“What am I doing here? This question kept running through my mind as the incoming freshman medical students at the University of Chicago assembled for the first time.” The person asking the introspective question was Marvin Stone, fresh out of college, recently married to his wife, Jill, and now a nervous 21-year-old student at a renowned medical school in the nation’s third largest city. Dr. Stone recalled the culture shock he and his young bride encountered.
Title:When to Act and When to Refrain: A Lifetime of Learning the Science and Art of Medicine
Authors: Marvin J. Stone, MD, MACP, FRCP
Publisher: Marvin Stone, MD
Publication Date: October 2018
Price: $32.95, hardcover, 284 pages
“Jill and I lived in a third-floor walkup apartment over a grocery store…. It was like a war zone. Many of my classmates were robbed at some time during medical school…. The unrest that occurred in many American cities in the 1960s was already prevalent on Chicago’s South Side in the 1950s.”
This kid from Bexley, a suburb of Columbus, Ohio, was justifiably overwhelmed. But, as they say, the rest is history, and it is told in clear, understated prose in When to Act and When to Refrain: A Lifetime of Learning the Science and Art of Medicine, a memoir by Marvin J. Stone, MD, MACP, FRCP, a venerable man of science and medicine. His story stretches over a 60-year career, much of it spent as a cancer researcher and Director of the Baylor Sammons Cancer Center, Dallas.
Mentors and Eye-Opening Discrimination
When to Act and When to Refrain is organized in four parts: Mentors and Training, Patients, Colleagues, and Summing Up. The narrative is spiced up with figures, pictures, and appendices, which include several tributes and extensive interviews with Dr. Stone. They drill deeper into the personal perspectives he shared in the body of the book.
In the opening section, Dr. Stone introduces several of his fondest mentors, each of whom helped shape different facets of his career path and general philosophy. “The profession of medicine involves caring, knowledge, skill, accountability, empathy, and lifelong learning,” writes Dr. Stone. His passion for knowledge and learning was first nurtured by his close-knit family, which was led by his father, an attorney with a voracious appetite for scholarly reading. The dinner table was not only a gathering place to break bread, but a forum for shared ideas about current events and their effects on society.
“No other profession is like medicine…. What will not be altered by technology is the need for physicians to relieve suffering and embrace healing.”— Marvin J. Stone, MD, MACP, FRCP
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The most poignant memory in the opening speaks volumes to the current zeitgeist that has taken hold of the nation. Dr. Stone had become intensely interested in pathology early in his studies at the University of Chicago Medical School. While working on a tumor immunology project, he met Lloyd N. Ferguson, a Black medical student 2 years ahead of Dr. Stone. He was “bright, stimulating to talk to, and fun to be around—I looked up to Lloyd and learned a lot from him,” the author comments.
The two young medical students arranged to attend a course in the fundamentals of cancer at MD Anderson. It was the first trip to Texas for both men. Dr. Stone recalled: “Lloyd asked if I’d mind sharing a room, and I said, ‘Of course.’ We made reservations at the Shamrock Hotel, a first-class hotel near the medical center. As we stood on line to register for our room, the hotel manager asked us to step inside his office, where he told us, ‘Local custom does not permit us to take care of Dr. Ferguson, but we’d be glad to take care of you, Dr. Stone.’” The two friends shouldered the embarrassment and anger and spent the night together in a rooming house in the Black section of town. “That experience opened my eyes to the anger and pain Black Americans felt and the impact of blatant discrimination,” writes Dr. Stone.
Antiwar Protests and Medical Advances
Dr. Stone’s coming of age as a researcher at the National Institutes of Health was made memorable by his world-class mentors, such as pioneering immunologist Henry Metzger, MD, who not only mentored Dr. Stone in his laboratory, but also in antiwar protests. It was the height of the Vietnam War. Dr. Metzger was active in the Medical Committee for Human Rights (MCHR) and introduced Dr. Stone into the organization.
“Many of us in the MCHR provided medical support for the ‘March on the Pentagon,’ in October 1967. I participated in the event, mixing in with the crowd for about 6 hours…. It was very moving, especially to see veterans of Vietnam, some in wheelchairs, who were demonstrating against the war,” writes Dr. Stone. During this section, readers, especially those old enough to have been through those incredibly turbulent times, will marvel at how Dr. Stone faced the rigors of a burgeoning career and made his own contributions to social justice, along with being a young husband and father.
Dr. Stone does a good job of integrating his stories about treating patients with cancer and interweaving the medical advances that coincided with their treatment. Dr. Stone displays his prowess as a medical historian in this section, and, once again, readers will meet well-known oncology luminaries such as Drs. James and- -Jimmie Holland.
In addition, there is an especially lively and informative chapter on Judah Folkman, MD, who also graduated from Bexley, Dr. Stone’s high school alma mater. “Judah was 5 years ahead of me. His father was our rabbi…. I followed Judah’s career through the years,” notes Dr. Stone.
A Close Call and a Glimpse Into the Future
In Chapter 19, aptly titled “Derailment,” Dr. Stone offers a vivid description of his diagnosis of a serious heart condition that required surgery. However, persistent remnants of the condition forced him to give up his clinical practice, a devastating blow. “I knew it was the right thing to do, but, as anticipated, I missed my patients immensely.”
The last chapter is called “The Future of Medicine.” Here, Dr. Stone makes some bold predictions, among them: “Hospitals will decrease in number; many of those that remain will become giant intensive care units. Rehabilitation and assisted living units will proliferate. Telemedicine and virtual doctors’ visits will increase and expedite patient care. Whether quality of care will improve as a result remains to be seen. Concierge medicine will increase for those who can afford it.”
However, as medical technology races forward at dizzying speed, helping and sometimes displacing humans, Dr. Stone ended his fine memoir with a confident nod to the profession he cherished: “No other profession is like medicine…. What will not be altered by technology is the need for physicians to relieve suffering and embrace healing.”
Dr. Stone left his mark on medicine and shared it with confidence and clarity. His memoir is highly recommended for readers of The ASCO Post.