No Stranger to Tears: A Surgeon's Story

National Review, Dec 28, 1992 by Wilfrid Sheed

THE MASTER Canadian humorist Stephen Leacock once suggested that the ideal university would start with a man smoking a pipe, around whom would accrete disciples and books, in no special order, and eventually some sort of housing to keep the books dry (the shade of a large tree would presumably do for the others: there's a lot to be learned from getting wet occasionally).

This, one might suppose, may be all very well for universities, but is not altogether practical for hospitals. Yet the one Dr. William Cahan writes about in his book, to wit, Memorial Sloan-Kettering Cancer Center in New York City, has always struck me on my grudging visits there as a Stephen Leacock kind of place, built around a cadre of wise men--not smoking pipes to be sure (make that damn sure) but pursuing wisdom to beat the band, and surrounded by student nurses, student patients, and even student visitors.

Each of the above will have learned before he leaves more than he bargained for, not just about cancer, but about life and death, the texture of fear and the stubbornness of hope; and he will have experienced the rare, almost dreamlike pleasure of being treated by doctors who love their work to the point of obsession and by nurses who treat the patients like friends, and not like the latest nuisance found in the in-tray.

It's safe to guess that Dr. Cahan, concerning whom I have no intention of being objective--I owe the man an enormous debt, and if he'd written a bad book, I'd be the last to tell you-- won't mind my sharing some of his space with the establishment where he works; because he loves it himself, with all his heart, and has probably done as much as anyone over nearly fifty years of service to shape its style.

At Sloan-Kettering, you will sense none of the prevailing sulkiness common to hospitals where medicine seems to be regarded as primarily a holding action, like weeding and doing the dishes. The personnel at S-K are part of a great enterprise and it shows in their work. To indulge, nay wallow, in a personal note: if Plato had written a dialogue on the nature of nursing he could not have conceived of this exacting art being practiced much better than it was recently practiced on and around me at Dr. Cahan's hospital. And the same goes for the doctoring of my own doctor, Elliot Strong, who might have a pretty good book in him, too.

Perhaps the greatest tribute to the seductive powers of this building is the simple fact that it has been able to nail such a free spirit as the author down to the same spot for the best part of a long, rich lifetime. By temperament, Bill Cahan had, and by the looks of him has, the makings of a pretty good playboy, and in his first exhilarating years on the job, he did his best to uphold the reputation of surgeons as the stunt-pilots or rakehells of medicine. It is no accident that Walter Mitty daydreamed in sequence of being a great trial lawyer, a World War I ace, and a super-surgeon. Surgery is one of those death-or-glory, high-stakes professions that seem to demand a corresponding flamboyance in the private life, or winding-down period. And Dr. Cahan's first marriage, to Gertrude Lawrence's daughter, gave him every opportunity to blast off, plunging him willy-nilly into an irresistibly distracting off-stage life among the beautiful people of New York, who turn up in the course of his book as both patients and playmates. And his current marriage to the editor Grace Mirabella hasn't exactly taken him out of the swing.

Yet always the siren song of work would lure him away from the rocks (Dr. Cahan's sirens are Jewish) and he would notice at the height of the revels a suspicious dot on the face of a celebrity he might be talking to, or hear a nasty cough from a cabdriver--the democracy of cancer is all the antidote he needs to the high life-and the whole scene changes. Cancer is at once so mysterious and so commonplace that all the world's a clue and all the men and women are under suspicion. On the strength of TV pictures alone, Dr. Cahan has forwarded health warnings to such diverse figures as Yuri Andropov, Jimmy Carter, and Bart Giamatti (this last was a mistake-Cahan mistook someone else's hands for the late baseball commissioner's on the screen). And in real life, woe betide the dinner partner who carelessly lights up in his presence: Dr. Cahan's passions are on call at all hours of the day, and his sermons on tobacco are ripsnorters.

There is never a dull moment in such a life, or in such a book. The very next patient who walks in the door may be the one who unwittingly reveals the secret to the whole thing; so Dr. Cahan has seen fit to keep his eyes wide open through fifty years of intense cancer research, to which his book constitutes the best guide I have yet seen.

But a guide to cancer is not like a guide to hangnail or croup. There are no detached observers at this bedside and no safe place to view it from. The democracy of cancer includes preeminently among its citizens the doctors who spend their days in its presence. Early in his career, Dr. Cahan suspected he had the disease himself and feared, as patients have feared since Galen was a pup, that his own doctor was not leveling with him about it; and later, he would experience the slight awkwardness a specialist feels in the presence of a colleague who has caught the house plague.