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Overview
An Amazon Best of the Month Book
"For all the insight he offers into the hard science and thorny logistics of studying cancer, Dr. Scadden’s most moving passages consider the effect of the disease on the people who suffer from it and those who care for them." —The Wall Street Journal
A doctor’s riveting story of loss and hope in the world of cancer.
What is it like to encounter cancer? How does it feel to face the unknown, to enter a world of hope, loss, and dread?
From the diagnosis of his childhood friend’s mother to his poignant memories in the lab, David Scadden’s seen the unknown world of cancer from the lens of a young boy, a classmate, a researcher, a friend, a doctor, and a neighbor. Scadden chronicles his personal memories of cancer – his visits to his sick neighbor and his classmate who left school and never came back.
Now Dr. David Scadden, co-founder of the Harvard Stem Cell Institute and one of the world's leading experts on immunology and oncology, writes his memoir, Cancerland, with Pulitzer Prize-winning journalist Michael D'Antonio. With riveting stories and moving compassion, Scadden and D’Antonio paint a still rapidly changing landscape in the context of all too common stories of loss. Ranging from Scadden’s personal childhood memories to his triumphs and regrets as a doctor, Scadden illuminates a light at the end of a dark tunnel.
Through opening a window into the science of medicine in the world of the unknown, Scadden and D’Antonio humanize cancer while inspiring action that we all so desperately need.
Product Details
| ISBN-13: | 9781250092779 |
|---|---|
| Publisher: | St. Martin's Publishing Group |
| Publication date: | 07/10/2018 |
| Sold by: | Macmillan |
| Format: | eBook |
| Pages: | 256 |
| File size: | 2 MB |
About the Author
As part of a team of journalists from Newsday, MICHAEL D'ANTONIO won the Pulitzer Prize for his reporting before going on to write many acclaimed books, including Atomic Harvest, The State Boys Rebellion, and The Truth About Trump. He has also written for Esquire, The New York Times Magazine, and Sports Illustrated. He lives in New York.
Read an Excerpt
CHAPTER 1
DAWN OF THE BIOLOGICAL AGE
It says something that at many medical schools, a student's first contact with a patient involves a cadaver in an anatomy lab. For most medical students, the dissection of a human body, one often shared with a partner or two, is a rite of passage that reveals the physical, emotional, and spiritual reality of medicine while shielding them from the more challenging task of facing a living, breathing human being in an examination room. As much as people talk about the challenge of this process, it is far more difficult to work with a patient who can feel the impact of what a physician may say or do.
It also says something about my medical education, at Case Western Reserve University, that my first encounter with a patient was with a woman expecting a child. All students were introduced to an expectant mother with whom they were to interact and visit in medical settings and on house calls during their education. It was an incredibly powerful affirmation of what medicine is about and spoke legions about what the school valued and why I went there. Although respect and empathy are the expected norm in all cases, the cadaver model impresses a doctor in training with the facts of anatomy and, let's face it, death. The Case approach, which sent entering med students to visit women at home, take their vital signs, and guide them through the process of obtaining prenatal care, emphasized life.
My first patient, a woman Yvonne Anderson,1 lived in a tough neighborhood off Euclid Avenue in downtown Cleveland. She was single and younger than I was, but when we met, I was the nervous one. I was twenty-three years old and feeling acutely the extent to which I didn't know medicine. But Yvonne sensed that she and I were learning the ropes of the medical system together and at least I might help by being inside it — something she certainly didn't feel as an African American first-time mother. Maybe I could at least help Yvonne navigate the system and get the best care for herself and her soon-to-arrive baby.
When I made my first home visit to Yvonne's, it was an epiphany. I knew medicine would stretch my mind about science. I didn't know how much it would open my eyes to cultures, the stuff for which there was no section of books in the medical library. I was about as white bread as anyone could be and walked down Yvonne's street for that first visit with my heart in my throat (medical term). All antennae were activated, as the neighborhood was not one I would have walked down even when in Paterson or New York. Shades were drawn on every window in every house, including hers. The doorbell didn't work, and the lack of response from my knock had me ready to spin around and head for cover. Then the door opened, and Yvonne gave me a stern look and walked me through dark rooms to the kitchen, where I would be expected to perform before her skeptical mother. One ceiling bulb, four mismatched chairs, and a table were the setting for the interrogation. Short-cropped answers from them, too-long, overcomplicated verbiage storms from me, and then we actually had a conversation. I was so relieved when a first laugh seemed to signal détente. By the end, Yvonne was making it clear that it was the two of us who would work together and win over the mom, who knew she would end up taking care of everything anyway. She made clear she knew more about pregnancy and childbirth than I did, and I didn't mind getting a real-world education from her. It worked out, and I did indeed learn a ton from the Andersons. They taught me that medicine always exists in a human context. That context impacts what people hear. White and black, side by side, hearing the same words from the obstetrician — we often had different interpretations. I wasn't naive enough to think this wouldn't happen, but I never expected how extensive it would be and how it could really affect the quality of care and health itself. There was so much suspicion about doctors' motives and so little ability to pay for the nonprescription part of medical care that it was eye-opening. It was also hard to know without seeing up close the impact of the stress from poverty and the anxieties that come with living in an area that was so rife with crime that everyone kept the shades drawn to confuse would-be burglars. (It took me a while to figure out that safety was the reason that the Johnson home was so dark. In a crime-ridden neighborhood it was best to keep your business, and your posessions, out of view.) My thinking and my way of communicating with patients were forever changed by my experience with Yvonne.
In 1976, when I arrived at Case, much of Cleveland lived with the pressures that Yvonne and her family dealt with every day. Labor issues and foreign competition in steel, cars, and other industries had destroyed so many jobs in the city that it was steadily losing population. In two years, Cleveland would become the first big city to default on its debt since the Great Depression. Then there was the environment. The air and water in Cleveland were notoriously polluted. In 1969, an oil slick on the Cuyahoga River caught fire. A river on fire! First-year medical students were given T-shirts with that image stating, CLEVELAND: YOU'VE GOT TO BE TOUGH. But it was a fabulous place to learn about medicine and people's lives and how the two collided. My friends and I all volunteered in the funky Cleveland Free Clinic in the evenings, getting a rich supplement to our cultural education. I felt I could navigate things better for my patients when Yvonne delivered her healthy daughter, Annette, and went to the pediatrician visits. I was going to class to learn about the body, but it was in the clinical experiences that I learned how to help people.
It was extraordinary to be first connected to hospital medicine through a birth. The word awestruck aptly captures what it was like to be a clueless medical student in the delivery suite, serving half as physician, half as patient advocate. Fortunately, not much was expected, because I was wobbly kneed through the whole experience. In the presence of a miracle, doing more than standing with mouth agape was beyond me. By the end of medical school, I had delivered more than a dozen babies, including twins, and done minor procedures postdelivery. Participating in the joy with parents at a delivery and understanding the remarkable state of pregnancy drew me to the field. But the need and the impact of emerging science were less evident to me in obstetrics, and I eventually turned away.
I was somehow compelled by basic scientific research, especially in the area of molecular biology. No one with even the slightest interest could have missed the fact that by the 1970s we had entered a revolutionary period. Great advances were being made toward understanding the chemical secrets of life itself, and with each new discovery, we were getting closer to designing more rational treatments that would save lives and ease suffering. These advances created their own big questions for politicians, religious leaders, government regulators, and everyday citizens. The city of Cambridge, Massachusetts, had already banned recombinant DNA research by my first year of medical school. All of society would be engaged in issues prompted by the promise and peril of the biology revolution. I could imagine nothing more compelling.
But as exciting as the scientific moment seemed, I wasn't completely confident in my abilities to participate. In undergraduate classes, I loved organic chemistry, which is the course almost everyone considers the make-or-break subject for people who hope to go into medical school. But organic chemistry is like mathematics, a language. You learn certain fundamental rules for how things relate and you can put them together in creative ways. That nature has done so to make the building blocks of life — proteins, RNA, DNA, lipids, and sugars — captures the imagination. Add the spark of being able to modify things by the same rules, and the language of chemistry starts to become song. But I was just a student, inspired but not equipped to really make the music. I assumed that was only for those born with a determination to be and do chemistry in capital letters. It has a complexity and diversity that can seem almost infinite and was, at the time, opaque and mystifying to me.
The connection to chemistry came back in a wave in the first class in medical school.
That first course, in a subject given the vague title of Metabolism, was supposed to give us a firm grounding in the ways that cells — the fundamental unit of life — create, store, and use energy derived from nutrients to assemble and maintain cells. It was remarkable to me how the reactions and principles of organic chemistry turned into the very basis for life. It was also remarkable how complex it all rapidly became. For a few of my fellow students, who had studied a great deal of science as undergraduates (I was an English major), the subject was so easy that they sat and read the morning New York Times while grunts like me struggled to understand the lectures. I didn't know whether I was not as bright as my classmates or there was something unusually hard about this course, but I truly struggled with it. Also, I felt uncomfortable just saying, "I'm stuck; help me." For all I knew, I was the only one feeling so lost.
Unlike at some other schools, where competition was overt and the general attitude was "survive it if you can," we were encouraged to think of each other as colleagues who learned together. In that very first course, I discovered classmates like Bruce Walker — one of my closest friends to this day — who were eager to both give and receive help. Away from the lecture halls, we often met in groups to review lectures that were sometimes filled with daunting medical and scientific details. Together, we solidified our understanding of the material but also considered how it all might relate to the responsibilities we would assume when we started caring for people whose well-being and even continued existence would depend on us.
Even though we were first-year students, far from becoming actual doctors, most of us were late-1960s idealists who wanted to use our talents and opportunities to help others. The people I knew didn't seem to focus on money or status, and they voiced strong advocacy for doing the right thing for patients. There was an implicit suspicion of the commercial side of medicine. Those I knew took very seriously the commitment to making the world better, to literally alleviate suffering. The anxiety most often spoken was that we might go into the world and make a serious, even fatal mistake with a patient because we missed something crucial in med school. With this in mind, we got together in the evenings and on weekends and tutored each other. Since classes were six days a week, the big break was when the dean of admissions would invite us over on a Sunday afternoon for croquet, cookies, and beer — a spectacular break even when your ball ended up deep in the poison ivy. For a few of us, the itch to get away was too great, and we took a weekend bicycling in Vermont rather than studying biostatistics. To a person, we learned to regret that gap in our knowledge made worse by the solid drenching of Green Mountain rain.
The tradition of student tutoring was well established at Case and kept all but the most ill-focused from falling behind. Once we got into the clinical time of our schooling, the third and fourth year of medical school, we were split into smaller and smaller groups, but the sense that doctoring meant continuous learning and teaching and learning again was preserved. People started distinguishing themselves by clinical specialties and areas of research. In the late 1970s, medicine was becoming more specialized as new disciplines arrived with their own requirements for training, testing, licensure, and standards for practice. Medical oncology was not a formal specialty until 1972, and many physicians eschewed any kind of subspecialty board testing and certification until it became imperative for participating in the era of managed care, the 1980s. This was not an entirely new idea. Physicians in ancient Egypt, believing each part of the body to be a separate entity, specialized along the lines of anatomy. In the modern era, some specialties like radiology emerged out of new technologies. However, the push for specialization came from those who believed that both clinical care and science would improve as minds were focused more intently on limited areas of interest and the amount of information in each burgeoned. Specialty information required specialty-specific knowledge that was tested by specialty-specific exams. This has led to an ever-heavier burden of credentials that physicians maintain, to the point of now-evident subspecialist revolt. But for medical students, it represented mostly a spectrum of information and activities that allowed them to sort themselves into comfortable spots across the spectrum. It also became evident that each specialty seemed to have a culture and an accepted set of behaviors. Personality-type matching with specialties was oddly predictable. The brooding self-reflectors never made the OR home, and the ex-athlete or ex-military rarely found the intangibles of psychiatry appealing.
I was inspired by all the advances being made in biology and genetic technologies, which were sending waves of excitement through this former English major, if not the medical world more broadly. This work promised to make comprehensible the opaque world of cancer and perhaps the immune system. Cancers of the blood, which reside in the realms of both hematology and oncology, were most compelling for study because you could see the disease evolve at the level of the cell by simple blood samples. What the patient was experiencing was sometimes vague, but the blood was more eloquent, revealing whether fatigue represented poor sleep or regrowing leukemia cells. Other so-called solid tumors were rarely so evident, requiring scans and x-rays and ultimately biopsies. To me, the proximity of patient symptoms to cells in the blood was very compelling. It seemed that the basis for the disease had to be closer to comprehension if you could actually visualize what was going on by blood samples. It was also apparent that cells of the blood were what protected us from invaders of all types: viruses, bacteria, fungi, and maybe cancer. Studying the blood seemed to me like a way to ride the rocket of new discoveries in molecular biology and have them meaningfully turn into therapies I could give to patients.
But before I could get aboard, I had to understand the landscape of the relevant science, which was changing faster than the seasons.
* * *
Most scientists recognize the creation of the first model of a DNA molecule, by James Watson and Francis Crick, as the breakthrough that began the era of molecular biology. (As The New York Times noted on its front page, their so-called double helix image brought us "near the secret of life.") At the time when their work was published, the British Crick and the American Watson were little known outside their specialty. A bookish man, Crick would say his one hobby was "conversation." A child prodigy who had appeared on the Quiz Kids radio show — sponsored by Alka-Seltzer — Watson had been briefly famous but then immersed himself in academia. He and Crick did their work at the University of Cambridge in a one-story, metalroofed building affectionately called the Hut. However, there was nothing modest about their achievement, and as James Watson famously noted, Francis Crick was never in a "modest mood." They announced their discovery to much fanfare and arguably too little attribution to those with whom they had worked, notably Rosalind Franklin.
The double helix established how cell division transmitted genetic content in a way that preserved the information encoded in DNA. It made clear the mechanics of inheritance by showing that DNA has two strands, with one being simply a reverse complement of the other. They defined the rules for how making new DNA strands from existing ones could lead to perfect copies. They unveiled what had baffled thinkers since before science was a discipline. Thanks to the work completed inside the Hut, biology had reached an inflection point comparable to the advance made when physicists split the atom in the New Mexico desert in 1945. Watson and Crick energized biological science and made real the possibility of altering DNA and thereby cells and organisms. Biology would no longer be just describing the things that are, but a dynamic experimental field that could define how we function and what governs how we change in development and disease. The puzzles inside of puzzles that represent life science looked like they might have had hard rules governing them — more like chemistry or physics than traditional field biology. That meant unleashing not just discovery but creativity: methods to change biology, perhaps to develop new therapies for biologic disease.
(Continues…)
Excerpted from "Cancerland"
by .
Copyright © 2018 David Scadden and Michael D'Antonio.
Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Introduction
1. Dawn of the Biological Age
2. Seeing Cancer
3. Cancerland
4. Chemicals in Conversation
5. Stem Cells and a Renewable You
6. Snuppy the Hound and iPCSc
7. Provoking a Response
8. Gene Hacking
9. From Gory to Glory
Postscript: Science in the Future Tense
Bibliography
Index