By now, it’s routine. Every third Wednesday, Bryant Lin, a Stanford clinical professor of medicine and primary care physician, leaves his white coat on the back of his office door and takes the elevator down two floors from his office in Hoover Pavilion to the blood draw clinic.
“Name?” asks the phlebotomist.
“Bryant Lin,” says the physician. He’s seated in the chair, his left shirt sleeve rolled up.
“Birthdate?” the phlebotomist continues. And just like that, tables turn and doctor becomes patient.
“I have a lot of blood draws,” Lin tells the phlebotomist, who is searching for a vein in his arm. “And a lot of IVs.” Lin continues, chatting on about how he gets pricked maybe nine to 10 times during each of his chemotherapy treatments, which occur on a three-week cycle. He has advanced lung cancer that has spread to his brain, to his liver, to his bones. It’s incurable but not untreatable. “The chemotherapy is on forever because I’m stage 4,” he says. Then he unclenches his fist and the needle glides right in.
Lin, who has written up thousands of social histories for other patients, freely shares his own: He is a 50-year-old man of Taiwanese heritage, from Menlo Park, married with two teenage sons, a nonsmoker “who never took a puff of anything in my life.” The co-founder and co-director of Stanford’s Center for Asian Health Research and Education is well aware of the irony that in the spring of 2024, he went from raising awareness of growing rates of lung cancer in nonsmokers of Asian descent to being a poster boy for the disease.
Lin is frequently thinking up new classes to teach, and by the fall, he had launched his newest: From Diagnosis to Dialogue: A Doctor’s Real-Time Battle with Cancer. Students would learn about diagnosis, treatment, and ongoing research while also delving into the importance of treating the patient as a whole person, considering not only their medical but also their nutritional, spiritual, and emotional needs. After all, that’s been the cornerstone of Lin’s career: figuring out how to keep medicine centered on humans.
“Something terrible happened to me and I wanted to see if something good can come of it,” Lin says. “I thought, as both a physician and a patient, I had something to share.”
The doctor and the diagnosis
“How many med students do we have?” Lin says. It’s September 25, the first day of the course. About 20 of the 50 or so people before him raise their hands. “How many undergraduates?” A dozen more hands shoot up. Add journalists and auditors, and the room is overflowing. A few people sit on the floor.
Lin invites his primary care physician, clinical associate professor of medicine Paul Ford, to join him at the front of the classroom. And the two begin:
“I was starting to have this cough,” Lin says. He thought it was allergies at first, but after about a month he consulted Ford, whose office is near his own. “I could hear his cough down the hallway,” Ford says. He conducted a lung exam, and the findings were unusual. “He had some very high-pitched kind of wheezing sound in his upper airway fields,” Ford says as Lin stands next to him, nodding his head. “So, I ordered a chest X-ray.” That was May 7, a Tuesday.
Lin’s X-ray appears on the classroom wall. “On the right side, there’s a little bit of fluid,” Ford says. “The right heart border should be a smooth line. In this case, there was all this haziness.” Ford walks the class through the next set of tests: a CT scan and a bronchoscopy. By Friday, the two doctors knew that Lin most likely had lung cancer. But Lin the patient still held out hope that it could be something else. “I was praying for infection,” he tells the class. His wife was scheduled to fly to Japan for work that weekend. He asked her to cancel the trip.
‘There were 50 spots of cancer in my brain. That drove it home.’
By Monday, the diagnosis was clear—non–small cell lung cancer—and by Wednesday, so was the extent of its metastases, from his lymph nodes to his bones and even under his skin. “There were 50 spots of cancer in my brain. That drove it home,” Lin says, walking the class through his MRI and PET scans. Still, he tells his students how lucky he is. He was diagnosed in a little over a week and started treatment almost immediately after that. One study found that lung cancer patients didn’t start treatment for an average of 72 days after they first consulted a specialist, and 43 days after they had a chest X-ray or CT. Lin’s a physician at a major medical center, getting top-notch treatment. He knows that.
Lin begins each class with an update on himself as patient. During one session, he shares how he’s handling his three-week chemotherapy cycle. The first week the nausea is pretty bad, but he learns over time to eat small amounts at short intervals, even if the thought of food turns his stomach, and he sucks on ice chips to relieve the pain of mouth sores caused by the toxic medicines. By the second week, he starts to feel better; his energy levels begin to return. During the third week, he almost forgets he has cancer. Then he gets his latest MRI results and, inevitably, they show evidence of disease. “Geez, I wish by magic, I’d get one of these things, and it would be gone,” he says.
Over 10 weeks, the course tells the story of Lin’s illness, from diagnosis and treatment to nutrition and mental health. He starts one session by pulling food-related books out of his backpack, describing how one of the first things his wife did after his diagnosis was buy them. “This one’s titled How Not to Die,” he says, laughing. He brings in guest lecturers: oncologists, psychologists, nutritionists, stem cell biologists, fellow patients.
One class hosts a panel of spiritual leaders, including a Buddhist minister and a Muslim cancer care chaplain. “I never considered myself a very spiritual person, but since I was diagnosed, so many people offered to pray for me, to chant for me,” Lin says. “I found it very comforting. I thought, ‘This is a great time to talk spiritual care.’
“As doctors, we see this narrow slice of patients’ time: at the clinic, at the hospital, getting a test. It’s a tiny percent of a patient’s life,” Lin says. He tells his students that when he ran a search for chemotherapy on PubMed, the definitive index of medical research articles, it produced 400,000 articles. A search for spiritual care produced only 8,000. “I would argue that in many individuals’ lives, the spiritual aspect is just as important as the medical,” he says. “Why are we not doing research on it?”
Lin may not label himself spiritual, but his life path is that of a seeker. He earned electrical engineering and computer science degrees at MIT, then worked as a management consultant before setting out in pursuit of a more human-centered career. Since completing medical school at Tufts in 2002, he’s used his engineering skills to help improve patient-centered care, amassing 15 patents for medical technologies. As a primary care physician at Stanford, he established the Consultative Care Clinic to evaluate patients with medical mysteries. His courses examine a broad array of medical topics, from storytelling to generative AI to the history and science of traditional Chinese medicine. During the pandemic, Lin, a former violinist, co-hosted the Stuck@Home concert series for Stanford’s Medicine & the Muse program, which integrates the arts, writing, and filmmaking into the lives of medical practitioners. In 2021, he stepped into the directorship of Medicine & the Muse. And now he’s examining the experience of being a seriously ill patient, well beyond the medical aspects. “There’s more of everything,” Lin says. “Just the more of life: the friendships, the importance of connection, the living of life. Each day, the deciding: Is this a worthwhile way to spend my time?”
Lin dresses much the same for each class session: khaki pants and a button-down shirt, a casual jacket, and glasses that he often pushes back up his nose with his forefinger. He’s a simple man. He’ll tell you that. He’s certainly not used to an outpouring of attention from reporters. “I’m an open book,” he repeats as journalists and students ask him questions. He talks about the constipation caused by anti-nausea drugs and how first thing in the morning he wakes up thinking about his mortality. He smiles and laughs and insists that optimism is essential.
“I will highly likely die from this cancer or something related to this cancer,” he tells the class. “It may be one year, it may be two years, maybe five years. I really don’t know.”
How to live now
“I’m anxious about getting the treatment,” says Lin in footage for a documentary he’s having made for family and friends. He’s unshaven, lying on a bed at the Redwood City Infusion Center with an IV inserted into his arm, awaiting his first chemotherapy treatment. His wife waits outside his room on a bench, reading a book. They’ll soon develop a routine: He drives there, she drives home. Lin has enlisted two friends to help him make the documentary: Wayne Wang, a filmmaker whose directing credits include The Joy Luck Club and Smoke, and Frish Brandt, who helps people write “lasting letters” to loved ones. Throughout the film, Brandt reads bits of Lin’s own letter to his two sons.
“There are things that I think about that won’t make complete sense now,” Lin writes to his sons. “I am 50 and vividly aware of my mortality.” He tells them about how their mom is his rock, and how if he’s not around, they must take care of her. He asks his sons to open themselves up to serendipity. The camera captures him in small moments: at home in the kitchen with his wife chopping vegetables, reading alone under a red umbrella on his back porch, smiling from a doorway as he listens to his sons play music together. These are the things that are important to him. First his family, then his patients, then the students he’s teaching about patient care.
For the ninth class, he invites his oncologist, professor of medicine Heather Wakelee, to speak. Since his diagnosis, the two have had many conversations, some about his medical care, others about how he wants to live his life. Learning about a patient’s values helps direct their treatment plan, Wakelee says.
“We talked about what’s important to him,” she says. “What are the things that are really valuable? How much of your time do you want to focus on treating patients? How much of your time giving out information [to the media]?” What he most wants, Lin says, is to live long enough to see his sons graduate from college. The younger one is 13, the elder 17.
The treatment plan Wakelee devised includes not only chemotherapy but a treatment targeted to Lin’s EGFR cancer mutation, a daily pill called osimertinib. It won’t cure him, but it keeps the cancer at bay. In an earlier course session, he’d walked up to the table at the front of the room, pulled six empty medicine bottles out of his backpack, and lined them up. The cost of the pills that keep him alive will surpass $100,000 a year. He knows he’s lucky he has good medical insurance.
‘I thought I knew what it was like to be a patient. I didn’t really know.’
“What I think about every day,” Lin says, “is how I should be spending my life when I have limited time. What I should say yes to, and what I should say no to.” Again, he finds gratitude. He was already living the life he wants to live. His goal is to continue doing this. And mostly he’s been able to. He’s slowed his pace a little, now primarily seeing patients online instead of in person. He’s cut back his teaching load. And occasionally, he even rests.
“I thought I knew what it was like to be a patient,” Lin says. “I didn’t really know.” And so he shares what he’s learned with his students, talking about the emotional toll, the daily grind of dealing with the medical system, the constant scheduling and rescheduling of medical appointments, the spiritual questioning, the importance of having a physician who listens to the patient.
“It felt like we were traversing this journey along with him,” says Hanan Rimawi, a medical student who is considering a career in palliative care. “I appreciated the rawness and the vulnerability that the class has brought out in all of us.”
Cancer and care
At the end of Wakelee’s lecture, Lin solicits questions from students, then poses one himself, joking that he’s “asking for a friend.”
“What happens if the cancer becomes immune to the medication?” he says. Wakelee nods, then talks about how quickly new cancer drugs are coming out on the market, five to 10 every year. If Lin’s targeted therapy stops working, she says, they’ll test his cancer for new mutations, then search for novel drugs to treat them. Lin likes to tell the story of a former colleague and fellow cancer patient who quipped, “You just have to live long enough for the next treatment to work.”
Lin dedicates the 10th class, the final one of the course, to cutting-edge therapies for lung cancer. Everyone’s listening closely, especially him. When the speakers finish, he thanks everyone and closes the class with his own speech.
“Lou Gehrig, one of the greatest baseball players of all time, always inspired me,” Lin tells the class, citing the “luckiest man” speech that Gehrig gave on July 4, 1939, two weeks after he retired from baseball due to amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease). Lin reads his own version off of a slip of paper.
“I’ve always considered myself the luckiest man,” he says. “I have friends to help me make a documentary; two healthy, happy sons; TAs who, [when] I told them about this crazy idea, helped me teach this course; patients who send me gift baskets.
“My dream is that some of you will go into cancer care,” Lin tells his students. Then he ends the course. He won’t teach it again.
“Thank you, and it’s been an honor,” he says.
Tracie White is a senior writer at Stanford. Email her at traciew@stanford.edu.
