Dr. Hammar: "They Should Not Suffer"
Dr. Sam Hammar is no ordinary pathologist. The prototypical pathologist
is a doctor who hunches over a microscope in a hospital basement, far
removed from patient contact. Dr. Hammar bridges the gap between sterile
academia and hands-on patient care. Richard Hahn of Wenatchee, Washington
was recently diagnosed by local pathologists with a pleural based tumor.
The pulmonary doctor was convinced the tumor was mesothelioma, but the
pathologist was uncertain. The Hahns learned of Dr. Hammar's expertise
and had the slides and pathology specimens sent to him.
Normally, that's as far as the contact goes. But Mr. Hahn's wife
was not getting satisfactory information regarding treatment options from
the local doctors in Wenatchee. So she called Dr. Hammar directly -- not
an easy man to contact. Dr. Hammar, who analyzed Mr. Hahn's specimens
on a fast track basis and, unfortunately, confirmed the diagnosis of mesothelioma,
took Mrs. Hahn's call.
I have found that patients do not necessarily want to hear evasive sounding
gobbledygook from doctors. They want to know what the diagnosis is and
what the options are. They don't want delay or indecision. Dr. Hammar
is a straight shooter. Dr. Hammar basically agreed with the local pulmonary
doctor's prognosis. This was not what Mrs. Hahn wanted to hear. The
Hahns were holding on to some hope that the tumor was not mesothelioma.
In the case of mesothelioma, the truth does not exactly set the patient
free. Nobody wants to be the bearer of bad news. But now the Hahns know
what they are dealing with and can make plans accordingly. They appreciate
Dr. Hammar's frank assessment of their case.
I have reprinted portions of Dr. Hammar's report on the Hahn case.
As a pathologist, Dr. Hammar is not directly involved in the management
of a cancer patient's treatment. However, his opinions regarding the
various treatment options are entitled to respect.
* * * * * * * * * * * * *
October 29, 1997
Dear Mr. Worthington:
Please find enclosed my report on Richard R. Hahn. This is an unfortunate
case of a 74-year-old man with a history of exposure to asbestos [electrician
in the Navy and at Alcoa Aluminum in Wenatchee, among other job sites,
from 1942 to 1985]. Mr. Hahn was also stated to have been a previous cigarette
smoker and had a history of coronary artery disease, hypertension and
Mr. Hahn was in his usual state of health until about the first week of
September, 1997 when he developed progressive dyspnea and pressure sensation
in his chest. He was found to have a right pleural effusion and right
pleural thickening. Mr. Hahn was evaluated at the Wenatchee Valley Clinic
by Dr. McBride. A thoracentesis and pleural biopsy were performed. The
thoracentesis contained cells that I thought were highly suspicious for
neoplastic mesothelial cells and the pleural biopsy showed what I would
have diagnosed as an infiltrating epithelial neoplasm that according to
the immunohistochemical studies that were done was consistent with an
epithelial mesothelioma. Dr. McBride indicated that the tumor was invasive
and that any further surgery would not specifically benefit Mr. Hahn with
respect to his treatment. Based on Mr. Hahn's history of occupational
exposure to asbestos, I conclude that his right pleural epithelial mesothelioma
was caused by asbestos.
I spoke with Mrs. Hahn today before I had reviewed the slides and medical
records in this case. I basically agree with Dr. McBride; namely, that
there is not a whole lot to offer Mr. Hahn. I talked to Mrs. Hahn about
possible therapies that were being done and told her that surgery was
probably the best therapy, but that could only be done in a small number
of patients that had stage I disease. It is clear the Mr. Hahn's disease
is not stage I.
I am not convinced that the gene therapy has any great success in this
disease at this point in time and also am not convinced that Onconase
or Taxol have any long-term favorable effects. I have seen a couple of
individuals have a dramatic response to platinum-based drugs and one patient
who had a dramatic response to an analog of Methotrexate. These chemotherapeutic
responses, however, are few and far between and from a practical point,
only rare patients will show any improvement.
I told Mrs. Hahn that about the best things that one could offer her husband
would be to make sure that he was kept pain-free and I think that should
be the goal in all patients who have mesotheliomas. They should not suffer.
Samuel P. Hammar, M.D.
POSTED NOVEMBER 4, 1997