She nearly died at her own hospital, and it taught her how to be a better doctor.

"I effectively bled to death in my own hospital," said Dr. Rana Awdish.

Dr. Rana Awdish. Photo from Henry Ford Hospital.

In 2008, Awdish was seven months pregnant and just finishing up her fellowship at Henry Ford Hospital in Detroit. On her last day, however, something suddenly went deeply wrong inside of her. She began to bleed into her abdomen — fast. Her body effectively crashed out. It took more than 26 units of blood products that night just to keep her alive. She would go through organ failure, respirators, even a stroke.


Ultimately, the hospital was able to save her, but unfortunately, not her baby. Later, they'd discover the cause was an undiagnosed ruptured tumor in her liver. Her recovery would take years and five major operations.

"I had to relearn to walk, speak, and do many other things I had taken for granted," said Awdish. She told her story in an article published in the New England Journal of Medicine.

Today, Awdish is back at work, but the experience forced her to confront some uncomfortable truths about her job.

Doctors are trained in how to cure patients, but actually being on the opposite side of that relationship revealed something Awdish had never realized: how inadvertently hurtful even an amazing doctor's words could be. Stuck in a hospital bed, Awdish saw how seemingly normal hospital jabber could hide a mess of tiny, unseen emotional barbs.

"We're going to have to find you a new liver," someone said to her. "Unless you want to live here forever."

“You should hold the baby,” another medical staffer said. “I don’t want to be graphic, but after a few days in the morgue, their skin starts to break down, and you won’t be able to anymore, even if you change your mind.”

But in those words, she also saw her own practice as a doctor.

"I overheard a physician describe me as 'trying to die on us.' I was horrified. I was not trying to die on anyone. The description angered me," said Awdish. "Then I cringed. I had said the same thing, often and thoughtlessly, in my training."

She realized that as a doctor, she had focused on getting people healthy. Just keeping people alive was her measure of success. But actually being sick herself brought up waves of emotion.

"I realized when I sort of kept dying in the hospital is that I had all this existential angst," says Awdish. "Can we talk about how I'm dying? You see it. I know you see it. You just coded it. This feels awkward that we're not discussing it."

But at the same time, Awdish realized she had been blind to her own patients confronting similar feelings. "I remember having patients ask me, when they're diagnosed with cancer, 'But how could this have happened?' And as a doctor, I had taken that as an invitation to give them data," says Awdish. "But that's not what they were asking. It was a request for a connection."

The problem, in the end, was that empathy had taken a backseat to everything else.

When Awdish went back to work, she decided to change her entire outlook of what medicine should be.

"My experience changed me. It changed my vision of what I wanted our organization to be, to embody," she explains.

While she had received years of training in how to fight illness — years of breaking disease into digestible parts, memorizing strategies, practicing care — there hadn't been an equivalent training in how to talk to patients. She had just been more or less expected to pick it up as she went.

Awdish began working with an organization called VitalTalk, which helps train physicians in how to communicate with patients. She and a group of like-minded doctors began recruiting improv actors from around Detroit and Pittsburgh to help them rehearse how to have tough, emotional conversations.

Awdish and her colleagues did this for years as a kind of grassroots movement. Today, Henry Ford Hospital has embraced Awdish's culture of empathy.

Awdish is now part of the hospital system's new Department of Physician Communication and Peer Support. Among other things, medical staff at Henry Ford now get access to a suite of talks, apps, workshops, and courses. They might learn how to recognize anxiety or how to connect with a patient's values before prescribing therapies, says Awdish. There are even shadowing programs, where the doctors can get discreet feedback and coaching.

New hires are also taught that everyone, not just doctors, can help people in the healing process. For this, Awdish can draw examples from her own experience.

"Radiology technicians learn what a kindness it was that they stopped trying to awaken my exhausted husband to move him from my bedside for my portable X-ray — instead throwing a lead cover over him and letting him sleep," said Awdish.

Awdish says even the doctors themselves could be benefiting from the changes. Physicians might have to have multiple, very difficult conversations with patients every day. It takes an emotional toll. By equipping doctors with the tools to better connect and communicate with patients, it's helping them too.

As for whether this is working, a pilot study suggested that patients can see a difference. The hospital is now collecting big picture data and plans on publishing it.

There will always be painful moments, but by putting empathy at the heart of medicine — as Awdish and Henry Ford Hospital did — we could potentially build better health system altogether.

People often think of government bureaucrats as being boring stuffed shirts, but whoever runs social media at the National Park Service is proving that at least some of them have a sense of humor.

In a Facebook post, the NPS shared some seasonal advice for park-goers about what to do if they happen to encounter a bear, and it's both helpful and hilarious. Not that a confrontation with a bear in real life is a laughing matter—bears can be dangerous—but humor is a good way to get people to pay attention to important advice.

They wrote:

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People often think of government bureaucrats as being boring stuffed shirts, but whoever runs social media at the National Park Service is proving that at least some of them have a sense of humor.

In a Facebook post, the NPS shared some seasonal advice for park-goers about what to do if they happen to encounter a bear, and it's both helpful and hilarious. Not that a confrontation with a bear in real life is a laughing matter—bears can be dangerous—but humor is a good way to get people to pay attention to important advice.

They wrote:

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Each year, an estimated 1.8 million people in the United States are affected by cancer — most commonly cancers of the breast, lung, prostate, and blood cancers such as leukemia. While not everyone overcomes the disease, thanks to science, more people are surviving — and for longer — than ever before in history.

We asked three people whose lives have been impacted by cancer to share their stories – how their lives were changed by the disease, and how they're using that experience to change the future of cancer treatments with the hope that ultimately, in the fight against cancer, science will win. Here's what they had to say.

Celine Ryan, 55, engineer database programmer and mother of five from Detroit, MI

Photo courtesy of Celine Ryan

In September 2013, Celine Ryan woke up from a colonoscopy to some traumatic news. Her gastroenterologist showed her a picture of the cancerous mass they found during the procedure.

Ryan and her husband, Patrick, had scheduled a colonoscopy after discovering some unusual bleeding, so the suspicion she could have cancer was already there. Neither of them, however, were quite prepared for the results to be positive -- or for the treatment to begin so soon. Just two days after learning the news, Ryan had surgery to remove the tumor, part of her bladder, and 17 cancerous lymph nodes. Chemotherapy and radiation soon followed.

Ryan's treatment was rigorous – but in December 2014, she got the devastating news that the cancer, once confined to her colon, had spread to her lungs. Her prognosis, they said, was likely terminal.

But rather than give up hope, Ryan sought support from online research, fellow cancer patients and survivors, and her medical team. When she brought up immunotherapy to her oncologist, he quickly agreed it was the best course of action. Ryan's cancer, like a majority of colon and pancreatic cancers, had been caused by a defect on the gene KRAS, which can result in a very aggressive cancer that is virtually "undruggable." According to the medical literature, the relatively smooth protein structure of the KRAS gene meant that designing inhibitors to bind to surface grooves and treat the cancer has been historically difficult. Through her support systems, Ryan discovered an experimental immunotherapy trial at the National Institutes of Health (NIH) in Bethesda, MD., and called them immediately to see if she was eligible. After months of trying to determine whether she was a suitable candidate for the experimental treatment, Ryan was finally accepted.

The treatment, known as tumor-infiltrating lymphocyte therapy, or TIL, is a testament to how far modern science has evolved. With this therapy, doctors remove a tumor and harvest special immune cells that are found naturally in the tumor. Doctors then grow the cells in a lab over the next several weeks with a protein that promotes rapid TIL growth – and once the cells number into the billions, they are infused back into the patient's body to fight the cancer. On April 1, 2015, Ryan had her tumor removed at the NIH. Two months later, she went inpatient for four weeks to have the team "wash out" her immune system with chemotherapy and infuse the cells – all 148 billion of them – back into her body.

Six weeks after the infusion, Ryan and Patrick went back for a follow-up appointment – and the news they got was stunning: Not only had no new tumors developed, but the six existing tumors in her lungs had shrunk significantly. Less than a year after her cell infusion, in April 2016, the doctors told Ryan news that would have been impossible just a decade earlier: Thanks to the cell infusion, Ryan was now considered NED – no evaluable disease. Her body was cancer-free.

Ryan is still NED today and continuing annual follow-up appointments at the NIH, experiencing things she never dreamed she'd be able to live to see, such as her children's high school and college graduations. She's also donating her blood and cells to the NIH to help them research other potential cancer treatments. "It was an honor to do so," Ryan said of her experience. "I'm just thrilled, and I hope my experience can help a lot more people."

Patrice Lee, PhD, VP of Pharmacology, Toxicology and Exploratory Development at Pfizer

Photo courtesy of Patrice Lee

Patrice Lee got into scientific research in an unconventional way – through the late ocean explorer Jacques Cousteau.

Lee never met Cousteau but her dreams of working with him one day led her to pursue a career in science. Initially, Lee completed an undergraduate degree in marine biology; eventually, her interests changed and she decided to get a dual doctoral degree in physiology and toxicology at Duke University. She now works at Pfizer's R&D site in Boulder, CO (formerly Array BioPharma), leading a group of scientists who determine the safety and efficacy of new oncology drugs.

"Scientists focused on drug discovery and development in the pharmaceutical industry are deeply committed to inventing new therapies to meet unmet needs," Lee says, describing her field of work. "We're driven to achieve new medicines and vaccines as quickly as possible without sacrificing safety."

Among the drugs Lee has helped develop during her career, including cancer therapies, she says around a dozen are currently in development, while nine have received FDA approval — an incredible accomplishment as many scientists spend their careers without seeing their drug make it to market. Lee's team is particularly interested in therapies for brain metastases — something that Lee says is a largely unmet need in cancer research, and something her team is working on from a variety of angles. "Now that we've had rapid success with mRNA vaccine technology, we hope to explore what the future holds when applying this technology to cancers," Lee says.

But while evaluating potential cancer therapies is a professional passion of Lee's, it's also a mission that's deeply personal. "I'm also a breast cancer survivor," she says. "So I've been on the other side of things and have participated in a clinical trial."

However, seeing how melanoma therapies that she helped develop have affected other real-life cancer patients, she says, has been a highlight of her career. "We had one therapy that was approved for patients with BRAF-mutant metastatic melanoma," Lee recalls. "Our team in Boulder was graced by a visit from a patient that had benefited from these drugs that we developed. It was a very special moment for the entire team."

None of these therapies would be available, Lee says without rigorous science behind it: "Facts come from good science. Facts will drive the development of new drugs, and that's what will help patients."

Chiuying "Cynthia" Kuk (they/them) MS, 34, third-year medical student at Michigan State University College of Human Medicine

Photo courtesy of Cynthia Kuk

Cynthia Kuk was just 10 years old when they had a conversation that would change their life forever.

"My mother, who worked as a translator for the government at the time, had been diagnosed with breast cancer, and after her chemotherapy treatments she would get really sick," Kuk, who uses they/them pronouns, recalls. "When I asked my dad why mom was puking so much, he said it was because of the medicine she was taking that would help her get better."

Kuk's response was immediate: "That's so stupid! Why would a medicine make you feel worse instead of better? When I'm older, I want to create medicine that won't make people sick like that."

Nine years later, Kuk traveled from their native Hong Kong to the United States to do exactly that. Kuk enrolled in a small, liberal arts college for their Bachelor's degree, and then four years later started a PhD program in cancer research. Although Kuk's mother was in remission from her cancer at the time, Kuk's goal was the same as it had been as a 10-year-old watching her suffer through chemotherapy: to design a better cancer treatment, and change the landscape of cancer research forever.

Since then, Kuk's mission has changed slightly.

"My mom's cancer relapsed in 2008, and she ended up passing away about five years after that," Kuk says. "After my mom died, I started having this sense of urgency. Cancer research is such that you work for twenty years, and at the end of it you might have a fancy medication that could help people, but I wanted to help people now." With their mother still at the forefront of their mind, Kuk decided to quit their PhD program and enter medical school.

Now, Kuk plans to pursue a career in emergency medicine – not only because they are drawn to the excitement of the emergency room, but because the ER is a place where the most marginalized people tend to seek care.

"I have a special interest in the LGBTQ+ population, as I identify as queer and nonbinary," says Kuk. "A lot of people in this community and other marginalized communities access care through the ER and also tend to avoid medical care since there is a history of mistreatment and judgement from healthcare workers. How you carry yourself as a doctor, your compassion, that can make a huge difference in someone's care."

In addition to making a difference in the lives of LGBTQ+ patients, Kuk wants to make a difference in the lives of patients with cancer as well, like their mother had.

"We've diagnosed patients in the Emergency Department with cancer before," Kuk says. "I can't make cancer good news but how you deliver bad news and the compassion you show could make a world of difference to that patient and their family."

During their training, Kuk advocates for patients by delivering compassionate and inclusive care, whether they happen to have cancer or not. In addition to emphasizing their patient's pronouns and chosen names, they ask for inclusive social and sexual histories as well as using gender neutral language. In doing this, they hope to make medicine as a whole more accessible for people who have been historically pushed aside.

"I'm just one person, and I can't force everyone to respect you, if you're marginalized," Kuk says. "But I do want to push for a culture where people appreciate others who are different from them."