No one knows when, exactly, Mutlay Sayan was born. His mother told him it was sometime in the summer, before the harvest. The delivery took place on their porch, with the help of the neighbors, who used a heated kitchen knife to cut the umbilical cord, in a year that may or may not have been 1987. Eventually, someone invented a birthday for him, to satisfy the needs of official documents, just as he would fill in all sorts of other gaps — a real-life David Copperfield who went from little kid in his parents’ fields to child factory worker in Istanbul to radiation oncologist in New Jersey.
He grew up at the eastern-most tip of Turkey, which pokes like a nose into Armenia and Iran — and when describing his childhood, he often starts with everything it didn’t have. There was no electricity or running water. He’d never seen a car or a television. He didn’t go to school, so he didn’t know what a weekend was, and never learned to read. The memories feel recent to him, warm and vivid, but they’re tinged with a time-warped strangeness. “It feels like centuries ago,” he said.
He liked riding out in a horse-drawn cart to the fields in the morning before first light. He remembers being small enough that the cotton rows reached above his head as his parents pulled the tufts from the bolls. They also coaxed beets from the soil, for a passing cart to collect and take Somewhere Else to transform into sugar. At the end of the season, the family would sit on the floor with a mountain of cotton between them, separating out the seeds with their fingers. They looked like apricot pits. Those that weren’t sent away and pressed for oil were burned in the winter for warmth.
For his colleagues, the image is hard to square with the one they have of him now: lab coat over a shirt and tie, detailing a treatment plan with a patient just diagnosed with cancer. It might involve snapping the strands of a tumor’s DNA, blasting energy from a device so big it has to be lowered into a hospital by crane, the roof rebuilt above it.
“I think of him using our proton unit, which is this massive $10 million particle accelerator that he’ll use to delicately treat a child’s brain tumor — a monster of a machine,” said Joseph Weiner, who directs the clinical radiation oncology residency at Rutgers Cancer Institute of New Jersey, where Sayan is now chief resident. “It’s funny, for someone who had never seen a light bulb until he was nearly a teen.”
It was so incongruous that Weiner wasn’t really sure to believe it, the first time Sayan told him where he was from. They were sitting in a cramped pizzeria on Clarkson Avenue in Flatbush, Brooklyn, not far from the hospital where Weiner was then a resident and Sayan a medical student on rotation. “I was floored. I didn’t know if it was real,” Weiner said. “I was like, This sounds like a movie.”
As they talked, though, Sayan showed him the scars across his knuckles from his factory days. Weiner couldn’t see it then, but hints of Sayan’s own story are visible in his research, too. He tracks not only survival statistics and side effects, but the experiences that lurk behind them — the days away from home for treatment, the missed appointments, the fatigue.
“If you are extending someone’s life, it should be a good life,” said Sayan, who was recently named a STAT Wunderkind. “God forbid, we’ll extend your life for three months but those three months will suck.”
What landed him in the factory was a cancer in the family, though it didn’t present that way at first. “One year, my dad lost his voice, and his voice never came back,” Sayan said. His father waited until the harvest season was over, and then caught a ride into Igdir, the nearest city, where doctors found something growing in his lung. He rode back to the farm, and the family set about selling their scrap of land so they could move to Istanbul for his cancer treatment.
The bus ride took nearly 24 hours. Sayan thinks he was around 11, and everything about the trip felt new and strange. He remembers going through a tunnel for the first time, and telling his mother that the bus was entering its stable. He remembers his first glimpse of TV, and thinking the people who appeared on the screen could see him, too. His mother had the same reaction, and immediately covered her hair.
They settled into Bagcilar, an industrial suburb on the European side of the Bosporus, and as Sayan’s father started treatment, he, his mom, and his sisters all started work in a textile factory. It was grueling work, surrounded by the deafening whir of machines. Someone would sew a seam on a T-shirt and then drop it into a basket. His job was to gather the piles, cut the connecting threads, fold the shirts, and carry them to the next pieceworker. Because he was still too short to reach into the baskets, he’d jump up and balance his belly on the edge. “You had no time even to breathe,” he said. “You had to rush from machine to machine to machine.”
Sayan hated the factory. He spent so many hours using scissors that the handles dug troughs into his skin, which began to bleed.
But city life was expensive. They’d brought dry corncobs with them from the farm, and at first, those kernels were sometimes all there was. The doctors had asked them to weigh Sayan’s father, to make sure he wasn’t wasting away, and the scale became another source of income: On Sundays, his one day off, Sayan would carry it to the market and weigh people for money. The first time he did it, he made enough to buy some carrots and apples, and he felt a flush of triumph.
As if to taunt him, there was a school visible from the factory lunchroom, so he could always glimpse the life he wasn’t leading. He’s not sure what gave him the idea, but one lunch break, he walked over and asked to see the headmaster. When he met her, he begged her to let him in.
“She said she was busy, could not talk to me, she brushed me off,” Sayan remembered. “But she did not say it was impossible.”
He went back every day for three months. His strategy was simple. He wasn’t going to let her forget him. “Showing my face through the windows and door cracks,” as he put it.
Eventually, she gave in: “I was making 11 Turkish liras in a month, and this headmaster, God bless her, she said, ‘OK, Mutlay, we found a scholarship that will pay you the money you’re making in the factory, so your dad can continue treatment.’”
At first, she wasn’t sure what to do with him. He didn’t know how to read or write. He’d be out of place in first grade and unable to keep up in sixth. So she made a compromise. In the mornings, he’d be with classmates roughly his own age. In the afternoons, the librarian would teach him everything he’d missed. “I was so scared that if I didn’t do well, they’d send me back to the factory,” he said. “That gave me the drive.”
He graduated from elementary school in three years — and was promptly pushed into a vocational high school for agricultural business. As the only member of his family who could read or write, he took his dad to appointments, listened to the doctors’ analyses. That sparked his interest in medicine. But what allowed him to pursue it was an unlikely hopscotch of stunning achievement and chance.
Having the highest GPA in his class at Istanbul University unlocked an internship in the United States. He stayed with a Turkish family in Vermont for a month. While he was there, his host sister happened to be applying for college at the kitchen table. She wanted to study engineering.
“I laughed and said, ‘It’s not possible, your father is not in engineering and your mother is not engineering, they’re never going to take you,’” Sayan remembered. “She said, ‘No, in this country you can study anything you want.’” It was a revelation to him. He transferred to the University of Vermont. Once there, living with an American family, he recorded lectures, which sped by in a language he hardly understood. In the evenings, his host mother helped him pick through them.
Just as he’d set his mind on elementary school as an escape hatch from the factory, he now decided he was going to volunteer in a cancer lab, and sent email after email. “Nobody responded. I said, ‘OK, well, they must be busy people, so I’m just going to knock on doors,’” he said. “I’d done that before, I could do it again.” He ended up barging in on the lab meeting of a researcher who happened to be studying the mesothelioma caused by mineral deposits in central Turkey, and was interested in having a Turkish-speaker on board.
That ended up paying off in Petri dish studies. Sayan examined how mesothelioma cells resist chemotherapy — and how targeted cocktails of drugs might circumvent resistance. “That was one of the things that got me into med school,” he said — though graduating Phi Beta Kappa and summa cum laude probably didn’t hurt. He’d also drawn on his memories of scritching over frozen ponds in his village to start figure skating in Istanbul, and in Vermont, he’d become a coach.
By the time he was starting residency, he’d already dreamed up a study that had begun recruiting brain cancer patients at the University of Vermont, to understand why they experienced such long-term fatigue.
He wanted to work on it in New Jersey, too. To the radiation oncologists there, it signaled that this wasn’t their average trainee. As Bruce Haffty, chair of radiation oncology at the Rutgers Cancer Institute of New Jersey puts it, “It’s pretty unusual for a medical student to already have been working on a clinical trial that was their own idea.”
For Sayan, the research was also personal. Under all of those layers of achievement — the degrees, the prizes, the publications — ran a current of hurt. His father died when he was finishing high school, but the man he’d known as a little kid had already been gone for years. Between the illness and its treatment, he’d been a kind of ghost. “I don’t remember any good memories with him in Istanbul,” said Sayan.
It was part of the reason he was interested in fatigue. He saw brain cancer patients dragged down by it not only during chemo-radiation, but also in some cases long after it ended. He wanted to know what exactly was causing it. The tumor? The treatment? If he pinpointed who felt what and why, then maybe he could take that sensation away, allow people to live a little more fully.
“It’s an underappreciated question. We chalk it up to the treatment and the tumor,” said Salma Jabbour, chief of gastrointestinal radiation oncology at the Rutgers Cancer Institute of New Jersey. “Wanting to study the question shows a care for what your patients are going through. It’s memorable.”
The trial wasn’t the only part of his work that made him think of his dad. When he began studying whether it was possible to safely consolidate therapy for breast cancer into fewer, more intense bursts, the question was as much about economics as it was about physiology.
“Traditional breast cancer treatments are about five to six weeks, but not everyone can come for such a long period of time,” he said. “Vermont is rural, and forget about Vermont, in Turkey …”
He knows just how much of a hardship traveling for treatment can be, that its duration or its price might determine what is possible.
And he knows, of course, its costs. His sisters eventually married, but his mother continued to work in the same T-shirt factory until he graduated from medical school and started getting paid. “With my first paycheck, I was able to start sending money for my mom every month,” he said. “She no longer has to work at the same factory, I’m so happy.”
Sayan goes back every so often, to visit, but also for research. Two summers ago, he traveled between Mardin and Gaziantep and Hatay and Mersin, collecting data on cancer rates among the Syrian refugees who’d settled in and around each town. He found that comparatively few of them get radiation therapy, and that for those who do, many end up missing treatments, which lowers their chances of survival. The care itself is free, as is medical interpreting, Sayan said, but he wonders whether the issue might be one of time or transportation.
To some, that might seem like a given, that certain therapies aren’t getting to some of the world’s most vulnerable populations. But the pattern worries him, just as any barrier to treatment does, no matter where the patient is from.
It’s easy to think of cancer research in a quiet vacuum, science striving to prolong lives, far from the noise of geopolitics and policy. It’s less comfortable to think about who takes in asylum-seekers and refugees and who turns them away, which sorts of legislation underpin good care. Sayan’s is the kind of story America loves, a bildungsroman of possibility. We all want to see ourselves in him — at once brilliant and warm, fun to talk to, tirelessly pursuing something deeply moral and worthwhile. We never imagine ourselves in the role of the factory owner, turning a blind eye as our employees bleed.