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A Lesson in Healing

VUSM supports medical student who finds himself on receiving end of cancer care

Third-year medical student Mike Powers learned a lot about being a good doctor by being a patient. Diagnosed with cancer just over a year ago, he has a new connection to patients and to the Vanderbilt University School of Medicine community who saw him through some dark days.

Each challenge Mike and his wife, Jenny, faced was met with acts of kindness and generosity from friends, family, VUSM faculty and classmates. At every turn, no matter how far they fell into the pit of illness and despair, there was someone there to reach down and pull them up.
“Families are one thing, and they were definitely next in line, but then there were all of these other people who are part of the Vanderbilt community who showed me what being a good person is really, at its core, all about,” Jenny said.

 

BOY MEETS GIRL
Jenny and Mike, both 32, are a highly accomplished, bright, optimistic couple. Mike graduated from the University of Pennsylvania, where he played football with the goal of joining the NFL. He signed with the Cincinnati Bengals but was let go after sustaining an injury. He had considered medical school early on, but pre-med wasn’t compatible with pursuing the NFL, Mike said.

He worked as a journalist with McGraw-Hill before earning his MBA from the University of Notre Dame. He dabbled in entrepreneurship and did a summer internship with a small, start-up investment fund.

“I knew I didn’t want to spend my life on spreadsheets and sales calls,” said Mike, explaining his decision to pursue medicine.

Jenny graduated from Harvard University and was accepted to Vanderbilt Medical School. They met at a gathering at the home of her classmate and Mike’s best friend from high school, Will Moore. Jenny graduated from VUSM in 2008, and she and Mike were married a few days later. They settled in Boston where she did her residency, and he enrolled in pre-med classes at Boston University and was a research associate at the Harvard School of Public Health.

“It was a fun time. We had a 400-square-foot apartment in the middle of Boston. We traveled a lot. We went to China and to Korea,” Jenny said.

Mike was accepted to VUSM in fall 2011 at age 29 and received the David Hitt Williams Scholarship. Jenny finished her residency in Boston and moved to Nashville in July 2012.

“We closed on our first house and were settling in, connecting with old friends from my med school days. It was my first job, so that was a little bit of an adjustment. Things were just kind of rolling along,” said Jenny, who is an assistant professor of Dermatology at Vanderbilt.

 

SIGNS AND SYMPTOMS
In fall 2012, Mike began to experience episodes of low-grade fever, chills, fatigue and lower back pain. He made an appointment with Andrew Scharf, M.D., the attending physician at the Student Health Clinic, and his lab results came back normal.

Thinking it could be stress-related, Mike and Jenny headed to the beach with his family to celebrate Thanksgiving and to announce her pregnancy. She was due with their first child at the end of June. When they returned to Nashville, he had another episode of fever and pain, and that’s when they knew something was wrong. He visited Scharf again and this time his lab work showed some slight abnormalities. Scharf recommended a CT scan.

“I wasn’t sold on the fact that it was something serious,” Mike said. “I texted Jenny and asked her if I should do this.”

“There was enough on the table that in my mind we just needed to check it off the list,” Jenny said.

He had the CT scan on Wednesday, Dec. 5. Later that day, Mike logged on to his laptop to check his medical record to see if the report had been posted. Sitting alone at his kitchen table, he read it and saw the words: 15 cm mass in retroperitoneum (behind the abdominal cavity).

“The first thing I thought was, ‘Oh, God, I’m expecting a child. I can’t bring a child into the world and abandon it,’” Mike said.

This 6-foot-3 inch, 245-pound, former offensive lineman broke down into tears. Jenny was working in the Dermatology Clinic at One Hundred Oaks, so he drove to campus and met with his trusted adviser, Amy Fleming, M.D., assistant professor of Pediatrics. After reviewing the report, Fleming looked at Mike and said, “This is very concerning.” She drove Mike to Jenny’s office so he could tell her in person that he was seriously ill.

“I remember Amy poked her head around into my clinical workstation and she had this serious look on her face. She pulled me out to the hallway where Mike was. I remember he was wearing a blue and red flannel shirt and jeans,” Jenny said. “The three of us sat in my office, and I initially put all of the emotion aside and wanted to get things moving.”

The next day, Mike’s mother and father, a pathologist, came up from Birmingham, Ala. His other adviser, Ban Allos, M.D., associate professor of Medicine, arranged for him to have a biopsy on Friday morning, Dec. 7. He also had a testicular ultrasound that showed some calcification.

“It was nerve-wracking waiting to have a biopsy to find out what kind of cancer I had,” Mike said.

They spent the weekend prepping the house for Christmas. On Saturday Mike developed a fever and was in extreme pain. On Monday, Allos advised him to go to the Emergency Room where Corey Slovis, M.D., professor and chair of the Department of Emergency Medicine, was waiting for him. A work-up revealed that he had a bleed in his retroperitoneum caused by the biopsy. From his hospital bed, Mike anxiously texted pathologist Joyce Johnson, M.D., to learn the result of his biopsy.

“The preliminary report was it could be seminoma (testicular cancer) or it could be sarcoma. Extensive sarcoma is bad. You don’t live very long with that,” Mike said. “When Joyce realized I was alone in the ER, she came and sat with me for an hour.”

Slovis got the call with the pathology results. “Congratulations. It’s seminoma!” he told Mike with a big grin. The lesser of two evils, the diagnosis came as a relief, but the reality was Mike had Stage IIC testicular cancer.

 

CANCER, CHEMO AND CHRISTMAS
Mike’s parents shared the burden of his care. They, along with many people from the Medical Center, saw the couple through the course of treatment. Jenny and Mike’s classmates threw a chemo kick-off party and a dozen of them shaved their heads in a show of support.

“From the diagnosis phase, we had the red carpet rolled out every step of the way. We were getting the most up-to-date information and it makes you realize that it is absolute agony waiting for information. We had Mike in treatment within one week of his biopsy. We had the best specialists at our fingertips, and multiple doctors in the family (including Jenny’s father) and it was still pretty horrible,” Jenny said.

Mike started chemotherapy on Dec. 17, 2012, and underwent 21 infusions. Unable to eat, he sustained himself on ginger ale, water and IV fluids. A particularly low point came on Christmas Eve. He developed terrible chest pain caused by reflux and nothing seemed to help. Jenny took him to the ER where he was treated with morphine and oral lidocain to no avail. Finally, intraveneous Pepcid did the trick. They left hours later with a prescription and headed to the only pharmacy open at 9 p.m. on Christmas Eve, near the airport. There were 30 customers waiting in line when they arrived.

“I told the pharmacist that my husband was a chemo patient in horrible pain out in the car and they got it to us a little bit sooner,” Jenny said.

Over the next few weeks, Mike experienced frightening side effects of chemotherapy including an irregular heart rhythm at home.

“His heart was racing. We were trying to decide if we had to take him to the ER. Was he going to die at home?” Jenny recounted. “I am a dermatologist and this is the kind of stuff that I dread. And when it’s your husband, you can’t even think straight.”

For Mike the worst night was when he developed a neutropenic fever that caused his whole body to shake uncontrollably.

“After nearly an hour, I just started crying, and I told Jenny, ‘I can’t take this anymore,’” as he lay under a pile of blankets and his wool coat in the ER. Jenny, now in her second trimester of pregnancy, spent the night with him there.

Throughout treatment, Mike’s classmates brought them food and kept them entertained, and faculty members, Fleming, Allos and Kathy Murray, M.D., whom they call their three angels, went above and beyond too many times to count. Mike was never alone during his chemotherapy infusions, which lasted several hours.

“When Mike was super sick from chemo, they would come and watch him for an hour or so, which meant getting him drinks and blankets to keep him warm. That kind of support was just great,” Jenny said.

His last day of chemotherapy was Feb. 11, 2013. Too weak to go to school, he worked from home on the days that he felt well enough. With the help of classmates, including one who made handwritten duplicates of all her Pharmacology flash cards for him, he was able to take his exam. His instructor dropped it off at his house and told him to take it when he was able. It took him four days to finish. He was not able to attend a single lecture until April.

“They really just helped me in any way that they could,” Mike said.

Mike had surgery on May 17, his and Jenny’s fifth wedding anniversary. What was supposed to be a three-hour surgery took eight hours. Urologic surgeon Mike Cookson, M.D., dissected all of the scar tissue left from the cancer in order to preserve Mike’s kidney and abdominal aorta.

“I don’t know that many surgeons would have been capable of doing that, and I am immensely thankful,” Mike said. “Surgery was pretty awful. It was more pain than I knew was possible to endure. Between the chemo and the surgery, I’ve come to appreciate how much pain we’re capable of inflicting on patients. It’s really bad. I’ve found I have a much deeper connection with patients now.”

 

A NEW LIFE
Mike was recovering from surgery and starting to get his energy back when Jenny underwent a C-section on July 4 and delivered their son, Teddy.

What was certainly a joyous occasion was tempered by yet another setback.

“That’s another saga, but I managed to get out alive after I developed a severe infection,” Jenny said. “I developed rigors (shaking due to fever) like Mike did, unfortunately.”

They have matching scars, both physical and emotional.

“It’s the most seriously ill I’ve ever been. It’s been a wild ride. Those were challenging times when I was recovering and Mike was recovering still. I was like, ‘I can’t believe this is our life.’ I was so physically sick from my delivery. It was rough month,” Jenny said.

Their family and the Vanderbilt community continued to pitch in while they recuperated and cared for their newborn. Mike also had to study for step one of the boards. In fall 2013, Jenny returned to work and Mike gradually returned to the classroom. The faculty continues to work with him on his third-year schedule to accommodate his energy level. His surgery rotation, the most physically demanding, has been postponed.

“I have spells where I am basically myself, but I only have a certain number of hours in the day where I feel like my old self,” Mike said, nearly one year after his diagnosis.

“Since then life has continued to be on the mend,” Jenny said.” I am juggling work and the baby. Our son is such a joy.

“I can’t say enough for all of the people who helped us along the way. I feel like I’ve learned a lot about what’s really important in life. I know how busy their lives are, but they just stopped and literally poured out their energy and their help and that included in the postpartum period. That’s the kind of stuff that floors me,” she said, wiping tears from her eyes. “There’s been this continued presence of his classmates and the three angels who have been so great.”

Mike feels that his experience has confirmed he made the right decision to study medicine.

“I’m thankful that I chose to go to medical school. My experience has confirmed to me the ability of a good physician to have an immensely positive impact of people who are at their most vulnerable. Because of my experience, I find that I am able to connect with both patients and their families, even at the end of life. Death doesn’t scare me now that I’ve faced it.”