[Congressional Record (Bound Edition), Volume 148 (2002), Part 8]
[Senate]
[Pages 10617-10619]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   IN MEMORY OF DR. RICHARD J. WYATT

  Mr. DOMENICI. Mr. President, it is with great sadness that I rise 
today to remember a man who played such an important role in mental 
health. I would like to make a few remarks to honor Dr. Richard J. 
Wyatt, a friend of mine and my wife and my family and a distinguished 
advocate for the mentally ill.
  On Friday, June 7, 2002, the mental health community lost an 
inspirational researcher and leader in the field of mental health to a 
long battle with cancer. Throughout his career, Dr. Wyatt received 
numerous awards and honors and was highly respected among his 
colleagues. He served as the chief of the Neuropsychiatry Branch at the 
National Institutes of Mental Health.
  For 33 years, Richard played a leading role in understanding the 
biological basis of mental illness. His work pioneered the view that 
Schizophrenia is not the result of bad parenting or frailty of 
character, but it is due to a diagnosable and treatable disorder of the 
brain. This creative understanding of the basis of brain disease led to 
new treatments with antipsychotic medicines easing the burden of the 
disease.
  In addition, Richard and his wife, Dr. Kay Jamison, worked to end the 
stigma attached to mental diseases. Richard focused on research and the 
biological effects of Schizophrenia. Kay wrote books about her personal 
struggles with depression and how to overcome it. Together, they co-
produced a series of public television programs that provided 
information on manic depression. All of their efforts helped to raise 
public awareness of brain disorders.
  Not only did Dr. Wyatt receive praise for his work on mental health, 
but he was a strong and courageous individual who fought a lifelong 
battle with cancer. In a letter to a friend diagnosed with cancer, Dr. 
Wyatt candidly discussed his experiences and shared his insights into 
overcoming this disease.
  Mr. President, I ask for unanimous consent that the February 13, 
2001, Washington Post article entitled, ``Words to Live By'' be printed 
in the Record following my remarks. I believe this article is truly 
inspiring and exemplifies the qualities of this extraordinary 
individual.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit No. 1.)
  Mr. DOMENICI. From myself and my wife, Nancy, we wish to express our 
heartfelt condolences to Richard's friends and family. To his wife, 
Kay, we send our greatest sympathies for the loss of your husband, and 
we thank you for your work as well. Dr. Wyatt's strength of character, 
and his compassion and work on behalf of the mentally ill will truly be 
missed.

                             Exhibit No. 1

               [From the Washington Post, Feb. 13, 2001]

                            Words To Live By

       Drawing on knowledge born of hard experience, Washington 
     psychiatrist Richard J. Wyatt penned this personal note of 
     advice after a close friend and fellow physician was 
     diagnosed with cancer. A cancer veteran himself, he underwent 
     two years of aggressive radiation and chemotherapy to fight 
     Hodgkin's disease in his thirties. When at age 60 he was 
     diagnosed with Burkitt's lymphoma, he withstood another 
     course of chemo and a bone marrow transplant. Since he wrote 
     the letter, he's begun a third fight--this time against lung 
     cancer. In the letter's introduction, he voices the hope that 
     the ``battle-won knowledge'' he offers here ``will help 
     others facing this difficult journey.''

       Dear Jim, I wouldn't have the audacity to write this if I 
     hadn't fought cancer three times myself. But maybe you'll 
     find the following advice helpful. I also offer the 
     comforting and indisputable fact that I am here today to 
     offer it.
       Try not to sweat the big things. Once you have made the 
     decision to put yourself in the hands of a good oncologist, 
     it is his or her job to fret. If you find that you are 
     second-guessing him on big issues, you have the wrong person. 
     Your job is to concern yourself with the small things. It 
     also helps to find a treatment facility that makes you feel 
     secure. I was treated at Johns Hopkins. The doctors, as I 
     expected, were superb. And one cannot say enough about the 
     quality of the nursing care at Hopkins. Everyone, including 
     the housekeepers, takes pride in their work.
       Finally, as you know from the adage, a doctor who is his 
     own doctor has a fool for a patient. In short, despite the 
     temptation, do not try to compete with your doctor. How to 
     choose an oncologist: Carefully. Most people have no basis 
     for choosing a specialist other than the recommendation of 
     their internist or family physician. In most cases this works 
     well. My internists are superb, and they could not have been 
     more helpful at a number of important stages of my care. But 
     they have only a limited number of people they know well 
     enough to make referrals to.
       The local oncologist is unlikely to have treated Burkitt's 
     lymphoma or other unusual cancers, and even if he has some 
     experience, it is likely to be slim. And he won't have the 
     support team to deal with the many complexities that will 
     arise.
       You want to be at an academic center where there is a great 
     deal of experience, and where nobody does anything without it 
     being

[[Page 10618]]

     questioned. The local oncologist can work with the academic 
     oncologist, particularly if there is a geographic distance 
     involved. The question I would ask, probably of the local 
     oncologist, is, ``Who would you ask to treat your family 
     member if he or she could go anywhere in the country?''
       Do not be shy about this, and do not worry about offending 
     your doctors by asking such questions. This may be among the 
     most important questions you ever ask.
       As an aside, when I went out to Stanford for my Hodgkin's 
     treatment, the radiation oncologist there said he could do 
     better than the other people I was considering when I asked 
     him this question. The other oncologists I was considering 
     were as good as they get. But the Stanford doc turned out to 
     be one of the best physicians I have come across. His well-
     placed self-assurance probably saved my life.
       Protect your veins. This is one of those small things I 
     told you that you should worry about. Think of every 
     venipuncture as a nosebleed where you must apply continuous 
     pressure to the puncture wound for five minutes, even though 
     the person drawing your blood will want to just put a bandage 
     on it. Your arm will soon enough look like a maple tree in 
     the fall, but there is no need to hurry the seasons. Try to 
     get as much out of a single needle stick as possible. If you 
     are going to need blood drawn twice in the same day, a device 
     (a heparin lock) can be left in your arm which will prevent 
     the need for a second sick. And start squeezing rubber balls. 
     My arm veins have never been better.
       A bad hair year. I have noticed that neither of us has 
     high-maintenance hair. As far as I'm concerned, the only 
     reason for having hair is to keep our heads warm. (If I were 
     a woman, I might feel differently.) You have the wisdom to 
     live in a warm climate, but when it does get cold, wear a 
     hat. One of my fellow patients tied a bandanna around his 
     head, which I thought looked pretty snazzy, but because of 
     some medication-induced numbness and tingling in my hands, I 
     was having enough trouble with buttons and shoelaces.
       And there are some major benefits to hair loss. If all goes 
     well, you have many months of not shaving. Just think of Yul 
     Brenner and Michael Jordan. And James Carville. You will not 
     be experiencing the radiation I received for Hodgkin's 
     disease. It burned up a lot of me. Twenty-seven years after 
     my radiation treatments, I still do not have any inconvenient 
     sweat glands. I can wear my shirts for weeks without any 
     telltale signs. And since both of us are academics, not one 
     will notice the wrinkles.
       Get your finances in order. Make sure everything is in one 
     place where your wife can find it, and in a form she can 
     understand. I note that the night before Sen. John McCain had 
     surgery for his melanoma, he said that his wife, Cindy, was 
     going through their insurance policies. It got a laugh, but 
     she was right. I have all my financial papers in a black 
     three-ring notebook in plain sight, and I update it pretty 
     often. Visit your accountant to see if you are over the 
     limits you can leave a spouse and kids without it being 
     taxed. Wills, powers of attorney and so forth are a must. Do 
     not forget your friends.
       Nausea and vomiting. This time the chemotherapy is mild and 
     fairly innocuous. Even a year ago, despite undergoing rather 
     rigorous treatment, I had very little nausea or vomiting--a 
     big difference from 27 years ago. Today there are good 
     medications to prevent nausea and vomiting. Most of the time 
     last year I got an IV dose a few minutes before receiving the 
     day's medications. The pill form also worked well, even when 
     they were dumping Drano directly into my cerebral spinal 
     fluid. Burkitt's cells are apparently scoundrels: If they're 
     allowed to, they hide in the brain.
       I think you will want to start the pill form of anti-nausea 
     medication about an hour before treatment, and take it about 
     every eight hours for the next 24 hours. Your anti-cancer 
     drugs may sit in the body longer than the ones I received, 
     but I think most of them set on their target receptors within 
     a few minutes.
       An aside about spinal taps: If you need to have one, to 
     prevent headaches, remember to lie on your back for two or 
     more hours after each tap. Out of nine spinal taps, I had 
     only one mild headache, but it did last about a week.
       Although by previous standards there was essentially no 
     nausea or vomiting, I recommend carrying a purple surgeon's 
     glove in your pocket at all times, just in case. I am not 
     sure why all the gloves have suddenly become purple, but 
     Barney seems to have had a pervasive influence. I had to use 
     the glove only once, but it saved my wife's car from that 
     indelible stink. Since you have had much less practice and 
     therefore probably do not have my Olympic-quality aim, you 
     might want something larger than a surgeon's glove. Think 
     leaf bag.
       Tastes and foods. I developed strong aversions to many 
     foods and tastes I normally like. One of the most surprising 
     was my sudden dislike of chocolate. I have since learned that 
     this reaction is quite individualized. I think I almost drove 
     my wife to murder demanding that my food be prepared in 
     specific ways and then rejecting it. Nor is this something 
     that suddenly goes away. Fortunately, it appears to be in 
     women's genes to be patient with us.
       A year later, my appetite has yet to return. But then again 
     there are not many men our age without a potbelly. You would 
     be surprised by the number of friends who are slightly 
     heavier than they would like, and who would be pleased to 
     merge with you or offer to provide a transplant of their 
     extra tonnage. They, and others, have offered many 
     suggestions for increasing my appetite. One of my more 
     endearing nurses advised me to have a beer before meals. 
     Ensure, a ``Sun Chip and Benecol [a special kind of 
     margarine] diet,'' Remeron [an antidepressant], Megace [a 
     hormone] and marijuana have all been strongly encouraged. Of 
     these, I like the idea of marijuana the best, but it is 
     illegal and, despite a real effort under a porch when I was 
     14, I never learned to inhale. No matter what I have tried, I 
     find I am as good at pushing food around a plate as I was 
     when I was a child.
       Dry mouth. You will have it. Ice chips work well. A great 
     gift was a Chap Stick. I have used it to its nubbins and it 
     is the only one I never lost.
       Amusement. Get a comfortable lounge chair for home, a high 
     wattage light for reading and good TV videotapes. These 
     should not be in the bedroom (see below). The best gifts I 
     received during this time were books on tape, so you will 
     want a good headset and tape player. If you have not already 
     done so, start with Harry Potter.
       Apparently, flowers attack you when your immune system is 
     down, so somehow you have to figure out a way to discourage 
     friends from sending those large ``get well soon'' bouquets. 
     Our cleaning lady got a lot of beautiful hand-me-down roses 
     in the last year. They come pretty much only in the 
     beginning, so she has no conflict of interest in seeing me 
     get better.
       Chivalry, sex and movies. Have a place you can go at 2 a.m. 
     when you cannot sleep and do not want to disturb your wife. 
     You may want to subscribe to an extra movie channel. In the 
     early hours of the morning, you can never be sure what will 
     pop up on cable TV, but the porn flicks went to waste--I, at 
     least, lost any libido I might have had left.
       My wife has been great about renting movies, and we usually 
     have a large stack at any one time. Make the most of whatever 
     you can of political coverage and hope for a good scandal. My 
     bout with Hodgkin's coincided with the Watergate hearings. 
     Few people appreciate Richard Nixon like I do. A year ago I 
     had John McCain and his exciting campaign. Actually, I 
     suggest starting some sort (any sort) of rumor about one of 
     our current or former Washington luminaries. How about 
     something involving a randy act with one of the baby pandas 
     at the zoo? Root for the absurdities of another Ken Starr, 
     Bob Barr . . . the list is long.
       Sleep. With the permission of your doctor, have a supply of 
     sleeping pills on hand. I have always used Valium because it 
     has been around the longest. Because it is now off patent, it 
     is also cheap. I buy one large bottle every 10 years. I think 
     you said you like Ambien. Let me warn you that in the last 
     few years I have seen two people, although older than us, 
     become pretty goofy on Ambien. You might warn your wife about 
     your potential for goofiness, because it is a little hard to 
     assess on your own.
       Thinking. By the way, I am not sure most oncologists 
     realize the extent of it, but the anti-cancer drugs affect 
     one's cognition. The change is subtle and you will probably 
     be the only one who knows it has occurred. This is not the 
     time to expand your ideas on superstring theory.
       While in the hospital with the bone marrow transplant, I 
     received a great many medications. Just before they 
     discharged me, I had a fever of unknown origin and one night 
     became delirious. My wife and I are still arguing whether it 
     lasted for a few hours or may more. You know which side she 
     is on. My oncologist, who is generally pretty blunt, says he 
     was not there and has refused to get involved in the 
     discussion. In a more tactful manner than is usual for him, 
     he did say that such deliriums usually last for days or 
     weeks. The delirium did go away and has nothing to do with 
     the more subtle cognitive change mentioned above.
       Pain and enemas. I had some bone pain with the Hodgkin's 
     and used small amounts of codeine with aspirin. When the pain 
     was at its worst, I used Valium as well. My treatment last 
     year was fairly pain-free. The problem with opiates, which I 
     enjoy otherwise (do not pass up a shot of Demerol if you are 
     going to need a biopsy or surgery), is that they are 
     constipating. Do not allow yourself to get constipated. 
     Colace and sena work pretty well, but if you start getting 
     bottled up, enemas (yuck!) have worked well for me. Fleet's 
     or its generic equivalent has done the trick on a number of 
     occasions. It's probably a good idea to have several around 
     the house. Just don't leave them in the living room or where 
     the dog can get at them.
       Invisible shield. After chemotherapy, your chance of 
     developing shingles will be pretty high (assuming, of course, 
     that like most people our age, you have had chickenpox). 
     There are now several antiviral agents available which, if 
     started with the first symptoms, can greatly reduce the 
     amount you will suffer from this scourge. Unfortunately,

[[Page 10619]]

     by the time you recognize the symptoms, describe them to your 
     doctor, get a prescription, have that prescription approved 
     by your HMO or insurance company and get the drug at your 
     pharmacy, several days or more will have passed.
       Aware of this problem, I asked my physician to write a 
     prescription before the symptoms developed. My insurance 
     company has been fairly generous throughout my illness, but 
     it took more than two weeks for them to send the drug. It 
     came a week before my symptoms developed.
       If you want to know how worthwhile this exercise was, 
     consider this. When I had Hodgkin's disease, shingles got the 
     better of me for many weeks; it was on both sides of my body 
     and spread vertically across all my ribs. I still get pain in 
     these areas every winter when I go out into the cold. But 
     this time, just one rib was involved. And it itched more than 
     it hurt. I think I may be left with a small residual seven 
     months later, but it is trivial. I have read that adding 
     small doses of the antidepressant amitriptyline [Elavil] to 
     the antiviral agents helps prevent the post-shingles pain.
       The sporting life. To the degree you can, exercise. It may 
     not be possible at first. But as soon as you feel up to it, 
     give it a try, even if you only walk around the block. 
     (Believe me, the first time you complete this herculean task, 
     you will be very impressed with your physical prowess.)
       I still try to get on the treadmill every day, as I have 
     done most of my life, even if the workout isn't what you 
     would call herculean. The only time I missed it recently was 
     a two-week period last month when I contracted pneumonia and 
     hadn't yet responded to antibiotics.
       Before my latest cancer diagnosis, I got shoved out of bed 
     every morning to be at the gym by 6:15. Mostly, while there, 
     I was too out of breath and my pulse too rapid to do anything 
     but read the newspaper, but I got on the treadmill every day 
     even if I had to hold onto the rails for balance. I think the 
     balance problem is related to weakness, but it could also 
     have been the Drano.
       Cancer talk. This issue is one that may be left over from 
     our parents' generation. They did not talk much about cancer, 
     but I have always been willing to talk about mine. This is a 
     secret I did not want to try to keep. And just how do you 
     explain sudden baldness, needle tracks and a great imitation 
     of Casper the Ghost?
       Some of my best discussions have been in oncologists' 
     waiting rooms. There is almost always a wait, so there is 
     plenty of time to meet others going through more or less the 
     same thing. At least for me and my wife, the time spent in 
     oncologists' waiting rooms has been an unofficial form of 
     group therapy, and I have never met a person there I did not 
     like. It is rather remarkable how being in the same boat on a 
     rather rough sea pulls people together. I believe all those 
     studies that say that group psychotherapy improves the 
     survival time of patients with cancer. My experience is that 
     such therapy doesn't have to be formal; it develops 
     spontaneously.
       Spiritual issues. This has not been my strong suit, but 
     despite living in a somewhat cynical society, you and I both 
     have many friends who pray. For the most part they do so in 
     private. Few have Joseph Lieberman's exuberance. As you will 
     find out, however, when they perceive you need them, they let 
     you know they are there for you.
       And you will find that those friends who don't pray will 
     also find wonderful ways of encouraging you.
       One more thing. In case you have ever wondered why you got 
     married and had kids, this is it. This is your best chance 
     ever to get a lot of attention. Breakfast in bed is a good 
     start.
           Love,
     Richard.

                          ____________________