On Nov. 4, Dr. Terry-Nan Tannenbaum stood before a packed house at McGill University, the last speaker at a forum called Fighting Cancer with Knowledge and Hope. A public health physician, she had led the battle in Montreal against superbugs and other afflictions such as SARS, tuberculosis and HIV infection, but this time she was not speaking as a professional. Rather, she was giving her own testimonial – at once courageous, passionate and a little bit angry – as a woman diagnosed with terminal lung cancer.
Whenever she told people she had lung cancer, the inevitable response was, "But you don't smoke," as if only smokers ever contracted the disease, she told the audience. Unspoken was the judgmental subtext that smokers were responsible for their illness and their fate because the habit is filthy, unhealthy and antisocial.
For her, this was anathema.
"Nobody deserves to have lung cancer, whether they've smoked or not and no one should have to feel ashamed of having such a terrible illness," she said sharply. "Why doesn't lung cancer receive its own chair of research funding? Why don't we see walks for lung cancer like we do for breast cancer? Why don't we see a lot of people wearing green ribbons? How many of you even knew that November is lung cancer month?"
Dr. Tannenbaum, who was only 63 years old when she died in Montreal on March 17, was speaking from both personal and professional experience. Her entire career in public health revolved around working on behalf of the dispossessed, of street people, drug users and hospital denizens who were admitted because they were sick and contracted a superbug that made them sicker. From the start to the end, her mantra as doctor and patient was the same: Do not judge people because of what they suffer from, and work as hard as you can to make them well.
"Terry was totally engaged in what she was doing," said Dr. Richard Massé, the director of Montreal's public health department. "In meetings, you knew she was listening when she was doodling psychedelic designs on a piece of paper, tugging on her hair and sipping from a can of Diet Pepsi."
She always had your back, Dr. Massé continued, and could cut to the quick of any argument – a medical detective who, like her childhood hero, fictional sleuth Nancy Drew, followed the clues to the source of an outbreak and then furiously worked with her team to find a solution.
Terry-Nan Tannenbaum was born in Montreal on April 13, 1952, the eldest of Dr. Isaac Tannenbaum and Ada Tannenbaum's three children. Her father was a family physician who preached that if you do something, do it to the very best of your ability or else not at all; her mother was a homemaker. The family lived on the city's west side, where the little girl was a star student from the get-go.
"The day she graduated, she came home and announced that her teacher had said she could go to any university she wanted," Ada Tannenbaum recalled. "We wanted her – we expected her – to stay close to us in Montreal. But she went to Brown [University, in Providence, Rhode Island]. We were terrified. She was determined."
Precocious, young Terry-Nan made her first diagnosis when she was little more than four years old. Her brother, younger than her by only 11 months, hadn't been feeling well and was sleeping in his bed. She hit him over the head like she always did when she wanted to bug him. When he didn't wake up, she marched downstairs and announced to her parents that there was something really wrong.
It turned out that David Tannenbaum had meningitis. Their father had downplayed the symptoms until the little girl sounded the alarm.
"She maybe even saved my life," said David Tannenbaum, who would grow up to become a family physician in Toronto. "Right to the end of her life, she always wanted to know how everyone else was doing."
After completing a bachelor of arts at Brown in 1973, she came home to do a qualifying year at McGill University before entering medical school at the University of Calgary. Following in her father's footsteps at first, she did a residency in family medicine at Montreal's Jewish General Hospital before following her passion with another residency in community health at a medical centre in Worcester, Mass., affiliated with the University of Massachusetts. At the same time, she completed a master's degree in public health, also at UMass.
Dr. Tannenbaum was dealing with the most vulnerable among us – senior citizens – before joining the public health department as it battled to track and reduce cases of tuberculosis in the city. From there, her jobs included overseeing efforts to contain the outbreak of swine flu in 2009.
Along the way, she married André Dascal, an infectious disease specialist at the Jewish General whom she met in 1978, when both were residents and working long shifts in the emergency department. The couple had two children and somehow over the years, she managed to be a present and engaged parent while wearing a plethora of other hats, from adjunct professor and acting director of Montreal's public health department to researcher, author and mentor to medical students.
For her, public health had no boundaries. At the start of a project in 2000 to control tuberculosis in Ecuador, which had the worst TB-control record in the Americas, Dr. Tannenbaum spent a whirlwind three months in that country. She helped develop programs, motivated physicians and nurses, and learned Spanish, all at the same time.
She was president of the management committee at Dawson College from 2001 to 2005. Then, wanting to further improve her leadership and management skills, she embarked on a master's degree in management as part of the International Masters for Health Leadership program at McGill, completing it in 2008.
She was a hiker, a public speaker and a crusader for equality in health care despite income disparity – a whirlwind until it all came to a stop in January, 2014, when she became the patient. It was to be a routine CT scan, ordered by her doctor because of blood test irregularities that seemed to have resolved themselves once she had an abscess in her foot drained. Instead, the radiologist found a mass on her lung that was inoperable. Despite undergoing chemotherapy and radiation, it was soon classified as Stage IV lung cancer, the most advanced form of the disease.
"It was as if we were living in a different reality," her husband said. "But she was determined to adapt and to fight."
As a doctor, she knew what was in store. As a patient, she decided to share her experience through a blog that can be found on the Canadian Lung Association's blog page. She was an informed "Dr. Everywoman" who happened to have terminal cancer, an activist who fulminated about a lack of research funding, advocacy and awareness, and a science wonk who, unlike others, was not able to find comfort or answers in anything spiritual.
In one entry, from July, 2014, she wrote of lesions being found in her brain. "My first reaction was, 'Why can't I just get a break? Why does this cancer always seem to be one step ahead of me, no matter how hard I try to fight it?'
"As one wise colleague said, it was like we were running to keep ahead of the depression that was trying to catch up to us," the entry continued.
In another entry, from November, 2014, she wrote that her body, as sick as it was, still had things to teach her. "Most days, I feel pretty well and I am tempted to live as normal a life as possible. … Inevitably I push myself too much and I get sick again," she wrote. "I am finally learning there is a new normal, which means I have to set limits on what I do each day. … These are the kind of lessons I should have taught myself years ago."
At that speech last November, she echoed the call in her blog not to blame patients for lung cancer, the cause of which could be any number of factors. Better to increase funding to find a cure, she said, to wear the green ribbons and have empathy for those who suffer.
"This is what we want," she said. "We want to grow old."
The audience gave her a standing ovation.
In recognition of Dr. Tannenbaum's work in lung health, she received the Queen Elizabeth II Golden Jubilee medal in 2002.
She leaves her mother, Ada Tannenbaum; brother, David Tannenbaum; sister, Lynn Collin; husband, André Dascal; and children, Michael and Leanne Dascal.
Editor's note: An earlier version of this story inadvertently omitted sister Lynn Collin and had the wrong last names of Michael Dascal and Leanne Dascal. Also, Andre Dascal's profession is an infectious disease specialist, not a microbiologist and immunologist. This is the corrected version.