Download Stations of the Heart

Stations of the Heart
Parting with a Son
Richard Lischer
Alfred A. Knopf, New York 2013
Patients with melanoma are among our most memorable patients. We all
know some who have or will of the disease. Presently, PubMed has some
95,000 references on melanoma; more than even the most compulsive
dermatologist can read, more than any oncologist can master.
Of these 95,000 articles, only one addressed how melanoma affected the
patient; and it tangentially discussed the journey of a patient with
melanoma.1 Richard Lischer’s “Stations of the Heart: Parting with a son” is
a welcome addition to the literature of melanoma and illness narratives. It
chronicles the journey of Lischer’s son, Adam, who succumbed to
melanoma at age 33.
As a physician, I have been interested in pathographies for over 20 years. A
pathography is a narrative that gives voice and face to the illness experience.
Anne Hunsakder Hawkins tells us that:
Pathographies not only articulate the hopes, fears, and anxieties so common
to sickness, but they also serve a guidebooks to the medical experience
itself, shaping a reader's expectations about the course of an illness and its
treatment. Pathographies are a veritable gold mine of patient attitudes and
assumptions regarding all aspects of illness. These narratives can be
especially useful to physicians at a time when they are given less and less
time to get to know their patients but are still expected to be aware of their
patients' wishes, needs, and fears.2
I started a blog on these illness narratives a number of years ago.3 “Stations
of the Heart” is the first book I have encountered that addresses the journey
of a patient with metastatic melanoma.
It is the story of a remarkable young man, an idealistic lawyer who develops
metastatic melanoma and dies roughly 16 months after a wide local excision
of a melanoma on his back. From the standpoint of a clinician, it would
have been nice to know the initial thickness of the lesion, but perhaps, that is
beside the point.
Adam received state-of-the-art treatment at one of the U.S.’s premier
medical institutions, yet the progress of his disease was insidious and
relentless. His father, Richard Lischer, an ordained Lutheran minister on the
faculty of Duke University, narrates the book; yet it deals with patients, their
families and friends and is not focused primarily on the spiritual or religious.
As Adam got sicker with brain metastases Lischer does not call on God but
intones, “I was angry at the seizures. I was enraged that it was my son who
was being raped by cancer and robbed of the consolation prize he had
chosen for himself and Jenny.”
We learn how one young man, newly married and his wife make plans for an
uncertain future in the face of great personal tragedy. Adam’s wife Jenny is
pregnant with their first child and they find joy in the hope for the time to
come.
In my career, I have seen over a hundred patients with melanoma, but never
taken a journey with any of them like the one I traveled with Adam Lischer
and his family. “Thomas Merton once said, ‘souls are like athletes that need
opponents worthy of them, if they are to be tried and extended and pushed to
the full use of their powers.
“Now Adam, too, had discovered an opponent that would push him to the
full use of his powers. A road had been revealed to him. Actually two
distinct paths opened before him: one would take him through the maze of
chemo and radiation to an uncertain end. The other would lead him through
the labyrinth to his true destination.”
It is tempting to summarize much of this book for the reader. I remember
Anthony de Mello’s admonition about moral stories.4
A disciple once complained, “You tell us stories, but you never
reveal their meaning to us.”
Said the master, “How would you like it if someone offered you fruit and
masticated it before giving it to you?”
No one can find your meaning for you.
This is how I feel about recommending “Stations of the Heart.” It is a
superb and valuable pathography. It is a profound story of how melanoma
affected one man and his family. It gives insight into how diseases that we
treat impact on individuals and those around them. As we focus on the
evermore technical and specialized aspects of disease we need to remember
an aphorism of Maimonides, “It is sometimes more important to treat the
patient who has the disease, than the disease the patient has.”5 Spending
some time with Adam Lischer and his family give us insights into melanoma
that 100,000 PubMed articles fail to reveal. Those who read this book with
be enlightened and enriched.
References:
1. Afeef M, Alkhoulli L. Surprised by joy: a journey through suffering.
Asian Pac J Cancer Prev. 2010;11 Suppl 1:125-6. (Open Access)
2. Hawkins AH. Pathography: patient narratives of illness. West J Med.
1999 Aug;171(2):127-9.
3. The Pathography Blog www.pathography.blogspot.com
4. de Mello A. The Song of the Bird. Doubleday 1984
5. Maimonides. Treatise on Asthma