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Dealing with death keeps doctor going

By Deborah L. Shelton, Chicago Tribune, Source: MCT News Service

CHICAGO _ As Dr. Richard W. Byrne labored for more than three hours to remove a malignant tumor from his patient's brain, he knew his efforts would not defeat the deadly cancer.

The goal was to buy time. Time for the 44-year-old patient to spend with his wife and two young children. Time for the man to enroll in a clinical trial for a new chemotherapy drug that could possibly offer a cure.

A neurosurgeon at the Brain Tumor Center at Rush University Medical Center in Chicago, Byrne treats people diagnosed with brain cancers that almost always kill. He is the one to break the bad news and the one patients rely upon when the prognosis is the worst imaginable.

In his office, clocks line the top of a cherry wood bookcase. The neurosurgeon received them as presents from families _ expressions of gratitude not for a cure but for the gift of time.

In an area of medicine that many might view as bleak, Byrne finds inspiration, a sense of reward and hope. In addition to buying precious weeks or months for terminally ill patients, he contributes to research into these deadly cancers, hoping to see progress in treatment within his lifetime.

"What keeps me going is the fact that there are a lot of people who need us. Most of them come to us desperate and scared," said Byrne, whose penetrating gaze and low-key presence convey both intensity and calm.

As Byrne operated on John Petro, his 44-year-old patient, he concentrated on removing as much of the tumor as safely possible. Petro was diagnosed in June with a malignant glioma, the same type of aggressive cancer that killed the late Ted Kennedy in August at age 77. Petro's cancer was a type called glioblastoma multiforme. The surgery was his second in about nine months.

Finding and removing a tumor among variations of gray brain tissue requires patience, persistence and a keen eye, along with sophisticated equipment. Cancer cells infiltrate the brain much like a spot of red paint diffuses when dropped into a can of white, Byrne explained. Even if the red spot (the tumor) can be removed, it's not possible to safely take out all of the pink, the area where cancer cells mix with normal tissue.

The goal is to cut out as much of the cancer as possible and kill the rest with chemo drugs and radiation.

As he methodically removed the cancerous mass, Byrne was mindful of what he and Petro share in common. A year apart in age, they live in neighboring western suburbs _ Petro in Downers Grove and Byrne in Oak Brook _ and Petro's children, a 4-year-old daughter and 7-year-old son, are close in age to Byrne's two daughters, 8 and 10.

In a field where death is a constant, "you can't help but see your own mortality," Byrne said near the end of the surgery.

The number of brain tumors diagnosed in the United States has increased in recent years for reasons that are not clear. Among the debated causes are better detection and statistics, the aging of the population and possible exposure to unknown environmental causes, according to Deneen Hesser, research director for the American Brain Tumor Association, based in Des Plaines.

Also, more cancer patients live through their initial treatments and develop metastatic disease, which sometimes spreads to the brain.

The day before his surgery, Petro was hopeful.

"Everyone wants to talk about the prognosis _ it's kind of like, how long do you have?" Petro said, as he sat cross-legged on his hospital bed wearing a Fighting Illini T-shirt. "But (Byrne) said: 'I feel positive about this. Let's not talk about dying.'"

Byrne has treated several brain cancer survivors who have lived as long as five or 10 years. They serve as reminders of what is possible.

"I returned to work and to a life with four children who were so grateful to have a father," David Rowland wrote in an e-mail to Byrne in 2008. Rowland, a labor and employment lawyer with the Chicago law firm Seyfarth Shaw LLP, had two surgeries in 2004 for an aggressive brain cancer called anaplastic astrocytoma. "Thank you for saving my life."

Reached at his office last week, a cheerful Rowland said he continues to do well.

Doctors cannot accurately predict how long a brain cancer patient will survive, Byrne said, and patients should hold on to hope that they will live long enough for a cure to be discovered.

"Of course there are days when you see somebody who is suffering and you realize how much trouble they are in," Byrne said. "That can be depressing. You have to keep your focus and realize that what you are going to do for this helps."

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Byrne, 45, said medical students were not taught how to talk about death when he was studying at Northwestern University's Feinberg School of Medicine. But now at least half of U.S. medical schools say they teach their students how to deliver bad news, and all of them teach wellness courses that cover the impact of dealing with stressful situations, such as the death of patients, said Dr. John E. Prescott, chief academic officer for the Association of American Medical Colleges.

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Chairman of the department of neurosurgery at Rush, Byrne performs between 100 and 150 brain tumor operations a year, as well as surgeries on patients with epilepsy and benign brain tumors, some of them life-threatening.

Fueled on a breakfast of coffee and Diet Pepsi, he might juggle surgeries, hospital rounds, clinic appointments, meetings, teaching, paperwork, dictation, reading and research, depending on the day of the week.

In one recent week his clinic schedule included four people with malignant brain tumors and six others with benign tumors, all new cases. Emergency appointments are common.

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Petro was working his job as a project manager for PepsiCo on June 18 when a pinpoint of red light partially obstructed his vision, like someone shining a laser in his eyes. Later he learned that a large, fast-growing tumor had triggered a series of seizures.

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Byrne performed surgery just four days later and Petro received standard radiation and chemotherapy. Then Petro signed up for two clinical trials studying possible new treatments. Within four weeks of enrolling in the second trial, an MRI showed the tumor had returned. Malignant glioblastomas frequently grow back.

Petro had the second surgery on March 4, and went home two days later. He is recovering well.

During clinic appointments the day before Petro's operation, Byrne talked calmly to visibly nervous patients. He was direct and plain-spoken as he answered questions and showed each one imaging scans of their tumors.

Raised in Chicago's Beverly neighborhood, Byrne was named for an uncle who died of an infection following a head injury as a youngster. The same year the uncle died, a clinical trial succeeded in showing the effectiveness of penicillin, an antibiotic that might have prevented his death.

Knowing that cures might be found at any time is a motivator for Byrne.

"We're learning a lot about the molecular genetics of gliomas," he said, "and someday some basic science researcher is going to get it right."

Because he treats patients with malignant brain tumors, death is a constant. It reminds him of life's priorities and how unfair life can be.

"It can get you down at times," Byrne said. "At the same time, it focuses you on making sure you live your life fully."

His wife, Dr. Armita Bijari, a neurologist, said Byrne is "extremely intense" in every aspect of his life.

"He doesn't just do a triathlon, he has to do Iron Man," she said, laughing.

He takes the same approach with his work, she said. "Sometimes he will jump out of bed at two or three in the morning with an idea and he goes and writes it down," she said.

Byrne said his intensity is the result of trying to accomplish as much as he can, knowing that time can run out.

"I'm in a hurry to live," Byrne said. "There's a lot to do."

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