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A Life in the Balance: BMC Caregivers Come Together Over a Difficult Case

Paul needed immediate treatment for his throat cancer to prevent death from choking.
Paul Sayer's and his mother, Dottie, during a recent
visit to BMC. Paul's cancer is in remission after five
CyberKnife treatments.

At Boston Medical Center, an ethics committee comprised of physicians and staff convened to debate a difficult case. A 57-year-old man's life was in jeopardy, an aggressive tumor had taken root in his throat. He required immediate treatment to prevent a horrific death from choking. But the question on everyone's mind that morning remained: "How would it be possible?"

For nearly 40 years, Paul Sayer has suffered from schizophrenia, a disease that requires permanent residential care at a nearby VA hospital. The optimal course of radiation therapy for his cancerous tumor would require 30 treatments, which his doctors feared would be far too demanding a schedule due to Paul's mental illness. BMC's CyberKnife was Paul's only hope. Extremely precise, the CyberKnife can administer doses of radiation so powerful that Paul could be treated after only five visits to the hospital.

Paul's 83-year-old mother, Dottie Sayer convinced BMC physicians and staff that her son understood he needed medical intervention and could withstand the rigorous treatment plan required of him.

"I was driving Paul to our favorite lunch spot and I turned to him and said 'Paul if you don't do this you are going to die' and Paul, who usually doesn't speak a lot, turned to me and said 'Hell! I don't want to die!" recounted Dottie, whose fierce love for her son has made her a lifelong advocate for him and others suffering from mental illness.

Once Paul was cleared for treatment, the reality of how best to care for him set in.

"Under normal circumstances, patients are not anesthetized during CyberKnife therapy but for Paul it was necessary in order to keep him as still as possible. Because of the high doses of radiation emitted by the machine, I could not be in the same room as the patient while he was treated. So it became my responsibility to figure out how we could administer the anesthesia remotely," explains Mauricio Gonzalez, MD, anesthesiologist and BMC vice chairman of Clinical Affairs.

Dr. Gonzalez collaborated with staff from BMC's Biomedical Engineering Department to specially design a system for Paul. After several visits to Radiation Oncology, Dr. Gonzalez came up with a way to train cameras on the anesthesia equipment and run cables from the bedside to the CyberKnife control room in order to safely monitor his vitals. The mask normally worn by patients undergoing treatment had to be specially-fitted for Paul, allowing a hole for a breathing tube.

On June 1, 2009, Paul was transported from the VA for his first treatment. Dr. Gonzalez cleared his morning schedule to ensure Paul's care went smoothly. To minimize the amount of disorientation Paul would feel, a special area was set up in the Post Anesthesia Care Unit (PACU) where his anesthesia could be administered and where he could recover after treatment. During his first days at BMC, physicians and nurses became quickly attuned to care for Paul, who cuts an imposing figure at over 6 feet tall and well over 200 pounds.

They learned to gingerly wake and feed him as soon as the anesthesia started to wear off. Paul began calling Dr. Gonzalez "Buddy" and shared with him stories of his training as a corpsman in the U.S. Army before his schizophrenia diagnosis. PACU nurses made Paul's last treatment a special event. When he woke up in recovery he was greeted to a table set with a cloth and flowers and a peanut butter and jelly sandwich (his favorite).

Paul's mother came to every one of Paul's treatments and was kept company by clergy from BMC's Pastoral Services until she could be reunited with her son.

"All of us had a lot of questions about this case before we decided to take it on. But after seeing the joy that Paul gets every time he sees his mother, we all felt differently. I think all of us felt that it was an honor to care for Paul and a very humbling experience," said Sheryl Katzanek, BMC director for Patient Advocacy.

Incredibly, Paul is now cancer free. Dottie commented that no place else would have done what BMC did for her son. "They did a wonderful job for Paul. They really understood him," she said.

"At BMC we don't say 'no.' When everyone came together for Paul: Radiation Oncology, Otolaryngology, Anesthesiology, Biomedical Engineering, Patient Advocacy, Chaplaincy, the PACU, it was amazing what we were able to accomplish," said Dr. Gonzalez.