"This e-mail is different from my usual. No smiley faces or funny cartoons, for I have moved on to another location…. My place in the long line of life has suddenly been jumped up to the head of the queue, and now I have a boarding pass,” notes Harry, a patient with end-stage lung cancer who has come to grips with his own death. Harry’s oncologist, Kashyap Patel, MD, wrote a compelling book in which Harry’s journey toward his ultimate death was the glue that held the rest of the stories together.

“As an oncologist, my profession had me witness death every day. I wrote this book to help patients and their families come to terms with what really takes place versus what they wished would happen,” writes Dr. Patel in the opening of his book, Between Life and Death: From Despair to Hope. And, indeed, the humanity and clear-thinking intimacy in this doctor-patient narrative will truly shed light on cancer and dying.

A Clinic Based on a Holistic Approach to Care

Dr. Patel is a practicing oncologist and has been working directly with patients who have cancer for the past 20 years. He is currently Chief Executive Officer of Carolina Blood and Cancer Care Associations, where he is a certified trainer for physicians with the education in palliative and end-of-life care program. His work with patients who have cancer facing their own mortality has given him an intimate window into the existential and spiritual process of dying, and he has clearly taken meticulous notes along the way.

Between Life and Death is organized into 13 chapters that are tied together by the lessons Dr. Patel’s patient Harry learns along the way, which ultimately enable him to plan his own exit from the world in a graceful manner, without the fear of dying. The backdrop for this immersive experience is Dr. Patel’s clinic, which was “founded on a holistic approach to the treatment of cancer. We had constructed the building in a U-shaped design that would allow all patients with cancer to look out to a healing garden with a gazebo with a golden dome…. It wasn’t just for the patients’ comfort because during difficult discussions, a quick glance at the garden in bloom or the smile of a patient resting in the sun grounded me, put in perspective, and reminded me of my mission of service.”

The Art of the Story

Dr. Patel’s “mission of service” is illustrated when Harry—the husband of Dr. Patel’s friend and colleague, Sue McGill, the head of his clinic’s oncology services—has a private sit-down with Dr. Patel and tells him that he wants to forgo any life-prolonging treatment and instead prepare himself for his death in “celebration not gloom.” Harry says, “My wife told me that you [Dr. Patel] were great with counseling your patients near their end, and that you interspersed spirituality and philosophy with science…, but whatever knowledge, understanding, experiences, and beliefs you share, in whichever format you do, will help me.”

In turn, Dr. Patel assures Harry that he will share his personal journey, along with stories of other patients with late-stage cancer he has counseled, in the hope “we both can learn something” about the mysterious passage to death that will make it less daunting. So, Dr. Patel agrees to meet with Harry once a week at lunchtime. When Dr. Patel asks Harry what kind of stories he should begin with, real-life, young, old, ICU, hospice, or home, Harry responds: “First tell me about your father. It’s obvious he’s had a great influence on you. Tell me how he helped you become fearless.”

Many of the stories about patients with advanced cancer will seem familiar to the oncology community. Moreover, there have been many other fine books about dying, most notably How We Die: Reflections on Life’s Final Chapter, by Sherwin B. Nuland, and When Breath Becomes Air, by Dr. Paul Kalanithi. However, Dr. Patel’s intimate and somewhat avuncular approach to his storytelling give it a valuable place in a crowded niche.

Fittingly, the final chapter, “The Flight to Eternity,” tells the story of Harry’s final days, up until his death with his wife and daughter at his bedside. “Harry’s body jerked a bit. His eyes remained closed, but his arms stretched out as if he were trying to embrace something in the air. His facial features softened. His tense eyebrows relaxed…. His wife Susan swallowed to help push the words past her bone-dry throat. ‘He’s gone,’” writes Dr. Patel, who was also there with his patient near the end, offering whatever solace he could.

One of the most important takeaways from Between Life and Death is the extraordinary relationship oncologists have with their patients. Naturally, not every oncologist is as devoted as Dr. Patel, but he certainly offers a model to aspire to, making this a very useful book for oncology fellows.

BOOKMARK

Title: Between Life and Death: From Despair to Hope

Author: Kashyap Patel, MD

Publisher: Random House India

Publication Date: August 2020

Price: $27.95, hardcover, 204 pages

Subtle Messages

Every life is unique from any that has come before it, and so is every death. Dr. Patel has seen a lot of death in his long career in oncology, and he assures readers that if we know the truth about the physical process of dying, it will help us deal with false expectations and fear. Also, without hammering the reader with moralistic platitudes, as some in this genre are guilty of, Dr. Patel’s stories subtly convey a vital message: The dignity we seek in dying should be sought not just in our final weeks, days, or moments, but in how we’ve lived our lives up until then.

This gentle but powerful book is highly recommended for readers of The ASCO Post and their patients.