Paul Sugarbaker takes an even breath, leans over the left side of his patient and slices her iodine-coated abdomen from pelvis to ribs.
The air of the red-and-pink-tiled Operating Room 1 of MedStar Washington Hospital Center is chilly and smells of antiseptic; the only sound comes from the beep-beep-beep of the heart monitor as a digital clock on the wall flips silently from 11:09 to 11:10 a.m. In just five seconds, the surgeon completes the 12-inch incision, beginning what will be a marathon operation that he hopes will rid his patient of cancer.
After 15 minutes of slicing with his No. 10 blade and of searing flesh with his cauterizer, the surgeon confronts the enemy — a grape-sized tumor lodged in scar tissue from previous operations. With his left thumb and index finger, Sugarbaker peels back tissue and peers at the mucinous wartlike blob. He excises it with one clean swipe of the scalpel and plops it onto a steel tray. The swift act feels good, but only for a moment. The gray-haired surgeon, clad from head to toe in blue surgical garb, knows what lies ahead.
The high-stakes surgery will last 10 hours and involves cutting open the patient’s abdomen, removing her organs and hundreds of tumors, and then soaking her belly in a toxic elixir of chemotherapy drugs for 90 minutes. If everything works well, Sugarbaker says, the patient has about a 33 percent chance of living another five years and a 25 percent chance of being cured. Without it, he says, “her chances of survival are near zero.”
This is the Sugarbaker procedure — a controversial operation that is seen as the last hope for those suffering from advanced stages of some cancers. It is performed about 1,000 times a year at more than 100 medical centers across the country and is named after this 71-year-old blue-eyed surgeon, who has dedicated an entire career to pioneering, honing and promoting this treatment, which has left him with a permanent stoop from having spent so much time hunched over patients. He performs about 70 such operations each year on cancers that have spread into the abdomen from places such as the appendix and colon.
Whether he’s jetting across the globe to preach his procedure’s benefits at medical conferences or conducting back-to-back marathon operations, Sugarbaker is racing against time, hoping to outlast his critics and establish a legacy that he believes will save many more lives. His determination is not unique to medicine, but in Sugarbaker’s world, the stakes could not be higher. He is often his patient’s “last hope,” the surgeon who will operate when others have declined to take the chance.
Like many doctors treating those with potentially deadly illnesses, Sugarbaker faces countless questions — some of the same ones raised by his detractors — that will only grow more sharp as the country begins to focus intensely on reducing health-care costs: Does he turn away a patient who is too sick? Does he continue an operation even when hope seems lost? Is it worth the time? Will the surgery and subsequent hospital stay be worth the estimated $120,000 cost?