He was the first giant I'd ever seen. My chance meeting occurred on an otherwise uneventful afternoon in radiation oncology at Stanford. I was a visiting summer extern waiting for rounds to begin when I noticed a physician—one whom I didn't recognize—standing nearby. Something intrigued me about the six-foot-plus physician poring over a patient's chart.
I remember studying how his head bent forward, as if pulled by a string attached to the chart's binding, and my trying not to stare after spotting his macrodactyly—his gigantic thumb, index, and middle fingers aside the remaining normal fingers of his right hand.
I whispered to a Stanford med student, “Who is he?”
The name—Henry Kaplan—didn't ring any bells until years later, when I realized the eminence of this pioneer in the history of modern oncology and regretted not knowing more about him. So I jumped at the chance to read Henry Kaplan and the Story of Hodgkin's Disease, written by Charlotte DeCroes Jacobs.
In OT's September 25th issue, Mikkael Sekeres, MD, MS, offers a review from the oncologist's perspective, giving it a thumbs-up--”a great read for those of us who trained in an era of evidence-based medicine, and want to learn what it was like to actually create the evidence, and for the first time make a difference in our patient's lives.”
Nodding in agreement, I'm piping in with my take on the book.
Biographies serve many purposes, such as offering insights into a different time period or into a leader's decisions that affect our lives. Some biographies guide and inspire those of us facing similar challenges. Others simply entertain with stories of fascinating people or ordinary people doing extraordinary things.
As a writer, I'm impressed by how this book offers something for everyone. Jacobs, an oncologist and professor emeritus at Stanford, performs a remarkable feat of literature by integrating varied angles on the life of Henry Seymour Kaplan with the history of the disease he vowed to cure. I'd say it reads like a novel, except frequent quotes keep pinching us to remember it's true.
As Sekeres points out, the book offers a close-up view of the trials and tribulations of developing radiation therapy and then chemotherapy. Insights about past progress in cancer care can help us maintain a useful perspective as we argue about how best to divvy up limited research funds today. For example:
- Serendipity often plays a role in new discoveries.
- Failures are part and parcel of progress.
- Radical ideas can be good—or bad—in the long run.
- Disagreements among researchers can propel progress forward—or hold it back.
Today's clinical trials are on trial, with some patients and clinicians advocating for faster paths to drug approval. Jacob's descriptions of the tensions between Kaplan and his colleagues sound cautionary notes for us all:
- Modern medicine will always be a struggle to find balance between our obligations to today's patients and to future patients.
- Just as patients need to keep emotions in check when weighing treatment options, researchers and clinicians need to do the same when evaluating novel ideas and raw results of studies.
- Just as we expect our best diagnostics and therapeutics to be replaced with safer and more effective measures, we should expect the “gold standard” of proof to be a moving target, too.
My unabashed enthusiasm for this book stems in part from my heightened gratitude to Kaplan for the therapies that helped save my life. I shudder to think where we'd be had Kaplan not been the strong-willed scientist who refused to stand down just because colleagues rejected his sound ideas, even mocking him. More important, I want people to hear Henry Kaplan's understated but critical message about compassion.
Nowadays fear abounds that compassion in modern medicine is threatened by the many forces driving clinicians and patients apart, not the least of which is increasing time pressures.
Throughout the book, we see Kaplan—an uber-busy clinician/researcher/administrator—become a gentle giant whenever he's with patients. His brief visits make a world of difference for those under his care. As archetypes do, Kaplan's example inspires us to believe that no matter how medicine changes and no matter how busy we get, we can and must preserve compassion.
Lastly, Henry Kaplan offers a multifaceted story of hope on both sides of the stethoscope. We feel the hope of researchers who believe cures are possible. We feel the hope of patients who put their trust in our hands. We feel the hope of administrators who build institutions to continue a legacy of cutting-edge research and compassionate care long after we are gone.
Poignantly, we are privy to Kaplan's hopes at the end of his life. As he comes to terms with his dying, he first expresses profound sadness at being denied the time needed to fulfill his lifelong mission of curing cancer. Then he shares his hopes.
Kaplan hopes to tie up loose ends, using his limited energy to help those who work in his lab find new positions. He hopes for closure with family, friends, and colleagues. And, for a while, he hopes for a reprieve for himself, even asking a colleague to have a sample of his lung cancer tested at the NIH for drug sensitivity.
Clearly, “even if you're the greatest cancer specialist in the world, and you know all the facts, hope still springs eternal.”
Henry Kaplan can help us think and talk about the best direction for the future of oncology care. And we can do this only by standing on the shoulders of yesterday's giants.