As oncology professionals, what initially drew us into this field was some mix of the mystery and intrigue of cancer with the hope and exhilaration involved in attempts to conquer it. Along the way we encounter the patient, a separate entity from the cancer in question, but often even more challenging and difficult. Although approaches to the patient vary as much as do treatment regimens, many oncology professionals train, practice, and retire with one great question underexplored: how the patient's experience affects us, and how we, in turn, reflect back our own feelings, uncertainties, and needs.
This complex reverberation is the subject of Common Bonds: Reflections of a Cancer Doctor. The author is a practicing oncologist who appears to have become a writer in order to share his insights in an open, sometimes painful, but ultimately admirable way. He discusses the book as an attempt to learn from victories and failures with patients and their disease and to examine "the anatomy of the relationship." We follow his practice over a period of time while sitting on his shoulder, hearing conversations with patients, receiving test results, conducting follow-up examinations, giving treatments in the hospital and office, and encountering patients, colleagues, and his own family. Even for those readers who follow a similar daily itinerary, it is interesting reading because we hear what happens, followed by the author's thoughts about those events, in an unvarnished way.
More like a diary or memoir, the book discards stoicism and pretense to lay open the physician's vulnerability, using the direct and honest language that many medical professionals routinely reject. Before the first 20 pages are complete, we hear Dr. Berger reporting that while relating bad news, he "hid behind a composed face," that he was "angry" that he could not offer a cure, that he felt helplessness and despair but tried to "distance myself emotionally," and that he returned home "tired and depressed." But the book is neither an excerpt from a stream of bad days nor the confession of an unsuitably sensitive soul. Rather, it is an honest account of a real doctor who struggles with the sad and unsolvable, and instead of shutting his reactions away, he examines them and shares that examination with us. True to his honest reporting, he does not always cope smoothly, and we hear about that too, as well as his occasional cigarette during tense staff conferences and his tendency toward an irritable colon.
Although the emotional narrative distinguishes this book, it also tells absorbing stories of patients, which we follow eager to know the ending, even if it is not a happy one. These case histories, interwoven throughout the chapters, provide a useful and affecting counterpart to the author's soul laid bare, since they remind us of the fascinating individual dramas of people struggling with disease, and that sometimes wonderful things can happen either by craft, fate, or chance. Without making a point of it, the author uses this balance to show that even if you risk your heart by practicing oncology with the kind of feeling and presence that he does, the intellectual and scientific rewards can be great, and serve to keep you going.
Dr. Berger makes it clear that this is a book for all readers, most certainly including people with cancer. His coauthor, Linda Mittiga, is a former patient whose story we learn, and she is one of his successes. Trying to appeal to many audiences, terms such as "very malignant" coexist with "alopecia" (undefined, but we forgive this). Reading with the eye of the professional, one has the occasional wish to shield the author from the almost brutal force of his own emotions. But reading with the eye of the patient, one is struck with what a very human being sits across the desk, and how much Dr. Berger's empathy enhances his already comforting medical expertise. These qualities strengthen his ability to talk to his patients with the right proportions of truth and hope. From any perspective, this book is a good internal checklist for our own behaviors, and suggests how we could do better-for our patients and for ourselves-as we work through our difficult days.
A 52-year-old man presented with an erythematous lesion in the axilla of unknown duration. Surgical excision was performed. What is your diagnosis?
