Source: www.mypalmbeachpost.com
Author: Daphne Duret – Palm Beach Post Staff Writer

A knock on a door stopped Richard Tendler mid-sentence. His back straightened almost instinctively in his chair, just as it has at the first sign of every verdict. Two decades as a criminal defense attorney in Palm Beach County have taught the 51-year-old West Palm Beach man to never predict how things will go.

“I’ve had cases I thought I won come back guilty,” Tendler had said hours earlier. “Then there were cases I was sure I lost, and the jury would come back not guilty.”

Another certainty: Tendler knew was that he would go home a free man that night, regardless of his client’s fate. This time was different.

Tendler was seated in an examination room at Moffitt Cancer Center in Tampa, where he is one of 10 patients in an exclusive clinical trial for cancer patients whom other doctors have told to prepare to die. Knocking on the door was Dr. Christine Chung, who is treating Tendler and nine others with an immunotherapy regimen as part of a trial that includes 500 patients in the U.S. and around the world.

Chung, the chief of head and neck oncology at Moffitt, was ready to deliver her own verdict — on the results of Tendler’s third six-week cycle. She greeted Tendler’s larger-than-usual entourage that day with polite handshakes and a tight smile.

After the first two cycles, she said, the treatments have cut in half the size of one lesion on Tendler’s lung and slightly shrunk another. A pair of smaller lesions on his liver remained the same size. That much was welcome — though it’s still early in the treatments.

Regardless of whether it’s good or bad news, Tendler has been here before.

By the time he first felt a lump in his throat in December 2015, Tendler was just several months past one of his most high-profile cases. It ended with what was widely considered a great plea deal allowing Boynton Beach mother Heather Hironimus to escape criminal charges for running away with her then-4-year-old son to prevent his father from having him circumcised.

His previous cases ranged from the most tragic to the most bizarre, earning Tendler a reputation as a survivor of the grueling grind of private practice. Among his clients: People involved in deadly car wrecks, a university gunman in the wake of another college shooting, and a teenager charged with killing a goose.

Comforting his mother
Two weeks before Tendler discovered the lump in his throat, he had consoled his mother, Sonia, through a doctor’s tragic prognosis giving her just two months more to live with end-stage pancreatic cancer.

Her sister, his aunt Vera Muller, noticed the lump when he came to visit his mother at her Miami apartment.

“I said, ‘Oh, my God, Richard’ and he said ‘Shhh!’” she said before Tendler’s visit to Moffitt last month, putting her finger to her lips to mimic the gesture her nephew made back then. “He didn’t want his mother to worry.”

Doctors by then had confirmed Tendler’s suspicion. The lump was cancer, brought on by an illness Tendler didn’t know he, too, would soon be diagnosed with.

According to the Centers for Disease Control and Prevention, 79 million Americans had been infected with human papillomavirus, or HPV, as of last year. With 200 strains, most of which carry no symptoms and go away on their own, HPV is the most common sexually transmitted infection in the nation.

The strain Tendler contracted at some point in his life was the rare variety that caused his cancer, his doctors informed him. Although there now exists a vaccine for the virus that is recommended for teenage girls and boys alike, no such prevention existed when Tendler was growing up.

On Jan. 25, 2016, Tendler’s 49th birthday, he underwent a nine-hour surgery to remove the cancer from his throat. He had to be on a feeding tube for a month and recovered at his mother’s Miami apartment, with aunt Vera playing nurse to both her sister and her nephew.

Now 75, and moving to South Florida from Tendler’s native Venezuela, Vera Muller remembers her sister died six weeks into Tendler’s recovery. She was 68.

With his grief still fresh, Tendler then went through a grueling round of radiation and chemotherapy, which required him to live on the feeding tube for another four months.

“It was worse than the surgery,” Tendler remembered. “I couldn’t drink water. I couldn’t even swallow a pill.”

Three months later, Tendler returned to the courthouse much thinner and scarred from his surgery, but cancer-free according to his tests. His doctor reassured him that the worst was behind him.

“He told me ‘I’ve never had one come back,’” Tendler remembers.

His did.

In May 2017, doctors noticed a spot on his chest, and eventually discovered three cancerous lesions on his liver. The cancer had spread, or metastasized, the doctors told him.

Tendler remembers one oncologist telling him he only had months to live. The doctor suggested, matter-of-factly, that he prepare for his death.

“That oncologist talked to me like a piece of dirt,” Tendler said.

He visited several others, and although they were more gentle in their delivery, their news was largely the same. The sentence for the defense attorney was death, they told him, and it would be coming soon.

A doctor offers cautious hope
That summer, Tendler visited Chung at Moffitt. Having immigrated to the United States from Korea with her single mother and two brothers as a child, Chung went to medical school and decided she wanted to be an oncologist.

Tendler and Chung soon learned that, while in different professions, they shared similar views and experiences. Like Tendler’s clients, Chung’s patients are a varied group, including former smokers and people like Tendler, who contracted throat cancer from a rare strain of HPV. The common denominator: They all have a right to treatment.

“None of us is guaranteed good health tomorrow. It is a gift,” Chung said.

Tendler, like most criminal defense attorneys, believes every person accused of a crime, no matter how heinous, is entitled to a fair and just journey through the legal system.

Chung received grants from a pair of foundations that paid off all her medical school loans, a fact she says makes her believe her work is to serve the public. Tendler, who started his career as a public defender, understands.

And with Chung, he found not just an advocate for his life but a doctor who Tendler said was the first to really treat him like a human being. Tendler says her presence in his life tops the list of blessings he makes a habit of thanking God for daily.

Chung told him they would fight the three lesions with CT ablation, a form of targeted radiation that successfully obliterated the three spots. But soon afterward, two more lesions appeared on his liver, and another pair of cancer lesions were now in his lungs.

Chung is clear, both in her conversations with Tendler and in an interview on the day he receives his test results, that there is currently no cure for Tendler’s cancer. She calls the current clinical trial a form of palliative care, meant to reduce the cancer’s severity and alleviate Tendler’s symptoms in hopes of keeping him healthy long enough for researchers to find a cure.

The clinical trial, sponsored by Bristol-Myers Squibb, is a blind study in a treatment that involves immunotherapy, a process that stimulates parts of the patient’s own immune system to fight the cancer.

All patients in the study receive doses of the immunotherapy agent Nivolumab. Two-thirds of the patients also receive a second drug, and the others receive a placebo.

No one — not even Chung — knows which patients are receiving the second agent, a secret she says is vital to the research to see if the two agents together work better than the single Nivolumab treatment alone.

Tendler’s lesions are not as severe as some of her other patients, Chung says, and after two cycles, the results are promising.

Although he is on pain medication, his treatment has been a breeze compared to his radiation, he said. And the fight for his life has brought with it an unanticipated life lesson.

Tendler, who for 20 years poured his life into his work, is learning how to celebrate.

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