July 16th, 2020
| Survivor: Colorectal (Bowel) Cancer
In 2014, I was a research trainee (a 'post-doc') in Jack Johnson’s laboratory at The Scripps Research Institute in La Jolla. I had moved from the UK to the US aspiring to become a virologist and structural biologist, solving the three-dimensional structure of viruses and phages using electron microscopy and crystallography. During that time, I carved out a small niche in his lab using next-generation sequencing to study how viruses move their genetic cargo. Work was going well. I always knew that I wanted to run my own laboratory, and so I had been eyeing-up opportunities to start my own lab as an assistant professor studying virus evolution and structure.
In September while I was putting together my application materials to apply for new faculty positions, I was forced to go to the ER with abdominal pain. It was quickly found to involve septic colitis, and within a day or so I crashed, going into septic shock, DIC, and organ failure. I spent over two weeks intubated in the ICU (though often conscious and able to interact with my care-team and friends). Only a few days after an emergency colectomy it emerged that I had stage II colon cancer that likely allowed the unknown infection to take grip. It took around ten surgeries to successfully ‘restore domain’ of my abdomen and install an end-ileostomy. It is difficult to exaggerate the grimness and the trauma of this scenario that my wife (Brittany) and I now macabrely refer to as my ‘spa treatment’. Indeed, the situation was so dire that a definitive diagnosis (even that of cancer) was quite a relief.
During this time, I received extraordinary care and concern, not just from my family and close-friends, but from all my colleagues and lab-mates at Scripps.
It was patently clear that I did not simply have a group of colleagues and co-workers, but a close-knit support network akin to a family. Due to the disorientation that is common among ICU patients, my friends and my (now) wife put together a collage of several drawings and pictures to adorn the walls of my hospital room. These images were encouraged by the nurses to conjure comfort and a sense of familiarity during distressed and confused wakeful periods. One of these images was a picture of a single particle of Flock House virus - one of the subjects of my research in Jack's lab. This provoked much amusement and interest among my doctors and nursing staff. I remember trying to communicate through scribblings on paper and an iPad (there was no talking care of the multiplicity of tubes in my throat) that I was a virologist and did next-generation sequencing and that I would love to sequence myself to see what I had. It wasn’t till I was extubated that I was able to explain that Flock House virus is a simple yet fascinating insect virus and that we use it as a model system to study the lifecycle and molecular biology of other human pathogens.
Despite all expectations, and thanks to wonderful and compassionate care from many nurses and doctors at the UCSD Thornton hospital and support from my friends, colleagues and family, I pulled through. Within a month I was back at home, writing new code, checking out new datasets and binge-watching Downton Abbey. However, the challenges did not stop there. Stage II colorectal cancer carries around a 75-80% overall five-year survival rate. Despite this, it seemed natural to continue with the applications.
Stage II colorectal cancer carries around a 75-80% overall five-year survival rate.
There were many details of my application and background that might not have screamed Professor. I had no ‘high impact’ papers. Nor was I working on hot-button topics that might woo a headline-seeking search committee: I was not chasing Ebola, designing HIV vaccines, or engineering human genomes with CRISPR. Rather, I was proposing to study Flock House virus as a model system in Drosophila (fruit fly) cells to understand the mechanism of the evolution of viral genomes.
Nonetheless, I fielded a small number of applications and was delighted when I was asked to interview at the University of Texas Medical Branch (UTMB) in February (only four months after leaving the hospital). I contacted the chair of the department and I told him about my health and that during my interview I would be in the middle of adjuvant chemotherapy (albeit mild and with few visual manifestations). Faculty interviews often occur over multiple days and are notoriously gruelling, so I requested to have extra time after the interview to recover and rest before heading home. I still had an ostomy device at the time and so I would also need extra time before long meetings or seminars and travelling might not be easy. Initially, I was nervous about bringing this up. I asked him to keep this information private as I didn’t want to make needlessly dramatic first impressions during meetings. Mentioning the ‘cancer’ word can elicit a broad range of unpredictable responses. However, the chair's response was highly compassionate, reassuring and professional, which was strongly predictive of the supportive and kind boss that he has now become.
So off I went to Galveston for the first time. The experience turned out to be excellent. Given my interests in molecular virology and using next-generation sequencing strategies to study virus evolution, it was clear that UTMB would be a highly fertile place in which to work and collaborate. I was made a job offer only days later. Being a native Brit, I never imagined myself becoming a resident Texan. Nevertheless, in 2015 my wife and I set out on this new chapter, and we are delighted that we made the effort to seek out a new home in Galveston.
Now, I am over five years past my original diagnosis and remain cancer free. The physical recovery is essentially complete. If anything, I am fitter and healthier than before, by many standards. Life without a dicky colon apparently runs a little smoother. However, the mental challenges have lingered the longest. Anxiety and a persistent sense of guilt or shame (hard to describe) have followed me more closely than any physical disability. Navigating a new and stressful career in the aftermath of a cancer diagnosis presented many unexpected challenges. I feel I am only just beginning to be able to share those experiences.
Photo courtesy of Unsplash.
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