Ask Deb Mattson what she is proudest of in her 30 years as a physician assistant at Fred Hutchinson Cancer Research Center, and her answer is deceptively simple.
“I’ve done the very best job I could for each patient,” she said.
That, of course, meant everything to her patients — there have been thousands since she started at the Hutch in 1988 — and their families.
Nor did it go unnoticed by the physicians and researchers she has worked alongside, first in the Bone Marrow Transplant Service and, since 1992, in the Infectious Disease Consult Service.
“Deb is a rare combination of knowledge, empathy, persistence, compassion, and just plain goodness,” said Dr. Larry Corey, Fred Hutch president and director emeritus and former head of its Vaccine and Infectious Disease Division. “She has been the glue that held us all together and made the infectious disease program at the center world-class.”
Infections were the most common cause of death in the early days of bone marrow transplantation, which explains why Fred Hutch, which pioneered transplantation under Dr. E. Donnall Thomas, built one of the largest infectious disease programs of any cancer center. Mattson, who started before Corey became division head, is the keeper of the history — both of the program itself and of the patients it serves.
The consulting service is made up of Fred Hutch physician-scientists and clinician-scholars who specialize in infections in immunocompromised patients and develop policies on how best to treat and prevent them. They consult on infectious complications, generally rotating through intense two-week shifts several times a year.
Physician assistants like Mattson, by contrast, treat patients before, during, and after transplantation throughout the year.
“We will see them during their initial chemotherapy, during their transplant, and, if they have an infection, after the transplant,” she said. “We remember these patients. We know their histories.”
Mattson’s role went beyond providing continuity. She also brought a gift for navigating often difficult discussions among patients, their families, their oncologists and the rest of the infectious disease team, no matter how stressful the circumstances.
“She is,” he said, “amazing.”
In the early days, bone marrow transplantation was reserved for the very sickest patients who had exhausted all other options. Already weakened by cancer, they would undergo intensive chemotherapy and radiation to prepare for their transplants, essentially killing off their own immune systems to make room for a new one to engraft. Viruses that would seldom trouble people with healthy immune systems could kill a transplant patient in mere weeks.
Despite or maybe because of these challenges, Mattson found the work deeply satisfying.
“The patients were much more ill than they are now, and the conditioning regimens were much more toxic,” she said. “But while the patients were really sick, the medicine was fantastic, and you felt like you were doing something that mattered.”
She also has had the satisfaction of witnessing the strides made over the years. Transplantation is still a major undertaking, she said, but hematologists have refined conditioning regimens to make them less toxic and gotten better at matching stem cell donors to patients, eliminating or at least easing complications from graft-vs.-host disease, in which immune cells from the donor recognize body tissues in the patient as “foreign.”
The infectious disease program made similar strides.
“When I started, people had infections you couldn’t diagnose,” Mattson said. “And when you could finally figure out what it was, you couldn’t treat it. Now diagnostics have gotten better, and therapies for infections have gotten much better and less toxic.”
Another change: For her first 20 years, Mattson was the only infectious disease physician assistant. Today, she has been joined by Leah Yoke and Pooja Bhattacharyya.
What hasn’t changed is the amazing care delivered. The three recently won the Vaccine and Infectious Disease Division’s inaugural Impact Award.
Fred Hutch’s reputation attracted bone marrow transplant patients who were well-known outside hospital walls. Mattson recalls treating both writer and intellectual Susan Sontag and renowned astronomer Dr. Carl Sagan.
“I distinctly remember sitting in the hospital room with him having conversations about how we were going to work up his particular infection,” she said of Sagan. “He was such an interesting individual and a friendly man. He was someone I had seen on TV as a kid, and it was kind of overwhelming to have someone like that entrusted to your care.”
But Mattson was adamant that, just as cancer does not discriminate between celebrities and the person next door, neither do caregivers.
“My goal has been to make sure everybody got the same level of attention,” she said — a level of attention that has earned her recognition multiple times in Seattle Met Magazine as a top physician assistant in infectious diseases.
Here is one of the hard truths of being a cancer caregiver: Even with the best care in the world, not everyone makes it.
How does she cope?
“I think everybody has to figure out how you’re going to do it,” she said. “You want to be present for the patient. But if you become emotionally involved with all of them or even most of them, you won’t be able to do your job.”
Mattson learned that lesson the hard way early on when taking care of pediatric patients. She would think they would make it through the transplant, and when they wouldn’t, “It was absolutely heartbreaking.”
“So I’ve gotten very good at trying to compartmentalize,” she said. “I am 100 percent invested in my patients and how they do. But if I lost it with every patient who did poorly, I would never be able to go back to work again.”
Mattson came to Seattle with her husband, John Phillips, who worked as a physician assistant at Swedish. (“We met over rat liver mitochondria [as undergraduates] at University of California, Santa Barbara,” she said. “It was incredibly romantic.”) Phillips is also retiring now, and the two — who moved to Seattle after falling in love with the city during bicycle trip in the 1980s — are looking forward to more time to travel.
Back at the Hutch, Mattson’s legacy will continue, not just in the lives of patients and families she helped but in infectious disease fellows she helped train — more than 150 of whom have rotated through the Infectious Disease Consult Service during her tenure.
Her advice to those who remain is as simple — and profound — as her proudest moments from her 30 years here.
“My life advice is just be kind,” she said. “I think it works.”