Born to heal
Dr. Sharyn Lewin, new to Holy Name, talks about gynecological oncology, helping women, and saving lives
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Dr. Sharyn Lewin |
Ever since she was a small girl, Sharyn Lewin knew that she wanted to be a doctor.
But not just any doctor. The laser-like precision of her goal, from the time she was very young, was oddly specific.
“My earliest memory was going to school with a white coat and a stethoscope for Career Day,” Dr. Lewin said. By the time she was about 8, “I didn’t even know what an obstetrician or a gynecologist was – but I knew I wanted to be one.”
Very soon, Dr. Lewin narrowed her goals even further. She wanted to be a gynecological oncologist, studying and curing women’s cancers. She wanted to take after her grandmother, Dr. Gerda Bruno, who was a gynecologist at a time when few women were. And she succeeded. Dr. Lewin is newly arrived at Holy Name Medical Center in Teaneck, where she has begun a practice and eventually will inaugurate a full-service women’s health center. “It will be a comprehensive venue, where women can come for complete care,” she said.
Dr. Lewin grew up in Lawrence, Kansas, with a family history that tied her both to medicine and to this area.
Her great-grandfather, who was a German Jew, contributed research that eventually led to Dr. Jonas Salk’s polio vaccine while he still lived in Germany. Her father’s parents both escaped World War II by coming to this country. Her paternal grandfather, Norbert Lewin, was an ophthalmologist with a practice on Manhattan’s heavily Jewish Upper West Side. They lived on West End Avenue, “in a beautiful first-floor apartment that now has been made into four apartments,” Dr. Lewin said. Her grandfather’s wife – Dr. Bruno – worked in Washington Heights, in northern Manhattan. The neighborhood was a magnet for Jews fleeing the war in Europe.
Dr. Bruno worked with Margaret Sanger, the great pioneer in the movement that both legalized birth control and gave it to the poor women who needed it most desperately. In fact, Ms. Sanger quoted Dr. Bruno in the foreword to one of her books. “My grandmother was an advocate for women,” Dr. Lewin said. “She advocated for women to have control over their reproductive systems, so they could control when they had their families.
“She was really before her time, not only medically but also socially and politically. She really was my first role model and mentor. She used to talk to me about being a physician – particularly about being a woman physician. And so I always wanted to be a women’s health care doctor.”
The urge to become a physician seems to have skipped a generation in the Lewin family. Dr. Lewin’s father, Thomas Lewin, is an academic; he is a professor of history and business at the University of Kansas at Lawrence. “He is a very entrepreneurial person,” his daughter said. Her mother, Phyllis Lewin, also New York-born, is a junior-high-school guidance counselor.
Lawrence is an active, liberal, intellectually oriented place, Dr. Lewin said; the one thing it lacks is a large, active Jewish community. When she grew up, “I was not as connected to the Jewish community as I would have liked,” she added.
Dr. Lewin earned her undergraduate degree at the University of Kansas in Lawrence. She lived at home – “I was very industrious,” she said. “I studied all the time. I knew the path I was on.” She next went to the University of Kansas in Kansas City for medical school – not living at home – and then did her residency at Washington University in St. Louis. Then she moved to New York.
For “four wonderful years” she did a fellowship at Memorial Sloan Kettering, she said, and then she went to Columbia University’s New York Presbyterian Hospital, in Washington Heights. “I had come full circle, practicing where my grandmother did,” she said.
On July 3, Dr. Lewin went to Holy Name, which “is a wonderful place to take care of people in a compassionate, professional, cutting-edge way,” she said.
Although she has been living in Manhattan, she plans to move soon to Bergen County. She also plans to become an active part of the Jewish community.
Dr. Lewin is unusual in that she performs a great number of jobs usually divided among more than one physician. She is a surgeon and an oncologist – she provides the chemotherapy that many of her patients require along with surgery. “We are all trained to do both, but most of us do one or the other,” she said.
Dr. Lewin was recruited specifically to spearhead a comprehensive center in Bergen County that will focus on women’s health, and on their lives. Now she is working out of Holy Name’s cancer center, but eventually she and the center will move, although it will remain part of Holy Name.
She is working with Phyllis A. Tarallo, a nurse practitioner with a doctorate in nursing and many years of experience in women’s cancers.
“There is an unclaimed market in Bergen County,” Dr. Lewin said. Although there are many doctors, “There are not a lot of oncological gynecologists, and studies have shown that women with ovarian cancer do better if they are treated by specialists.
Dr. Lewin has a particular interest in hereditary cancers. “We know that women with ovarian cancer have a 25 to 30 percent chance of having a BRCA problem,” she said. BRCA is the name given the chromosomal mutation that often, although not always, leads to breast and other cancers. (Of course, just as having the BRCA gene does not mean that woman will go on to develop cancer, just as not having the gene is not a guarantee that a woman will remain cancer-free.)
“National guidelines have just recommended that all women with ovarian cancer receive genetic testing,” she said. “Also, certain women under 45 with breast cancer or family histories of cancer also warrant genetic testing. Testing is a huge area of prevention.”
Ashkenazi Jewish women are more likely than members of other groups to test positive for the BRCA gene. “I think we have a real need in Bergen County to educate women. If they have a family or personal history of cancer, they should be evaluated to see if it is a genetic predisposition.” The testing is easy, requiring just blood or saliva.
Although she works with all kinds of women’s cancers, Dr. Lewin does not confine her work to malignancies. “I also do a lot of surgery on benign tumors,” she said. She talks to her patients about healthy living and exercise – living in as healthy a way as possible, although not a guarantee, is the best way to prevent disease. But it is far from foolproof.
“I see a lot of women who already have ovarian cancer,” she said. “I encourage them to have their children tested.” The surest way to keep cancer at bay is through constant vigilance. “If women have the BRCA mutation, we can screen their ovaries every six months until they are done having children, and then we can remove their ovaries and tubes,” she said. “With breast cancer, early discovery can catch it when it is still Stage I, and some women choose prophylactic surgery” if testing shows their risk to be high.
Perhaps surprisingly, “we know that removing tubes and ovaries reduces the risk of breast cancer,” Dr. Lewin said. “We think it’s the hormonal depletion.” Nevertheless, although menopause reduces a woman’s hormone levels, “the risk doesn’t usually go down with naturally occurring menopause.” Why might that be? “Sometimes we learn more things, and then we have three times as many questions,” she said.
Doctors already know, as the result of six randomized trials, that “women who do the best have surgery first to remove the cancer, and then a port in their bellies for chemotherapy. It has been shown to give a huge survival benefit to women.”
Dr. Lewin talked about some of the research that most excites her. “When I was at Columbia, I worked with Hipec – heated intraperitoneal chemotherapy,” she said. “When cancer spreads in the peritoneum, we can remove the cancer and do a hot chemotherapy bath in the belly. We think that the heat makes the cells more sensitive to the chemotherapy.
“It works like a perfusion pump. A machine heats up the chemo, and it runs through a tube, sloshes around, and then leaves. It circles for at least 60 to 80 minutes. It’s been shown to be effective in some cancers.”
She is also interested in personalized medicine, particularly with molecular targets for cancer. “It involves seeing what targets are in the tumor itself, so we can give patients newer biological agents that have been shown to be effective with different types of cancer,” Dr. Lewin said. “In women with the BRCA mutation, studies show that a drug called a parp inhibitor can work.” But how and what to target is highly individual.
Just as she is unusual in that she is a researcher and a clinician, a surgeon and a care-giver, Dr. Lewin also cares both about the hard science and the harder-to-quantify issues of quality of life. “I was the medical director of the Woman to Woman program at New York Presbyterian,” she said. Presbyterian was “the first pilot site; it now expanded to about 15 sites in the country. It was funded with a one-time grant from the Ovarian Cancer Research Fund. The great part of the program is that we match women newly diagnosed with cancer with women who have survived that cancer, so they have peer one-on-one mentoring.” The program also includes the services of a dedicated psychologist.
“We try to train people to advocate for themselves, to empower them to be advocates in their own health care, and also to help address some of the financial burdens, which are very real and very powerful.”
Dr. Lewin has great ambitions for a similar program at Holy Name.
“What I want to build here is a multidisciplinary team for patients with cancers, so we can address the psychosocial aspects as well as providing things to improve their quality of life, including acupuncture, guided imagery, and massage.”
That kind of care is expensive. In order to fund it past the initial stage, nurtured by the seed grant, “I started a foundation to raise more money. It’s called the Lewin Fund to Fight Women’s Cancers.”
By this point, the listener is staring with open-mouthed amazement at this 39-year-old woman, who can talk about science and compassion as if they co-exist in the real world, who juggles clinical distance and loving connection as if they went together like a horse and carriage. Not many doctors who do surgery and administer chemotherapy and educate other medical professionals (yes, she does that too) also have their own foundations.
So where did the money for the Lewin Fund, which opened in December 2012, come from? “I had a very grateful patient, and she really wanted me to continue this work,” Dr. Lewin said. “So when she passed away, she gave us money to start the foundation, and then, just through a lot of energy and excitement from our board, we have helped make it grow.” Seven people now sit on the board.
“It will take a lot of philanthropy to build and support these programs, and part of my job will be fund-raising. I really want the foundation to partner with Holy Name,” she said. “We hope to make this a national program, but now our work is definitely starting to help women in this part of the country.
“We have a lot of plans to help women with prevention and also by funding research. We also want to be a concierge service, connecting women with the best services for them.”
That is a big and ambitious job. “I love taking care of patients, so when the foundation is big enough I hope that someone else will run it, but for now I’m doing it,” she said. “I don’t think I could ever give up taking care of patients.” Holy Name, she said, provides the mix of “friendly professionalism and cutting-edge medical care that is so important.
“There are a lot of people we care for, and we extend many women’s lives and improve their quality of life,” she said. “That’s what I really love – the bond we create with patients and their families. That’s what’s special about being a surgeon and doing chemo. We get to know patients and their families so well.”
There is another balancing act that Dr. Lewin, like all doctors, must perform. That is the dance between letting herself become emotionally drawn to her patients to the point where her clarity of vision might be compromised, or drawing boundaries that keep even necessary and healthy feelings in a soul-draining quarantine.
“I really believe in the war against cancer – and it really is a war,” she said. “My goal is to work my hardest to give patients the best quality of life I possibly can. There are women I get very emotionally connected and bonded to, and I think about them and their families all the time.”
Sometime it is really hard. “The young patients are particularly heartwrenching,” she said. “The first day I started at Holy Name, I saw a 25-year-old with ovarian cancer.
“How do I deal with it? People who are drawn to take care of patients with cancer need a blend of a good bedside manner and compassion and bonding – and also to protect themselves. All physicians deal with sick patients and tough outcomes. I always want to know that my patients and their families know that I am always there for them, as an emotional as well as an intellectual resource.”
Part of her mandate is education. September is ovarian cancer awareness month, she said, but all year round women should pay attention to possible symptoms. They include feeling bloated or full too quickly after eating too little food, having any pain in the abdomen or pelvis, or having trouble urinating. Any of these signs, if they are recurring, should be checked out.
Her job, she concluded, is “addressing the whole person, not just the cancer.”
Ellen Kapito, who has just retired after a 35-year career as an oncological nurse, worked with Dr. Lewin for two of them. “I can count the special doctors on one hand – and she is one of them,” Ms. Kapito said.
“She is very sweet, and she is very caring. She doesn’t sit behind her desk; she will give patients 100 percent of her attention. She really listens and takes care to explain everything.”
But the other side is there as well. “She is from the Midwest, she is so nice – but she is aggressive. When she is doing surgery, she will stand there for six hours and pick out every cancer cell. She is relentless. That’s what you want – somebody who will be aggressive with your cancer.
“She is a top-notch surgeon, but she doesn’t have a huge ego. She is really passionate about women’s health. It is not an act.”
Ms. Kapito is on the board of the Lewin Fund. “There is not enough support for women with cancer,” she said. “I think that’s because they are always juggling so many things. Mothers, daughters, wives – they are always trying to protect their loved ones, but there is not enough support out there for them. I think that women’s cancers are a little bit different.”
Part of the need for the Woman to Woman program is to make the kinds of cancers women have less unmentionable. “Because it generally deals with the sex organs, it’s more taboo,” she said. Part of the support the group supplies is providing women with the vocabulary and the permission to discuss their bodies.
Another important function is to provide the kinds of services that provide patients with support but are neither obvious nor exotic – services including acupuncture, massage, and nutrition therapies. They are mainstream but thought to be minor, so they are rarely offered to patients.
“The foundation wants to support all these things, plus, hopefully, ongoing research for women’s genetic cancers,” Ms. Kapito said.
Patricia Myruski lives in Monroe, N.Y., now, but she grew up in Bergenfield. She was born at Holy Name, and worked as a candy striper there when she was in high school. That makes it even more comfortable for her when she follows her doctor, Sharyn Lewin, to her new professional home.
“She is more than a doctor,” Ms. Myruski said. “She is a friend.
“I don’t even know how to describe it,” she continued, emotion clear in her voice. “My surgery took 10 hours, and I was in the hospital for 17 days.
“She was there every day. Dr. Lewin made me her last patient at night, so we could just sit and talk. One day, when I had been there a long time and it was getting frustrating, I said to her that I would just like a cup of coffee and a muffin. Is that so much to ask?
“And the next day, she brought me coffee and a muffin.
“She gave me and my husband her number, and she called me at night to see how I was doing. She called me after I went home.”
Ms. Myruski’s loyalty is unshakable. “I told my husband, very seriously, that I will go wherever she goes. If she ever went to California, I would be flying there every three months. She brought me so far – I don’t want to lose her.
“She told me exactly what to expect all the way through, and what not to expect, so that I wasn’t in for any surprises.
“When I first met her, I said I need more time with my family – with my husband, my kids, my grandchildren. She said, ‘I have devoted my life to treating people like you.’ To me, that said a bazillion things. She has given her life to helping people.”
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