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A FIGHTING CHANCE
AA FIGHTING CHANCE WHEN A TUMOR APPEARED FROM NOWHERE AND NEARLY KILLED A YOUNG PATIENT, A TEAM OF TAMPA GENERAL HOSPITAL AND USF HEALTH PHYSICIANS FOUGHT BACK
By Dave Scheiber
It began with a nagging cough. The sound was a bronchial hack that Noah Schwartz attributed to springtime allergies. After all, he was in excellent health at age 24—a strapping young man from Jupiter, Florida, with upcoming plans to move to Los Angeles with a pal from his alma mater, the University of Miami, and grow their budding music company.
But then came the shortness of breath and difficulty sleeping on his back at night, forcing him to sit upright in bed. Since this was April 2021, with serious COVID-19 cases on the rise, Noah wondered if he might have contracted the virus. He tested negative. His primary doctor in Miami suspected bronchitis and prescribed a regimen of antibiotics, but they did no good.
Not long after, while walking to the garage at his house, he ran his hand across his chest and felt an unusual bump under the surface of his skin.
“It felt more internal than external, and it really concerned me,” Noah recalled.
It was the start of a nightmare. Within days, Noah was on the verge of death. He was diagnosed with a large tumor, caused by non-Hodgkin’s lymphoma, that was pressing dangerously against his heart, lungs, and windpipe. Yet it also set in motion a dramatic chain of events that brought Noah to Tampa General Hospital—rushed across the state by ambulance—and a series of critical decisions by a world-class team of TGH physicians that ultimately saved his life.
“When an airplane crashes, it happens after a sequence of mistakes,” said Dr. Eduardo Sotomayor, director of TGH’s newly established Cancer Institute and one of the physicians who played a vital role in the unfolding life-and-death situation. “But in Noah’s case, it was the opposite of an airplane crash. All of the right decisions were made at the right time for this kid. And the sequence of events that took place—at each step of the way—is why he is alive today.”
Here is how that sequence in 2021 played out—with every hour, every move, counting in a race against the clock to keep the tumorous mass from stopping his heart.
Monday, April 12: Sotomayor, a world-renowned oncologist and leading expert in lymphomas, arrived at TGH to direct the new Cancer Institute after leading cancer care and research at George Washington University Cancer Center in Washington, D.C., for five years. The first critical step in the sequence—unbeknownst to anyone—was in place.
Friday, April 16: The next step involved the local hospital that Noah went to so the mysterious bump could be examined. A CT scan revealed the ominous mass. Fortunately, the physician on the case—Dr. Abraham Schwarzberg, now senior vice president of network development and chief of oncology at TGH—recognized immediately that Noah needed to be treated at an academic medical center offering the best possible advanced care. “Dr. Schwarzberg told me, ‘We can do the biopsy here, but this kid needs to be in a place that has one of the best intensive care units in the state,’” Sotomayor recalled. “This situation cannot be, ‘Handle it here.’ Luckily Noah was immediately transferred to TGH.” Noah was admitted at TGH that Friday night and seemed to be doing fine. But all that was about to drastically change. Saturday, April 17: Noah was taken to the operating room the next morning for a biopsy and the physician on call happened to be Dr. Eric Sommers, medical director of
Time was of the essence after doctors discovered a large tumor in Noah Schwartz’s chest. Opposite page: Noah with his mother and sister, who had Hodgkin’s lymphoma while in college.
ATGH thoracic oncology and a highly experienced cardiothoracic surgeon. Sommers’ presence proved vital. What began as a routine biopsy changed in a fl ash as the anesthesia increased the tumor’s pressure on Noah’s heart and lungs, causing him to go into cardiac arrest. With no time to spare, Sommers assessed the situation and knew his only chance to pull Noah through was to place him on an extracorporeal membrane oxygenation (ECMO) machine. ECMO machines are used in heart and lung transplants, and TGH had about 10 of them available. Sommers was well versed with their use. Noah appeared to be dying, so Sommers made an urgent call to the oncology physician on call—the man who had started at TGH only six days before, Sotomayor. Looking back, Sotomayor thought it was unusual that he was on call his fi rst week, but he wanted to get a feel for the hospital. And that put him in a position to fi eld the urgent call from Sommers. “It was meant to be,” said Sotomayor. “He said to me, ‘Welcome, and I have a patient with an aggressive lymphoma in his chest. By the way, he is on an ECMO machine and needs to be treated immediately,’” Sotomayor recounted. Yet another unexpected twist was about to take place. “I went to the waiting area to talk to Mom and tell her what had happened,” Dr. Sommers related. “She looked at me stunned and said,
Left: These 3D models of Noah’s chest (created in collaboration with the Division of 3D Clinical Applications, USF/TGH Radiology) depict the tumor (in pink) that was pressing against Noah’s heart, lungs, and windpipe. Right: Noah began IV chemotherapy two days after the mass was detected. Opposite page: Noah has made a full recovery and has been celebrating his health with family.
‘This is exactly what happened with his sister.’” I n d e e d , N o a h ’ s s i s t e r h a d b e e n s t r i c k e n w i t h H o d g k i n ’ s l y m p h o m a w h e n s h e w a s i n c o l l e g e , b u t s h e m a d e a f u l l r e c o v e r y t h r o u g h c h e m o t h e r a p y w i t h o u t c o m p l i c a t i o n s . N o a h ’ s c a s e , h o w e v e r , w a s p r o v i n g f a r d i f f e r e n t a n d m o r e c r i t i c a l , w i t h h i s l i f e h a n g i n g i n t h e b a l a n c e o f e v e r y d e c i s i o n . In short order, he was stabilizing on ECMO, while Sotomayor alerted TGH pathologist Dr. Julie Vitko to request an urgent pathology diagnosis. She obliged, diagnosing Noah within 12 hours of seeing him with primary mediastinal large B-cell lymphoma, which often impacts younger individuals with large masses. “ W i t h o u t t h e E C M O , ” s a i d S o t o m a y o r , “ N o a h w o u l d b e d e a d . P e r i o d . ” Sunday, April 18: With the diagnosis in hand, Sotomayor made a call to an old friend, Dr. Kieron Dunleavy of Georgetown University’s Lombardy Cancer Center. “After 25 years, I think I know a little about lymphomas, but Dr. Dunleavy is the leading expert in the world in primary mediastinal lymphomas,” he said. “He told me, ‘You need to start chemotherapy treatment today, right now.’” Sotomayor was visiting the Dali Museum in St. Petersburg when the call took place but he raced back to TGH and spoke to Noah’s mother,
Dr. Eduardo Sotomayor Dr. Abraham Schwarzberg Dr. Guilherme Oliveira Dr. Eric Sommers Dr. Gaetane Michaud
Lesli Schwartz, about starting chemotherapy. “I said, ‘Look, we can cure Noah—what he has is 95 percent curable, so we need to fight. If he is able to survive the next two to three weeks, we are going to cure him.”
By Sunday night, chemotherapy was under way—with Sotomayor personally invested, thinking of his own son, who was Noah’s age. It was now an all-out race between the chemo and the tumor. In the early going, Noah suffered every possible side effect. But an experienced multidisciplinary team that ultimately included oncology, pulmonology, and cardiology—one of the advantages of an academic medical center like TGH and USF Health—helped Noah weather the storm.
Among the physicians was Dr. Gaetane Michaud, a TGH pulmonologist and faculty member in the Division of Pulmonary, Critical Care, and Sleep Medicine at the USF Health Morsani College of Medicine, and Dr. Guilherme Oliveira, executive director of the TGH Heart and Vascular Institute and professor and chief of cardiovascular sciences in the Morsani College of Medicine. Luckily for Noah, he was an experienced cardio-oncologist.
Michaud had arrived in Tampa Bay only several months earlier from New York University Langone Health. Oliveira came from Case Western Reserve University School of Medicine in 2019. “An A team was in place from experts that came to TGH from very prestigious academic centers,” said Sotomayor. As Sotomayor and his nurse, Tracy Stegeman, began visiting Noah on twice-daily rounds, Michaud and Oliveira took over his care when he developed lung and heart complications.
At one point, it appeared Noah might need a lung transplant due to the severe damage caused by the mass, but the threat passed. Then there was the scare when the lymphoma began closing off his windpipe.
“ O n e S u n d a y n i g h t , I ’ d b e e n a t t h e b e a c h t h e e n t i r e d a y w i t h m y k i d s , a n d h i s a i r w a y c o l l a p s e d , ” s a i d M i c h a u d . “ I w a s a b o u t 4 0 m i n u t e s a w a y w i t h o u t b e a c h t r a f fi c , s o w e f r a n t i c a l l y g o t h e r e [ t o T G H ] a n d t o o k h i m t o t h e o p e r a t i n g r o o m , a n d w e w e r e a b l e t o o p e n u p h i s a i r w a y s a g a i n . ”
Michaud would play a huge part in Noah’s gradual recovery over the next seven weeks as he remained in an induced coma. When he
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awakened, terrified and disoriented, he had lost 100 pounds from his 6-foot-3-inch frame. “I was in shock, and emotional for sure,” he said. “I couldn’t move at all, and it was beyond scary.”
But with Michaud’s team helping his lungs heal, Oliveira and his team taking care of the heart, and Sotomayor’s work to cure his lymphoma, Noah was gradually on the road to recovery. After six cycles of intense chemotherapy under the supervision of Sotomayor’s team at the TGH Cancer Institute and Schwarzberg’s team in Jupiter, imaging studies showed no sign of the lymphoma that nearly killed him. Today, he has gained back his weight, regained his life, and is once again immersed in his music media and artist management company, Sheeshmedia.com, which had been sidetracked by the pandemic and then his ordeal.
Noah and his mother are deeply grateful to the team of experts at the TGH Cancer Institute. “If I ever get married, which I plan to one day, Dr. Sotomayor will be in attendance,” Noah said. “He’s a lifelong friend.”
“Doctors also believe in miracles, and many people were praying for Noah,” said Sotomayor. “This was not his time. I’ve told him: ‘Noah, you have a mission in life. I don’t know what it is—you have to find out. But you were given a second chance.’”
Thanks to a perfect sequence of events—the right decisions, the right doctors, and the right place, every step of the way.
