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A top cancer doctor fights the lethal disease himself, finding help in the alternative methods he had scorned.
By JEANNE MALMGREN, Times Staff Writer
© St. Petersburg Times, published February 7, 2002
Dr. William Fair was late to his first-ever yoga class.
It was 6:30 a.m. in Sausalito, Calif. Carpeted room. Dim lights. Everyone wearing workout clothes and apprehensive expressions.
Most, like Fair, had never done yoga before. They were at the Preventive Medicine Research Institute because they had a serious illness. Congestive heart failure, maybe. Diabetes. Cancer.
During the one-week program, developed by good-health guru Dean Ornish, they would learn how to destress, slow down and eat healthfully. Take back their lives from the clutches of disease.
Fair, a highly respected surgeon at Memorial Sloan-Kettering Cancer Center in New York City, had long since accepted the irony of his situation -- a cancer doctor stricken by cancer himself. He had endured two surgeries, countless radiation treatments and a year of chemotherapy, much of it administered directly into his abdomen.
And then the tumor was back, relentless, hulking underneath his liver.
It was time for the cancer doctor to try some of the things he used to scoff at. Yoga. Meditation. Herbs. That "touchy-feely California stuff," he called it.
But in the rows of yoga mats that morning, one was empty.
"Where's Bill?" the teacher asked.
Fair was back in his room, on the phone, calling New York to check on his patients. Making rounds from 1,000 miles away, when he was supposed to be focusing on his own health.
"That's so him," says Mary Ann Fair, with a small, sad smile.
Mrs. Fair sits on a sofa in the elegant Longboat Key condo she and her husband moved into in spring 2000. She sips tea from a flowered china cup. She is slender, with a cap of short, dark hair and petite, silver-rimmed glasses. She wears a sleeveless navy blue silk shift and a scarf in the colors of sunset. Outside a wall of glass, the gulf is flat.
Bill Fair is no longer here. He died Jan. 3 at Sarasota Memorial Hospital, at 66.
His obituary in the New York Times lauded him as one of the nation's foremost prostate cancer experts. Chairman of urology at Sloan-Kettering, he was an authority on tumors of the bladder, prostate, testes and kidney, a man at the peak of his career in the highly competitive world of medicine.
The obit also spoke of Fair's transformation from physician to patient and of the extraordinary journey he undertook, seeking out unconventional therapies and subjecting them to a scientist's scrutiny before trying them himself.
The journey began in 1994 when Mary Ann Fair, a former nurse, suspected her husband was sick. He was rundown and easily tired, though he managed to keep up his grueling schedule of 16-hour work days. She urged him to see a doctor.
"I made appointments, and he kept canceling them," she said.
It wasn't until the next year, 1995, that Fair finally submitted to an exam. The diagnosis: colon cancer.
Fair, of course, would be treated at Sloan-Kettering. He fully expected to maintain his practice throughout his treatment -- and did. As he was wheeled in for his first operation, he spied one of his own patients on another gurney. Fair had been scheduled to operate on the man that day.
Propping himself up on an elbow, Fair assured the man he would be fine and that he'd check in with him when they both reached recovery.
After that surgery, in which the tumor was successfully removed, Fair marked his 60th birthday by kayaking in the Galapagos Islands with his wife and son, Bill Fair III, who goes by the nickname "Trip."
But the cancer recurred, and in February 1997 he underwent surgery again. Murray Brennan, the Sloan-Kettering chairman of surgery, performed the operation. Seven months later, in August 1997, a cancerous mass showed up on scans, this time in the lymph nodes near the liver.
That spring Fair decided to give up his post as chairman of urology. He shed some administrative duties but continued performing surgery.
He knew his chances of survival were fading. He also knew the last-resort chemo treatments for end-stage cancer were highly toxic and debilitating.
He told Brennan he wanted no more of that kind of treatment. He planned to look into alternative therapies.
It was a surprising move for a man so steeped in mainstream medicine. Studies show that nearly half of Americans have investigated alternative therapies, but Fair belonged to an exclusive club of men and women who had built their careers and professional reputations on the tenets of modern medicine.
He held both an M.D. and a B.S. in pharmacy, from colleges in his native Pennsylvania. He did his internship while serving in the U.S. Army, at Fort Bragg. His residency was in urology at Stanford University. He also worked at Washington University in St. Louis and at a cancer research center in London. He spent more than a decade running the urology department at Memorial Sloan-Kettering, one of the top cancer hospitals in the country.
After deciding to stop conventional treatment, Fair sought advice from James Gordon, a physician in Washington and clinical professor at Georgetown University Medical School. Gordon wrote a book about integrating conventional medicine with alternative therapies and founded the Center for Mind-Body Medicine.
"What I heard was the sharp, analytical mind of the surgeon and at the same time a wonderful openness, a humbleness about what he knew and what he didn't know," Gordon said.
About that time, Dean Ornish called Fair to see how he was doing. The two had met when both were doing research into nutrition for prostate cancer patients. Ornish, also a physician, is clinical professor of medicine at the University of California-San Francisco. The author of many books and founder of the Preventive Medicine Research Institute, Ornish was one of the first to suggest that lifestyle changes such as low-fat diet, exercise and relaxation could help prevent or reverse heart disease.
Ornish suggested Fair head back out to northern California, this time for a weeklong residential program at Commonweal Cancer Help, run by Ornish's friend Michael Lerner.
Every day at Commonweal starts with yoga, meditation and guided relaxation. Later, patients sit in support groups with a psychotherapist. The afternoons are a mix of individual counseling, massages, art therapy and walks along the beach.
In the evening, Lerner lectures on topics ranging from conventional cancer treatments to death and dying.
Fair later told an interviewer he was frustrated, trying to bend into the pretzel positions of yoga and tame his racing mind during meditation. But he kept at it, and he grew to appreciate Commonweal's approach of honoring conventional medicine at the same time it offered other choices.
The label Fair decided to use for his explorations was "complementary," as in one therapy complementing the other, not replacing it. Mainstream medicine plus holistic methods.
Fair, said Lerner, was "a true scientist. A true scientist is not bound by dogmas and is unafraid to explore hypotheses outside of the safe ground so thoroughly tilled by others."
By the time Fair got home, he was eager to make use of the new practices -- at least those he felt were medically sound.
"He would go out and talk to a shaman or a yoga teacher or a massage therapist, and he would ask questions," said Trip Fair. "He never did the warm, fuzzy, kindred spirits, we're-all-one kind of thing. He just said, "Let me ask you some questions about what you do. Help me understand how it works.' "
When he heard about a Chinese herbal formula that might help him, Fair had a colleague run trials on mice in the laboratory. The herb, marketed as SPES-II, contained several kinds of mushrooms and herbs. When the tumors in mice that were fed SPES-II shrank by 50 percent, Fair began swallowing the pills every day.
Mary Ann Fair hired a yoga teacher to come to their Manhattan apartment to teach a private class. At their weekend house on Long Island, Fair designed a Japanese meditation garden with stream, waterfall, polished river stones and a platform for sitting.
"He would meditate whenever the spirit moved him," Mary Ann Fair recalled. "Sometimes 20 minutes, sometimes an hour and a half."
In 1999 Fair told Yoga Journal magazine that his new routine helped him live more fully with cancer.
"The time I have left -- how do I want to spend it? This is what I asked myself," he said. "If I had accepted the chemotherapy treatments, I would have spent last year sick and miserable."
The Fairs also changed their diet. They gave up red meat and started eating more fish. Tofu and edamame soybeans became staples. Bill Fair stirred soy powder into everything he drank. He frequented a place in Manhattan called Sushi Mania.
At the same time, a colleague of Fair at Sloan-Kettering was working for him in a different way. Taking a slice of the last tumor removed from Fair's body, the researcher had grown a vaccine tailor-made for Fair's strain of cancer. The vaccine would be ready, should he need it.
But Fair was feeling great. On a routine scan in March 2000, the tumor wasn't even visible. Fair decided to retire. He and his wife moved to Longboat Key, where they had been visiting for several years.
Fair kept busy answering hundreds of e-mails from cancer patients who had seen him on NBC's Dateline the year before and read about him in an article in the New Yorker. Jim Gordon invited him to serve on the White House Commission on Complementary and Alternative Medicine Policy.
He also felt compelled to share what he was learning with other cancer patients and physicians. His most important theme: the difference between curing and healing.
"Some people are cured but they're never healed," he said in one interview. "Other people are healed even though they may die. They've reached an understanding, or balance, or an emotional acceptance, that no one lives forever. They can, even though it's difficult, adjust and make the best of the time they have left."
But the relentless pace of his travel and lecture schedule began to take its toll. In late 2000, in Southeast Asia, Fair had to use Bengay for mysterious back pain that was plaguing him. It was a warning.
Back in New York, he had a scan. It showed tumors growing in his liver and lungs. Fair reluctantly submitted to six weeks of radiation, five days a week.
During that time, even as he struggled anew with his disease, Fair realized a long-held dream. He and his son opened Haelth, a center for complementary medicine in the SoHo section of lower Manhattan. The center offers yoga, meditation, Eastern forms of exercise such as tai chi and qi gong, nutritional counseling, acupuncture, herbal therapies and support groups. The idea was to bring together, under one roof, a variety of practitioners who would work as a team to tailor individualized health programs for each client.
Trip Fair, 38, a former health care consultant, serves as president of Haelth.
In May, Fair decided it was time for the cancer vaccine. Once a week he and his wife flew to Duke University in North Carolina, where the vaccine had been frozen.
"He'd get the shot, and we'd fly up and back in a day," Mary Ann Fair said. "He thought this would be so great if it would work."
It didn't.
By July he had to start CPT-11, a high-powered chemotherapy. Because Fair was determined to keep up his lecture schedule, he had his oncologist fax an order for CPT-11 to the hospital nearest wherever he was headed.
At home, Mary Ann Fair had a saltwater fish tank installed in their condo. Built into the wall, with a graceful curving edge, the tank houses tropical fish in bright blues and yellows.
"I thought, when he can't get around anymore, we'll just sit here and watch the fish. I was preparing myself for months of deterioration. But he didn't even have that in him."
The first week in December, Fair went to Washington for a meeting of the White House Commission on Complementary and Alternative Medicine Policy. At the two-day session, he spoke vigorously about the importance of educating children in good health practices. Mary Ann Fair, worried, called her husband twice a day.
"I said, "Are you eating?' He said "Yes, and I feel fine.' "
But when he came home at the end of the week, she was shocked by his appearance. Fair was clearly fading.
He went to bed in their eighth-floor condo. A week dragged by, then another. He had raging fevers, lots of pain. A few days before Christmas, Mary Ann Fair decided her husband needed to go to the hospital.
"He was very mad at me. He didn't want to go. But he walked out of here in a starched white shirt, navy blue shorts all pressed. He looked like a million bucks."
Fair died right after New Year's.
Dean Ornish spoke to Fair several times while he was in the hospital. So did Jim Gordon.
"In our last conversation, he was talking about a study linking obesity and diabetes," Gordon said. " "We've got to do something about that,' he said. Then he asked me if he was being clear. He was worried about the medication making him woozy. I told him he was being very clear."
Gordon is one of several people who will eulogize Fair at his funeral Feb. 20 in Arlington National Cemetery. Because Fair served in the U.S. Army, he will have full military honors.
Trip Fair has been working on a video tribute to his dad. He's also writing an essay about the experience of watching cancer kill a loved one. He likes to call his father a "gentle giant," a person who was at the top of his game, who had boxes of plaques and honors but radiated humility.
Mary Ann Fair said if her husband had the Superman complex of a high-achieving surgeon, he had his Kryptonite, too. It was cancer.
Others who knew him say his death wasn't a failure. He may not have found a cure, but he was healed.
"He was able to build bridges with people," said Ornish. "And I think that's really what healing is about."