Tribute to the Doctor Heroes: This story was told by Martha Man on the occasion of Fu-Tin's 80th birthday party. 

[Martha was an oncologist working in the private practice, South Bay Oncology, when Fu-Tin became ill. The practice was later bought by Stanford Healthcare.]

Elena Man Introduces Martha.  Martha speaking:

Okay. So now comes the time for a special tribute to all the wonderful doctors who helped to get my father to this point. This has been a very long story. Having cancer in general is a long road, a long journey, a very long course of treatment. So I will echo the sentiments of my older brother Dave. From a child's perspective you grow up and you think, wow, parents always going to be there. They know everything; they have the answer to everything; they're indestructible. You can't imagine a time when they won't be there.

When I think of my dad, I remember he was my first tennis teacher and helped to prepare me to getting on the high school team. We would hit balls for one and a half, two hours, and then spend an hour after that doing serving practice. So he had no problem keeping up with all of that and hanging in there with me. And it seemed like after retirement, if anything, the degree of exercise just seemed to escalate. He just had more time to work. He found a group of people to play tennis with, would spend hours at the gym, half the day doing physical activity.

So it came as somewhat of a surprise to me when I got the first inkling that something not quite right with his health. I was doing residency at the University of Michigan and in 2001 I got a call from my brother saying my father had a very low platelet count and there can be a much higher risk of bleeding and other complications. So eventually he was diagnosed with a disorder, an autoimmune disease ITP. [Idiopathic thrombocytopenic purpura].

(ITP) is a rare condition described as the scarcity of platelets, which are responsible for producing blood clots that help prohibit bleeding.] In ITP, the body somehow triggers an attack and destroys its own platelets. Dealing with that wasn't such a smooth road. He had to go through a number of different medicines to suppress the immune system and had his spleen removed, but eventually became stable and things seemed to be fine.

I had my son Evan in 2008 and my parents came out and spent six months with us helping take care of the baby. My father by far had the most patience with the baby, would hold him for hours, sit and play with him; he was in great shape then. In December of 2009 my parents came out to visit me and my father became really seriously ill, he developed very high fevers, had substantial diarrhea and weight loss and was hospitalized at a hospital where I worked, at Good Samaritan in San Jose, and went through a battery of tests, none on which really showed a clear indication of cancer at that point. But in retrospect that was really a foreboding of things to come.

The following year, 2010, he developed extremely red swollen skin accompanied by terrible itching. From a doctor's perspective, pain is something we can control and we have really good medicine for that. Itching, that is much, much harder to control. It's a much more worse for the patient, and it was difficult because he had a number of different consultations with skin specialists without really a clear diagnosis or without any relief. He tried a lot of different topical treatments, tried using light treatment and eventually, finally after about 18 months of that, he got a referral to Dr. David Peng after my parents moved out to California.

So Dr. Peng was the director of medical dermatology at Stanford, now the chair of dermatology at USC. But I have to say, I give this man a lot of credit because the key thing here was really diagnosis. We had no diagnosis after 18 months of suffering and you cannot move forward with the appropriate treatment until you know what you are dealing with. So the Dr. Peng started working with my dad in 2011, immediately hitting harder against the rash by prescribing much stronger topical treatments and eventually stronger immunosuppressant medicines like cyclosporine. But quietly behind the scenes he was every month checking for a diagnosis called Sezary syndrome. Extremely difficult to diagnosis, it was not apparent based on the many skin biopsies my dad had that there was a sign of a lymphoma problem but what the doctor was looking at was in the blood. Sezary cells are a T-cell, part of the immune system designed to help fight infections. But Sezary cells are basically rogue cells which have become cancerous and which can infiltrate into the skin. Sometimes you can have a diagnosis from the blood, but it’s like looking for a needle in the haystack. The doctor had a very difficult time making the diagnosis. But in September of 2011, we got the call from Dr. Peng in the evening that he finally had enough data, enough confidence to say this is what Dad has – Sezary syndrome. I did more investigation. I am an oncologist, but Sezary is extremely uncommon, affecting .8 or .9 patients per million. It’s an extremely aggressive form of lymphoma and by the time my father was finally diagnosed he already had stage 4 disease, so it had been very widespread.

So this leads us to our next hero doctor: Dr. Peng referred us to Dr. Youn Kim, professor of dermatology at Stanford and the Director of Multidisciplinary Cutaneous Lymphoma Clinic. She’s the world's expert on this type of lymphoma and how lucky it is the she’s just up the street in Palo Alto. I will say, she was such an amazing person! After she met my parents, she took the time to personally talk to me. She said okay, I know I can talk to you on the same level and then detailed all the aspects of the pathological physiology. I knew then that this was big trouble. In the hopes that she can turn the trajectory around, he was started right away on aggressive chemotherapy, but he could only handle about five doses before he developed serious side effects. He had infections complications, a known skin complication called Stevens-Johnson's syndrome. She then used light treatments [photopheresis] and added in high dose vitamin A and all of these came with their share of side effects and complications. But in the end we could see the Sezary count was improving.

Knowing from experience that the benefits of the current treatments will not continue, Dr. Kim eventually suggested the option of a stem cell transplant and that leads to us our next hero doctor – Dr. Wen-Kai Weng. When I heard that transplant was being considered, I have to say it was with some trepidation. I had taken care of a lot of patients going through stem cell transplant and, for sure, these patients were among the sickest patients you would ever see in the hospital. It’s a very high-risk kind of treatment. I often tell my own patients, well, sometimes we have to pick between not-so-great choices. This was the not-so-great option but really the only option in terms of trying to get him longer-term control of the lymphoma.

I went with my parents to the very first meeting with the Dr. Weng and he outlined the option of participating in his Phase II trial. Dr. Weng’s trial, offered even to older patients like my father then age 72, was a lifesaver! As part of the transplant you have to get rid of the patient's normal bone marrow with super high dose chemotherapy or a combination of immunosuppressant and radiation treatments. My father readily signed up for the option, again, not many options left at that point. So the first step was to look for a donor.

My father has three siblings, normally the highest chance for finding the match comes from family but none of the siblings were a match so we had to go to the regular donor database. So the huge majority of people in the database, however, are Caucasian. So if you are Caucasian patient they might look for a match and find hundreds of matches for you. Because of his race, and all of much higher match with someone of the same race, my father had two choices. So two probably donors from Asia and not only do they have to be a match but they have to agree to participate. It is definitely a process for the donor to go through as well. But he was very fortunate to have a young man be the donor for his transplant. So after going through an aggressive process with radiation and high dose immune therapy drugs, the date of the transplant was November 2nd, 2012. And I remember talking to my mom after the transplant and she was like okay, now he'll be all better and I was like no, this is just the beginning. It is a very, very, very long road to get through a transplant. You have to be sure the transplant takes and sets up inside the patient and starts functioning properly. There are many, many life-threatening complications from a stem cell transplant. Something called graft-versus-host disease can be a life threatening complication and could be life-threatening infection, have to have medicines that suppress the immune system for a long time after treatment. So I was not surprised when there were complications. He was hospitalized at Stanford in May of 2013 with severe graft-versus-host disease involving the gut. Basically he had terrible diarrhea, pain, terrible sores in the mouth and couldn't eat anything.

He seemed to start to recover from that and then on July 10th, 2013, I was in my clinic and I had just start seeing patients when I got a frantic call from my mother. She said she found Dad unconscious. She had called 911 and the ambulance was taking him to Good Samaritan hospital. So I finished seeing the one patient and had to cancel all the rest and drove down to the hospital where I saw our next hero doctor, Dr. Baldev Singh. He is an intensive care specialist, part of a excellent group of doctors I have worked with through the years over at that hospital, so I had a lot of faith and I knew right away my dad was in good hands. I walked into the ER and Dr. Singh was there literally about to intubate. So my dad had arrived in such poor shape, he was barely breathing on his own, was unconscious, blood pressure was extremely low. Everything was pointing to extremely serious life-threatening infection. So Dr. Singh intubated him, got him settled in the intensive care unit, hooked him up to the ventilator and started several antibiotics. My mom and I sat in the waiting room to see how things would go after my dad settled in and we then spent time with him. When patients on a ventilator, they have to be sedated. It's not a comfortable situation to have a tube down your throat and, when I left the hospital on that day, I knew things could go either way. I am not an intensive care specialist but I knew the ventilator was on the maximum amount of support it could provide, providing the maximum amount of oxygen, that it could provide. So if my father was not going to survive, there was nothing else that could be done. He had been getting everything possible. And I will say through the next 24-48 hours, Dr. Singh took charge. He did amazing work with manipulating the ventilator, adding a setting I had never even heard of to get Dad through that really critical time. When patients are that sick, we as doctors can provide support, we can give you medicine to support your circulation, hook you up to the ventilator to help with oxygenation, dialysis to support kidneys, but in the end the patient's body has to turn around and work better on its own or they will not survive. So my father spent about two weeks on the ventilator and under the vigilant care of Dr. Singh and his team. He was able to come off and recover from a very serious infection. When he was ready to leave the hospital, he went to a rehabilitation facility to learn how to walk again, a very long process.

It’s super amazing to see him here now. It's been about six and a half years now since the transplant, a great milestone in oncology, and to have him here and have such quality time with his family and have a good quality of life is an incredible accomplishment! So I know I want to personally thank, and, I'm sure all the family does too, to extend our thanks to the amazing team of physicians who helped with his care. I personally know how hard it is to take care of patients that are this sick, the complexity, the medical decision making, the amount of data you have to simulate every day to try to manage the patient's care, all the care behind the scenes, talking to the nurses, consultants, insurance company, all of this goes ton try to get patients to this goal. So we are incredibly grateful and thankful for all of the extra time that we now have with my father. So Dr. Weng is here with us. [applause]. And so is Dr. Singh. [applause]. [cheering].