Book Review: Common Bonds: Reflections of a Cancer Doctor

As oncology professionals, what initially drew us into this fieldwas some mix of the mystery and intrigue of cancer with the hopeand exhilaration involved in attempts to conquer it. Along theway we encounter the patient, a separate entity from the cancerin question, but often even more challenging and difficult. Althoughapproaches to the patient vary as much as do treatment regimens,many oncology professionals train, practice, and retire with onegreat question underexplored: how the patient's experience affectsus, 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 practicingoncologist who appears to have become a writer in order to sharehis insights in an open, sometimes painful, but ultimately admirableway. He discusses the book as an attempt to learn from victoriesand failures with patients and their disease and to examine "theanatomy of the relationship." We follow his practice overa period of time while sitting on his shoulder, hearing conversationswith patients, receiving test results, conducting follow-up examinations,giving treatments in the hospital and office, and encounteringpatients, colleagues, and his own family. Even for those readerswho follow a similar daily itinerary, it is interesting readingbecause we hear what happens, followed by the author's thoughtsabout those events, in an unvarnished way.

More like a diary or memoir, the book discards stoicism and pretenseto lay open the physician's vulnerability, using the direct andhonest language that many medical professionals routinely reject.Before the first 20 pages are complete, we hear Dr. Berger reportingthat 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 "distancemyself emotionally," and that he returned home "tiredand depressed." But the book is neither an excerpt from astream of bad days nor the confession of an unsuitably sensitivesoul. Rather, it is an honest account of a real doctor who struggleswith the sad and unsolvable, and instead of shutting his reactionsaway, he examines them and shares that examination with us. Trueto his honest reporting, he does not always cope smoothly, andwe hear about that too, as well as his occasional cigarette duringtense staff conferences and his tendency toward an irritable colon.

Although the emotional narrative distinguishes this book, it alsotells absorbing stories of patients, which we follow eager toknow the ending, even if it is not a happy one. These case histories,interwoven throughout the chapters, provide a useful and affectingcounterpart to the author's soul laid bare, since they remindus of the fascinating individual dramas of people struggling withdisease, and that sometimes wonderful things can happen eitherby craft, fate, or chance. Without making a point of it, the authoruses this balance to show that even if you risk your heart bypracticing oncology with the kind of feeling and presence thathe 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, LindaMittiga, is a former patient whose story we learn, and she isone of his successes. Trying to appeal to many audiences, termssuch as "very malignant" coexist with "alopecia"(undefined, but we forgive this). Reading with the eye of theprofessional, one has the occasional wish to shield the authorfrom the almost brutal force of his own emotions. But readingwith the eye of the patient, one is struck with what a very humanbeing sits across the desk, and how much Dr. Berger's empathyenhances his already comforting medical expertise. These qualitiesstrengthen his ability to talk to his patients with the rightproportions of truth and hope. From any perspective, this bookis a good internal checklist for our own behaviors, and suggestshow we could do better-for our patients and for ourselves-as wework through our difficult days.