Dr. Timothy Mullett remembers when he first knew something was wrong. That something turned out to be stage 4 liver cancer.
The University of Kentucky surgery professor and lung cancer specialist was lying on a bunk in Afghanistan on Christmas Eve 2012. He is an Army Reserves surgeon also, and he periodically takes time off from UK to serve abroad.
He had recently lost 40 pounds and thought he was in great shape.
"I felt something move in my belly," said Mullett, 52. "I'd felt that before in other people, and it wasn't good."
For the first time, Mullett shared the fear and anxiety of the patients who arrive in his office with cancer of the lung, esophagus or chest, he said.
These days he tells some patients about his experience from stage 4 cancer to relative health, but "I don't want to offer false hope." His job is to combine empathy with realism, he said.
After a stop in Kuwait on Christmas Day in 2012, Mullett arrived in Fort Benning, Ga., where he saw the results of an ultrasound. He would later have a CAT scan and a biopsy to confirm the diagnosis, but when he saw the ultrasound, he knew things were bad. There were masses "too numerous to count" on his liver.
"I gasped at knowing what that could be: metastatic cancer," Mullett said.
He arrived home in Lexington on New Year's Eve with a burden of dread.
"If that was indeed metastatic cancer, I'd seen this go on for months, and the patient is gone," Mullett said.
Life suddenly seemed more finite.
Mullett had a liver biopsy on Jan. 2. On Jan. 4, he started a $9,000 a month pill regimen of a drug called Gleevec, which can shrink existing tumors that are inoperable or metastatic, slow down the spread of tumors and help stop tumors from recurring. It works by inhibiting abnormal cell growth.
Mullett has what is called GIST — gastrointestinal stromal tumors — tumors of the gastrointestinal tract, what he called "a relatively uncommon disease."
A PET scan showed a nine-centimeter mass in his liver.
The primary site of Mullett's cancer was in the intestine. The next PET scan and the ones after that showed a few small holes in the liver where the tumors used to be.
"I can only put this up to the progress made in targeted therapy," said Mullett who got his diagnosis and treatment at UK's Markey Cancer Center. The cancer center had the capacity to go from seeing abnormalities in his liver to diagnosis and therapy in just a week, he said.
"It's not just a tribute to the medication, but the system that we work in," he said.
Those diagnosed with GIST today have a much better chance at surviving the cancer over a five-year period than those diagnosed before 2000, according to the American Cancer Society. Someone diagnosed before 2000 who had cancer that had spread to the liver would have had a 13 percent survival rate over five years. With treatment advances, that has improved to 53 percent.
Mullett now appears exuberantly healthy and is running two miles at a time. He had back surgery to repair a slipped disc in late February.
Like many cancer patients, Mullett finds that his life has a definite break: Before he knew he was sick, and the life he forged after finding out.
And he has an enhanced sensitivity to what his patients are feeling — from the shock of the initial diagnosis to the concerns about what to tell family and friends to how to proceed.
The fear that gripped him when he first had back pain and leg pain earlier this year was from wondering if his cancer had spread again. Mullett said he now understands what his patients go through each time a new pain or symptom appears after their initial diagnosis.
Such fear never truly goes away, he has found.
Also, he now has a heightened understanding of what his patients endure: the survivor's persistent fear that every health scare, cough or stumble might be another cancer.
And he praises the Markey Cancer Center staff that he said takes extraordinary care not just of him, but all its patients.
"We are all trying to make sure patients get their answers as quickly as they can," he said.
Mark Evers, chief of the Markey Cancer Center, called it "a true inspiration" to see how Mullett has handled his battle with cancer, "which as any cancer patient knows, is an extremely tough and trying process.
"He hasn't missed a beat in his care and dedication to his many patients despite undergoing cancer treatments himself."
Mullett has been busier than ever, leading statewide efforts for lung cancer screening and clinical trials, and chairing the Cancer Committee at Markey in addition to his clinical work, Evers said.
Marti Mullett said the speed with which her husband was diagnosed and began treatment was whiplash-fast and, like her husband, she now looks at ailments through the possibility of their being a sign of cancer.
Because she's the wife of a cancer physician, she said, "He didn't have to explain to me what all this meant. I knew. I knew this outcome and what we were looking at."
Initially, she didn't even want to know what stage the cancer was, eventually relenting and allowing her husband to write it on a slip of paper and show it to her.
"It was precious that he got to walk our daughter down the aisle" in October, she said of daughter Kristy's wedding. The Mullets have another daughter, Casey, and a son, Will.
"I don't talk about it a whole lot," she said. "And interestingly enough, a lot of our friends don't know because it happened so quickly."