Dr. Abe Chachoua is a cancer doctor. Not long ago, he became a cancer patient. Hear how a physician who loves to make people laugh found meaning through his darkest days of treatment.
Dr. Abe Chachoua is a cancer doctor. Not long ago, he became a cancer patient. Hear how a physician who loves to make people laugh found meaning through his darkest days of treatment.
Vital Signs - Season 2
By Sirius XM and NYU Langone Health
Dr. Chachoua: Transcript
Title: I Wanted To Die, But I Didn’t
Description: Dr. Abe Chachoua is a cancer doctor. Not long ago, he became a cancer patient. Hear how a physician who loves to make people laugh found meaning through his darkest days of treatment.
Voices:
Dr. Abraham Chachoua, Guest
Rose Reid, Narrator
Dr. Chachoua: Doctors are bad patients, at least this doctor is a bad patient. The worst part for me was the pain, the pain in the leg. Okay. It was so bad. And, and I'll be honest. I mean, there were days where I just wanted to die. Work was a salvation for me. You come to work, you, you basically are busy seeing patients, sharing their stories, talking about things. I think to me, that is and remains, remains a salvation for me.
Dr. Chachoua: My name is Abe or Abraham Chachoua. I am a medical oncologist at the Perlmutter Cancer Center at NYU Langone health. I am also the Medical Director of the Outpatient Clinical Services of the Perlmutter Cancer Center. But first and foremost, I'm a doctor who looks after patients with lung cancer.
Narrator: A few years ago, while he was busy looking after cancer patients, Dr. Abe Chachoua became one.
Dr. Chachoua: One day the shoe will drop, uh, what will I do when the shoe drops? Right? What will I do? Will I be here to see my kids go to college and finish college? Will I do that? So these are all things that as cancer patients we think about. And no matter how much you come to work and you function at high level, the back of your head is always something like this.
Narrator: Receiving a cancer diagnosis is a vastly different experience than delivering one. But facing cancer on either side - as a patient, or as a provider - is also an undeniably emotional experience. And feelings are something Dr. Chachoua has rarely been able to hide.
Dr. Chachoua: When I was going through medical school, and that was a long time ago, the teaching was that you have to be able to build a wall between you and your patients, because otherwise you'll get emotionally involved and you would get hurt and then you wouldn't be able to manage. Ok but then I realized that building a wall makes you actually a worse doctor. My personal life is very open with my patients. I think of my patients as really just an extension of my family. If you can laugh, even when you have a bad disease, I think it goes a long way.
Narrator: From SiriusXM and NYU Langone Health, this is Vital Signs, where medicine is made personal. I’m your host, Rose Reid.
Music break
Narrator: Dr. Abe Chachoua is really good at demystifying medicine. He’s a person before he’s a doctor, someone you can joke with and hang out with, whether you’re a patient or a friend - or both. It’s hard to say exactly where this fluency came from, but growing up around a physician - and in different parts of the world - probably didn’t hurt.
Dr. Chachoua: My father was, uh, was a physician, a doctor. He was a primary care doctor. He insisted that we're all doctors, me, my sister and my brother. Okay. So we had basically no choice. My one rebellion against my father, which was, uh, he really, really, really, really wanted me to be in private practice with him, and like he was going to leave the practice to me. And, and my rebellion was no, I'm going to sub-specialize and I'm going to be better than you.
Narrator: His family comes from Egypt, where he was born and lived until he was 13 years old.
News clips: War in the Middle East. Israeli forces drive spearheads across the Sinai Peninsula, occupying the old city of Jerusalem. As one looked, one could only feel that as before, surrender would deepen Arab hatred for the Jews. That nothing had been solved for long.
Narrator: In the aftermath of the Six Day War in 1967, it quickly became dangerous to be Jewish and living in an Arab country.
Dr. Chachoua: When I asked my parents, why did we end up in Australia? They said, because it's the furthest, the, it's the end of the universe from Egypt. They wanted to get as far away from Egypt as possible.
Narrator: His family was able to escape religious persecution in Australia, but they couldn’t escape all bad things. For the first of what would become many times throughout his life, Dr. Chachoua was confronted by cancer.
Dr. Chachoua: When I was in medical school, my father was diagnosed with cancer. He had something called multiple myeloma. And that was years and years ago, before all these amazing breakthroughs in medicine, in this particular disease. In retrospect, he did very well with the treatment - he lived seven years. But the end, when it came, was not great. He ended up in the hospital, and he was laying in a bed. And he had a good medical oncologist as far as knowledge is concerned or a hematology oncologist, but this person would do rounds on him every day, uh, and would stand by the door and never actually walk in the room. And he'd say, how are you? And then you would say, okay, great. And you would walk out the door. So at the end, my, my dad died really poorly. He was having a lot of pain, the pain medication was not all that effective. His doctor did not ever come in the room to sit down and talk to him. Nobody really talked to him about dying. So this perhaps was the first germ in my head that perhaps it's not about giving the meds, it's about the doctoring that goes around the meds. And I felt that maybe, if I ever get through medical school, um, I could try and do that better.
Narrator: The oncology community in Australia was very small in those days. Most doctors who wanted to specialize sought out additional experience abroad.
Dr. Chachoua: When I finished my training, I was encouraged to leave. And we affectionately call it in Australia to earn my BTA, “Been To America” degree. So you apply, you send letters, and it's an example of how in life, you make decisions that are based on not much fact, and they can change your life completely. Okay. So I applied and I got several offers to come to the U S and work in various institutions. And one night I got a call from another Australian who was actually working in NYU. And he said, you should come to NYU. You will work with the most inspirational people ever that you will meet, and you will be successful here. So I said, okay, sounds good.
Narrator: It was the early 1980s, and New York City was in the throes of a crisis.
News report: Good evening. The disease has claimed more lives than Legionnaire’s Disease and Toxic Shock Syndrome combined. And yet still, surprisingly few people are familiar with the Acquired Immune Deficiency Syndrome, or the acronym, AIDS.
Dr. Chachoua: So I get here and this was around about the time when AIDS was just beginning. It was 85, 84 or 85. Didn't know the cause, didn't know much about it. And there was tremendous fear that if you walk by somebody who has AIDS, you're going to get the disease. So it so happened they needed somebody to be the doctor to work with AIDS patients. So back in those days, interestingly enough, oncology in many places, oncology managed the AIDS patients, uh, because the AIDS patients would get cancers, skin cancers, Kaposi sarcoma, lymphoma. So I came to become the AIDS doctor. And I did the first study of AZT in patients with Kaposi sarcoma. And I would go every afternoon. Uh, I would, I would treat, treat these, these patients with Kaposi sarcoma, with this drug who would ran the studies. And you got to meet so many creative, inspirational people. And it's an interesting, um, you know, if you think about it, we lost so many, so many people, we lost so many people. And nowadays AIDS like a chronic illness, right? It was a fatal disease, now it's a chronic disease because of medical discovery. And so I was there at the beginning when we didn't know much. And now obviously we know a lot more, which tells you a little bit about the pace of medicine and discovery, and when you can devote enough funding to research, you can achieve a lot.
Narrator: As he cared for these very sick and frightened patients, Dr. Chachoua drew on his experience with his father’s cancer. Instead of standing by the door, he walked into the room - and stayed a while.
Dr. Chachoua: I'll tell you one of the stories that always sticks with me. I was seeing a particular patient and he happened to work in the opera. And one day I'm examining him and he's got his chest is all bruised. Right. It's got a huge bruise on his chest. And I said, I'm sorry - how, how did you get this bruise? He said, Pavarotti fell on me. And I'm like, okay. Okay, fine. So I, I let it go. And then, and then like a year later, I'm watching TV and there was a Pavarotti Sutherland special. And there's Pavarotti surrounded by townspeople, my patient, and he’s singing Lucia di Lammermoor. And he stabs himself and he goes whack right on my patient's chest. And I'm like, he was telling the truth. It's like, go figure. But you see, you see here are maybe some of the beginning of getting to know people, getting to know what they do, as opposed to: Just take this pill and come and see me in a week.
Narrator: Eventually, infectious disease doctors took over treating AIDS patients, and Dr. Chachoua immersed himself in oncology, specializing in lung cancer. It can be difficult for health care professionals to articulate what drew them to a specific field - but not for this doctor.
Dr. Chachoua: What do I love about oncology? That’s a, that’s a very big, uh, question. What I love about oncology is getting to know the people that I treat. Uh, now you could say that's not unique in oncology. Okay. But it is unique in that you are dealing with people who have life and death problems. And for me, to be able to be like a stranger who walks in and gets to know that person and gets to know what their family does, gets to know what they do on the weekend, gets to know kind of a little bit about their personal life. And they get to know about my personal life. My personal life is very open with my patients. I think of my patients as really just an extension of my family. Now, it comes back to what I said earlier - it's not about giving the medication and of course you have to know that part of it. But it's about the doctoring, right? It's about, it's about getting people in distress, making them feel better. Every patient wants to be cured. If you achieve that, it's very, very rewarding. There is nothing better that lights up your day, but, but it's the doctoring part that I enjoy the most about what I do.
Narrator: Lung cancer is - by far - the leading cause of cancer death among both men and women. It accounts for nearly 25 percent of all cancer deaths each year, according to the American Cancer Society, killing more people than colon, breast, and prostate cancers combined. It is not an easy cancer to treat. Over the years, Dr. Chachoua has helped a lot of patients, but he has also lost a lot of patients.
Dr. Chachoua: It may not be as strong as a spouse or a brother or a parent, but I feel the loss as well. And it's very, very distressing to me when that happens. When I was going through medical school, and that was a long time ago, the teaching was that you have to be able to build a wall between you and your patients. Because otherwise you'll get emotionally involved and you would get hurt and then you wouldn't be able to manage. So I think when I look back at my career, and my career now has been for a long time, I think in the beginning, I was a little bit like that. But then I realized that building a wall makes you actually a worse doctor. And so I think I, the wall has gone.
Narrator: For as difficult as lung cancer can be to treat - Dr. Chachoua has seen a lot of progress throughout his career.
Dr. Chachoua: We're living in a, in an age of revolution, as far as cancer treatments are concerned right now. You can imagine, uh, going through medical school and early career in medicine, when everybody says, you know, if we can just decode the genetics of the cancer and understand what makes the cancer tick, we'll be able to drug that. And at the time, and we didn't believe that, but it came to pass. It came to pass and, and, and we now can decode the genes and we can target with drugs that have an impact on quality of life and length of life.
Narrator: Another game-changer in lung cancer treatment has been immunotherapy, which boosts the body’s immune system to help it find and destroy cancer cells. It doesn’t work for everybody but when it does - the results can be dramatic.
Dr. Chachoua: You actually can cure people with advanced disease with immunotherapy. And I have patients like this, you know, I have this particular woman who I think of all the time, and I treated her with immunotherapy and her cancer went away. I mean, completely went away. And now she's like, you know, I think she's almost six years later, or five, six years later when that cancer walks into your office. It's inspirational. The only thing about immunotherapy, I would say in the lung cancer world is we need a little bit more, right. We need to learn how to combine the immunos with other immunos. Now we have many more weapons that we can use. I think we need more.
Narrator: As he sees it, cancer treatment isn’t just about the destination, but the quality of life on the way there.
Dr. Chachoua: I think if you have a patient with metastatic cancer and the odds are that you're probably not going to cure that patient, it becomes then a question about what does that journey look like. If you get to know your patient and you get to know what they do with their family, you let them into your house. Yeah, the end result is not what anybody wants, but, but I guess it's what you have done for them along the way. So, so my advice to anybody who was starting out, it is a shock when a patient dies, you may feel that you've failed. You may feel that maybe you didn't do as much as you could have done. That's generally speaking, not true. But you've got to reflect back and rejoice in the life that you have given them the events that you have given them. I saw a patient, she was an elderly elderly person. Um, and, and the first visit she said to me, I want to see my granddaughter graduate. And luckily we did that, right. She survived for years. She went to a granddaughter's graduation. Eventually she passed from her disease during the course of all this, this actually became very friendly. My family became very friendly with her family with particularly her daughter. And every time I see the daughter now, she would say to me, you know, my mother, she, the one thing she wanted to do was to get to that graduation and you made it happen. And for that, I will always be grateful to you.
Narrator: When you talk to Dr. Chachoua about practicing medicine, he almost always pivots to a story about a patient. Or about that patient’s family.
So, what would it feel like …to be the patient?
Dr. Chachoua: Let me preface this by saying that doctors are bad patients, at least this doctor is a bad patient. My cancer story starts when I went to do a race in Washington. The Cherry Blossom Run. And like an idiot, I thought it was a 10K run. It was a 10 mile run, but in my head, it was 10K, right. So I end up in, in Washington and it's a beautiful run. It's a beautiful run. So I'm running and I'm thinking it is 10K but it doesn't end at 10K. It keeps going. And at mile eight I get chest pain. So what do you think of chest pain? Heart, right? I ended up slowing down, finishing the run, and then I told my wife, I had this chest pain and she said, you know, you should go and see a cardiologist. So I saw the cardiologist, he did some blood work. He did a coronary calcium scan. I didn't have any coronary calcium. Turns out my chest pain was, you know, I drank the Gatorade too quickly. Right. But my PSA was 4 . The upper limit of normal is 4, uh, it was maybe 4.5, something like that.
Narrator: PSA stands for prostate-specific antigen. It’s a protein produced by the prostate; a small gland, about the size of a walnut that helps men make semen. Normal prostate cells make PSA, but so do cancerous prostate cells. High levels of PSA in a man’s blood can indicate the presence of prostate cancer. Normal PSA levels vary by age. Sometimes a big jump in PSA - even within a normal range - can be concerning.
For Dr. Chachoua, who is in his sixties, a PSA of 4.5 was concerning.
Dr. Chachoua: So I went and saw a urologist and, um, they thought they should get an MRI. Now, interestingly, they examined me and they said, yeah, it feels okay, but you should get an MRI anyway. I got the call right after the MRI that, um, there was a very highly suspicious, uh, area in my prostate. So they said, this is highly suspicious for cancer, and your next step is that you should get a biopsy. So here I am, oncologist extraordinaire, uh, with a potential cancer diagnosis. Right. So, okay, you tell yourself, well, it's not going to be that I'm sure. Haha ha. Not going to be that. So I go and have a biopsy. Let me tell you the biopsy was not the most pleasant procedure ever. And then I got the call that this was cancer.
Dr. Chachoua: So there's something called Gleason. Uh, Gleason is a pathologist that came up with a scoring system for prostate cancer. Again, it goes from zero to 10, the higher the worse in terms of aggressive behavior. And this was a nine, so it was a Gleason nine. So, so at that point then, um, there are many alternative paths to treatment and the question is what is the best path?
Narrator: He sought advice from friends, colleagues, and of course, his physicians. There are a lot of options for treating prostate cancer, and some of the side effects can be unpleasant. Ultimately, Dr. Chachoua decided to have surgery.
Dr. Chachoua: I had robotic surgery to remove the prostate, to remove the lymph nodes. So nowadays, uh, you're in the hospital one overnight stay, and then you go home. And you wait for the results. So there's something about waiting. I mean, I honestly think nobody should ever wait for pathology reports, right. if I look at my practice, as much as people don't like me to do this in my office, I think if you're coming in for a cat scan or something, you got the cat scan, you see me right afterwards and I'll get the results for you. Right. That's what I've done with my career with my patients. So I went home, waiting for the results. Um, and then I got a call to tell me that indeed there was a Gleason nine and indeed I had positive lymph nodes. Um, so basically couldn't have asked for a worse outcome.
Narrator: As the news went from bad to worse, Dr. Chachoua found himself at a crossroads.
Dr. Chachoua: So I got the results and the question now is I needed to have, uh, more treatment. So I’ve gone from having hopefully nothing too bad cancer, to surgery and hopefully nothing surgery then radiation and hormonal therapy. So I ended up getting hormonal therapy and radiation therapy. Um, and that was tough. I think, you know, hormonal therapy in a guy it's anti androgen, you completely obliterate your testosterone level, which is what we need for energy, for function. So I had none of that, and you become tired, you gain weight. I became very depressed. I didn't want to do anything because I couldn't DO anything. I came to work but that's about all I could do.
Narrator: He also started to have hot flashes and then - awful, unrelenting pain in his leg.
Dr. Chachoua: And I would say, why do I have pain? And I would get - it’s from the radiation and whatever. Okay. So the pain kept getting worse. And it got to the point where I actually wanted to do a house call after my radiation treatment. Okay. So I went and got radiation, tried to walk the two blocks and I couldn't do it. It hurt, it was so much pain. So I came here, I did my own scan. It turned out I had a fluid collection that was pressing on the obturator nerve, which is a nerve that is in the pelvis. And that was just giving me significant pain. I ended up requiring drainage for this thing four times. Okay. Each time would we accumulate quickly and cause worse pain.
Narrator: Dr. Chachoua had spent 40 years working in medicine, weaving in and out of hospitals and clinics and treatment centers. And yet, so much about Dr. Chachoua’s experience with prostate cancer was new to him. As a patient he was learning a lot about his disease - but also about doctors.
Dr. Chachoua: It was an interesting experience being on the other side. There was one other thing that was an eye-opener for me. As doctors, you say things like, I say, all the time, I say, have this thing taken out, you should have it taken out. But you don't necessarily think about the consequences of that for a patient. You got to live with the pain. Well, you got to live with a nerve injury, you got to live with all the other stuff that goes with it. And I think, I think personally we don't do a great job at explaining. Interestingly, when I was talking to one of the other surgeons, I know he said, yeah, because if we told patients all the possible complications, they would never have surgery. So that was a bit of an eye opener for me is that we need to be very honest, very straightforward with the patient about what you can expect after recovery Because I wasn't really prepared.
Narrator: He also wasn’t really prepared for the emotional roller coaster that would come along with the physical one.
Dr. Chachoua: The worst part for me was the pain, the pain in the leg. Okay. And, and I'll be honest, I mean, there were days where I just wanted to die. I mean, it was so bad. You know, it was just so severe and you would take, you would take no drugs to, to help with the pain, which then make you dopey and you couldn't work, but there were days where I wanted to die. You know, I took some antidepressants. I spoke to some, somebody about all that, but, but pain, pain is kind of the worst thing. I think I got better when the pain got better. Work was a salvation for me. You come to work, you basically are busy, seeing patients sharing their stories, talking about things. I think to me, that was, that is, and remains, remains a salvation for me. I said I want it to die. Uh, but I didn't. Um I didn’t.
Narrator: It has been more than three years since Dr. Chachoua was diagnosed with prostate cancer, and he’s doing okay. Not out of the woods exactly, but not so deep in them either. He still goes for lots of follow up tests, and wears compression stockings to cope with the discomfort of lymphedema, which is a chronic swelling in one of his legs.
Music break
Narrator: For all their training and expertise, doctors don’t have all the answers. Every day, with every patient, they are doing their best, but they can’t always predict accurately, treat effectively, or cure entirely. It’s a humbling thing to practice medicine - and then, to suddenly be on the receiving end of it. Dr. Chachoua has called himself a quote bad patient, but what if he was just a regular patient? Who was scared, and anxious, and in pain? It was a dark time for him, as it is for so many other patients who have cancer, or any other serious illness. Even before his own diagnosis, Dr. Chachoua could sense what some of his patients needed from him in these moments. Sometimes, it was as simple as being himself.
Dr. Chachoua: Cancer is a serious business. I think if you can laugh, even when you have a bad disease, I think it goes a long way. In order to be successful at humor, with a patient who has cancer, it has to be humor that is directed at yourself. I can certainly laugh at things that I did or happened to me. And everybody has a funny story to tell about their life, right? Everybody has a funny story to tell about their in-laws. Everybody has a funny story to tell about their wife. I didn't do it consciously. It's just part of what, what I am.
Dr. Chachoua: So what do I learn from all this? I there's many lessons, I think. As patients, we don't want to wait forever for results. That's bad. We want to know the full implication of what we're getting ourselves into. I've always in my practice, when a patient tells me a story in terms of symptoms, if I don't know what it is, I say, look, I don't know what this is. But I can try and find out. I don't make up stuff. I learned also as a patient, every three months, when you have a test - high anxiety, right? One day the shoe will drop. What will I do when the shoe drops? Right? What will I do? Will I be here to see my kids go to college and finish college? Will I do that? These are all things that as cancer patients we think about. And no matter how much you come to work and you function at high level, at the back of your head is always something like this. And every three months you have to have another PSA test and whatever. And you wonder again, is this the time when the shoe drops and what will I do when it does?
Dr. Chachoua: I'm documenting to you my own experience and, and how that taught me perhaps to be a better doctor than I was. And I thought that was pretty good before, but now I think I'm better.
Narrator: Vital Signs is a co-production of NYU Langone Health and SiriusXM. The podcast is produced by Jim Bilodeau, Julie Kanfer, and Keith King, with sound design by Jim Bilodeau and writing from Julie Kanfer. SiriusXM’s executive producer is Beth Ameen, in partnership with Allison Clair and Jim Mandler of NYU Langone Health. Don’t miss a single episode of Vital Signs and subscribe for free wherever you listen to podcasts. To hear more from the world-renowned doctors at NYU Langone Health, tune into Doctor Radio on SiriusXM channel 110. Or listen anytime on the SXM app. To get in touch with our production team, email VitalSigns@siriusxm.com. For the Vital Signs podcast, I’m Rose Reid. Join us next time as we bring you stories of medicine made personal.