Oncology

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I just finished reading Sid Mukherjee’s book, “The Emperor of All Maladies: A Biography of Cancer.”

It. Is. Awesome. (and the NYT review totally sucks…)

In no particular order, the things that I loved about it.

1. The compassion and relationships he builds with his patients. Cancer is deadly serious. Patients need someone to save their lives. You can be that someone. That’s pretty cool. And, it makes sense that you would want to have a real, longitudinal relationship with someone who saved your life / whose life you saved. In a different way than if you fixed their sprained ankle / chipped tooth / cold. It reaffirms my desire to work in a high risk / high reward subfield of medicine where there are real consequences, meaning that things don’t always go well.

2. Timing is really fucking important in medicine. Oncology in 1950 was undertaking. Oncology in 1970 was, mostly, undertaking. Some parts of Oncology in 2010 are basically sure things. Some parts are basically undertaking, combined with a sadist’s worst dream of what science can be. And some areas are rapidly developing, one drug away from being perfected. At least that’s how it seems now.

3. Science moves non-linearly. I saw a talk recently by David Jones that discussed the history of CABG vs. stenting and he made the point that medical procedures have an evolutionary / competitive component. But I think something even more profound, in science, is the forgetting of knowledge and its rediscovery. A counterpoint to the parallel tracks (think Newton v. Leibniz, many other examples) is that, sometimes, NO ONE is working on the right track even though someone once was. Sometimes new clinical realities require basic science BACKTRACKING down another fork and sometimes new basic science discoveries push clinical realities forwards, backwards or sideways. The idea of a constant linear progression is silliness.

4. Clinical and basic science are divorced, angry, hateful parents who share a (possibly bastard) child. They can hide their hatred for one another long enough to sit through a little league game or a few meetings but, in the end, the each retreat to their own separate corners. You’d think that one would be inspired by the other, and that someone would be able to design an environment which played to both of their strengths. No such luck.

It was a pleasure (though of course, I had no idea at the time) to meet Sid four years ago when I was transitioning from coaching rowing into medical research. In about 30 seconds he made it abundantly clear that I had no business working in his lab because I knew nothing (he was right) and also because he didnt have the money to pay me (probably right about that too). More importantly, he still took the next half hour to speak with me and explain his operation, gave me a manuscript to read, and some advice about medicine that I’m sure I’ve forgotten.

I’m glad that our conversation didn’t go better, in some ways, because it could have been pretty bad for my overall trajectory in medicine to have been stuck in a lab for years. It might have given me a completely different exposure to MGH, to research, and to science. Still, I’m both grateful to have met him and learned a little from him (and grateful to a mutual friend for supporting me and for introducing me to him).

Maybe that’s another sub-message, that I’ve consciously tried to emulate in recent years. Make shidduchim between people. If you know someone in place A and someone else who’s interested in Place A, then set them up! Even (especially) if you have no self-interested stake in the game. I’ve been the benificiary of these arranged meetings in the past, and they have lead to unexpected opportunities. Sometimes I’ve had to work hard to make them for myself, and sometimes I’ve been fortunate enough to have a friend, family member or acquaintance help things along a bit.

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