This post was written by Courtney Leach, social media manager, Parkview Health.
At 7 a.m., Bogna Brzezinska, MD, settled in next to me for the Gynecologic Oncology (GYN/ONC) Tumor Board. The other two surgeons who represent the cancer site, Christina Duncan-Lothamer, DO, and Anya Menzies, MD, also attended the meeting along with additional key care team members, all there to review current cases and offer recommendations from a multidisciplinary perspective.
The physicians, who specialize in endometrial, cervical, ovarian, uterine, vaginal and vulvar cancers, took turns presenting their cases. “Patient was seen for vaginal bleeding in the ER,” Dr. Brzezinska began, before going into the individual’s medical history and any unique considerations. “Let’s look at imaging, please.”
Dr. Jeffery Birne then projected ultrasounds and CT scans. As he talked, he moved the mouse, manipulating the visuals on the large screen at the front of the room, and the smaller screens at our table. He scrolled and clicked, and the anatomy shifted and bloomed in inky, black-and-white scenes, until a mass appeared like a ghost, pale and menacing. Next, Dr. Hassan Arekemase did the same with pathology, walking through, what looked to my untrained eye, to be coral or fingerprints, but were in fact, clusters of cells cast in a purple hue. Clues from the growing and dividing matter in question.
Armed with the latest information, various parties then weighed in on facets of care, including the medication regimen, genetic counseling or therapies, clinical trials, palliative care and nutrition. Dr. Brzezinska shared her recommended course of treatment and asked if everyone agreed.
This detailed exchange of information was repeated for each patient on the list that day. Physicians mentioned things they’d employed to treat other patients, other victories, hoping it would perhaps lead to more wins for others.
Rendezvous with a robot
Once Tumor Board was complete, it was surgery time for Dr. Brzezinska. The three surgeons are in the operating room (OR) on different days, except Fridays, when both Dr. Menzies and Dr. Brzezinska do procedures. We stopped in to check on the patient, who would be undergoing a minimally invasive hysterectomy to stage and treat endometrial cancer. After answering questions, Dr. Brzezinska reviewed the recovery instructions, which included some lifting restrictions, over-the-counter pain medication and no intercourse for six weeks.
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In the locker room, as I pulled on the soft royal blue scrubs, I learned that Dr. Brzezinska, who is originally from Columbus, Ohio, didn’t follow a straight line to healthcare. “At first, I wanted to be an engineer,” she told me. “Then I leaned toward biological anthropology. I wanted to study lemurs in Madagascar, but then I pivoted to medicine. When it came time to choose a specialty, I felt like we needed more women in women’s health. It’s hard for females to open up about their symptoms, their anatomy, their sexual health. Particularly older generations, where we see this idea of ‘don’t look, don’t touch.’ I wanted to be an outlet for women, where they felt safe.”
While many residents who enjoy the obstetrics and gynecology (OB/GYN) rotation go into labor and delivery, Dr. Brzezinska wanted something different. “I also loved operating,” she said. “But, often, you’d see a trauma case, and then never know what happened. When I discovered GYN/ONC, it had everything I wanted. I get to operate and be in women’s health, but our patients, ideally, stay with us for a long time. Through surveillance up until they graduate. Of course, sometimes we see them through the end of their life. It’s a very special relationship.” She completed her gynecologic oncology fellowship in Augusta, Georgia, and joined Parkview in 2023.
Around 8 a.m., we entered the OR, where the team, including Stephanie Anthony, CSFA, CST, who serves as first-assist to all three of the surgeons, were circled around the patient on the operating table. Dr. Brzezinska walked over and put her hand on the woman’s knee, teetering her thumb ever so slightly to soothe. “We’re going to take good care of you,” Stephanie assured, as the patient drifted off under the group’s empathetic gazes and anesthesia.
The team then gathered for time-out, where they reviewed the procedure, the patient’s allergies and any particulars pertinent to the case. At 8:15, expert hands made the initial incisions that would serve as access points for the da Vinci surgical system. “I’m ready for the robot, please,” Dr. Brzezinska said. The machine was brought to the table and the arms, consisting of motors and cables that control the instrument tips inside the patient, were lowered to begin.
Dr. Brzezinska took her seat at the surgeon’s console, where she would pick up the highly responsive controls and camera. I was able to sit at an observer’s console to experience the magnified view. The surgeon later told me, “Robotic surgeries offer different tactile feedback. It takes practice, but ultimately, you get more dexterity with the robot, like 360° rotation and the ability to change angles, compared to traditional straight instruments.” The doctors use pre-op imaging to guide them, so there aren’t many surprises. This also ensures they pursue the best method. “We make decisions about the procedure based on a number of criteria,” Dr. Brzezinska said. “If it’s a bigger mass, for example, we might need to do an open surgery, versus robotic.”
Through my view, I watched the metal instruments, one bipolar device, which could clamp and cauterize and another to cauterize cut (hot scissors), come to life.
As part of the procedure, indocyanine green dye was injected to map the sentinel lymph nodes for biopsy. “The goal is to learn if there are suspicious cells spread beyond the initial area of concern, in this instance, the uterus,” the surgeon explained. Dr. Brzezinska would occasionally flip the camera to Firefly Mode, swapping the soft pink view for black and white, akin to night vision goggles, making it easy to identify any glowing spots (suspicious cells). It felt like mining for bioluminescent matter in a cavern at the bottom of the ocean. Dr. Brzezinska would then use her instruments to extract the lymphatic tissue before collecting it in a small blue “bucket,” comparable to the tip of a surgical glove. Once the tiny container was filled with lymph nodes, it was removed and placed on a tray next to the operating table. Another bucket was inserted, if needed. I pulled my gaze from the console and saw one, brimming with critical pathological data.
Dr. Brzezinska outlined that she would address the concern via hysterectomy, collect what was needed to biopsy and then restore the patient’s normal anatomy. With her metallic extremities, an extension of her skilled hands, she moved throughout the area, pointing out notable landmarks like the tiny ureter, the bladder and the uterus. The view was otherworldly, a trip on the Magic School Bus, over organs and across bumpy lymphatic tissue. Through the speakers in my console, she introduced me to the obturator nerve, a thick white tube that serves as an anatomical marker and border. She knew the territory so well, and I was an awe-struck onlooker.
Working meticulously, the surgeon stripped and severed the fallopian tubes and ductwork connecting the uterus, respectfully avoiding arteries and working to minimize bleeding by cauterizing as she went. The process is truly a marriage of innovation and training, machinery and medicine. The communication between Dr. Brzezinska at the console and the team members at the table was constant and paramount.
With life-giving arteries pulsing in the background, the surgeon moved about, first burning tissue, the singe initiating a subtle plume of smoke, then a black receipt of char, followed by a smooth cut, freeing the material from its infrastructure. After nearly an hour of this delicate smoke and severing, a brilliant blue line appeared. “That’s the uterine manipulator I inserted as a guide,” Dr. Brzezinska explained. The uterus was amputated, removed through the vagina and suddenly out of my magnified view.
From her spot at the operating table, Stephanie irrigated and flushed the area, then inserted a suture and slightly barbed thread that Dr. Brzezinska used to begin sewing – pulling the tissue back together, restoring the natural anatomy. As a final step, the surgeon packed a hemostatic agent, which looked similar to gauze, in the area. She called it her security blanket, because “it tucks everything in so nicely.”
“OK, we’re done!” Dr. Brzezinska said. She thanked the team and moved to the computer to begin charting, while Stephanie and team closed the patient. The da Vinci was rolled back against the wall, cleaned and powered down.
We met the patient’s partner in the post-op waiting room, and she assured him everything went well. They would go over the pathology at her next appointment and share Tumor Board recommendations.
The surgeon, who does around four procedures on her two designated surgery days, had learned earlier that her second surgery for the day was cancelled. The patient had been admitted after an ER visit the day prior. I pulled on my Parkview polo and followed Dr. Brzezinska up to the clinic.
Clinic + Camaraderie
With lingering surgical mask lines across my cheeks, I was handed off to Dr. Duncan-Lothamer. With more than five years at Parkview Packnett Family Cancer Institute (PFCI) on her resume, Dr. Duncan-Lothamer serves as medical director for the GYN/ONC tumor site, meeting regularly with Alan Yahanda, MD, FACS, the president of PFCI, in addition to her two OR and three clinic days.
“We treat all gynecologic cancers below the diaphragm,” she told me. “Even tumors found at pregnancy. We see a new patient through surgery, follow-up, chemotherapy and radiation, and surveillance. It’s long-term patient care.”
With a scribe and two nurses, I followed Dr. Duncan-Lothamer in for a surveillance appointment. Together, they reviewed the imaging. “The CT scans looked very reassuring,” she said. She then asked the patient a series of questions. “Any lumps or bumps? Bowel movements OK? Urinating? Are you sexually active? Any pain there? Any other pain? Any itching?” She then performed a physical exam, talking to the patient throughout to help her relax. “Feel my touch,” she said. Then, “Good, everything feels OK. We’re going to take good care of you.”
Dr. Duncan-Lothamer, who is from Georgia, did her undergraduate education in California, medical school in Colorado and residency in Michigan, where she met her husband, who’s from Fort Wayne. “I was previously in the ICU, and I loved the patient complexity,” she told me. “I also loved my general surgery rotation. I was having a hard time choosing between obstetrics/gynecology and general surgery.” Clarity came during her Internal Medicine rotation. “They put me on a case with the Labor and Delivery secretary’s sister, who had cancer and wasn’t doing well. She asked me to please, find a cure. I always think about her.” Now, years into her specialty, she hasn’t looked back. “You have to love what you’re doing to have a career like this, and GYN/ONC gives me the complexity I like, with the continuity of following patients.”
When I asked her about the challenges of the role, the answer came quickly. “A patient is always going to remember who told them they have cancer, and that’s a huge responsibility. You go into one room and give good news, then you go into another and deliver bad news. Then, you have no time to process before you go into the next room and give good news. It’s draining and rewarding and incredibly hard.” What does she do to get through those challenging shifts? “I go home and hug my husband. Faith, also, is important.”
Dr. Duncan-Lothamer gives a lot of thought to how to show love to the women who pass through their clinic. The mother of two young children shared that, “As a woman, it’s easy to relate. I just think, if it were me or my loved one, how would I want them to be treated?”
There are many nuances to gynecologic care, but Dr. Duncan-Lothamer and the rest of the team are working to dismantle some of the challenges that impede on early intervention. The sooner a patient gets their diagnosis, the better. This is why screenings and knowing your body are so critical. “A lot of women don’t know, bloating is a sign of ovarian cancer. Vaginal bleeding, especially after menopause is a symptom of endometrial cancer. Cervical cancer can be caught with a Pap test. We see so many patients who stop getting pelvic exams, develop an itch and get large vulvar lesions. That’s why regular checkups and paying attention to symptoms are so important.”
Of course, after the diagnosis, after the intervention, many patients transition into surveillance. I observed two appointments where Dr. Duncan-Lothamer’s patients moved from appointments every three months, to the two-year mark, where they are seen every six months. Cause for celebration! “Unless there’s a problem,” she was quick to say. “I’m here if you need me.”
What surprised me perhaps most was the range of medical concerns patients brought to Dr. Duncan-Lothamer. Pulmonary setbacks and hernias came up more than once. She listened and offered guidance, referrals and recommendations. “Everyone here has the common goal of providing excellent care,” she said.
Part of that is a commitment to getting the right team members in place. Over the last six months, the surgeons have focused on building up their practice. “Myself, Dr. Menzies and Dr. Brzezinska share a vision for camaraderie. We care for our patients in similar ways, and all agree that when things are happy here, people go home happier. And that goes for everyone. We’re stronger doctors, together. And we’re even stronger with this team.”
Currently, this includes the three surgeons, one ambulatory pharmacist, two navigators, one rounding nurse, six medical assistants, two clinic nurses, three chemotherapy nurses, two surgical nurses, and, as of the day of my interview, two nurse practitioners. Mary Knotts, NP, who has medical oncology experience and will be dedicated to chemotherapy needs, and Kayleigh Carr, NP, previously a surgical nurse, who will assist with surveillance appointments after the two-year milestone.
Her staunch commitment to creating relationships and an exceptional patient experience was best illustrated during my final clinic visit with Dr. Duncan-Lothamer. She was seeing a playful character, getting ready to graduate into the next phase of surveillance. I was charmed by her sharp wit and breezy attitude, but, as the check-up went on, I noticed that, under the patient’s humor, there was a lingering fear.
She finally expressed it. “I’m scared it’s going to come back somewhere else,” the woman said of her cancer.
“That’s why you see me,” Dr. Duncan-Lothamer eased. “It usually comes back within the first two years, and you’re almost there.”
“I’m so happy you caught it so fast, honey.”
Guides for the journey
One topic that came up quite a bit was the role of stigma and secrecy in the gynecological space. “We’re dealing with intimate anatomy and cancer,” Dr. Duncan-Lothamer told me. “We are constantly seeking ways to make that lighter.”
It begins with normalizing conversation around female health, and Denise Glasser, care navigator, has a hand in that. As a sex therapist, Denise is keenly equipped to help women facing uncertainty about changes to their bodies. “Sexuality and intimacy are everyday quality of life issues,” Denise said. “The best thing we can do is talk about them as such.”
This includes addressing concerns around sexual function and dysfunction. “I remember we had a young patient who was really struggling with some of the changes following her treatment,” Dr. Duncan-Lothamer shared. “And Denise showed her photos of vulvas, and explained to her how it’s normal for women to look different.”
In addition to the psychologic and emotional aspects of a gynecologic cancer diagnosis, Caylin Boles, OCN, nurse navigator, is on hand to help traverse any clinical questions. “It varies based on the patient’s journey,” Caylin explained. “If they’re having side effects from chemotherapy, hair loss, struggling with their identity, I am there to help with all of that.”
The navigators come in at the end of the patients’ appointments, often after they’ve seen multiple providers, from the doctor to palliative care, and they review the visit summary. “A lot of what we do is repeating back what they’ve already heard, making sure they understand. We want them to feel safe asking questions,” Denise said. “Often, they call in for clarification, and we’re always here to help.”
I was learning that all roads led back to treating the whole person. “This clinic is a safe space. We work to break barriers and facilitate conversation,” Denise said. “We have women who live alone, maybe they’re widowed, and they face challenges getting here. Maybe they need help securing food. Women are proud and they want to be independent. We make sure the patient feels heard and their concerns are expressed. Our goal is to remove any obstacles so they can focus on getting better.”
Rounding out the afternoon
Around 12:40, Taylor Palmer, RN, rounding nurse, came to invite me on rounds with her and Dr. Menzies, something each surgeon does for a seven-day stretch.
Dr. Menzies came to the United States from Ukraine in 1992. “My parents wanted more opportunity,” she explained, as we crossed the sun-bathed hallway connecting PFCI to Parkview Regional Medical Center (PRMC). A long-time Fort Wayne resident, she attended the University of Saint Francis for her undergrad.
Taylor, the only team member dedicated to inpatient care, including pre- and post-op cases and those admitted through the ER, is on site Monday through Friday. She often sees patients in the morning, briefs the doctor on rounds and then joins them for a second visit in the afternoon. She can help order labs, communicate within multidisciplinary teams and make sure the provider has all the information they need before seeing the patient.
Our first stop was Dr. Brzezinska’s other surgical patient for the day, who was admitted for an infection after coming into the ER. Dr. Menzies did a gentle evaluation before informing the patient that the procedure would need to be delayed. “Your health and safety are our top priority,” she said. Before she left, she made sure to inquire, “Is there anything we can do for you? Anything you need?”
As we briskly navigated the turns and secure doors of PRMC, Dr. Menzies explained that the scope of cases the GYN/ONC surgeons respond to when on call is wide, as gynecologic oncologists do surgeries for patients with known malignancies as well as those with complex pelvic problems. The team could be called for obstetric cases such as a delivery that requires a hysterectomy or a patient with gynecologic complications. “I might go see someone who just had a baby and is doing well and then a woman in hospice care,” Dr. Menzies explained. “It’s really full spectrum in this role.”
The second patient was on the first floor, just off the ER. Dr. Menzies first stopped to consult with the hospitalist outside the patient’s room. “I brought the equipment to do a biopsy at bedside,” she explained, “but we’ll see what the patient wants.”
This was the guidepost Dr. Menzies used throughout her time in the woman’s room. She stood beside her, asking questions, gathering a thorough recount of the patient’s medical history. She explained why she was there, what she saw in the imaging, and what it could mean. “I don’t have any big answers right now, but I would like to do some tests and see if we can learn more. But, at the end of the day, you’re the boss,” she said.
“Do what you need to do, hon,” the patient said.
Taylor and Dr. Menzies set up, walking the woman through the steps. They positioned her and worked together to gather the sample they needed for the biopsy. “You OK?” they kept asking. Taylor told her to wiggle her toes, keep breathing. Women supporting women.
The procedure isn’t comfortable, but it’s a necessary step for evaluating the potential presence of cancer cells. “All done,” Dr. Menzies said, sensing the patient was nearing her threshold. “I’m sorry, I didn’t want to cause you any pain.” She then explained the particulars of the procedure that made it unpleasant, offering the answers she did have. Empowering her through education, as I was quickly learning Dr. Menzies so often did.
We had to head back to the clinic, where she had three patients to see, and one already checked in.
Like her colleagues, Dr. Menzies credits the balance of surgical intervention and relationships for her devotion to the specialty. “We’re shepherding them through this journey,” she said. “I love operating, but the continuity of following these patients and getting to know them, their family and their values, is so special. Sometimes we are walking them toward the end, but I see that as an honor.”
She did both her residency and minimally invasive surgery fellowship at Stony Brook University Hospital in New York, then her gynecologic oncology fellowship at Wake Forest, before returning to Fort Wayne. “We have a good balance between surgery, rounding and clinic,” she said. “And because we do both chemotherapy and surgery, we see a broad range of cases. There’s always something new and challenging.”
In her office, which she shares with Dr. Duncan-Lothamer, she pulled up the imaging for her next case. “Some things are hard to tell on a CT scan, so at times, an ultrasound is preferred,” she explained over her shoulder, inviting the nurses as well to come in for a better look. She pointed to the mass in question. “If it’s a simple cyst, it looks hollow and not too concerning, but when we start to see nodules, it could be something different. We want to be very careful not to have it rupture.”
The patient, a younger woman, had had an endometrial ablation, a procedure in which targeted tissue is burned to try and minimize excessive menstrual bleeding. “The problem is,” Dr. Menzies said, “they don’t always last.” The patient was now experiencing pain with bleeding tied to ovulation in addition to the cyst.
Once in the woman’s room, Dr. Menzies asked her a series of questions. “Have you noticed any changes to your weight? Do you have a family history of cancer? Any pain with intercourse?” With each new piece of information, the doctor seemed to be calculating, weighing probabilities and potential outcomes.
After the discussion, the team left so the patient could disrobe for an exam. Once complete, Dr. Menzies told her, “I’m going to come back and we’re going to put all the pieces together.” As the door shut behind us, she told me that she likes to let patients get dressed before they review next steps. “It’s what I would want. I think it helps them feel more comfortable.”
She then went over the patient’s most recent lab work and imaging with her, before moving into her treatment options, from a very conservative approach (repeat imaging in several months) to a more aggressive one (minimally invasive hysterectomy). Dr. Menzies doesn’t take her recommendations lightly, factoring in variables like whether the patient will want reproductive-sparing measures, any complications they might experience down the road, quality of life and pain. “I want you to know your options. Ideally, it’s shared decision-making.”
She explained that, if the patient pursued a hysterectomy, she would have pathology take a look at the mass immediately and proceed with the new information she had. Dr. Menzies shared that she didn’t want to take the young woman’s other ovary if she didn’t have to, as that would send her into menopause. “Common things being common, we won’t have to worry about that, but there are zebras, and I want you to have all the information in making your decision.” The patient was swift in arriving at her choice: a hysterectomy. Decision made, Dr. Menzies explained that the procedure wouldn’t impact sexual function, she’d be feeling better in 2-3 weeks and back to herself in 4-6 weeks. Rhonda Lindner, RN, surgery nurse, came in with release forms and to schedule the procedure.
When I commented on her thoroughness, she told me, “I don’t do it to cause worry or panic, but to minimize surprises. Sometimes it takes me longer, but I want to walk them through things carefully and offer my counseling.”
Around 2:30, we saw her final patient for the day, a woman who would be having a biopsy, the same procedure I saw Dr. Menzies perform bedside earlier. She was helping the patient, who also had several complicated health considerations, manage endometrial hyperplasia with hormonal treatment, an IUD placed months before. This was combined with positive lifestyle changes, like weight loss and smoking cessation.
I would be ending in a room with good news. “We’re seeing it shrink,” Dr. Menzies said. “If it grows or gets worse, of course, we’ll reevaluate, but otherwise, we keep going.” They retrieved the cells, Dr. Menzies working carefully, so as not to dislodge the IUD. “A little pinch,” she explained, “and some cramping. OK, we’re all done. You may experience some spotting. You’re doing great. Keep it up.”
Dedicated pharmaceutical support
Before I left, I sat down with Benjamin Allen, PharmD, one of five ambulatory pharmacists at PFCI. He’s been with the team since November 2023, as the primary pharmacist for GYN/ONC.
While the physicians and other care team members interact with patients, Benjamin attends Tumor Board, follows treatment plans and serves as an extra set of eyes to monitor the patients’ progress, all behind-the-scenes. “I ensure recommendations are in line with evidence-based medicine,” he explained. If something needs adjusted or fixed based on tolerance, Benjamin can assist.
He works with all members of the care team, including the nurse navigator, Caylin. “I make sure the patient’s a good candidate for the treatment. If a patient is back with a recurrence, I look at how they tolerated the treatment last time, or if it needs altered. I get feedback about how they’re feeling and see if we can change a medication, dose or frequency, or add in supportive care medications, based on their response.”
This level of specialized pharmacological attention is a huge differentiator. “I’m working off the facts. Leadership invested in us because this approach to care is incredibly effective. As fast as oncology medications change, making sure you’re tailoring plans to the patient and the guidelines is key.”
There are also times when Benjamin assists with non-cancer diagnoses. “Dr. Brzezinska, for example, had a patient with an infection today,” he shared. “And I made recommendations for antibiotics. Because my physicians are surgeons as well, we see more varied needs.”
Benjamin explained how unique the collaborative nature of the GYN/ONC team is. “Because they’re surgeons first and foremost, our doctors are out of clinic a lot. There are even times they might need an extra set of hands and work a case together. So, the team is set up so that nothing falls through the cracks. They talk about their cases, see each other’s patients if they’re inpatient. Really, we’re all up to speed so we can help. It’s a special situation. Everyone has the support they need.”
Learn more
For those navigating a gynecologic cancer diagnosis, the team at Parkview Packnett Family Cancer Institute has found an ideal approach in the tension between compassionate, patient-focused care, and the latest innovations and techniques. They marry the skills necessary for thoughtful intervention, with the resources necessary to support the whole person, every step of the way.
To connect with someone regarding any gynecological cancer questions or concerns, including a request for a second opinion, call 833-724-8326.
