When a health care professional becomes the patient, turning off that desire to help others is difficult.
Such is the case with clinical psychologist Stephen Chermack, Ph.D., who is former chief of mental health service at the VA Ann Arbor Healthcare System, an addiction specialist and professor of psychiatry for the University of Michigan Medical School.
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He had been feeling fatigued and then noticed his skin looked jaundiced. After several tests, around Thanksgiving 2015, he was diagnosed with metastatic pancreas cancer at age 50. He knew that its stage 4 designation meant his disease is terminal.
"I was told life expectancy without any treatment is two to six months," Chermack said.
While the tumor on his pancreas had already spread to his liver, giving up wasn't an option. He embraced the idea of chemotherapy treatment to extend his life by slowing the cancer from spreading. After all, he had more people to help.
Forwarding science
One of those he helped unexpectedly was his University of Michigan Rogel Cancer Center oncologist, Vaibhav Sahai, MBBS, M.S. Chermack started chemotherapy in January 2016. He has now completed 34 cycles of the chemotherapy intermittently over the past 2.5 years. For pancreatic cancer, with a median overall survival less than 12 months, this is an exceptional response.
"He's broken the mold," Sahai said. "Fewer than 10 percent of patients with pancreatic cancer have a genetic mutation that responds well to targeted treatment in clinical trials. Chermack underwent genomic analysis and does not have a targetable mutation, but he is still responding very well. It raises questions as to why he is having this exceptional response to standard chemotherapy."
Other factors influence the outcome as well, Sahai noted. Chermack has done well because of his young age, sheer determination to fight and the influence of his wife, Melissa, who is his caregiver.
After almost three years, Sahai recommended Chermack change to a second line of chemotherapy drugs this month based on his recent scans and labs.
Pancreatic cancer accounts for only 3 percent of all cancers in the United States, according to the American Cancer Society but is slated to be the 2nd most common cause of cancer related deaths by 2020. About 55,440 people will be diagnosed with it in 2018 and an estimated 44,330 will die from it this year.
Death has been on Chermack's mind. After his diagnosis Chermack immediately went on medical leave and then long-term disability. During this time he maintained contact with colleagues and contributed to several manuscripts accepted or published in peer reviewed journals. Now, he's getting to know his employer as a patient, which has provided different insights and encouraged him to consider how he can help improve patient care and advance science. Chermack donated some of his tumor tissue and blood to help Sahai better understand this unusual response.
"As a health care provider he wants to continue to help others," Sahai says.
Building a home
The cancer diagnosis came three months after Chermack and his then girlfriend, Melissa, and her two daughters, purchased a home together.
"I knew the impact this terminal disease would have on me but I started thinking about everyone else in my life," he said. "What's going to happen to them and what can I do for them now?"
The answer emerged a couple days later: a wedding ceremony.
Chermack married Melissa in the family room of their home in December 2015.
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"We got married because we love each other," but the diagnosis played a role in terms of timing, he explains. He and his wife wanted her to be part of his medical treatments and the legality of marriage would facilitate that process.
His family is also instrumental in keeping his mind off the cancer. "My wife seems to know when it's time to get me out of the house, even if it's just for a ride, a movie, a concert or a trip to the grocery store," he said.
They also have been supportive of his research that examines interventions to reduce post addiction-treatment aggression and substance use in veterans. He recently submitted it for review at a professional journal.
The power of music
Music has been therapeutic as well. Chermack is a long-time musician, playing bass in a two-person band, Death Wish Squirrel, with drummer Deepak Somashekar.
"We may be a two-person band but we sound like a five-piece on stage," he said.
Most of their music falls in alternative and rock and roll categories, with humor-laced lyrics as the unifying thread. "One of the songs is called 'Why Would Anyone Take a Baby on a Plane?'" Chermack said.
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Chermack has spent the past two years taking the band's recordings, tinkering with them, adding vocals and creating three albums' worth of music.
Despite having a strong response to treatment that has lengthened his life, he knows pancreas cancer will eventually kill him. But he's spending some of his remaining time creating a legacy. He wants his family to have easy access to his creative outlet after his death. He also sees this as a method for raising money for pancreatic cancer. He will donate any proceeds to the Sky Foundation, Inc., which hopes to increase awareness for the early detection and treatment of pancreas cancer.
Helping others has been his life's work and he wants it to be his swan song.
"I feel pretty good about how I lived my life," Chermack says. "In spite of it all, we're grateful."
"I don't dwell on dying. Let's focus on today."