What We Remember: From D-Day to Cancer Care
I RECENTLY returned from Normandy, France, where my wife and I attended events honoring the 75th Anniversary of D-Day and the millions, including close friends and family, who fought and died in the Second World War. My wife and a journalist from Los Angeles laid a wreath on Omaha Beach in honor of their fathers. Above the bluffs overlooking the beach, we participated in services at the American Cemetery, where more than 9,000 graves form long rows of crosses and Stars of David, each and every one adopted and tended to by a family in France.
Jonathan Lewis, MD, PhD
We also visited Pointe du Hoc, adjacent to Omaha Beach, where the Ranger Monument sits. Surrounded by 100- foot cliffs, Pointe du Hoc was taken by U.S. Rangers at great human cost on June 6, 1944, in order to disarm the 155-mm German guns pointed at Utah and Omaha Beaches. One of these Rangers—“the boys of Pointe du Hoc”—a dear friend of my wife’s family, played a special role in my life.
About 10 months after my wife and I married, I was returning to New Haven to recover from a significant injury to my right knee and proximal tibia, which had been operated on emergently in the Austrian Alps. A cast covered my leg from hip to ankle, and as a 4th-year surgical resident at Yale, I was unable to work for 3 months.
We lived in a two-story walk-up, and the busy lives of friends and colleagues in those days meant I would face many hours of immobility and solitude in that apartment. Yet every few days, this former U.S. Army Ranger, an acquaintance who was busy running a large business, would come by, carry me up and down the stairs despite being smaller than me and in his early 70s, and take me to physical therapy. His smile, his encouragement, and his care for me, all helped heal me.
A man who started off as a relative “stranger” to me played a pivotal role in how I was cared for. His care was delivered with compassion and humility. It was not until several years later that I learned from him the details of his WWII service. He remembered well his feeling of “caring leadership” from the very top, through his commanding officers, together with his extremely rigorous and tough training that contributed to his being able to get up and over those cliffs.
Thrust Into the Deep End
ANOTHER LESSON in care came a little later. When I started as an attending at Sloan Kettering in 1994, I was fortunate to be well supported and funded for laboratory and translational research. One of my first grants was an ASCO Young Investigator Award. I was also gifted “protected time” to set up a research program.
During that time, my first summer as an attending, I remember receiving a phone call on a Saturday afternoon, where I learned that my surgery mentor had sustained a significant injury to a finger on his left hand. I was asked to help take over part of his practice starting that Monday morning. I did not need to ask for details, and I didn’t hesitate to accept the request, as I would do anything to help a man I saw as my role model.
“Fortunately, most of those around me , importantly including those at the top … knew the power of a caring environment, and this enabled both enormous personal growth and the capacity to pass that caring on to my patients and those who trained under me.”— Jonathan Lewis, MD, PhD
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This meant being thrust into the deepest of deep ends. While I was well trained and skilled at what I did, I was inexperienced. I was faced with helping people through some of the most complex and difficult-to-treat cancer problems at a very early time in my journey as a physician. Fortunately, most of those around me—importantly including those at the top—knew the power of a caring environment, and this enabled both enormous personal growth and the capacity to pass that caring on to my patients and those who trained under me.
THE LESSONS of that time have stayed with me. I have been most fortunate to have a career in patient care in surgical oncology, experimental laboratory and translational therapeutics, and biotechnology research and development in cancer and beyond. I also continue to oversee patient care and stay in communication with patients and families from around the world, long after our clinical interaction has ended. Many of these individuals visit my family and me in my home, and, in turn, my family and I visit with them in their homes.
Effectively delivering treatment for complex medical conditions takes a substantial amount of education, knowledge, mentoring, and experience. Yet, in a career that has crossed many facets of health care, from complex surgical operations to research and drug development, what I have found is that how the patient is cared for is what patients and their families truly care about and, ultimately, value the most.
Often, with the anniversary of a treatment or the death of a family member, I get a call or a visit, and I listen to what the person contacting me remembers. Compassion and empathy play a central role in patient care, which I think the three memories I share below help illustrate.
“In a career that has crossed many facets of health care, … what I have found is that how the patient is cared for is what patients and their families truly care about and, ultimately, value the most.”— Jonathan Lewis, MD, PhD
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A Woman With Melanoma
A WOMAN in her 50s was referred to me with complex trunk melanoma for surgery and novel experimental therapy. I remember seeing her in the outpatient clinic room, where she was alone, without any family or friends. After the fellow and team had seen her, I introduced myself, explained what I knew about her and her diagnosis, and informed her that after we reviewed her pathology slides, I would come back and discuss a treatment plan. The pathology review took much longer than expected, and so, I returned to her room a few times to stay in communication.
On my second visit back, I saw she was still alone and said, “I see you are here with no one else; are you okay?” It was then that she started to unburden herself. “No, I’m not. I am going through a vicious divorce.” Courteous smiling turned into great sadness and weeping.
As she remembers it to this day, I sat down next to her, placed my hand over hers, and listened. I didn’t break eye contact as she told me what she was going through and what she was feeling. I treated her like a human being, not a patient or procedure. “That is when my healing started,” she now says.
I remember it was an extraordinarily busy clinic day, but I understood the profound need to sit with her those few minutes. I also remember the extreme complexity of her operation—a surgical resection with major pelvic venous structures involved—as well as the subsequent experimental therapy and even some of the molecular structures and receptor-binding kinetics. Her operation and subsequent treatment went well, despite the demanding complexity. She remembers my hand over hers, my listening, and that “moment when her healing started.”
A Surgeon Facing His Own Mortality
A VERY well-known, highly experienced surgeon was referred to me with a complex high-grade proximal thigh sarcoma. He was a humble man, surrounded by a loving family. He was also frightened, which I could sense, and his family was expecting to see “the world-renowned, highly experienced surgeon” who had trained me, likely causing added discomfort.
I remember that after I explained the planned treatment and operation, I asked him: “What does it feel like being a surgeon facing an operation like this?” This simple question opened a floodgate. I listened to him for a few minutes. This helped as much as any explanation I gave before the operation.
About 9 months after an extremely complex, femoral neurovascular margin-free resection including a portion of the femoral vein, which was considered a success, he developed lung metastases. He began chemotherapy as an inpatient and requested to be on my floor. He had some response to treatment, but ultimately, the disease progressed. It was difficult for me to see this, but then I also remember how much positive emotional energy I gained from being with him, and he from me, even as he was dying.
“Compassion and empathy play a central role in patient care.”— Jonathan Lewis, MD, PhD
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More than anything, just being there with him and his family was enough, even if only for a few moments each time. Sometimes it was just a phone call as I was getting on or off a plane somewhere in the world—Tokyo or Milan or Boston. I also visited his home when he was dying. I made the effort to be there, even if it was just for a few minutes. His family, whom I still see, remembers how important these moments were for him and for them. They remember how important, how helpful, and how strengthening the phone calls and the visits were then and, I think, continue to be.
His wife visited my home just recently. She is now in her 70s. She sat talking with my four teenage daughters—the fourth, an exchange student from Zürich, Switzerland, has been living with us since last August—and the surgeon’s wife told them that her husband’s death, in part because he was surrounded by love and care, was “spiritual and beautiful.” She also humbly told them that she recently passed her 6th dan black belt in karate, and when asked how she did this, she answered that she has repeatedly “kept on doing what she knew she couldn’t do.”
A Wildlife Photographer With Sarcoma
I AM CURRENTLY helping oversee the care of a man in his 50s, living and being treated in an overseas country, with multiply recurrent retroperitoneal sarcoma. I remember his first outreach to me, which was accompanied by a spectacular photo of a newborn elephant in the wild. (His primary hobby is wildlife photography.) While many other wonderful and dear patients send me photos of their children, grandchildren, and some great-grandchildren, he sends me wildlife photos—some of the best I have ever seen. Each one represents ongoing life, and he constantly reminds me of the magnificent ecosystems of nature and biology and how resilient they are. He lives in a home with lands surrounded by many of these animals, often in his garden. Remarkably, he continues to do well through ongoing recurrences and multiple operations.
After every one of his operations, I get new photos. Some remind me of Mama’s Last Hug: Animal Emotions and What They Tell Us About Ourselves, a book by Frans de Waal. (Learn more about Mama in this video.) In it, the author writes, “emotions are our body’s way of ensuring we do what is best for us.”
After 25 years of treating people, what so many of my patients and their families remember is much more than what I did in the clinic, my clinical and scientific expertise, my seminal publications, my awards, medals, and honors. They remember my smile, my hugs, my holding their hand, my moments being with them, and my seeing and listening to them as fellow human beings. ■
DISCLOSURE: Dr. Lewis has been Chief Executive Officer and a board member of Samus Therapeutics and has stock ownership of Allergan PLC, Alynlam Pharma, Bio Rad Laboratories Inc, Capricor Therapeutics, Celgene, Cyclerion Therapeutics, Elanco Animal Health Inc, Flatiron Health, GlaxoSmithKline, Hansoh Pharma, Incyte Corp, Ironwood Pharmaceuticals, Johnson & Johnson, Laboratory Corp of America, Lexicon Pharma, Eli Lilly & Co, Livanova PLC Group, Medicines Co, Medtronic PLC, Novartis AG, Samus Therapeutics, Shire Pharma, Takeda Pharmaceuticals, United Health Group, and Zoetis Inc.