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AGR-feature

On the Other Side of the Stethoscope

Alyssa G. Rieber, MD

By the time she graduated from Muscle Shoals High School, Alyssa Rieber, MD, knew she wanted to be a physician. What she didn’t know was that the path to realizing her dream would find her on the other side of the stethoscope.

The second of Dr. and Mrs. Michael Gosney’s three children, Dr. Rieber always excelled in her classes, despite having attended six schools by the time she began fifth grade.  “Alyssa and her sister were growing up while I was in medical school, residency and early practice,” Dr. Gosney recalled. “Looking back, I am amazed at the amount of change that our family accepted and survived.”

The high school class valedictorian, Dr. Rieber was also a National Merit Semi-Finalist and scored exceptionally well on the ACT, factors that could allow her to participate in an early acceptance program  offered by the medical schools of the University of Alabama at Birmingham (UAB) and the University of South Alabama (USA). If students accepted into the program maintained a certain grade point average and completed their undergraduate studies at either of these universities, they were guaranteed acceptance into that

institution’s medical school. While the prospect of guaranteed acceptance was tempting, Dr. Rieber chose not to enroll in the program and attended Vanderbilt University on an academic scholarship instead. “Her decision to turn the program down was difficult for me to accept,” Dr. Gosney said. “I knew that she could have a hard time because acceptance into medical school is not a guarantee.” When asked about discussing this decision with her father, Dr. Rieber said with a laugh, “I had forgotten all about that, but I bet his checkbook remembers it quite clearly!” Despite his initial reservations, Dr. Gosney admired his daughter’s determination. “Alyssa said she wanted to be a physician and if it was meant to be, it would all work out. She believed.”

Graduating cum laude from Vanderbilt University in 1997 with a degree in molecular biology, Dr. Rieber interviewed at several medical schools, including UAB and USA. Upon finding out she was waitlisted at UAB, Dr. Rieber planned to get her Master’s degree in Public Health through UAB’s Alabama Rural Medical Student Program. Those plans changed when she learned she had been accepted into medical school at UAB, and it was just a few months into her first year of medical school that Dr. Rieber’s life took an unexpected turn that helped her become the physician she is today.

It is not surprising for medical students to convince themselves they are suffering from the diseases they study. “For every rotation, you needed a day off to see a specialist to make sure you didn’t have that disease,” Dr. Rieber joked. However, it was not funny when she discovered a swollen lymph node between her neck and shoulder. “This was actually my first encounter with something that was palpable,” she said. “Always before, you hear about something and think, ‘Oh my goodness, I have that,’ but this was something I could actually feel that was not normal and it was a little bit concerning.” So much so that Dr. Rieber asked faculty members and friends to feel the lymph node and even had it evaluated. When the evaluation indicated everything was normal, Dr. Rieber planned to take a “wait and see” approach; however, her father insisted she come home to Muscle Shoals for further testing. And just a few days later, those tests revealed Hodgkin’s lymphoma.

As difficult as it was to hear she had cancer, Dr. Rieber faced what she considered a far more daunting challenge – the prospect of not being able to stay in school while undergoing treatment. “I was only three months into medical school and I was thinking about all of the hard work I had put in,” she recalled. “While it was ‘just’ three months, I thought, ‘I am NOT doing this again. This is my dream and this is my life.’” And because this was her dream, Dr. Rieber did stay in school, receiving her treatment at UAB with Peter Emanuel, MD. Of her time undergoing chemotherapy and radiation, “The school was very generous and the leadership, especially the Associate Dean for Students Kathleen Nelson, MD, the instructors and the professors were all so understanding and accommodating,” Dr. Rieber said. And while she was able to attend most of her classes, she did miss occasionally due to evaluations and chemotherapy, and was hospitalized twice, suffering from the effects of treatment, including low blood counts, fevers and tachycardia due to low hemoglobin. “My counts were low and I had actually gotten on a plane and travelled to visit my sister,” she recalled of one hospital stay. “Whenever you’re young, you don’t think about the implications of things. I just wanted to keep going to school, to keep living. That’s what you are supposed to do as a 21- or 22-year old.”

In remission, Dr. Rieber completed treatment in the spring of 1998 and it was through her own experience and meeting fellow patients in the waiting room that she realized her future was in oncology. “I am a Christian and I firmly believe that everything happens for a reason, whether you understand it at the time or not,” she said. “I completely understood what patients and their families are going through on an emotional level and then it also became more about wanting to understand it scientifically.”

Graduating in 2001, Dr. Rieber was named “outstanding female medical student” by her classmates and following her internal medicine residency at Baylor College of Medicine in Houston, she was accepted into the medical oncology and hematology fellowship programs at the University of Texas MD Anderson Hospital. During her fellowship, Dr. Rieber completed a two-year continuity clinic at LBJ Hospital and as Chief Fellow for LBJ her third year, she was able to perform extensive hands-on clinic administration. “I loved the patients there and it was through this experience that I knew I wanted to continue my work with the county population,” she said.

Today, Dr. Rieber is Assistant Professor in the Department of General Oncology in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center in Houston. She is also the Director of the Lyndon B. Johnson (LBJ) Hospital Medical Oncology Service, overseeing its clinical and research components. The service provides care to the low income, minority and underserved residents of Houston’s Harris County. Staffed with 18 fellows, 4 core faculty members, as well as 8-9 adjunct faculty members, the Medical Oncology clinic treats approximately 50 new patients per month and has about 6,000 return visits per year. In addition, there is also a weekly survivorship clinic which Dr. Rieber herself runs. This clinic serves as a valuable resource for the health, psychosocial, and even physical residual aspects affecting patients who are further out of treatment. “I really love the survivorship clinic,” she said. “It is so very important for patients to have a place to go, and having someone to call is very helpful to them.” Currently pursuing grant opportunities, Dr. Rieber hopes additional funding will allow the clinic to increase the services it provides and offer an even stronger infrastructure for the program.

Being there for her patients is a main priority for Dr. Rieber. “I cry with them and the one thing I am able to do when I give them a diagnosis is empathize,” she said. And with empathy comes creditability. “Because I can explain what it’s like to be that sick, to know what it is to be anemic, to have neutropenic fevers, I can, with some authority, say, ‘You’re going to have some bad days and you’re going to have some good days. It’s okay to have a bad day but it’s not okay to have a bad day every day.’” She also stresses the importance of having a positive outlook. “I tell them, ‘I went through chemo, too, and look at me – my hair grew back and I am married and have two beautiful children.’”

Not only can Dr. Rieber relate to what her patients experience from the treatment perspective, but she also understands that feelings of uncertainty linger, even when treatment is complete. “There is absolutely a feeling of paranoia and is ‘a cold just a cold?’, but moving forward comes with time and I think every year it gets easier,” she said. But with time comes the need to remain aware of the effects of treatment. “Even with the training and knowledge I have, I do still struggle because I know I have a higher risk of secondary cancers, including breast cancer, and that means I have screenings every six months,” Dr. Rieber explained. “I don’t know that the feeling ever completely goes away, but the ability to control it comes with time.”

As Dr. Rieber can attest, cancer is something not to be taken lightly, but sometimes it can’t be taken too seriously, either.  “Humor is so very important,” she stressed. And through her own experience, she provides patients with the honesty and laughter that come with treatment effects such as hair loss and lack of seasonal allergies. “For me, it was actually easier not to have hair,” she recalled. “I didn’t have to shave my arms and legs! And because my immune system was shot, I didn’t have allergies during treatment. These were wonderful things to me!” Even with a strong sense of humor, Dr. Rieber admits that she is a “softie” and cries every day at work. “Part of that is coping,” she said. “I was emotional before, but sometimes I am an absolute wreck.” And it is through these emotions, that humor again finds itself in the strangest of places. “Since I cry, I buy the tissue for the clinic because I didn’t think it was good enough,” Dr. Rieber confessed with a laugh. “I am a high-volume tissue user and what we had was awful!” And to make sure the “good stuff” doesn’t disappear? “We write ‘Oncology Clinic’ on our boxes of tissue so other staff will feel guilty if they take it!”

Through modern medicine, laughter and tears, Dr. Alyssa Rieber offers her patients exceptional medical care, as well as a unique and compassionate perspective that comes only with having travelled down the same road. “I really enjoy what I do and try to share my experience as a positive story, she said. “There is absolutely always hope.”