He specializes in cancer care; now he’s got patient experience as well
BY AMBER SMITH
In the weeks before nurse practitioner Ibrahim Thabet turned 31, he took care of patients with cancer, as he has for more than eight years at Upstate.
In the weeks after his birthday, he became a cancer patient.
Thabet had a rare cancer with a poor prognosis. After months of treatment, he’s back at work. One of his patients says he’s got “street cred” now. This is his story.
A troubling cough
It was a mid-October weekend in 2018 when Thabet noticed a cough. “For some reason, I couldn’t complete a sentence without coughing.” He sometimes deals with a cough that comes from drippy sinuses, so he was ready to ride it out.
But he was also feeling a bit of pressure in his chest, and his mother was insisting he go to an urgent care clinic.
An X-ray showed dilated arteries in his lungs. The urgent care doctor suggested Thabet may have pulmonary artery hypertension, or high blood pressure in the lungs. The diagnosis was troubling to Thabet, who was otherwise healthy.
He decided to mention it at work Monday to his colleague Stephen Graziano, MD, Upstate’s chief of hematology and oncology. The two men had become friends, having worked together the past six or seven years. Graziano listened to Thabet’s story about his urgent care visit; he also didn’t like the sound of Thabet’s cough.
As it turned out, Graziano was headed to a meeting with Ernest Scalzetti, MD, the chief of thoracic imaging. He invited Thabet to come along and show Scalzetti the X-ray.
Scalzetti, a renowned radiologist who specializes in cardiopulmonary imaging, studied the image. “I think I see something,” he said.
Thabet would need an additional imaging scan using computerized tomography. Later that day, the CT revealed a mass in the front of Thabet’s chest, sitting on his heart and lungs. The tumor was 9.6 centimeters, just under 4 inches. That’s what was causing the pressure he felt and the cough.
“I have a very strong faith,” Thabet said.
While his medical colleagues went over the disease the mass might signal, he sat thinking “to God we belong, and to God we shall return,” a phrase Muslims recite in times of tragedy. Then he thought of his children: Dhuha, 10; Jenna, 7; Ismael, 6; and Aleena, 4 months.
Thabet finished seeing his patients that afternoon. Then he took leave.
At home, talking privately, his wife, Sara, began crying.
Thabet underwent several blood tests the next day, including one to measure his alpha-fetoprotein level. A normal level for an adult is less than 10 nanograms per milliliter. Thabet’s was 4,912 nanograms per milliliter. The results indicated cancer.
Among the additional tests he underwent was an echocardiogram, an ultrasound of his heart.
Graziano, the cancer doctor who works with Thabet, was at a conference in Chicago as all the test results came in. He and Thabet texted back and forth.
Thabet’s diagnosis was a rare cancer: He had an extragonadal mediastinal germ cell tumor. Those tumors develop from sperm or egg cells that stray from their intended location in the gonads. This happens during the time a fetus is developing in utero, when the gonads are starting to form.
“Most of us have these cells, and they don’t become cancerous,” explained Graziano.
Extragonadal cells that go on to develop into tumors may grow anywhere in the body. Usually they begin in organs such as the pineal gland in the brain, the back wall of the abdomen, or in the mediastinum, the area between the lungs, according to the National Cancer Institute. That’s where Thabet’s tumor grew.
“People who have rare cancers, in general, tend to lack hope because there’s not that research or data out there to show the outcomes,” he said. Thabet relied on his faith.
Sam Benjamin, MD, became Thabet’s oncologist. He came up with a treatment plan. Before starting treatment, like many patients with the diagnosis of a rare cancer, Thabet sought a second opinion.
Graziano recommended Thabet travel to the Indiana University School of Medicine, where he knew of a particular doctor who treats more patients with Thabet’s diagnosis each year than most doctors treat their whole careers. Thabet would be one of about six patients with extragonadal germ cell tumors that Lawrence Einhorn, MD, would see in 2018. The doctor agreed to see Thabet three days later, on a Monday.
So one week after the X-ray at the urgent care center, Thabet and his family loaded into a car and drove to Indianapolis. Einhorn told him the cancer he had was considered high risk, and it had a poor prognosis. Thabet discourages patients from asking their survival odds, but Thabet couldn’t help himself. He wanted to know his chance of surviving. The doctor was straight with him: 30%.
After the consultation, Thabet drove back to Syracuse to begin chemotherapy at Upstate. Einhorn agreed with the plan Thabet’s oncologist had proposed.
He would be hospitalized for a week of infusions, then go home for two weeks. Then he’d return for another week of chemo, and go home for two more weeks. And so on, until mid-January. During his hospitalizations, because of his heightened risk of infection and how sick and weak he became, Thabet had to go without seeing his children.
He chose Upstate for his care, among Benjamin and other caregivers who are colleagues, because “I trust the people here,” Thabet said. “I’ve seen them deal with patients, and I know the level of care and the state-of-the-art facility we have.”
Thabet was encouraged after his first round of chemo. That pressure in his chest went away. And, his alpha-fetoprotein level that had been 4,912 nanograms per milliliter dropped to 751. After the second round, it was down to 55. The third round brought it to 7; the fourth, 3. At the conclusion of the infusions, another CT scan of his heart revealed the mass had shrunk in half, to 4.5 centimeters.
Einhorn, the doctor in Indiana, had told Thabet three things needed to happen before moving forward with treatment:
-- The tumor had to shrink.
-- The tumor markers or blood work needed to normalize.
-- And, he needed to tolerate chemo.
With all three accomplished, Thabet returned to Indiana in early February.
“Your tumor shrank, but…” the surgeon began. Thabet wasn’t discouraged about the “but.” He knew many patients didn’t make it through chemo, and their tumor markers didn’t respond. He was simply grateful to have made it this far.
The “but” referred to the delicate surgery Thabet would have to undergo to remove the remnants of the tumor. It was sitting on the phrenic nerve, which allows the diaphragm to expand and contract. If the nerve was cut, Thabet would be left unable to breathe normally.
The operation to remove what was left of the tumor lasted about an hour and a half. The phrenic nerve was undamaged. Thabet spent a week recovering in the hospital. On the third day, the pathologist’s report came back withencouraging news. The tissue removed by the surgeon was dead tissue. It appeared the cancer was out of Thabet’s body.
“We feel there’s a possibility you are cured,” the surgeon told him.
Thabet undergoes blood work and scans every couple of months. “Obviously there’s a chance it could come back,” he explains, “but I don’t let it dictate my life.”
He recovered enough to return to work at the Upstate Cancer Center in early April. Thabet brings with him a new understanding and ability to relate to patients. So many physical, mental and emotional aspects are similar among the various types of cancers. He says the experience has made him a better nurse practitioner. “You gain things that are not taught in a book.”
Before, he could describe how a port was installed. Now he can tell patients what it will feel like to have it done. Before, he believed he was cognizant of what patients were feeling. Now, as one patient said to him, “You’re one of us.”
This article is from the spring 2020 issue of Cancer Care magazine.