Letter From Houston
Physician, Heal Thyself
What happens when a neurosurgeon who’s treated hundreds of patients with malignant brain tumors gets one himself?
SAM HASSENBUSCH HAD BEEN HAVING HEADACHES. They weren’t severe—he could knock down the pain with Tylenol—but they kept coming back. He mentioned them to his wife, Rhonda, who thought maybe he’d been pushing himself too hard. At 51, Sam was full of energy, and his career was peaking. He was a senior neurosurgeon at the University of Texas’s M. D. Anderson Cancer Center, in Houston, and an internationally renowned specialist in pain research and management. In 33 years of marriage, Rhonda had seen her husband take time off only once—a few hours on the day he had had his wisdom teeth removed. His weeks were a nonstop swirl of intricate brain surgeries, patient consultations, procedures to treat cancer and chronic pain, and lectures throughout the country and abroad. He was president of the American Academy of Pain Medicine and one of M. D. Anderson’s resident experts at applying the regulatory and insurance codes that made sure doctors and institutions got paid. A soft-spoken man whose beard veils boyish dimples, Sam came to work with cowboy boots under his scrubs and habitually ate two McDonald’s cheeseburgers, medium fries, a hot apple pie, and a chocolate shake for lunch. His idea of recreation was to turn a three-mile commute in the snarl of Houston traffic into a fifty-mile cruise on his Victory Vegas motorcycle. The headaches were probably a symptom of stress, Rhonda speculated, but why not just get them checked out. Sam asked a neighbor who is a radiologist to schedule an MRI, and on May 10, 2005, he and Rhonda went to get the results.
“You can’t imagine how many times in how few seconds you can check to see if maybe, somehow, they attached the wrong name to a film,” Sam recalls. He likened the shape of the tumor they saw on the screen to a small banana or a hot dog. “The radiologist looked at it and told me, ‘Yeah, you’re right.’ Rhonda was terribly upset, of course, but unlike her, I knew exactly what that tumor meant. A three percent chance of five years’ survival.”
The neurosurgeon had glioblastoma multiforme, the most common kind of malignant brain tumor that originates in the brain and one of the most aggressive of all human cancers. Glioblastoma is so lethal because even if surgery and radiation appear to have removed the tumor, it may still have spread through the brain in tentacles, every microscopic cell on a different tear of destruction, all of them running amok. Glioblastoma claims the lives of about 10,000 Americans a year. Sam had treated about 500 brain cancer patients in the course of his career, and he had performed more than 150 surgeries to remove glioblastoma tumors. Whenever he had to break the news to patients that they had the cancer, he’d try to be upbeat about chemotherapy protocols and ongoing research, but he knew that glioblastoma typically kills half its victims within 52 weeks. With no hint of a cure, little progress had been made in treating the disease. It was a bitter dose of irony for a brain surgeon at the most celebrated cancer hospital in the Southwest to realize that the very kind of tumor that had most defied his training and skill was now growing inside his skull.
That night, when Rhonda finally slept, Sam’s thoughts raced in lonely and jumbled horror. “What’s our real estate worth? How good is my life insurance? My retirement plan? My disability? I did sign up ten years ago for that disability plan, didn’t I? Did thirty-one years of medical study and practice as a neurosurgeon just go down the drain? With a brain tumor, will I be allowed to operate on anybody? Am I going to be debilitated? In a wheelchair? Unable to ride my motorcycle?”
On and on his fears sped—a long night of the soul. “But I’m obsessive-compulsive,” he said, “and the next morning I was in the office planning details of my surgery. This person would be the anesthesiologist, this would be the scrub nurse.” He asked two longtime colleagues, Fred Lang and Raymond Sawaya, to perform the surgery. “I wanted two neurosurgeons because of the tumor’s deep edge and because it’s better for them psychologically if something goes wrong. A neurosurgeon decides how far and how deep to cut but rarely walks out of the surgery saying, ‘That was perfect.’ There’s always a gray area when dealing with the brain.”
After his diagnosis, it took Sam about three days to steady himself, to “land on my spiritual base,” as he put it. He was brought up in the Reform Judaism faith in Saint Joseph, Missouri, where he met Rhonda when they were in their teens. He was educated in Catholic school, and one night on a date she gave him a copy of the New Testament as a gift. At Johns Hopkins University, in Baltimore, where he went to undergraduate school and continued with his medical training, picking up a Ph.D. in pharmacology along the way, he became a devout Christian. Sam is a lay biblical scholar and a fundamentalist whose faith is Scripture based—not long ago he was rereading the entire New Testament every 21 days—but there’s nothing in his manner of the bristling and domineering evangelical. He was an elder of churches when he and Rhonda lived in Maryland and Ohio, and in Houston they had joined a congregation called the Four-Square Church. A large part of its appeal to him was that 20 or 30 percent of the members shared his passion for riding motorcycles.
“In both Judaism and Christianity,” he said, “there’s a Bible passage of great importance: Genesis 22. Abraham is going up Mount Moriah with his son Isaac, who’s saying, ‘Where’s the ram? I thought we were going to make a sacrifice.’ Abraham doesn’t want to tell Isaac he may have to be the one offered, and he says, ‘God will provide,’ ‘Jehovah-jireh’ in Hebrew. And God does. They find the ram stuck in some thorns.” In different ways, through different vessels, he chooses to believe God will provide for him.
Neurosurgeons often operate immediately upon seeing evidence of glioblastoma, but Sam was determined not to let his illness overwhelm the lives of his children. He and Rhonda decided to put the surgery off for ten days; they didn’t want to darken a long-planned celebration of their daughter’s graduation from Vanderbilt University. The Hassenbusches also have two sons, one in Colorado and one who’s pursuing an MBA at the University of Houston. The son pursuing an MBA said, on seeing his dad’s MRI, “You don’t have to be a brain surgeon to know that’s a primary malignant tumor.”
The May 20 surgery went well, and Sam’s colleagues were able to remove the cancer from high and deep in his right temporal lobe. Because of the location of the growth, his cognitive functions were not in immediate peril, and from his hospital bed the next day he e-mailed colleagues that he was ready to get back to work. He also made some calls. Amy Heimberger, an M. D. Anderson neurosurgeon and immunologist, recalls that Sam was barely out from under the anesthesia when the phone rang in her office. “An assistant on our team hung up and said, ‘I just got a call from Dr. Hassenbusch. He wanted to make sure we had gotten his tumor specimen.’ She was really flustered, so I said, ‘Well, have we? What’s wrong?’ She said, ‘Oh, it’s not that. I’ve just never gotten a call from a patient in intensive care.’”
Sam wore an eye patch at first because the surgery had left him with slight double vision, but in four days he was participating in staff meetings. A week after his operation he performed a nonsurgical pain procedure on a patient, and on the eighth day he got back on his motorcycle. After he’d gone through the rounds of radiation and initial chemotherapy, he decided that he would keep his head shaved. He thought it enhanced his look as a biker.
The most remarkable display of the doctor’s mettle and faith came when colleagues presented his postsurgical options. Sam’s neuro-oncologist, Mark Gilbert, told him he must start a course of a fairly new chemotherapy drug called Temodar, or temozolomide. Taken in capsules, Temodar acts directly on DNA and inhibits the growth of all cells, including cancerous ones in the brain. After the initial concentrated dosage, it’s employed as maintenance, for years, to fight the deadly tentacles of glioblastoma. Appraising the chemotherapy, Sam said, “Temodar has been very effective when the cancer first appears. Less so if it comes back.”
Heimberger urged him to consider instead a promising vaccine that she had helped develop as part of a research team at the Duke University medical school. Between 30 and 50 percent of brain tumors have on their surface a single type of protein, or cell “marker.” The experimental vaccine contains a synthesized version of that protein. The vaccine stimulates the entire immune system, and it activates a cell that attacks any cell that has the marker. Heimberger told Sam that his glioblastoma cells were studded with the distinctive protein; relatively young and otherwise healthy, he was an ideal candidate. The test group of patients who had received the vaccine was small, but the results were encouraging. The median survival for those trying the vaccine is 29 months, compared with 14 months for those treated with the most current chemotherapy and radiation and a bleak 4 months for those who are untreated.
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