number, and I was put in touch with someone. I explained how much I wanted to be a part of the study and help in any way that I could to gather information, as well as to better understand the factors we experience that can contribute to cancer in our area. Eventually, I was presented with the opportunity to be a part of the Community Advisory Board. It has been a wonderful opportunity that has opened a lot of new friendships and opportunities to speak with other people in science and research.” n
“It is my hope to provide the necessary resources and information for our community to understand the significance of what this study represents for future generations.”
– Candace Wong
Innovations
Caitlin Demarest, MD, PhD
Innovations
Delicate balance
Cancer patient receives lung transplant
The Vanderbilt Transplant Center has performed its first lung transplant on a patient with lung cancer, and she is now cancer free.
Carole Taylor, 48, of Nashville, Tennessee, said it all started with stiffness and soreness in her right shoulder. “It was growing increasingly stiff and got to where I couldn’t really move it,” she said. “And then I started having really painful muscle spasms in my right shoulder.”
One day, the pain grew so bad that Taylor went to orthopaedic urgent care in Durham, North Carolina, where she was living at the time. As she was about to move back to her hometown of Nashville, a doctor there referred her to a Vanderbilt University Medical Center pulmonologist, Fabien Maldonado, MD, MSc, professor of Medicine and Thoracic Surgery.
Maldonado performed a biopsy which resulted in a diagnosis: non-small cell lung cancer. “It was surreal,” Taylor recalled. Her brother had died of the same cancer in 2017. “It was hard on me. I’m a single mom with two children. It was hard for my children and hard for my whole family because we had been through this.”
Maldonado referred Taylor to the Vanderbilt-Ingram Cancer Center. She started receiving chemotherapy every three weeks, but a transplant wasn’t initially presented as an option. A lung transplant had never been performed on a patient for lung cancer at Vanderbilt before.
It didn’t occur to Taylor that it was an option until she had a conversation with her best friend, a nurse in Atlanta, who had a relative pass away who was an organ donor. That sparked a question in her mind, and she discovered that another medical center had transplanted lung cancer patients.
“I hadn’t heard of that at all, so I looked into it,” Taylor said. She was referred to the Vanderbilt Transplant Center and Matthew Bacchetta, MD, MBA, professor of Surgery
and surgical director of the Vanderbilt Lung Institute. He was honest: He couldn’t guarantee anything. But, after a discussion with David Erasmus, MD, associate professor of Surgery and medical director of Lung Transplant, she would move forward with an evaluation to determine if she would be listed for transplant. “I was excited and hopeful,” she said.
Transplanting a cancer patient is a delicate balance. Immunotherapy and chemotherapy must be discontinued for a period before transplant to prevent organ rejection issues. But if it is discontinued for too long, the cancer spreads, and a transplant is not possible. Caitlin Demarest, MD, PhD, assistant professor of Thoracic Surgery and associate surgical director of Lung Transplant, performed a procedure to ensure it was safe to list Taylor for transplantation.
This year Taylor was at work as director of college counseling at St. Cecilia Academy in Nashville when she got the news that she was listed for transplant. She remembers getting the call that her new lungs were available the evening of New Year’s Day, 2024, when she was in the kitchen baking a cake.
She came to VUMC the next day for her transplant and remembers the moment just before anesthesia was administered, then remembers waking up in the ICU with two new lungs. Demarest and Bacchetta performed her lung transplant.
“We carefully orchestrated this complex transplant to ensure strict adherence to oncologic principles and transplant practices — a
delicate balance,” Demarest said. She also noted that few transplant centers in the world perform such procedures.
Taylor’s anesthesiologist was Frederick Lombard, MBChB, associate professor and chief of Cardiothoracic Anesthesiology.
There were a couple of bumps in Taylor’s road to recovery. She caught COVID-19 shortly after her transplant. She learned to breathe again on her own after her time on oxygen, growing stronger week by week.
Three months after her procedure, she was released from rehab, cancer free. Her lung function is great, she said.
“I’m really amazed, truly amazed by the progress I’ve made in the first three months,” she said. “The respiratory therapist and rehab are just amazing. The whole transplant team, they’re just wonderful. Everybody has been so wonderful.”
She credits not only her providers, but a very supportive community at St. Cecilia as well as her primary caregivers, her son Issac, 21, and daughter Sophia, 18.
“I’m just thankful every day,” she said. “When you go through a journey like this, you really learn to truly live in the present and be grateful for every moment that you feel well, every day that I’m able to spend with my children and my family. You just don’t take things for granted.” n
STORY BY MATT BATCHELDOR
PHOTOGRAPH BY DONN JONES
Carole Taylor (center) at the hospital with her two children, Issac and Sophia.
Chic Awearness
Fashion fundraiser celebrates success
THE TOTAL AMOUNT raised for ovarian cancer research and patient support by the annual Chic Awearness fashion show is expected to surpass $1 million with the 2024 gala, scheduled for 6 p.m., Sept. 20, at W Nashville, 300 12th Ave. South, Nashville, Tennessee. This year will mark the event’s 11th anniversary.
Chic Awearness through the years:
1. Lexie Sheucraft, an ovarian cancer survivor and Chic Awearness board member, on the catwalk
2. Ronald Alvarez, MD, MBA, the Betty and Lonnie S. Burnett Professor of Obstetrics and Gynecology
3. Platinum-selling recording artist George Thorogood performs at the 2023 gala. He founded the Marla Thorogood Memorial Fund for Ovarian Cancer Research in honor of his wife who died from ovarian cancer in 2019.
4. Marci Houff, founder of Chic Awearness, addresses the attendees after being given flowers.
5 and 6. Table displays at Chic Awearness are teal, the official color for ovarian cancer awareness. The theme was reflected in the decorations and cocktail glasses.
7. Television personality and journalist Tuwanda Coleman served as emcee at one of the annual galas.
Visit chicawearness.org to learn more or to purchase tickets.
Robotic technology makes simultaneous surgeries better for patients
Eighty-year-old Lois Taylor is getting a big kick out of telling everyone she knows that she’s a celebrity.
And she’s not wrong. Lois is the first person at Vanderbilt University Medical Center (VUMC) to undergo a fully robot-assisted, minimally invasive colon and liver resection to remove cancer performed by two surgeons under a single anesthesia.
The Russellville, Kentucky, resident came to VUMC after a routine colonoscopy in her hometown revealed a 3-centimeter lesion. She was referred to a surgeon and was shocked to learn the diagnosis: stage 4 colon cancer. Imaging revealed that her cancer had metastasized to her liver.
Overwhelmed, Lois listened to two proposals to treat the cancer from clinicians at other medical facilities. Both involved open surgeries, meaning large, open incisions to remove cancerous tissue. She was also told she wouldn’t likely be scheduled for surgery for a month or longer.
Her daughter, Geneva Taylor, has always marveled at her mom’s unflagging vitality and positivity. But she wasn’t so sure she could survive one or two major, open surgeries at her age, especially knowing there would be an extended period of postsurgery recovery and rehabilitation, likely followed by chemotherapy.
Geneva, who is Lois’ only child, is determined that one day her mom will hold her first grandchild, and both women were not at all convinced they heard the best option to make that possible.
STORY BY JILL CLENDENING PHOTOGRAPH BY ADOBE STOCK
“I CALLED VANDERBILT AND WAS CONNECTED
to a patient advocate who, after they taught me how to share her records, bumped Mom’s appointment up to the very next week,” Geneva said. “That was amazing because when you hear that your mom has stage 4 cancer, you don’t want to wait a month or six weeks just to establish new patient care.”
The pair met with medical oncologist Rajiv Agarwal, MD, assistant professor of Medicine, Hematology and Oncology at Vanderbilt-Ingram Cancer Center. The mother and daughter quickly noticed a difference in how they were involved in decision-making during the consultation. Agarwal turned his computer screen around so they could follow along as he pointed out areas of concern on the scans of Lois’ colon and liver. He answered every question and put them both at ease.
Agarwal recommended an immediate consultation with his surgical colleague Kamran Idrees, MD, MSCI, MMHC, Ingram Associate Professor of Cancer Research, chief of the Division of Surgical Oncology and Endocrine Surgery, and director of Pancreatic and Gastrointestinal Surgical Oncology. Idrees has a global reputation as a leader in innovative surgical approaches to pancreatic and gastrointestinal cancers and is highly skilled in robot-assisted procedures.
“Ten years ago, we likely would have done at least one of these surgeries open or both of them open,” Idrees said. “We had a frank discussion with Lois and her daughter, Geneva, about the pros and cons of doing this procedure. The simultaneous presentation of liver metastases with a stage 4 presentation of colorectal cancer is not common, but we felt like she had a good functional status. We felt that she could tolerate both surgeries. And we know for a fact, that when we do robotic surgeries, we can do the same oncological or cancer operation that we need to do, and the recovery is faster.
“The liver is a completely sterile organ, so the risk of any infectious complication is really low. The colon is the polar opposite, full of bacteria. When the goal is to combine the two procedures, then the risk of infec-
tion goes up slightly. In carefully selected patients we can do the resections simultaneously,” Idrees said.
“Dr. Idrees involved Mom in the decision-making,” Geneva said. “He showed us the lesions on her liver and explained the difference between open surgery or a robotic surgery. After weighing our options and knowing Mom is 80, we knew we didn’t want her to have to recover from being open from basically sternum to pelvis. We decided we really wanted to do a robotic surgery. ”
In open surgery, a large incision is made in the abdomen or pelvis, and the procedure is performed by a surgeon’s hands. In robot-assisted surgery, a surgeon manipulates a robot’s surgical tools through much smaller incisions while guided visually by a high-definition image captured by a three-dimensional camera on the tip of one of the robotic arms. Additional imaging such as CT or MRI scans can also be referenced for guidance during robot-assisted procedures.
The magnified view, as well as the dexterous, slender robotic arms allow the surgeon to clearly see and access areas that can often be difficult with traditional surgical techniques. Robot-assisted surgery typically re-
Kamran Idrees, MD, MSCI, MMHC, Ingram Associate Professor of Cancer Research, chief of the Division of Surgical Oncology and Endocrine Surgery,
assisted Khan with the surgery.
met with the family to discuss the best approach and involved the family in the decision-making process.
sults in less postoperative pain and fewer complications, as well as fewer days in the hospital and a quicker recovery time. This means if chemotherapy is required after cancer is surgically removed patients can begin this next stage of treatment sooner.
“Some might make the argument that for an 80year-old patient combining two big surgeries does not make sense,” Idrees said. “On the other hand, putting someone this age through two different anesthetics and two surgeries at two different points in time may not be wise. You have to use clinical judgement in conjunction with the anesthesia team and all the involved parties. We felt like we could do it; we knew it was technically feasible; and we felt it would benefit this patient.”
Lois said she was never nervous about the procedures.
“I knew I had to have it done,” she said. “So, I said, ‘Get it out of here!’”
Idrees explained that he was one-half of the surgical equation, as he would be addressing only the cancer in Lois’ liver in the operating room. He knew just who to call for the colon resection — his colleague and expert in robot-assisted surgeries, Aimal Khan, MD, FACS assistant professor of Surgery.
Idrees and Khan reviewed Lois’ imaging together and spoke several times before her surgeries. Both men were confident they could perform a microscopically margin-negative resection for each organ, meaning leaving no trace of cancer behind in the colon and liver.
“I called the OR scheduler, Dora Snider, who’s incredible,” Khan said. “I told her we need to do this now, and we need to find time on a robot. You can’t just walk in, and a robot is waiting for you. Dora found us the room and the robot. We cleared our schedules, and we were operating within a week.”
Although they each had a game plan for their own surgery going in, the surgeons met in the operating
ROBOTIC PANCREATECTOMY SPEEDS RECOVERY TIME
Johnny Cleveland thought he was having a heart attack when he went to a community hospital, but medical imaging revealed something suspicious with his pancreas.
The retired educator from Red Bay, Alabama, then went to Birmingham for more testing where he was diagnosed with an intraductal papillary mucinous neoplasm — a cyst in the duct of his pancreas that put him at very high risk for pancreatic cancer. The duct had swollen to four times its normal size. Cleveland knew he needed complicated surgery, so researching his options, he learned about the Vanderbilt surgical team led by Kamran Idrees, MD, MSCI, MMHC, Ingram Associate Professor of Cancer Research.
Idrees, chief of the division of Surgical Oncology and Endocrine Surgery, specializes in difficult-to-perform procedures. His patients include those with pancreatic and other abdominal cancers, as well as premalignant conditions, who have been told their tumors are inoperable. Cleveland went to his initial appointment with Idrees expecting to hear about wide incisions, an extended hospitalization and a long recovery time.
Even though he had a total pancreatectomy — which in his case entailed removing his whole pancreas along with his gallbladder, spleen, duodenum, parts of the stomach and bile duct — Cleveland had only small incisions with no wide cuts. Idrees, working alongside Sekhar Padmanabhan, MD, assistant professor of Surgery, performed the pancreatectomy utilizing robotic technology. They then created two separate connections, one between the bile duct and small intestine, and a second connection between the stomach and the small intestine robotically.
Robotic surgery requires a highly skilled surgeon, who, from a console, uses a powerful camera to see inside the body and controls miniature surgical instruments that can be rotated in ways beyond the dexterity of the human hand.
“I had seven holes produced instead of being cut from side to side and split up and down,” Cleveland said. “My hospital stay was very minimal. It was five days instead of 10-14.”
Idrees has utilized robotic technology for pancreas surgeries since 2019 and has performed more than 100 procedures with colleagues. However, Cleveland was his first patient to undergo a total pancreatectomy utilizing robotic surgery.
Pancreatic surgeries are performed to address premalignant conditions and cancer.
“Robotic surgery offers the advantages of quicker recovery time, shorter length of stay, quick healing and less pain medication requirements,” Idrees said. n Tom Wilemon
Rajiv Agarwal, MD,
LOIS SAID SHE WAS NEVER NERVOUS ABOUT THE PROCEDURES. “I KNEW I HAD TO HAVE IT DONE,” SHE SAID. “SO, I SAID ‘GET IT OUT OF HERE!’”
room before the procedures began to marry the plans together and set up the robot, so both parts of the operation could be performed using the same incisions. The goal was to be as minimally invasive for their patient as possible, despite performing two significant procedures.
The surgeons marked where the incisions would best be placed for the access they needed, then they made small compromises, so only one set of incisions would be used to easily and safely achieve both resections.
Then Idrees began his surgery. A liver resection, or hepatectomy, is considered a technically difficult surgery, whether a surgeon is assisted by a robot or not. One reason is because the liver is laced with a network of small and large blood vessels, which can lead to substantial bleeding. The procedure is best performed by a highly experienced surgeon, such as Idrees, who can carefully navigate these vessels to remove only the cancerous tissue, leaving a clear margin.
During the surgery, Lois had enough blood loss that she required the transfusion of blood products. The surgeons and anesthesiology team watched her vital signs closely and paused to confer on whether it
was wise to continue with the colon resection. Lois’ safety was always first in mind.
After a short break, she had stabilized, and Khan was able to begin the colon resection. An important factor for patients undergoing colorectal cancer surgery is the potential need for a colostomy. “Our anesthesia colleagues did an excellent job of stabilizing her in the middle of surgery, so I was able to remove the cancer and connect her colon back together, avoiding a colostomy,” Khan said.
Lois was up and walking unassisted within 24 hours of surgery. After she was discharged from the hospital, she went back home to Russellville, Kentucky, to continue what she calls an easy recovery. Geneva laughs when sharing that she would remind her mom to take her postsurgical medication, gabapentin, and Tylenol, for pain. Lois would often take just one Tylenol because she felt she didn’t need the prescription medication.
“I never got really sore after surgery,” she said. “Just a tiny bit, and it never bothered me once I got home. I got a little bit sick from the anesthesia, but I always do. That was it.”
Lois Taylor had a robot-assisted, minimally invasive colon and liver resection to remove cancer performed by Aimal Khan, MD, FACS, assistant professor of Surgery (left), and Kamran Idrees, MD, MSCI, MMHC, Ingram Associate Professor of Cancer Research (right).
Lois is finishing a 12-week course of chemotherapy overseen by Agarwal for “insurance” against a recurrence of the colon cancer, but she said it’s been much easier than she anticipated. She’s back to baking her famous rum cakes (she even treated Agarwal and his staff to one) and whipping up Southern-style meals for her family.
“I’m doing great,” she said. “I get tired more easily, but I haven’t been sick whatsoever. I’ve never taken any medicine for nausea. I’m gaining some weight, too. Everybody at Vanderbilt did such a great job taking care of me, and I’m so thankful for them.”
Khan and Idrees are hopeful that this success with synchronous robot-assisted colon and liver resections will lead to more such procedures at the Medical Center when the right patients are identified.
“It’s one of those things that when you do it, people then start realizing that we have the ability and the tools,” Khan said. “Not every patient will be a candidate for this, but for the patients that are, the benefits are going to be tremendous. And it may mean the difference between recovering from the surgery and maybe never recovering from it.”
Surgeons share parallel journeys
The parallel paths that surgeons Kamran Idrees and Aimal Khan took to combine their skills in an operating room in Nashville, Tennessee, took several decades and more than 7,000 miles.
Khan, MD, assistant professor of Surgery, remembers his first visit to Vanderbilt University Medical Center (VUMC) in 2020 when he was being interviewed as a potential faculty member.
He and Idrees met for dinner and learned that they’d both come from the same state in northern Pakistan (Khyber Pakhtunkhwa) and the same town (Peshawar). In fact, they also both attended the same highly regarded military boarding high school (Cadet College Kohat), nearly an hour’s drive from their hometown.
Then, in mirror step, they attended the same medical school (Aga Khan University) nearly 900 miles from Peshawar in southernmost Pakistan. The two even completed a portion of their surgical training in the United States at the University of Alabama at Birmingham Medical Center. Idrees completed a general surgery residency there in 2008, and Khan completed a minimally invasive and robotic gastrointestinal surgery fellowship there in 2019.
For Idrees and Khan, the logic behind combining the two surgeries in one operating room, assisted by one robot, was never about achieving a first at the Medical Center, but rather about doing the best procedure to benefit the patient most with the highest likelihood of a good postsurgical outcome.
“The way I see it as a division chief, if we were going to move forward, the goal is always the best possible patient outcome, not personal accolades,” Idrees said. “Lois’ overall care highlights the strength of Vanderbilt-Ingram Cancer Center in regards to comprehensive multidisciplinary care, with multiple specialties including medical oncology, surgery and anesthesia under one roof, for cancer patients.”
“These are two major surgeries,” Khan said. “You must have the perfect team to do this. I would love to think that this success was the result of Dr. Idrees and my technical prowess, but it wasn’t. It was the OR staff, anesthesia and the nurses who help us with the robot. It was having the right technology. It was being here at VUMC where we have one of the best anesthesia teams in the country who can step in if a patient begins having issues. It was a team effort every step of the way.” n
“The funny thing is that we met at VUMC for the first time in our lives,” Khan said. “Dr. Idrees is 14 years my senior. The more he and I chatted, the more we found out we had in common. He said, ‘So basically, you’ve been following me around for 15 years. Everyplace I go, you go too!’
“Now, we frequently collaborate in research and clinical care of colorectal cancer patients. It’s the beauty of the American dream.”
Asked if the two surgeon’s eerily similar backgrounds are beneficial during their collaborations, Khan laughed.
“Well, sometimes the nurses can’t understand us!” he said.
Joking aside, the pair acknowledge that the similarity of their paths has proven serendipitous for their work together, both in the operating room and in the clinic.
“Knowing each other’s credentials and knowing the journey we had to take to come to this place, I think gives us a sense of trust with each other,” Khan said.
Idrees looks at their backgrounds and sees two men who have been laser-focused from the start to find success.
“It’s very rare the way our paths have gone,” Idrees said. “The road to become a surgeon is not
easy in the first place. It takes a lot of perseverance. We didn’t go to Ivy League schools. We had to make our way and prove ourselves at each step to be successful. We both did surgical residencies. Then, although most people do one fellowship, we both did two. I did a surgical oncology fellowship at University of Pittsburgh, then a liver and pancreas surgery fellowship at Washington University in St. Louis. He did a minimally invasive surgery fellowship at UAB and a colorectal surgery fellowship at Baylor. We are both driven by the same thing: to do the very best for our patients and to move the field forward.”
Khan is grateful his journey connected with Idrees’ at VUMC so they can work together.
“For us, it began at that first dinner — just hanging out and getting to know each other,” Khan said. “We go to each other’s homes; we invite each other over for dinner. My son’s birthday is coming up soon, and Dr. Idrees will be there. We’re just so lucky to be working in this place, at Vanderbilt, which helps give us the foundation to build these relationships on. These relationships then act like a primer to help our patients.” n Jill Clendening
High Notes
MUSIC THERAPY UPLIFTS PATIENTS
It’s a quiet March day on the hematology/oncology floor at Vanderbilt University Hospital (VUH), and the calming sounds from an acoustic guitar are trickling out of Kayla Kidney’s room.
Inside the room, Kidney, a Nashville, Tennessee, nurse who was diagnosed with acute lymphoblastic leukemia (ALL) in February, sat cross-legged on her hospital bed. Tori Langham, one of two board-certified music therapists employed at Vanderbilt University Medical Center (VUMC), sat in a chair beside Kidney’s bed, strumming her guitar and singing a beautiful song, “Desert Butterfly.”
“I refuse to worry. I will only be still. Though the seasons may change. Through the drought and the rain. I will keep on flying high, desert butterfly.”
But this is more than just a simple ballad played for a patient.
Kidney, 28, and Langham were putting the finishing touches on the song written by Kidney, her fiancé, Adam Newton, and her father, Kris. The lyrical ballad, sung and recorded by Langham, was played at Kidney and Newton’s small lakeside wedding in May.
It represents transformation, the love between Kidney and Newton, and the detour they’ve had to make around her illness. The title and refrain are also a meaningful nod to butterflies and the desert, two things that mean a lot to Kidney, a native of Arizona.
Building a rapport
In February Kidney was deep into planning her May 18 wedding when she started feeling unwell.
“After a couple of weeks of ignoring some signs and symptoms, I just chalked it up to not being a big deal,” she said.
But during the night on Feb. 22, she woke up with chest pain. She was taken to the hospital, tests were run, and she was diagnosed with ALL, a fast-growing cancer of the blood and bone marrow.
“It was pretty surreal,” she said.
Suddenly, finalizing the wedding of her dreams took a back seat to a three-week hospitalization at Vanderbilt and devising a plan to rid her body of ALL.
Weeks spent in a hospital can be grueling and anxiety inducing. Not only did Kidney’s body need to heal, but so did her mind.
Shortly after Kidney’s admission, a hospital chaplain and nurse sent a request for a consult to the music therapy program, which focuses on the use of music to help with pain management, physical rehabilitation, psychosocial support, procedural support, and coping with hospitalization and disease.
Within days Langham visited Kidney, and the two quickly built a rapport.
Sitting in on the collaborative writing of her wedding song was Sean Anderson, a chaplain resident in VUMC’s Clinical Pastoral Education program, who baptized Kidney the first week she was in the hospital and would be officiating at her wedding.
“Once the wedding is over, I’ll be taking my Amazon wedding dress off and putting a bathing suit on, and we’ll be on the lake,” Kidney said. (She and Newton have rescheduled their larger wedding for May 31, 2025.) “I don’t want to miss out on wearing my big dress,” she said, smiling.
“There’s something special about the raw, authentic sound of the guitar. It’s peaceful, soothing and distracting. You’re using a different part of your hearing to hear the music versus all the other noises going on around you in the hospital.”
– Kayla Kidney, pictured left below with Tori Langham
Tori Langham helps patients using a variety of methods, from playing music together to writing songs.
Andy Wooldridge, MD, is the program director for the adult music therapy program at VUMC.
Establishing a connection
Music therapy has been formalized as a professional field for more than 70 years. It has been available for pediatric patients for nearly 20 years but is relatively new to the adult patient population at VUMC.
Music therapists use evidence-based research protocols involving music and music-making, personalized to a patient’s clinical needs and goals. It’s not a one-size-fits-all approach. Sessions range from 15 minutes to two hours.
At VUMC, the music therapist meets with a patient after receiving a referral from a member of the patient’s treatment team.
“I go in and assess. I don’t just go in and play (music),” said Langham, whose position is funded through VUMC’s Department of Medicine. “I establish a connection with the patient, and we do things together to help them reach specific goals while hospitalized. We may write a song. We may need to build some rapport. We may work with physical therapy or occupational therapy to reach physical rehabilitation goals. Or our goal may be minimizing pain and discomfort. Maybe they aren’t able to write a song, but they can express themselves in choosing songs. We figure out what is best for the patient.
“Our goal is to improve the patient’s experience,” Langham said. “Our program has been having a remarkable impact. We are not just helping our patients, but staff as well. We all need support and to know what we are doing matters.”
After the successful pilot of the program for adults at VUMC in 2022, music therapy was expanded to three additional units at VUH, including hematology/oncology and palliative care. The music therapy program at Monroe Carell Jr. Children’s Hospital at Vanderbilt continues to thrive and now employs three board-certified music therapists.
Emily Owens, a music therapist in the adult hospi-
tal since February, is leading a six-month pilot which offers increased access to music therapy in two inpatient oncology units.
Owens said there were many roads that led to her becoming a music therapist.
“Two of my absolute favorite aspects about music are its ability to connect us to one another and how music allows us to communicate our inner emotions in ways that words may fail to wholly encompass. Music therapy has given me the opportunity to bridge my love and lifetime dedication to music and my interest in science and psychology along with my passion for helping others,” Owens said.
Langham said a personal experience led to her pursuing music therapy as a career.
“I’ve always loved music and the healing power of music,” Langham said. “I felt like if there was a way I could use it in a purposeful manner, I wanted to do that,” she said, adding that she became intrigued when her grandfather had a stroke and could sing, but couldn’t speak. “I found out later through music therapy that it’s because music uses an entirely different part of the brain. He was able to sing things he couldn’t speak.”
Owens has also received additional training in neurologic music therapy, which uses standardized and evidence-based techniques specifically for nonmusical goals related to functional rehabilitation and neurorehabilitation.
“Research has demonstrated that the therapeutic application of music can help create new neural pathways in the brain related to cognition, movement, communication and psychosocial function,” Owens said. “Music affects our entire brain, and we can use different facets of music, such as rhythm, lyrics of preferred songs, and melody, to access different parts of our brain for specific rehabilitation goals.”
DONN JONES DONN JONES
Both Owens and Langham work with patients who have cancer. For most patients there are many unknowns and often a lot of anxiety that music can help control, Langham said. “Maybe someone has just gotten a new diagnosis, and they don’t know how long they’re going to be in the hospital. Music can help them cope. It can also help relax and distract patients from any discomfort they are having with chemotherapy,” she said.
Music therapy in oncology care can address, but is not limited to, nonpharmacological pain management or perception of pain, helping patients develop musicbased coping skills, functional rehabilitation goals, and providing an outlet for emotional and creative self-expression.
“Sometimes this may look like a patient and myself improvising on instruments together,” Owens said. “However, the goals that we’re working on could be enhancing fine motor skills, recording a soundscape for the patient to listen to when they’re feeling anxious or distressed, or for nonverbal expressive communication and emotional expression goals.”
Langham said data shows when music therapy is working.
“When we go back and look at the data, it’s not just ‘Oh, wow, I think I helped this person,’” she said. “There is proof. I’ve seen heart rates go down on heart monitors when I’m working with a patient.” A recent study in VUMC’s trauma step-down unit showed a significant decrease in patients’ pain and anxiety scores.
Those pursuing certification as a music therapist need to complete an undergraduate degree in music therapy and 1,200 clinical hours including a full-time internship that usually lasts about six months. Following that, they must sit for an exam to be certified by the Certification Board for Music Therapists. This extra training and certification set music therapists apart from others using music in clinical spaces and help ensure their interventions are not only effective, but also safe for patients.
Humanities and medicine
Andy Wooldridge, MD, assistant professor of Medicine at VUMC, advocates for the adult music therapy program at VUMC through his role as program director of Arts and Humanities in Healthcare for the Department of Medicine.
“It grew out of my work in palliative care and supporting people with serious illnesses, including cancer, in all the ways we can,” Wooldridge said. “Our overall vision is to enhance the well-being on all levels at VUMC through the arts and humanities, and improving the patient’s experience with music therapy is a cornerstone of this broad initiative. Our patients and families have said that music therapy provides a unique dimension of healing when they come to our hospital. It heals in a different way than any of the other care we provide,” he said.
“The arts are powerful tools for healing,” Wooldridge said. “They are somewhat ancient because we’ve been healing each other with art and music since the dawn of humanity, but also modern and innovative because the more we study music and art therapy and other creative arts therapies combined with advances in our understanding of how the brain works, the more uses we will find for how to help patients with these powerful therapeutic tools.”
Wooldridge said he had little exposure to medical humanities until his palliative care fellowship where he met a music therapist.
“I realized that music therapy was the next cornerstone I wanted to lay in terms of expanding programs in our department,” he said.
Adding the humanities to healing is becoming more widespread at VUMC.
Wooldridge and other health care providers and trainees have participated in healing arts workshops at the Frist Art Museum, and he also led a medical student elective that uses poetry therapy, reflective writing and art therapy.
Of the patient populations studied in music therapy, there is a huge amount of evidence regarding cancer patients, Wooldridge said. “Many studies show improved physical symptoms, such as pain or shortness of breath, or improved psychological support through anxiety management, coping, processing, grieving and normalizing,” he said.
The Esen and Cano Ozgener Fund for the Healing Arts has helped provide creative outlets and therapeutic arts activities at Vanderbilt-Ingram. Owens’ position is funded through this fund. Wooldridge said he hopes that additional funding can be secured in the community to hire additional music therapists to expand into other areas of the hospital.
Wooldridge recalls a recent conversation with a nurse case manager about Langham’s impact on a patient. “She said she was so inspired seeing how impactful music therapy was for a patient in our unit. She said reading the chart about what Tori did and how positive it was for the patient nearly brought her to tears.”
Wooldridge said his role with the music therapy program varies. He recently accompanied Langham and Owens to the Tennessee State Legislature to advocate for state licensure for music therapists so their profession can become more recognized. A music therapy certificate was signed into law on May 28. Similar to a license, the Certified Professional Music Therapist provides title and scope of practice protection for music therapy and will serve to increase consumer access to safe and competent music therapy services.
“Sometimes I’m hands-on, coordinating. Sometimes I’m helping, advising, cheerleading, facilitating, breaking down barriers and helping to obtain resources.”
In 2017 Aylin Ozgener of Nashville, Tennessee, established the Esen and Cano Ozgener Fund for the Healing Arts in honor of her parents to support programs that provide cancer patients and survivors with creative outlets and therapeutic art activities at Vanderbilt-Ingram Cancer Center. The gift, given in honor of Esen and Cano Ozgener’s 80th birthdays, acknowledged the couple’s commitment to bringing the healing power of arts to those who are suffering. Vanderbilt University Medical Center’s music therapy program is one beneficiary of the Ozgeners’ generosity. Cano, who died in 2018, was a Nashville entrepreneurturned-artist. He was treated at Vanderbilt-Ingram for multiple cancers. Esen has been treated for breast cancer. Aylin is a founding member of the Vanderbilt-Ingram Ambassadors (formerly Young Ambassadors).
Desert butterflies
When Kidney, Newton and her father sat down with Langham to write the words to her wedding song, Kidney’s father suggested the theme of butterflies because Kidney has always loved them.
Growing up in Arizona, she loved to watch Monarch butterflies, which are plentiful between April and October. As a child she had a favorite pair of shorts decorated with butterflies that her mother had a hard time getting off her to wash, and her bedroom was wallpapered with pastel butterflies.
“Butterflies have just always been my thing,” she said.
When she was admitted to the hematology/oncology unit on the 10th floor, she discovered it had a butterfly theme. “They’re known for their transformative nature, and many people on this floor are getting bone marrow transplants. Their body changes. Their blood type can change. It’s a transformation,” Kidney said.
Langham said that writing the wedding song helped Kidney express herself while she was hospitalized.
“Sometimes a patient just can’t put their feelings into words, but with music we can make more sense of what’s going on.”
Music therapy and writing her wedding song helped Kidney with anxiety and gave her autonomy and control, Langham said. “Talking about her love story was a way to get her feelings out. I gave her choices. She chose the different vibes, how it sounded. She made all the decisions. It was something for her to do, to look forward to and reflect.”
Kidney is no stranger to music therapy. She’s seen it in action in her job as a nurse.
“I feel like it (being the recipient of music therapy) was something unexpected. I’ve seen it, but I’ve never experienced it from a patient standpoint. There’s something special about the raw, authentic sound of the guitar. It’s peaceful, soothing and distracting. You’re using a different part of your hearing to hear the music versus all the other noises going on around you in the hospital.”
As Kidney and Langham collaborated on the song in March, they worked through some options on sound. Langham recorded a few lines of harmony to blend with what she had already recorded, and the two discussed adding piano to the acoustic guitar in the song. Kidney had the final say, and she vetoed adding piano.
The bridge of “Desert Butterfly” conveys Kidney’s feelings about the healing power of love and her journey with leukemia.
“There is a love that I’ve never known. In this metamorphosis. Didn’t know my wings could ever stretch this far. The only way out is through this.”
“I love the song. It’s so, so good. It’s seriously like magic,” Kidney said. n
Desert Butterfly
Verse 1
“Can we talk?” is what you said I know our plans haven’t gone as planned
But you will ground me, protect this chrysalis
This is love, this is ours
Chorus
I refuse to worry
I will only be still
Though the seasons may change
Through the drought and through the rain
I will keep on flying high, desert butterfly
Verse 2
On that day in late spring
You’ll hold my hand and hold a ring
I don’t care where we are
Between walls, under stars
I am yours
Bridge
There is a love that I’ve never known
In this metamorphosis
Didn’t know my wings could ever stretch this far
The only way out is through this
Kayla Kidney and her husband, Adam Newton, pose for a wedding day picture.
Innovation Investment
The children of E. Bronson Ingram II and Martha Rivers Ingram have continued their legacy of giving with the establishment of the Ingram Cancer Innovation Fund.
This gift will propel treatment improvements for gastrointestinal oncology and sustain Vanderbilt-Ingram Cancer Center’s internationally respected leadership in cancers of the digestive system. The fund will also support research into precision oncology, utilizing molecular profiling to better match patients to new medicines for gastrointestinal and urologic cancers.
For Orrin Ingram, John Ingram, David Ingram and Robin Ingram Patton, the gift is inspired by family experience. They lost their father to cancer in 1995 when he was 63, and they — like most people — have had other family and friends diagnosed with cancer. For two of them, cancer has been a personal battle. Both Orrin and John are prostate cancer survivors.
Orrin was diagnosed in 2017, and his younger brother, John, was diagnosed the following year. Then in 2020, John and his wife, Stephanie, lost her parents to cancer.
The care that her mother, Agneta Akerland Currey, received for pancreatic cancer was one of the inspirations for the commitment to gastrointestinal oncology.
“Cancer is kind of an equal opportunity affector,” said John Ingram, who serves on the Vanderbilt University Medical Center (VUMC) board of directors. “Almost every family has got some sort of history with it. For me, it’s not just on the Ingram side. Dr. Berlin was my mother-in-law’s doctor. She had pancreatic cancer, and he was able to extend her life for three or four years. We know that. She was way off the bell curve, past what is normally the prognosis with that disease. Dr. Berlin and Vanderbilt-Ingram found a kind of drug cocktail that could beat back her cancer for a time and do it in a way where she didn’t have too many bad side effects from it.”
Jordan Berlin, MD, the Cornelius Abernathy Craig Professor of Medicine and the director of the Division of Hematology and Oncology, is an internationally respected physician and researcher for gastrointestinal cancers. Vanderbilt-Ingram is one of only six centers designated by the National Cancer Institute as a Specialized Programs of Research Excellence (SPORE) for gastrointestinal cancers — a distinction it has held since 2002.
Berlin has worked together with Robert Coffey Jr., MD, Ingram Professor of Cancer Research and SPORE principal investigator, as they and their colleagues have revealed the mechanisms of gastrointestinal cancers and improved treatments. Berlin also works closely with Cathy Eng, MD, the David H. Johnson Professor of Surgical and Medical Oncology, who co-leads the GI Cancer Research Program and co-directs GI Oncology.
The Ingram Cancer Innovation Fund is intended to be a bridge from past accomplishments to future development. Its purpose is to both honor the contributions of people such as Daniel Beauchamp, MD — a Vanderbilt cancer leader with expertise ranging from surgery oncology to cell biology who died in 2022 — and to support the vision of current leaders such as Ben Ho Park, MD, PhD, the director of Vanderbilt-Ingram and the Benjamin F. Byrd Jr. Professor of Oncology. The fund will also support a directorship that will enable VUMC to recruit an internationally renowned scientist in gastrointestinal oncology.
“When Dan Beauchamp was unfortunately taken by cancer, we wanted to bring in another international leader,” said Orrin Ingram, who is the longtime chair of the Vanderbilt-Ingram Cancer Center Board of Advisors. “We need other international leaders to keep us at the top of the game and keep us pushing to be the best. My father always said you need to always try to hire people who are better than you are.”
E. Bronson Ingram II, chairman of Ingram Industries — a business conglomerate consisting of barge transit, book publishing, personal computer products and other interests — was in the prime of his life when he was stricken by cancer. It was diagnosed at a late stage and was believed to have started as prostate cancer. The year was 1995 before several advancements in prostate cancer early detection and treatment had occurred.
After Bronson’s death, his wife, Martha Rivers Ingram, and her family decided to invest in cancer research and make Vanderbilt a world-class center for treatment. In 1999, they honored him by making the cornerstone investment in a national fundraising campaign that generated more than $180 million in philanthropy. Their commitment continued with the funding of Ingram Professorships through an endowment. There are currently 20 Ingram Professors. In 2014, Orrin and John established the Vanderbilt Molecular Analysis for Therapy Choice Program (V-MATCH) to help offset the cost of genotyping tumors for DNA mutations — testing that insurance won’t often cover. John and Stephanie Ingram have provided support for palliative care and integrative medicine. Robin Ingram Patton with her husband, Richard Patton, and David Ingram with his wife, Sarah Ingram, have influenced care in many other areas at VUMC, including children’s health.
Orrin and John needed care from Vanderbilt when they were diagnosed with prostate cancer a year apart. They both opted to have prostatectomies under the care of Sam S. Chang, MD, MBA, the Patricia and Rodes Hart Professor of Urologic Surgery and the chief surgical officer at Vanderbilt-Ingram.
“We’ve got a family history with prostate cancer,” John said. “I think it’s what killed my father, although they don’t know for sure. When they found the cancer, it had already metastasized, so they couldn’t find the primary cause, at least they couldn’t in 1995. I was preemptive about my care decision. Something is going to get me, but I wasn’t going to let it be this. That was my attitude. There are a lot of great things about the Ingram gene pool, but one of the less-than-great things is that we seem to have a virulent type of prostate cancer. You can outrun a lot of things, but you can’t outrun your gene pool.”
When the family made the initial gift, the brothers didn’t know how directly they would benefit from improvements in cancer care.
“John and I are now both cancer survivors,” Orrin said. “We didn’t even think about us needing Vanderbilt, but Vanderbilt saved our lives. Part of the dream has already happened. Cancer is not 100% cured, but, by golly, it’s a lot better than it was — and the earlier you detect it, the better the outcome.”
However, some cancers remain difficult to detect at early stages, including pancreatic cancer. Agneta Akerland Currey was an avid gardener, a doting grandmother, an animal lover and a resilient woman, who had already overcome a stroke when she was diagnosed with pancreatic cancer.
“She wasn’t put off by stuff; she kind of soldiered on and took care of the things that were meaningful to her,”
The Ingram family, (left to right) David Ingram, Orrin Ingram, Martha Rivers Ingram, E. Bronson Ingram II, Robin Ingram Patton and John Ingram
“It’s nice to be able to support people who are doing cutting-edge research. It will have a positive effect, not only for us and our family, but so many other families that we will never know.”
– John Ingram
Martha Rivers Ingram (center both photos) has enjoyed spending time with grandchildren as her family has grown over the years. Her husband, E. Bronson Ingram II, who died in 1995 after being diagnosed with cancer, did not live to see many of them born. The Ingram family has supported cancer research for decades, so that more families have more time with loved ones.
said John. “Dogs, horses and grandchildren were her loves. She cared for them on her farm. She had the most beautiful gardens, and she loved to get lost in her gardens. She was Swedish, and until the day she died, she sounded like she was brand new to this country. She was a very beautiful, loyal and tough-minded woman.”
She didn’t complain about the cancer diagnosis and went through treatment with her characteristic fortitude. She passed away on Oct. 20, 2020, seven months after the passing of her husband, Brownlee Owen Currey Jr., who died from Merkel cell carcinoma, a rare skin cancer. They had been married for 59 years.
“She had great affection for and faith in Dr. Berlin,” John said. “Stephanie is also a big fan of Dr. Berlin’s. She went with her mom to appointments, and the fact that this fund is related to him matters a lot to her. She really appreciated the fact that Dr. Berlin extended her mother’s life and helped extend it in a way that she could still enjoy life and not just be miserable.”
In addition to being a highly regarded expert on gastrointestinal cancers, Berlin is also loved by patients for making them feel at ease and often eliciting a laugh or two. The Ingram Cancer Innovation Fund will support research into gastrointestinal oncology to better understand and improve care for stomach, esophageal, colorectal and pancreatic cancers and other cancers of the digestive system.
“The Curreys are wonderful people, and it was an honor to get to know them during Mrs. Currey’s time with cancer,” Berlin said. “I am excited that the Ingram
family has provided us the ability to recruit an internationally renowned researcher to work with Dr. Eng and the members of the GI Program to bring even more high-impact research in gastrointestinal cancers to Vanderbilt-Ingram. We will be recruiting somebody whose work can be translated into the clinic where it can impact the lives of the people we care for.”
Throughout three decades, the Ingram family has provided flexible support to Vanderbilt-Ingram, which has helped it evolve into one of the nation’s foremost cancer research centers. With the latest gift, the center can leverage the fund to support several research initiatives.
“We are grateful for this investment that will allow us to capitalize on what we have discovered, venture beyond our current understanding of gastrointestinal cancers and delve into new areas of inquiry,” Park said. “Precision oncology — the tailoring of medications to meet the specific needs of individual patients — is relatively new in cancer care, and there is much to be learned. VanderbiltIngram Cancer Center helped pioneer precision oncology, and we are committed to staying at the forefront to further develop and improve treatments.”
Not everyone affected by cancer has the financial capacity to fund cancer research, but every donation — no matter how big or small — provides a sense of satisfaction and empowerment, Orrin Ingram said. It’s a way to fight back. The ability to make a difference in people’s lives is what inspires him to work and strive for success, John Ingram said.
“So many of us are going to continually have experiences dealing with cancer, either individually or through family members,” John said. “It’s nice to be able to support people who are doing cutting-edge research. It will have a positive effect, not only for us and our family, but for so many other families that we will never know. We will know, however, that we have helped lots of other people.” n
FORCE OF NATURE
Gail Kraemer did what she wanted, how she wanted, when she wanted to do it. In her early years, she traveled through Africa and Mongolia big game hunting. Later in life, she got her pilot’s license and became an avid golfer. Whether she was jet skiing around Tellico Lake or hosting a dinner party, Kraemer was always in charge. She had no time for limits — just adventures. When she was diagnosed with breast cancer in 2008, Kraemer immersed herself in the research, learning everything she could about other women’s experiences and how to successfully navigate her own. (She had a lumpectomy and radiation and was cleared after treatment.) When she was diagnosed with bladder cancer in 2017, she tried to take
Patient establishes program to support female bladder cancer care
the same approach. But because men are four times more likely to have bladder cancer than women, most of the support focused on men.
Thanks to Kraemer, that was about to change.
Steps to support
She was born in Missouri, grew up in Queens and was living in Long Beach, California, when she met Rich Kraemer through mutual friends. They were both widowed in their first marriages: Her husband died of a heart attack and his wife was killed in an auto accident. They fell in love, got married, and she became a stepmother to Rich Kraemer’s three children, Suzette, Kim and Rick. They lived in Franklin Lakes, New Jersey, moved to Hilton Head, South Carolina, in
2006 and then to a lake house in Vonore, Tennessee, in 2017 to be “close, but not too close,” to Suzette and Kim, who both live in Nashville.
“Gail went out and bought a jet ski right away,” Suzette said. “She jet skied until the end.”
Rich and Gail Kraemer traveled extensively around the world and were in Augusta, Georgia, for the Masters when she experienced tremendous pain that sent them back home after just one day. When she was diagnosed with noninvasive, high-risk bladder cancer, she opted for clinical trials and medication to avoid a cystectomy, or surgery to remove her bladder, but progression of the disease eventually made it necessary.
STORY BY DANNY BONVISSUTO
ILLUSTRATION BY SANDRA DIONISI
“Gail wanted firsthand perspective from women who’d gone through it, but found that very difficult,” Rich said. “She found women around the country who helped her somewhat, but it was all her own searching, and she felt more information should be available prior to surgery on what to expect and how to handle everything after. She felt very strongly about that and wanted to change it, so she spoke to her doctor.”
On matters of her care, Gail Kraemer and Sam S. Chang, MD, Patricia and Rodes Hart Professor of Urologic Surgery, didn’t always agree.
“Gail was a force of nature,” Chang said. “We’d get all the information, and she’d make her decision. I’d say, ‘I don’t know if I’d do that,’ and she’d say, ‘It’s my decision.’ I don’t think she really liked me that much in the beginning, but she kept seeing me, and we became very close. After many discussions and treatments, we came to a mutual decision to proceed with bladder removal.”
When she approached him after her surgery, saying she wanted to make a difference for female bladder cancer patients, Kraemer and Chang saw eye to eye immediately.
“We talked about our research, educational efforts for residents and patients, as well as many other important initiatives that we raise money for, and Gail was clear that she didn’t want to contribute to some fund,” Chang said. “We came up with the idea of funding and formulating a position we called the clinical care coordinator. Not for men or children but solely for women with bladder cancer.”
Different from patient navigators at Vanderbilt-Ingram Cancer Center (VICC) who help with scheduling and logistics like lodging and transportation, the clinical care coordinator assists in those tasks and has a thorough knowledge of all aspects of bladder cancer and how it affects women, including clinical trials, treatment evaluation, surgery, side effects, interventional radiology, ostomy care and stoma therapy — and all the questions that come up long after patients have left the doctor’s office.
“It’s a pretty all-encompassing position and sounding board,” Chang said. “I want and envision this role to be a model for other cancers at the VICC and across the country for people. That’s ultimately my goal — our goal.”
‘Just be a friend’
Brianne “Bree” Duncan has seen the gamut of the disease process as a research nurse specialist IV for a bladder cancer clinical trial, including one in which Gail participated for two years.
“They started as nurse and patient and came to care for each other,” Rich said. “When Dr. Chang sug -
gested Bree be the first person to hold the clinical care coordinator position, Gail was thrilled.”
Duncan became the first Gail Kraemer Care Coordinator for Female Bladder Cancer Patients in June 2022, after eight years with Vanderbilt Urology.
“Bree is awesome,” Chang said. “There’s a reason why she’s the first one.”
Duncan welcomed the opportunity.
“After conversations with Gail, Dr. Chang came to me and asked if I would fulfill this role for her. I was so honored to bring to life this idea that Gail had, and to help other women,” Duncan said. “I was also excited to work with her again, but this time on a different level, and to help carry out her wishes. Gail was vibrant, fearless and kind. She had the biggest heart, which continues to be felt and seen with the creation of this position I hold.”
In addition to supporting women in every aspect of bladder cancer and removal, Duncan knows how important it is to “just be a friend.”
“My goal is always to help make this process easier on these women because I know how scary it must feel,” she said. “I feel like the women have enjoyed having me in their corner — someone they know will always be there to answer their questions or calm their fears. I have received a lot of great feedback from the women who are so thankful that this role I fulfill exists.”
Leaving a legacy
Gail and Rich were visiting son Rick in New Jersey in December 2021 when she received word that her cancer had spread. She didn’t want to ruin anyone’s holiday and waited to tell Rich until they returned to Tennessee.
She had a radical cystectomy, with a specialized continent urinary diversion at her request — an internal reservoir that she controlled to empty. She left the hospital earlier than she expected.
“It didn’t stop her from living. She still played golf, boated, jet skied and entertained,” Suzette said. “Gail had nine lives. She always bounced back.”
Gail Kraemer pilots a boat on the lake (left) and enjoys a meal at a marina restaurant (right).
In July 2022, Gail visited Nashville to go honkytonking with Suzette, Kim and her sister, Pam, from Arkansas.
“She never let cancer define her,” Suzette said. “A lot of people didn’t know how sick Gail was, including myself. It never broke her spirit.”
Shortly thereafter, on Aug. 1, Gail was admitted to the hospital following a surgery follow-up appointment. The cancer had spread very quickly to her liver. She died on Aug. 9, 2022.
“I had dinner with Gail and Rich, and within three weeks she had passed,” Chang said. “Her disease progression was very, very rapid.”
“She was a tremendous fighter,” Rich said. “She had two major surgeries and recovered very quickly from both. When I took her to the hospital that week, I
WOMEN HELPING WOMEN
Gail Kraemer’s gift created “one of the biggest blessings” for patient
Leslie Sheffield’s life changed on her lunch break. The primary care nurse practitioner had a CT scan in the middle of her shift, thinking she had a kidney stone or urinary tract infection. It turned out to be a “very large” tumor on her bladder.
“I automatically started researching and trying to figure out how to increase my chances for survival,” said Sheffield, who was diagnosed with stage 4 bladder cancer on March 30, 2023. “The urologist here in Oxford, Mississippi, told me that if his wife was diagnosed with bladder cancer, there’d be no question about it — he would immediately call Vanderbilt.”
Sheffield’s Texas-based family hoped she’d receive treatment closer to them so they could support her family of six, but she and her husband were unsure.
“We prayed a lot about it, and I knew that the first visit with Vanderbilt Urology would tell me everything I needed to know,” she said. “I immediately had a sense of
peace and knew I was in the right place. Everyone was very kind, comforting and gave me a very clear medical treatment path.”
The staff for her surgeon, Sam S. Chang, MD, MBA, told Sheffield about Bree Duncan, the Gail Kraemer Care Coordinator for Female Bladder Cancer Patients, who was on maternity leave at the time.
“When Bree returned to work, she reached out to me, and from the first conversation I knew she was going to be my support person,” Sheffield said. “When I was in the doctor’s office, I felt overwhelmed with treatment options and facts, then I’d get home and start thinking about questions I forgot to ask and angles I forgot to consider. Bree was the person I always knew I could call when I was stressed out, and she would point me in the right direction and give me encouragement and support.”
Like Kraemer, Sheffield found the majority of the online support around bladder cancer to be focused on men.
never thought I wouldn’t bring her home. I think she just finally said, ‘I’ve had enough.’”
As a tribute to Gail, Rich continued to fund the care coordinator position after her initial gift, ensuring that women with bladder cancer will benefit for years to come.
“We are collecting data and records to help track and improve and create true touch points with patients. Where do we need more info? Where do we need less? What are the areas of concern? How did this make a difference?” Chang said. “This type of care requires time, support and the right people. It doesn’t make money, but it makes a difference. It takes philanthropy like this to change the process for the better. Gail and Rich’s efforts are making things better for women with cancer.” n
“There are a lot of personal female questions that come to mind when you’re talking about bladder surgery, and sometimes you don’t think about them until you’re home looking at your spouse,” she said. “To be able to pick up the phone and ask what my daily life as a female would look like if I had a certain surgery was so helpful.”
The biggest decision Sheffield struggled with was deciding between a urostomy, which creates a way for urine to leave the body through an opening in the abdominal wall, and the Indiana pouch, an internal reservoir that holds the urine until you drain it off via catheter.
“I’m a 39-year-old mother of four, and if I want to go for a run or chase my children outside, I want to do that without having a bag,” she said. “Talking through it with Bree made it more clear what treatment plan I should choose based on how active I want to be.”
In August 2023, Sheffield
underwent surgery in which doctors performed a total hysterectomy and removed her bladder and 46 lymph nodes. During her recovery phase, she continued to rely on Duncan for support.
“I had a lot of questions about whether I was recovering correctly, how to catheterize myself and how to take care of my body,” she said. “She was part of a lot of my follow-up visits and acted as a great liaison between myself and the health care team. I never felt like I couldn’t get a question answered.”
Sheffield has not returned to work after her diagnosis and has concentrated on healing, living a healthy lifestyle, spending time with her children and focusing on living out her life goals.
“Prior to my diagnosis, if someone would’ve asked what my life goals were, my answer would’ve been more along the lines of having a successful career, financial comfort and supporting a big family,” she said. “Now it’s
more about quality of life. I’m more interested in enjoying life with my family. I want to live — to truly live. My goal is to be 100% in tune to living life to the fullest, making an impact on others and raising my children to know just how much I love them, because tomorrow isn’t promised.”
Sheffield’s last few scans have been clean. Though she doesn’t need as much support following her surgery, she and Duncan still check in regularly.
“Sometimes I wonder how other women go through this without a Bree for support,” she said. “She was by far one of the biggest blessings in such a scary and challenging situation.” n Danny Bonvissuto
Bree Duncan, RN, BSN
My Story
FIRST-PERSON ESSAY
Cancer chaos
Survivor finds parallels to children’s book with her difficult journey
STORY BY SARAH DENGER
PHOTOGRAPHS BY ERIN O. SMITH
“However small the chance might be of striking luck; the chance is there. The chance has to be there.”
– Roald Dahl, “Charlie and the Chocolate Factory”
Stage 4 cancer monopolized three years of my life in my mid-20s. There is a platitude that likens the process of the diagnosis, treatment and survivorship of cancer to that of a JOURNEY. So, forgive me, while I lean into just that — finding my golden ticket, like in “Charlie and the Chocolate Factory,” and taking a trip into the factory of oncological medicine — wreaking havoc on all health matters: mental, financial, emotional, spiritual and physical.
I grew up a daydreamer. For as long as I can remember, I spent hours on end, thinking about the potential of my future. Just outside of Lexington, Kentucky, I had a normal, and even privileged childhood surrounded and supported by friends and family. Once I graduated college at 22, however, I felt ready to leave the safety net of home and start the whimsical new life I envisioned for myself in Nashville, Tennessee.
My first year in Nashville was all about adjusting to life away from everything I once knew. I was balancing a full-time job while trying to make friends and build community. Times were simultaneously lonely and exciting. I really didn’t have the extra time to figure out what these strange, new lumps were growing on the side of my neck.
I went into a walk-in clinic, expecting a simple explanation for the lumps. Turns out, there were multiple swelling “nodes” all down the side of my neck and through my collar bone. The provider said not to worry because I was young and healthy, but to stay in touch if things worsened or were the same in a week. OK, but I was worried. Call it a gut feeling, but I knew this wasn’t just going to resolve itself. I started having more symptoms: night sweats, pain and swelling all through the left side of my
neck and back, on and off flu-like symptoms, and unexplainable shortness of breath. The lumps were growing, and I couldn’t stop touching them. I had a new fixation, like the book’s Violet Beauregarde and her incessant gum chewing. I called this provider over and over again, all month. She told me I needed to wait it out longer. She finally agreed to do some blood work and ordered an ultrasound — the results were . . . swollen lymph nodes . . . we knew this for weeks. She recommended anxiety medication and a back massage. No joke.
Over the next few weeks as my symptoms worsened, I kept calling the walk-in clinic, and continued to be told to wait it out. Eventually, the pain in my chest was so severe that breathing became a struggle. Only then did the walkin clinic finally admit me to the hospital. I underwent a surgical lymph node biopsy, which confirmed a diagnosis: Hodgkin’s lymphoma. When the hospital doctor told me this, I asked him what was next. He said to get a referral from my primary care provider. Since I did not have a PCP, I called the walk-in clinic who let me know they were removing themselves from my care. “You have cancer, but this is not my problem,” was how I interpreted what I was hearing from these entrusted medical professionals.
It was the biopsy surgeon, of all people, who finally got me in to see an oncologist. With more tests, I learned I had stage 4 cancer. At 23 years old, my stroke of luck, my very own golden ticket — full-blown, late-stage cancer, swollen up to a blueberry, like Violet Beauregarde, at a point of no return.
Here I was, getting into my routine as a young adult, only to be swallowed by the chocolate river of all things cancer-related — surgical port placement, six months of ABVD chemo.
Did I want kids? “I don’t know yet,” is apparently the wrong answer. I took a weekly fertility preservation shot, causing menopausal symptoms. My hair wasn’t just falling out, it was painful, the death of the follicles burned my scalp. Sickness and fatigue were like clockwork. This thrashing ride was just getting started.
I was contemplating my mortality, facing the prospect of death at 23 years old. I was isolated. None of my peers could relate. “At least
you get extra time off of work.” What? Because of cancer? I felt minimized. I was also deeply insecure about my body image: no hair, puffy face from constant steroids; I couldn’t look at myself. I felt like I was losing my mind. Will I die? How much time do I even have left? What other misery do I have coming for me? I felt like the person I was before all of this was gone. I had bills coming in left and right. I exhausted my unpaid medical leave from work and went onto disability. At least I could pay COBRA premiums to keep my health insurance. All I had to do was pay what equaled double my rent each month, while still paying my rent.
The chocolate river was endless. Every time I thought I could get my head above the flowing mass, I would get knocked down again by another chemo treatment, another bill, another well-intended loved one saying the wrong thing. I was trapped; the only way out was through, I guess.
Six months of chemo in the books. Then what? That’s a good question. I felt entitled to a normal life. When any little thing didn’t go my way, something went off in my brain, like the book’s spoiled Veruca Salt screaming, “I WANT IT NOW!” I felt bitter. My 20s were supposed to be a magical experience — not this horrifying ferry ride through this dark tunnel. I wanted to get my life back in order and for the chaos to end.
The summer after I finished chemo, I was trying my best. I decided to take the LSAT, got to travel a little, and became interested in nutrition. Still though, I didn’t feel removed from what I went through. My supports receded since I was “all better.” While I was going through treatments, I was mentally dissociated, which didn’t allow for much emotional processing. Now that I was out of the woods, my brain would no longer let me rely on pure imagina-
“Every time I thought I could get my head above the flowing mass, I would get knocked down again by another chemo treatment, another bill, another well-intended loved one saying the wrong thing.”
“Though my “journey” will never truly be over, I now have tremendous gratitude for the medical care I received from Vanderbilt, for the days I can appreciate my able body, and for my newfound passion to advocate for better resources for patients and survivors.”
tion. My emotions took over, and I sunk into a deep depression. I felt trapped by my apparent inability to control my own future no matter how much I tried.
Six months later, I started to feel a glimmer of hope for my future again. That’s when, just like our friend Veruca Salt, life decided I was the bad egg anyway and threw me straight down the garbage shoot — a cancer relapse. This meant harsher treatments and a stem cell transplant. I really didn’t think things could get any worse.
Prior to the transplant, a cardiothoracic surgeon had to cut through the bone and cartilage of my chest wall to perform yet another biopsy. I asked my oncologist if this procedure was even necessary. The doctor, who had performed the previous, less invasive biopsy, told me with tears in his eyes that the readings on my pathology report matched my initial cancer cells. My oncologist’s response was if there was a possibility to spare me from receiving near-lethal doses of chemo, then he needed to be sure. My body wouldn’t know how to produce blood ever again without the help of stem cells. My immune system would be eradicated. Medically speaking, my body was starting over as a newborn, needing to reacquire all its defenses. Hadn’t I been through enough?
My relapse cancer care had at that point switched over to Vanderbilt University Medical Center, a new whole new big place to navigate. I did love my new oncologist and care team, but it felt like starting over. The transplant broke me. Having previous experience as a cancer patient did not prepare me for how sick, tormented, isolated and hopeless I would feel the second time around. I thought con-
My Story
FIRST-PERSON ESSAY
necting with other young cancer survivors via a support group would help me with the isolation, but my relapse made me a taboo amongst them. I shared my story, and one girl said she almost didn’t come back to the group because of me. So much for feeling less isolated. Spending a month posttransplant in Critical Care didn’t feel as lonely as this. Through all of this, the constant daydreaming and dissociation had returned, and I was once again emotionally bereft. When the transplant was a success, I opted for a year of maintenance chemo; my hair started to grow back; and my energy levels increased. I found my love and passion for fitness; I got to use my voice through a documentary called “Vincible,” shedding light on the under-acknowledged young adult cancer experience. This opened the door for me to serve on the board of directors for the Young Adults with Cancer Program at Vanderbilt-Ingram Cancer Center. On this board, I was able to network with Survivor Fitness, where I now work as a trainer to help others who have walked a similar path to mine. Sounds like I was given the key to the chocolate factory, right?
No. I had much to process — survivorship, the phase that lasts the rest of my life and healing from trauma in all senses of the word. It’s like I have been zapped and shrunk into a person 3 inches tall, a shell of who I once was, someone I don’t even recognize. Small, easily triggered by anything going “bump in the night,” whether it’s a mild cold or shortness of breath after exercise, I become convinced that the worst has come back to get me. No one listens. “You’re fine now,” they tell me. Maybe I am, but it feels more complicated than that.
I’m almost 10 years out of my initial diagnosis. Whoever I was when I first entered the factory with my golden ticket, I came out a different person. I endured a stage 4 diagnosis, swelling up into a massive “blueberry.” I flowed down the thick, suffocating river of treatment and sickness with no foreseeable chance to come up for air. I chuted down to the rock bottom of relapse, entailing harsher treatments and deeper isolation. I shrunk down to a shell of an unheard, anxious person in survivorship.
Cancer brought me to this factory, tested me, terrified me, confused me, leaving me with a sense of . . . perspective. Though my
“journey” will never truly be over, I now have tremendous gratitude for the medical care I received from Vanderbilt, for the days I can appreciate my able body, and for my newfound passion to advocate for better resources for patients and survivors. I would have never said this during my three years of treatments, but this experience proved to be the impetus for me to discover the path my life needed to take. For others out there who received the hopelessness of a golden ticket, I’d want them to know that the perspective I’ve gained proved to be invaluable. I wouldn’t choose this experience, but I don’t know that I would change it either, as my chance of striking luck had to be there. n
Sarah Denger teaches yoga from her home and works as a trainer for Survivor Fitness, which helps other cancer survivors after treatment.
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