1. Young, Robert C. MD

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If you are anywhere near my age you will immediately relate to the title of this book. Like its sister label, "The Big C," "The Big Casino" harkens back to a time in oncology when it was acceptable to use euphemisms to hide behind the poor prognosis of most cancers. In the early days of oncology, as the editors, Stan Winokur, MD, and Vincent Coppola, suggest, terms like neoplasm or mitotic lesion were used when discussing a cancer diagnosis and prognosis. Now we are more successful and more candid.

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Dr. Winokur is a well-known and well-respected oncologist, as well as a personal friend, who is now Medical Director of Axess Oncology physician network. He has partnered with Vincent Coppola to create and edit this compendium of brief physician-authored essays about cancer and cancer patients.

Robert C. Young, MD.... - Click to enlarge in new windowRobert C. Young, MD. Robert C. Young, MD Chairman

The editors reached out to 39 oncologists who each have provided a two- or three-page article on some patient-related topic of great personal importance. The spectrum of oncologists is broad and includes prominent academics, private physicians from both large and small practices from varied geographic locations, and oncologist-administrators.


It is a brief text (152 pages) meant primarily for patients. However, the editors have a very ambitious goal: "To provide this book at no cost to the offices of every hematologist/oncologist in the country, and from there to all newly diagnosed cancer patients in America." Such a daring objective might be easily dismissed unless you know Stan Winokur. He should not be casually underestimated.


So, if that is the goal, is the book appropriate for such widespread dissemination?


The essays are remarkably candid and revealing. Several of the oncologist-authors have been forthright about their own personal battles with cancer, as well as those of their loved ones. "Being a cancer survivor has made me a better physician," says one oncologist. Another openly discusses the last days of his wife's illness where she spent her time printing 3x5 cards about how to do things and then put them around the house for her family to find.


Another writer spells out the unique torment associated with being a knowledgeable oncologist with a spouse who died of HER2-positive breast cancer: "Had we been able to go back in time with the knowledge we now have, my wife could have been cured. It's just the facts." Sometimes we oncologists can know too much.


Many of the doctors comment on the frequently asked patient question of how we manage to practice oncology day after day. The answers are varied, but these oncologists are uniformly comfortable with their career choice and its rewards. As one said in response; "How could I not?"


When discussing the success stories, there is an overabundance of focus on Hodgkin's disease and breast cancer, and understandably less on the more intractable cancers. However, several doctors used AML as an illustration of the strength, courage, and hope displayed by their patients. It's no surprise that most of the personal lessons come from patients who are positive, tough, and heroic. Only one essay in the book deals with lessons learned from difficult or controlling patients.


Recurrent Messages

Several recurrent messages run through these essays. First: "My patients have always been my most important teachers." One doctor relates a patient's lesson: "Doctor, you have 400 patients; Very good. I have only one doctor." Every time that doctor gets an after-hours phone call, he remembers that lesson.


Many doctors have learned to always sit down and touch patients during bedside visits-a lesson learned after a patient remarked; "You don't understand doc, I need you to sit down."


The second common message is the inspiration physician's gain from patients who display courage, strength, and fortitude in the face of devastating illness. One doctor tells of his patient Sylvia: "She was one of those patients you meet in your practice that you believe is surviving to provide energy to the doctors, nurses, and the other patients in the chemotherapy suite. We had young doctors join our practice while Sylvia was there. She taught them how to take care of patients; how to talk to patients; how to love."


The third recurrent theme is providing tools that patients can use to refocus their lives. Cancer, says one oncologist, is like a roller coaster in the dark-a wild ride physically and emotionally. "Don't ride the roller coaster in the dark. Open your eyes to the richness of life." Another tries to "focus on how we can make this day a better day today." Another expresses it differently: "The most difficult part of my job is helping people understand that the disease does not define them."


In the introduction to the book, the editors suggest that early in oncology, patients often saw doctors as superhuman figures or feared us as harbingers of bad news. Much of that thinking has thankfully now dissipated. As one author comments; "Doctors are like anyone else. There are nice ones and less nice ones; smarter ones and those less smart; you treat people the way you'd like to be treated."


Some of the essays highlight the stresses of feeling the need for perfection in an imperfect field. One physician expresses it this way; "Things never advance fast enough if you have a patient who can't be fixed with what you know right now." Another says; "To this day, I constantly second-guess myself."


One of the professed goals of the book is to dispel the myths about oncologists and to connect with today's cancer patients personally. In short, to put heart and a human face on the people who dispense cancer care. These essays go a long way to accomplishing that objective. The book does not profess to be a robust presentation of cancer for the lay reader like, for example, The Cancer Chronicles by George Johnson ( OT 2/25/14 issue ).


So should this book be distributed to all newly diagnosed patients, assuming that tall order can be achieved? The answer, in this reader's view, is yes. The book does personalize the cancer doctor in a forthright way and is consistently upbeat and realistically positive without being Pollyannaish. There is little that would be frightening or confusing to cancer patients or their families. The book might help cancer patients better understand our motivations and put a human face on oncology.


2014, PAPERBACK, ISBN 149928571X


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