Paying It Forward (hopefully)

On a daily basis, 70% of the people I interact with currently have cancer - or they've just had it surgically removed. Diagnosing someone with cancer, or talking to people about their cancer, is something I do every single day. It is literally routine. I’ve come to think of cancer as common (if not more) as pneumonia, diarrhea, or a cough.

I’m spending this week with a thoracic surgeon, and today we saw about 6 patients in his office between 9 and 12. Each one of these people were referred to his consult for masses or nodules found in their lungs. It took until the last patient of the day, (4 weeks, 4 hours and 100+ patients in to my surgery rotation) for this epiphany to be made:

We were talking to a guy about the mass that was just discovered in his lung a few days ago - and he was running off the list of things he had to do that week. PET scan tomorrow. MRI the next day. Goes back to the oncologist after that. Has to see his cardiologist. Check in with insurance. We were going to send him to interventional radiology for a biopsy, then he needed to come back to us by next week with copies of all those test results.

While he was running through that list, I was viscerally reminded what it was like to be sitting in the doctors office, worrying about a diagnosis - and it wasn’t even my diagnosis. So much energy is spent making those initial arrangements, and there is such a sense of urgency to accomplish them. You’re trying to strategically asses your emotional reserve because news could be better or worse tomorrow after the PET. It could be better or worse after the MRI. Better or worse after the biopsy...it’s a storm that comes without warning, even when it isn’t your diagnosis.

Brendan’s oncologist was so calm. He wore a hippo tie. He stood casually in an exam room surrounded by 5 incredibly anxious adults, and at the time I was blown away by how stoic he seemed. 

I get it. 

I had already talked to 5 other people that morning about their pulmonary nodules that were all most likely cancer, and he was the 6th one of the day. In that snapshot of life - everybody had cancer, we can treat it and cut it out if we have to, see you in a week after your biopsy and tests. 

I get it, but I'm not sure how to feel about how that familiarity comes across to patients. 

In retrospect, we absolutely needed D. Rose to stand in that room, relaxed, in a hippo tie, calmly talking to us about the cancer like it wasn’t going to be a big deal. 

There was comfort in his confidence. 

I can only hope the energy we are giving off to our patients is comparable. 


In other news - things are amazing and wonderful for both of us. We couldn't be happier with where we are and what we're doing. 
This summer, I left the island for good and stayed with Brendan in Denver for a few months while we both studied for a big test. It was the best decision I've made in a long time. We climbed mountains, we hung out with majestic elk (picture below), we ate scorpions, we got tattoos, we got each other through a miserable test like champions. 
I've moved to New Jersey now for my rotations, Brendan has stayed in Denver. Next year we will both be applying to residency with the opportunity to pick up and move to another state yet again. Don't tell him, because he'll probably think I'm a creep - but I plan on being as close as geographically possible to my brother bear the next chance I get.

2 of 2 Klein doctors recommend elk spotting at Fern Lake, RMNP

Winter Break

The first time I saw Brendan since July, I gave him the biggest hug - grinning ear to ear. He had a head of shaggy hair (as evident in the picture to the left), a full beard, and an exquisitely creepy mustache that was long enough on the sides to be curled up. He shaved all of that off the next day. He says his facial hair can still be a bit erratic in it's growth, resulting in an occasional patchy beard. The one I was witness to was full and lovely.
We talked and compared experiences, marveled at the similarities and differences. We caught up and laughed and joked and I rediscovered all over again that there is no one else I enjoy being around as much as my brother.
Brendan dropped in to see Dr. Rose on his first day in town. He had been worried about a swollen something under his mandible - and although there were a handful of reasons not to be worried about it, there was one big reason to be worried. Doctor Rose examined the swelling three times to be certain, but maintained confidence that it was just a swollen submandibular gland and not a lymph node.
My woven bracelet has stood the test of time - sort of. Life on the island lead to it beginning to fray and tear, so I invested in super glue and just glued it together with enough slack that I could slip it off my wrist when I had to be elbow deep in cadavers. The gluing was surprisingly effective, until the glue started to give way. I ended up taking it off just to save myself from it falling off somewhere where it would truly be lost. I still have it though, and it hangs above my desk right where I can see it for inspiration. I'm planning a simple and discreet tattoo to replace it on my wrist.
So everything is still just fine. We both desperately love what we are doing, despite the life-changing amount of hard work that goes in to it. Everyone is healthy, everyone is happy, and things are going well.

Genetically Modified "Serial Killer" T Cells Obliterate Tumors in Patients with Chronic Lymphocytic Leukemia

This is so amazing!

“Within three weeks, the tumors had been blown away, in a way that was much more violent than we ever expected,” said senior author Carl June, MD, director of Translational Research and a professor of Pathology and Laboratory Medicine in the Abramson Cancer Center, who led the work. “It worked much better than we thought it would.”

After removing the patients’ cells, the team reprogrammed them to attack tumor cells by genetically modifying them using a lentivirus vector. The vector encodes an antibody-like protein, called a chimeric antigen receptor (CAR), which is expressed on the surface of the T cells and designed to bind to a protein called CD19.

Once the T cells start expressing the CAR, they focus all of their killing activity on cells that express CD19, which includes CLL tumor cells and normal B cells. All of the other cells in the patient that do not express CD19 are ignored by the modified T cells, which limits side effects typically experienced during standard therapies.The team engineered a signaling molecule into the part of the CAR that resides inside the cell. When it binds to CD19, initiating the cancer-cell death, it also tells the cell to produce cytokines that trigger other T cells to multiply building a bigger and bigger army until all the target cells in the tumor are destroyed.

Moving forward, the team plans to test the same CD19 CAR construct in patients with other types of CD19-positive tumors, including non-Hodgkin’s lymphoma and acute lymphocytic leukemia. They also plan to study the approach in pediatric leukemia patients who have failed standard therapy. Additionally, the team has engineered a CAR vector that binds to mesothelin, a protein expressed on the surface of mesothelioma cancer cells, as well as on ovarian and pancreatic cancer cells.

The work was supported by the Alliance for Cancer Gene Therapy…and the Leukemia & Lymphoma Society.

Our Lymphomathon donations were absolutely a part of this break-through. Hooray!

Living the Dream

Student Doctor, Brendan Klein

1 down, 1 to go

I took the picture early this morning, as Brendan was trying to get out the door. It is his first day of medical school. He talked about how nervous he was, and doubled checked his clothing choices with Dad and I before he left.

Dad met us in Parker on Saturday, after Brendan and I had spent two days crammed in his truck, dragging a U-Haul halfway across the country. The rest of the weekend flew by, and suddenly I was hugging Brendan for the last time in what will most likely be 4 months.

"This is it for the 3 amigos", Dad said last night over sushi. I thought that was funny - I never would have thought of us that way.

Also, I think that makes me Martin Short...

Lymphomathon 2011

I re-launched team Walking 'phoma Brother in this year's 5k Lymphomathon on August 14th at Montrose Harbor (same Bat-time, same Bat-channel).

Brendan and I are both unable to attend the walk this year - but if you and someone you love (or even someone you just sort of like) would like to have an excuse to take a sunny, lake-side walk the 2nd Sunday in August, then I have your excuse right here. You're more than welcome to walk under our name - it would be an honor.

The team page is RIGHT HERE, and most of you know the drill. There is a link on the top of the page that says "join our team" - just click it. You can sign up to walk with no donation required. You can also sign up with zero intention to walk, but overflowing intention to support the cause.

The only thing I ask is some time later that night, you Skype/Google+/GChat/iChat/email me in Grenada and tell me how it went.

Road Trip To The Future 2011: a must-see list

On July 22, a trailer and the back of his truck will be packed up (mostly with beef jerky, lets be serious). Brendan and I will leave Chicago in the early morning en route to Parker, Colorado. We are doing the trip in two days, (seeing some really educational, important, and historically valid landmarks along the way) hoping to land in Parker some time Saturday afternoon intercepting Dad and a new mountain condo worth of furniture.
Dad and I will fly back on Monday, and turn our attention to my impending trip on August 7th.

The excitement is palpable.