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When loss becomes personal: Reflections on one of our own
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About 2 weeks ago, Teresa Flippo Morton, MD, lost her all-too-short 5-week battle against pancreatic cancer.
Teresa was my colleague at Levine Cancer Institute, a vibrant and vital 55-year-old breast surgical oncologist who epitomized so many fine things about medicine. She was a gentle, empathetic, generous and kind physician, so much loved by her patients and their families, who recognized her passion for her work, as well as her ability to care for each one of them and to provide superb judgment, knowledge and care.
In the past days, so many of them have told me of their huge sense of personal loss. Thousands followed Teresa’s progress on a page she created on the website CaringBridge.org.
She was a role model to young surgical oncologists in general, and to women in surgery in particular. She was the den mother of our breast oncology team, a source of counsel, common sense and folk wisdom, and apparently devoid of ego, able to resolve concerns sensibly and altruistically.
‘Everyone wanted to help’
One of the things I so admired about Teresa and her husband Duncan, a pediatric surgeon, was their ability to combine work–life balance, to take real vacations, to do so many different things, and to see a world beyond medicine while never really leaving it. Duncan retired recently, and the two of them looked forward to a rich and happy future, allowing for the fact that Teresa planned to work a while longer.
I have been reflecting upon this and trying to get my mind around this dreadful and tragic event.
I have watched some very fine aspects of the profession that I love. I marveled at the way her team rallied around Duncan, their family and her while carrying on the extraordinarily difficult day job we have all taken on. Our pancreatic cancer team came together, formulated the best known plan, recognizing the limited tools available — notwithstanding the claims so often made about the efficacy of treatment of metastatic pancreatic cancer — and worked so hard to stem the tide.
Teresa was realistic and ever gracious, and she worked with them to strike the balance between fact and fantasy, reality, loss and potential gain. Everyone wanted to help. Everyone wanted her to pull through.
The pressure on her oncologist was immense, all of us offering help, support and advice while trying so hard not to second-guess. He bore this with calm and grace, wishing for good fortune and a rare significant remission, trying so hard not to disappoint Teresa, his friends and colleagues, and himself, and everyone stood by him as things went south.
Teresa’s boss and one of her best friends — Richard White, MD, chief of surgical oncology and a breast cancer surgeon himself — was a constant presence, as was Wendy Brick, MD, her career-long medical oncology buddy.
Rich had the presence of mind early on to establish a fund to honor her work, focused on training in surgical oncology. Teresa knew hundreds of her friends, patients and supporters pitched in to create a living monument to her life’s work, irrespective of the outcome of this battle.
Bittersweet breakthrough
Pancreatic cancer is notorious, and it has taken so many people of significance.
In the world of entertainment, they include Count Basie, Jack Benny, Rex Harrison, Michael Landon, Henry Mancini, Luciano Pavarotti, Patrick Swayze and so many more.
The world of medicine has not been immune. Harry Nurkin, the CEO who initiated the renaissance of Carolinas HealthCare System, succumbed to it after only a few months, as did the famous Belgian oncologist, Emmanuel van der Schueren, MD. My career-long friend and colleague, Rob Sutherland, PhD, an internationally renowned cancer biologist, slipped away in only a year. One day, they were wonderfully well … and then they suddenly were facing a death sentence, which was effected so quickly and inexorably.
A team at The University of Texas MD Anderson Cancer Center recently produced a fascinating report in Nature on exosomes containing glypican-1, a heparin sulfate proteoglycan involved in regulation of cell growth, as a potential biomarker for pancreatic cancer.
Their studies, including preclinical and clinical data, suggest quite striking sensitivity and contextual specificity as a biomarker for pancreas cancer, notwithstanding expression in other malignancies. From their report, it is absent in a normal and inflamed pancreas, can be detected in small amounts in the blood of patients with early pancreatic cancer, and increases or decreases in parallel to tumor progression or regression.
Clearly, confirmation and larger numbers are required, but this set of translational data is pretty impressive at first reading.
I hope that the confirmatory studies validate their strong initial data, and that this assay can be introduced into clinical practice quickly if it is as good as it seems.
I wish it had been available in time to stop so many people succumbing to one of the last implacable cancer killers. It is hard to deal with the irony that the month that one of the most promising potential advances in the management of pancreas cancer was reported, our team lost Teresa.
We deal with loss and death every day. We try to help ourselves and each other, and there is palpable nobility at times like this, which we see among our patients and their families every day when we grieve and empathize with them. When we lose one of our own, it just makes it a little tougher, and then we refocus on our mission and what we have to do.
Vale, Teresa! Rest in peace.
For more information:
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, is HemOnc Today’s Chief Medical Editor for Oncology. He also is president of Levine Cancer Institute at Carolinas HealthCare System. He can be reached at derek.raghavan@carolinashealthcare.org.
Disclosure: Raghavan reports no relevant financial disclosures.