Ian: 1 / Lymphoma: 0
by Lorna Thomson

It wasn’t polite. No quiet knock, no warning. Cancer barged in like a wild-eyed beast: snarling and uninvited.

Just a few weeks before, I was out on a trail run, enjoying the crisp morning air of the high desert. Ian was nearby, lost in his own rhythm. He loved building natural sculptures from twisted twigs and lava rocks, then crouching to photograph them when the light was just right. Our holidays were always like this. Road trips where the horizon never seemed to arrive. We packed cheese and tomato sandwiches, a flask of tea with milk and sugar, and sat cross-legged on our picnic blanket in any shade we could find.

Two days after we returned home, Ian boarded a flight to visit his family in Ireland. I went back to work. And then something shifted. He was in pain: unrelenting, inexplicable abdominal pain. In just two weeks, he lost twelve pounds. I listened closely. I asked the right questions. But the answers didn’t add up, and the unease began to gnaw. I ordered a CT scan to be done the morning after he landed back home. I wouldn’t have ordinarily intervened this way, but there was a sense of desperation that eclipsed waiting for a call or message back from his personal physician.

I was at work, surrounded by the hum of fluorescent lights, the soft beeping of monitors, and the faint smell of antiseptic, when I opened the report. That’s when the irreversible line was drawn. Before, we had a life filled with ordinary joys. After, there was only the beast.

It was all demanding and all consuming. It colonized us. Took over our calendars, our language, our sleep, our hope. Every conversation bent around it. Every plan paused. Every decision was made in its shadow. Cancer insisted that I stop everything and turn toward it full-hearted and full-time.

I kept thinking: How could I not know this was coming? In hindsight the clues had been there for a few months. As a hospital-based physician, I’m trained to approach symptoms with disciplined logic, always starting with the most likely explanations first. In medicine, we have a saying: “When you hear hooves in the hallway, think horses, not zebras.” So, the night sweats were from too many blankets, the bleeding gums from the electric toothbrush, the extreme fatigue from long-covid, and his increasing abdominal girth the signs of middle-age.

How do you unlearn decades of training when the person you love most becomes the patient? I couldn’t switch it off. The diagnostic part of my brain still hummed, scanning labs, never quite second-guessing the plan, but always quietly recalculating. I was still a doctor. But now I was also the wife and the housekeeper. Not only did I have to take over cooking duties, Ian’s area of expertise, but also pack the chemo bag, remember the anti-nausea meds, and fold the laundry - all the while trying to rein in the anxiety. An anxiety that gripped my stomach, ringed my heart, and ran away with every ounce of reason.

People would say, “You must feel so prepared for this, being a doctor.” As if that made it easier. But it didn’t. It made it worse. I knew too much; some days I felt like I knew nothing at all. I believed that if I just held everything tightly enough, I could control the chaos. I could control something.

I’ve never believed that doctors “save lives” in the way some people think we do; if we’re lucky, we make the unbearable a little more bearable. I could try to protect Ian from the many miseries of being a patient. I could hustle on his behalf. I could try to prevent delays and help navigate the maze that is American healthcare. I became the keeper of the details: the one who remembered every symptom, lab value, trend, and medication. The handoff person. The one who filled in the blanks for the rotating cast of providers. Sometimes, I could intervene when the risks clearly outweighed the benefits - when lack of continuity threatened to do harm. I could make it just a little less cruel.

In the first days after Ian’s diagnosis, a rare form of lymphoma, stubborn rather than swift, we held hands in bed and said nothing. No words could meet the moment. I already knew the world of illness and disease, but now I was on the other side of the glass, watching it unfold from within the story. In a single day, I went from standing at a patient’s bedside with practiced confidence to standing in my kitchen, chopping vegetables. I had crossed over.

Friends tried to help. They implied things like “seize the day,” and “be grateful for what you have.” They didn’t say it in so many words, but we heard what they inferred. Perhaps they were confronting their own mortality. This was the kind of situation that likely made some say, “if it could happen to them, it could happen to us.” Ian was fifty-five when he was diagnosed: fit, lean, and without risk factors.

I was already fluent in the language of mindful living. And yet now, I wanted none of it. I didn’t want to savor the present and live everyday as if it was our last. I wanted the past. I wanted the life we had before the diagnosis, before the shadow. I wanted to believe that my share of heartache had already been paid: that I’d earned the right to live in peace, wrapped in the safety of love and hard-won stability. Screw carpe diem.

Still, optimism was a habit I couldn’t shake. After six months of chemotherapy and a scan that showed no change, I clung to the oncologist’s phrasing like a lifeline: “It will take time for the tablets to shrink the spleen.” He added, “If we weighed it now, I bet it would weigh less than it did six months ago.” That was enough. We took it as a win.

I even threw a party. A celebration lunch in our backyard, complete with lime green tablecloths (lymphoma’s signature color), rented furniture, catered sandwiches and salads. I made a video in secret, collecting short messages from the healthcare team who had walked beside us. When I played it at the party, there wasn’t a dry eye in the house. For one afternoon, our celebration wasn’t for remission but for resilience.

A week later, we traveled to Ireland to see Ian’s family, a visit that was meaningful but utterly exhausting. We were careful and vigilant, remnants of pandemic-era caution as part of our routine. At Heathrow, I saw only one other masked family. Summer 2024. Lymphoma, a cancer of the immune system, doesn’t care what season it is.

Ian’s sister, brother-in-law, and nephews traveled from Scotland to meet us and Ian’s dad for a short holiday in a seaside town in Northern Ireland. We took long walks along the beach, the kind that ask nothing of you except to keep moving forward. Ian still needed frequent naps, but he was determined to be present for as much as he could manage. One evening we all gathered to celebrate his birthday at a small restaurant near the water. It was a quiet, heartfelt moment for a family that had crossed countries to be together, and we felt the meaning of it in a way we might not have in easier times.

We were responsible; until we weren’t. One morning, driving back from a seaside hotel with Ian’s father, we stopped at a crowded supermarket near Belfast. We didn’t wear masks. I don’t know why. We were distracted, excited about small indulgences - foods Ian might enjoy, things that reminded him of a carefree childhood. The next day, his father had a “bit of a cold.” We tried to isolate, unsuccessfully.

By the time we got home to San Francisco, Ian could barely lift his head. We both tested positive for the covid virus. I blamed myself. He was too weak to come downstairs. Too weak to speak some days. Each time he fell asleep, he feared he wouldn’t wake up. One day, while I was at the store, he wanted to write me a love note - just in case he was dead when I got back. He was too weak to get pen to paper.

We delayed checking his labs, knowing covid would skew the results. Eventually we made it to the lab. I was standing at the bottom of the stairs back home when the results hit my phone. Ian was asleep upstairs. His white blood cell count was higher than anything I’d seen in my decades-long career. My hands shook. My heart was beating so fast I could feel it in my throat. I stood there, quiet and alone.

His oncologist called immediately. Additional testing confirmed it: the cancer was back, or perhaps it had never really left. Covid may have triggered the spiral, but the disease was already poised. I built a spreadsheet, trying to calculate when exactly the numbers had begun to rise. Before the party? After? It didn’t matter. The beast was awake again - ferocious and demanding to be reckoned with.

Soon, we were referred to a university research hospital to be evaluated for advanced cellular therapy. Ian’s T-cells would be genetically engineered and designed to hunt and kill cancer cells. This wasn’t experimental. It had FDA approval for certain leukemias and lymphomas, including Ian’s. It was a beacon of hope wrapped in science fiction.

But first, the spleen had to go. That massive organ, long overstretched by disease, had become a liability. “Good riddance,” we said, with humor born of necessity. After six hours in the OR, the surgeon met me in the waiting room. “It was like delivering a really fat baby,” she said. I smiled, grateful for her calm.

But the path wasn’t smooth. On the first day of the next hospitalization, Ian’s labs came back dangerously abnormal. His counts had climbed beyond the lab machine’s upper limit. Worse, the lactic acid level in his blood bordered on incompatible with life. I’d seen this scenario before, only a handful times, but never from this side of the bed.

The on-call oncologist came in with a full team in tow. I recognized the choreography. This was the “come to Jesus” talk. I’d given it scores of times myself. Now I was the one seated at the bedside. I made it easy for them.

A few months earlier, Ian had asked me how physician-assisted death worked in California. He wanted to know the rules, the timing, the steps. “If it comes to it,” he’d said, “I don’t want to suffer. I don’t want to be kept alive just for the sake of it.” I’d told him the details of the Right to Die Act. We filled out our Advance Directives, signed and notarized them together. Still, I wondered whether part of his resolve came from not wanting to be a burden on me.

So, when the team gathered, we knew what we wanted. Ian asked me to speak. I said, “We’re not going to the ICU. No heroic measures. No life support. No machines.”

That night, the team adjusted his medications again, more aggressive this time. Astonishingly, his body responded. Six weeks later, he was stable enough to transfer to the university hospital. His own genetically reprogrammed T-cells were now ready for infusion.

The next forty days were spent in another hospital room. Complications came; some expected, some not. Fevers preceded by shaking chills so violent the whole bed shook, and vital signs that lay on the precipice of a cliff for days on end: that line between stable and critical. Confusion that reduced a brilliant engineer, the sharpest mind I know, into someone caught in a terrifying neurological loop, scribbling endless strings of the letter “r” in place of a coherent sentence. But eventually, something remarkable happened.

The cancer went quiet. Remission, at last.

A hard-earned victory, one that came at a staggering cost. For a year and a half, we battled the beast. Ian was a ghost of the person he’d once been - a quarter of his body mass gone. His eyes were sunken, his skin pale and loose against bones that had no fat left to soften them. The lightness I once clung to had been replaced by quiet frustration. I felt inept because I couldn’t protect him from a culture of arrogance that seemed more invested in its protocols, outcomes, and prestige. At times, Ian seemed like prop in someone else’s performance.

A well-meaning oncologist once told us, “Don’t forget your humanity.” I wanted to say, why would we? We’re the ones living this nightmare. If anything, I wished I could have said, “Right back at you.”

When we finally made it home, we were not whole, but we had survived. Ian needed nourishment in every sense, so I hustled. Within twenty-four hours we began tube feeding at home, something usually initiated only in the hospital. It made an immediate difference. His strength returned almost daily. He stopped napping as much, began spending time at his computer again, and even washed the car. Soon he was walking three miles at a time, his body finding its way back to itself.

During those early weeks at home, Ian’s sister and brother-in-law, Pat and David, flew in from Scotland to help us find our footing while I returned to work. Their willingness to cross an ocean for us felt like its own kind of medicine. We are also deeply grateful to Ian’s dad, Len, whose generosity helped us all. Their presence steadied us at a time when we were finding our rhythm again.

Within three months we were faced with another difficult choice. By expert consensus, a bone marrow transplant was recommended as the best way to prolong Ian’s remission. It felt as though the decision rested entirely with us because cellular therapy is still relatively new, especially for Mantle cell lymphoma, and long-term data remain limited. With so few established guidelines, nothing felt certain. Yet because Ian carries a troublesome mutation, the recommendation was strong.

At first we resisted. The idea of signing up for another high-risk treatment felt unbearable. By then we had already spent one hundred days in hospital rooms. We had endured disappointment, fear, and long hours of discomfort, each of us struggling in different ways. The thought of willingly stepping back into that world felt almost impossible.

What shifted our thinking was a single sentence from our local oncologist. He told us that advances in treating graft versus host disease, the main risk of transplant, are far ahead of the treatments available for a mutated lymphoma if it were to return. That truth stayed with us. The final factor was learning that our insurance would cover the transplant at the university hospital only one mile from home. Between the medical reasoning and the practicality of being so close to familiar surroundings, the decision slowly became clearer.

As we prepared for the next phase of treatment, a new transplant hematologist stepped in and began absorbing Ian’s eighteen months of complex medical history. At one point he looked at me and asked, “What do you think was going on with the liver?” He had me at “what do you think.” It doesn’t take much for providers to show empathy. Recognizing when a fellow physician has had to cross that invisible line between clinician and family member is a profound act of kindness, one that makes the unbearable feel just a little more bearable.

Within a few months a suitable donor was identified. We are not allowed to know who he is, only that he is a young man living in an unstable part of the world. For a short time there was real concern that his cells might not be safely transported out of a conflict zone. The idea that someone living amid upheaval could pause their own life long enough to offer this gift still humbles us. It is difficult to describe the gratitude we felt knowing that, in the midst of his own uncertainty, he chose to extend hope to a stranger.

In the beginning I held on to control with everything I had. I wanted to be the competent doctor, the steady partner, the capable caregiver. I thought if I stayed organized and vigilant I could keep the chaos at bay. Eventually the weight of all that intention wore through my defenses. In the end, I had to let the roles fall away and become one thing only: a person loving someone through something unimaginably hard.

The night before this most recent hospital admission, Ian looked at me and said, “We’ve got to just let it all happen.” It was the simplest truth, and it came from him. I felt something in me loosen for the first time in months.

Compared to the hospitalization for cellular therapy, when the cancer was completely out of control, the three weeks in the hospital for transplant felt almost manageable. That is not to say it was easy. The chemotherapy was fierce enough to erase his entire immune system and nearly everything that makes blood and bone marrow function. But suffering is always measured against what came before, and this time the nausea, fatigue, and hair loss felt survivable. Ian kept himself anchored by taking photographs around his room and then layering them with images he created or ones generated through ChatGPT. Soon the walls of Room 1227 were covered in a gallery of color and imagination.

A representative from an organization called Art for Recovery stopped by and was captivated by the work on his walls. Within weeks Ian was selected as one of thirty cancer patients whose pieces would be displayed at the San Francisco Museum of Modern Art (SF MOMA). It felt almost unreal to see his name listed alongside the exhibit. There were days when we were unsure he would ever leave the hospital, and now his art was headed for a major museum.

For the first one hundred days after transplant, we lived around clinic visits. Twice a week we went in for labs, appointments, infusions, and follow up tests. By the second or third week Ian was able to walk the mile to the hospital and back without much effort. His red blood cell count had settled into the range of someone decades younger, and the improvement was unmistakable.

On Day 100 we had our first true outing in years, the opening celebration for the MOMA exhibit. Standing there together, surrounded by art born from the hardest season of our lives, felt like an unexpected and gentle reward. It was not a finish line, but it marked the end of a long and harrowing stretch. In that moment, after so many months of fear and vigilance, we realized that we had made it to a place where hope felt possible again.