At the podium or in the classroom, Dr. Ed Cadman appears much larger than his 5-foot-8-inch stature. An eloquent speaker and eternal optimist, he has a gift for inspiring others with words like: "There is always a future, but destinies are for those who plan."
As dean of the University of Hawai'i John A. Burns School of Medicine, Cadman believed he could make a difference by developing a top-notch medical school and biotech research facility on a 10-acre campus in Kaka'ako. It was an ambitious project, but Cadman has a marathon runner's endurance for the long haul and a visionary's talent for uniting people.
One day in 2003, however, something in Cadman faltered. While introducing a medical conference at the Ko Olina Resort in Kapolei, he suddenly found himself at a loss for words. No one noticed, recalls Cadman. It barely registered in his own mind. "I thought it was just a word-finding problem," he says. Instead, it was a warning that his greatest challenge was yet to come.
Not that Cadman ever backed away from challenges. As a boy, he'd fished the rivers and ran the mountain trails of his small Oregon hometown when he wasn't working in his father's hardware store. As a young man, he graduated with honors from both Stanford University and the University of Oregon Medical School. He established a distinguished national reputation during his 13 years at Yale, where he served as dean, chairman and professor of medicine at the medical school, and chief of staff at Yale New Haven Hospital. He also became a top national masters 5K and 10K runner.
In late 1999, he gave it all up to become the new dean of the UH medical school. Why?
At the time, UH was struggling with financial problems and widespread faculty discontent. The medical school was well known for its problem-based learning curriculum, but many of the faculty and students realized that the medical school would not be nationally recognized until it had a research component. At the same time, the state had a goal to diversify the economy with the biotech industry. According to Cadman, a research component at the medical school would be the catalyst for the biotech industry, which would help make Hawai'i the premier health care center of the Pacific.
That had also been the dream of former Gov. Ben Cayetano. While in office, he'd tried to persuade world-class health providers like the Mayo Clinic and M.D. Anderson to come to Hawai'i, but then-UH President Ken Mortimer insisted a world-class medical school was needed to draw them. "When I first met Ed Cadman, I knew he was our man," Cayetano recalls. "I was struck by his sincerity and honesty."
But before going to the Legislature to seek funding, the former governor made Cadman promise that he'd stick around to shepherd the medical center's construction. "He told me he would make it his life's last project to see it through," Cayetano says.
Over the next few years, Cadman threw himself into a flurry of public relations activities, political networking, faculty recruitment, and fund raising. He gave moving speeches at the state Legislature, the Chamber of Commerce, the Rotary Club, and even the Boy Scouts, exhorting them to dream big. "We must really believe that we can become great," he said.
In February 2004, Cadman was introducing a conference on international terrorism at the Ala Moana Hotel when he experienced his own moment of terror. He'd kicked off his welcoming remarks with a joke, but was unable to deliver the punch line. "I couldn't fake it, so I just went on talking about the medical school," he recalls. Again, he dismissed the incident; he'd never been very good at telling jokes anyway.
In November, Cadman took a red-eye flight from Honolulu to Connecticut to give a presentation at the Yale Medical School. When he arrived, many of his old friends and colleagues were alarmed at his unusually slow speech. He brushed off their worries, explaining that he'd been up for 36 hours. Physically, he felt fine. But worries infiltrated his mind. Could he have a brain tumor? Or Alzheimer's disease?
Final Diagnosis
Just before Christmas, while on a family vacation in New York City, Cadman kept an appointment for a medical evaluation that a Yale colleague had made for him at New York's Memorial Sloan-Kettering Cancer Center. The chief neurologist there suspected Cadman had primary progressive aphasia (PPA) -- a rare neurological disease. But because there are no diagnostic tests for PPA, she referred him to Marsel Mesulam, M.D., the physician who named the disorder and its identifying characteristics in 1982.
Mesulam, the director of Cognitive Neurology and the Alzheimer's Disease Center at the Northwestern Feinberg School of Medicine in downtown Chicago, confirmed the neurologist's suspicion in March. Cadman was indeed suffering from PPA. "Compared to Alzheimer's, PPA is rare," says Mesulam. His clinic, which is in the forefront of research on PPA, follows about a hundred patients with the condition.
PPA is a dementia like Alzheimer's, but with a marked difference. PPA patients retain their memories, but gradually lose the ability to translate ideas and thoughts into words. ("I cannot talk fluently, but I remember everything," Cadman says.) Patients with PPA usually seek medical attention because of word-finding difficulties, abnormal speech patterns, and glaring spelling errors, according to Mesulam. There is no effective drug treatment for the condition. PPA's cause is unknown, but dyslexia may indicate a higher than average risk, Mesulam says. (Cadman has had lifelong difficulties with "atrocious" spelling and mild dyslexia.)
In the early stages of PPA, the mind generates thoughts in a logical, orderly fashion, but in the later stages, mental processes, reasoning and judgment are sometimes diminished.
On Feb. 1, 2005, Cadman announced that he would take an immediate six-month leave of absence to face a "personal health crisis." At that time, he chose to keep his condition and prognosis a carefully guarded secret. He sent a brief email to his three sons on the Mainland, saying only that he had an occasional problem finding the right words. "Don't worry; I don't have a life-threatening disease. You will see something in the newspapers about me soon, but I am OK."
After receiving his final diagnosis in March, Cadman speculated on what he was up against. How quickly would his PPA progress? Would he be able to continue as an effective spokesperson for the medical school? One thing was clear: "I could no longer talk extemporaneously to the public and the media," he says.
When Cadman told his sons that he had PPA, his oldest son, Tim, learned all he could about the disorder. "His next steps are to establish a game plan to deal with this disorder," Tim points out. "And then, he will simply execute it to the best of his ability, with as little emotional strain as possible."
A Wrenching Decision
On June 22, 2005, Cadman's voice shook as he told the UH Board of Regents that he suffers from "a form of dementia for which there is no known cure." He would step down as medical school dean, he said, and return as a faculty professor. "I don't want to embarrass the university, my medical school, nor myself," he said. "I will leave with dignity, not disgrace. I wish to hold my head up high with a smile when I exit."
In July, Cadman broke the news to colleague Lois Margaret Nora, M.D., a neurologist and president and dean of Northeastern Ohio University College of Medicine. "I want to set an example and be as candid about my illness as possible," he wrote. "My friends and colleagues, except for a few neurologists, do not know about this disease." Nora responded, "I know that your candor and example will help many other patients, as well as your colleague physicians. Hawai'i has flourished in your care and you have set the stage for great things in the college's future."
The Road Ahead
Cadman will return to Northwestern every six months for evaluation. In the meantime, he is re-training his mind to access some of the 50 percent of his brain that scientists say we don't use -- by reading silently and out loud, writing in his journal, listening to audio-books, and completing crossword puzzles, brain teasers, MENSA tests and IQ quizzes. He also runs, swims and bikes about 125 miles a week and occasionally competes in triathlons and road races to satisfy his competitive spirit.
His sons call him several times a week. "I talk about myself and then ask him to share details about his days to keep him in conversation and to exercise his speaking skills," says Tim Cadman. "He has good and bad days, sometimes carrying on a complete dialogue without pause, other times needing time to find substitute phrases for words he can't bring to mind. Life without language can be a lonely place."
Cadman takes it day by day. "I never look back -- except for a glance or two -- and I remember how I got to this point in my life," he says. "I am looking forward to a bright and rewarding future here in Hawai'i." He's comfortable talking about his diagnosis and its impact on his life. In August, he returned to the medical school as a facilitator and tutor for students in the problem-based learning program. He's also organizing the upcoming Hawai'i Bioscience Conference.
Cadman says his illness has given him the opportunity to do something special. He doesn't know exactly what it is yet, but he refuses to wallow in self-pity and says he has a lot more to contribute to Hawai'i and the medical school. "It's a new phase of my life, and I will deal with it with determination, ingenuity -- and most importantly, hard work."
In a speech to local Boy Scouts in 2000, Cadman said: "Remember that journeys are not in straight lines; the road to success has many curves and stops. Never be too stubborn to turn back and find another path."
He's now taking his own advice.