Philip G. McManis, MD

I would like to dedicate this issue of the Gastroenterology Clinics of North America to a colleague, Associate Professor Philip G. McManis, MD, who died peacefully of esophageal cancer on September 17 in 2004 at age 51 years ( Neurology 2005;64:598–599). Philip possessed great charm, a fierce determination, an acute intelligence, and a fine sense of humor. He was widely loved and respected. He was a wonderful husband and father. He was a supreme physician. Many thousands of friends and patients are in his debt.

Philip had no risk factors for the development of esophageal cancer and had no gastrointestinal symptoms until 3 months before diagnosis. In an e-mail to a colleague, he said, “I noticed that bread would stick at the lower end of the esophagus, but thought little of that. About a month ago, it started getting worse and I began having to eat slowly to avoid painful esophageal spasms, so I thought I should get it checked out. Ten days ago, I had a gastroscopy, which showed a fungating lesion at the cardioesophageal junction, and a biopsy showed adenocarcinoma, moderately well differentiated. There was no other abnormality and no signs of Barrett’s esophagus.”

In a recent e-mail from Philip’s wife Tamera, she poignantly describes Philip and his experience with esophageal cancer.

“Philip was truly amazing during his illness. I remember Philip consistently endeavored to make it easier for others, particularly his treating physicians, when they had to give him bad news (he was always several steps ahead of them)—he seemed literally to feel worse for them than he did about his condition and what he was ultimately facing. I remember toward the end, about 3 months before Philip died and he had had his dose of taxatere—by this stage the cancer had ravaged his body and the effects of the taxatere were equally less forgiving—he had a scan of his liver and although he hadn’t seen the results, he pretty much knew his liver was riddled with metastases, and he knew if he were lucky, he may have a couple of months, but in true character, it was never really about him, it was about all those who he cared about: his patients, his colleagues, and his friends and family. He endured much pain throughout the 18-month illness—mainly because he didn’t want medications to interfere with his capacity to continue to treat his patients, which of course he did up to a week before he died. Philip pretty much slept sitting up because it was too painful to lie down. His stamina was staggering. He somehow managed to tote his portable EMG [electromyogram] machine around until the end; I distinctly remember the moment he set it down for the last time.

On a personal note, I don’t know if the pain of losing Philip will ever disappear, but I know it will lessen with time. His love will be in my memories and they will grow richer and even more pleasant with time. I feel great comfort, too, knowing that Philip will be in the faces, character, and souls of our children who are a wonderful expression of the special union and bond that we had in this lifetime. What I have learned from this experience is that like Philip, we have to live each moment of each day to the maximum and try as best we can to express our love through caring. If we are able to do this, I think life’s trip will be worth it. I think it is fitting that in Philip’s death, he reminds us of what we need to do to make our lives worth living. That will be my tribute to Philip. If I had to summarize how we as a family approached Philip’s illness and death, it would be simply that Philip helped us to go on living and we helped him to die, with dignity, with acceptance, and most of all with love.”