r. Brian Stabler knows all about the stress that accompanies serious illness. As a professor of psychiatry at the UNC School of Medicine, Stabler has spent years studying the relationship between psychological attitude and chronic stress, and has focused primarily on those struggling with disease.
But twelve years ago, the table was turned, and Stabler found himself in the unenviable position of studying himself. In 1990, he was diagnosed with low-grade B cell non-Hodgkin's lymphoma, a form of cancer that attacks the body's immune system.
Since that time, Dr. Stabler has undergone a series of different treatments. The last, a molecularly targeted drug, has led him into a full remission. He has been in full remission now for four years. Below, Dr. Stabler describes his struggle with cancer treatment, and some of the important lessons he learned along the way.
Learning the News, or Drenched with Cold Water
Like a lot of people before diagnosis, I had symptoms of one kind or another. I was fatigued. I had night sweats. I was losing some weight. I felt as if I had a flu, sometimes for months on end. This went on for maybe a year. Then one day I was flying back from a business trip, and I literally couldn't breathe. I couldn't draw air, and I thought I was drowning up there at 36,000 feet and that's the first time I ever remember being really scared in my life. Not long after that, I had a chest x-ray, and my doctor called me at home. He said, "Brian, I have some good news and some bad news. It looks like you have lymphoma."
I can remember the physical feeling of being drenched by cold water, and I continued to talk to him, walking around the room, pacing, asking questions like, "Do you use chemotherapy? Do you use radiation? Will it go away by itself? What am I going to do? Oh my God, I'm going to die." That's what I was doing on the phone with my doctor, doing everything wrong.
The good news was that lymphoma can be treated, but I didn't hear that at the beginning.
Health
Watch and Wait?
The first thing that was suggested to me after the diagnosis was to "watch and wait". By that they meant, "Do nothing to see how this disease progresses, and if it gets bad, we'll do something."
And I remember thinking, "This is not good." I don't like the idea of having a disease like cancer, being told that I've got this life-threatening disease, and then being told in the next breath, "Well, maybe we'll just leave it alone for a while." It did not make sense. It did not compute.
Shortly after I began the watch and wait approach, my own anxiety was getting to the point that I needed to do something. I was saved a week later, when I discovered a node in my groin area. I informed my oncologist, literally that hour, and we started to think, "Let's do something. Let's intervene here."
First Action, First Side Effects
I was given an injection of alpha interferon at the hospital, and given some Tylenol and some Benadryl, and told, essentially, "Come back tomorrow, and let's see how you did."
Well, I did go back in the morning, but by that time, I'd had such a rough time with interferon - all night long I was sweating. I was stiff and achy, and there was no Tylenol in the world that could manage what I felt. And then they said, "Well, we'll do this for the next 18 months." Hello. That wasn't going to happen.
A Bone Marrow Transplant, and a New Lesson
Being treated with an autologous bone marrow transplant is like being beaten up to the point where you almost die. It's a very physically demanding and psychologically stressful thing to do.
One day, after I'd been in the hospital for about three days, they were giving me very high doses of chemotherapy at huge doses. I had promised myself, "This chemotherapy will not make me sick." I was holding on. There I was, in the bed, white, bald, skeleton-like, with these two tubes sticking out of my chest, standing up in the bed with my head thrown back, trying anything I could not to vomit, when in walked the senior nurse, and she had a couple of words for me that have stuck with me. She said, "Dr. Stabler, you must work with the therapy, not against it. You're trying to block it. Let yourself go." I lay down, turned to one side, and went on with the therapy and was severely sick, but that was a necessary thing at that point in time. It was a little learning moment. Sometimes you have to let go.
'Patient' Should Not Equal 'Victim'
One thing I learned along this journey is that the word "patient" does not mean "patience". I thought that for years and years. I should have known better. But I looked it up. It actually comes from a Latin word that means "victim." And if there's anything that I would say to myself, certainly, or to tell others, "Don't think of yourself as a victim, because if you do, you surely will fulfill that prophecy."
The Latest Treatment, and Longest Remission
The transplant gave me remission for about 2 years, and then the lymphoma came back. After four years of intermittent oral chemotherapy treatments, I read in the New York Times about a new, molecularly targeted treatment called rituximab.
I was literally the first person, as far as I know, to be treated with rituximab after the FDA approved it in 1998. After three weeks of treatment with the drug, CT scans revealed that there had been a complete remission and that the evidence seemed to be that the lymphoma had responded very powerfully. I've remained in that remission for four years without any other treatment.
Lifesaving Lessons
In my practice and in my clinical research, there are two personal characteristics that I've always found will tell us if a patient is going to do well. The first is curiosity, or interest in and wanting to know about things, including yourself. The second is sociability, or the ability to be emotionally and socially available to others.
If you work toward just those two goals -- being curious and being sociable -- my bet is that it will take you a long way down the road of survivalhood.
Cancer is a Lonely Place
One of the loneliest places on earth is to be a cancer patient, I think. You are cut off from the community, and I think another rule for us, or certainly one for me, is being -- that you need to be in touch with those who mean something to you, who are your family, your loved ones, your friends, your colleagues, your neighbors. It doesn't matter. The important thing is that you reach out and be in touch with them, because lots of times people are not at all sure about how to approach a cancer patient.
I've made a rule for myself that I will reach out to be in touch with others and to allow others to come into my life and to share my life and not to be afraid of that.
Ongoing Work: Leaving Cancer Behind
After undergoing at least three different kinds of therapy for lymphoma, I am working now toward two notions.
One is that I'm going to stop thinking of myself as a patient. Two is, I'm even wondering whether I'm going to stop thinking of myself as a survivor. Because these are things that I want to leave behind.
