Reflections of Autumn - and Cancer

I took a long walk through the crisp forests of Missouri last weekend, marveling at the bronze and yellow-gold giants of autumn. They towered over me, lightly swaying in the October breeze as I tramped along. Fall is especially a poignant time for me, and not just because of the pleasure of scanning the brilliant countryside stained with color. No, this season also reminds me of my profession. It announces the death of summer - the slow transformation of green life into dark, skeletal corpses. This allegory is familiar to the oncologist, who all too often sees the same change in his patients. As I stepped on a vast carpet of fallen oak leaves I continued the metaphor. These leaves, which once shimmered in the blue dome of a hot July afternoon, now rested quietly on the forest floor. Could any cancer specialist not see the obviously painful comparison? What do we do with such a gloomy conceit on a sunny October day?

What I did was to consider my patients, some doing well, some struggling to live, and wondered how many of them would soon, like the scene before them, float downward from life and lie on the shady hillside, joining the limitless pile. I recalled that leaves are delightful when turning color, but once on the ground they are either a nuisance to be raked, or to be crushed by the boot on the way home. They are forever forgotten - who ever remembers on which branch they hung? Upon this reflection, I saw the contrast. The lives of my patients were more memorable than that of these trees. Their lives touched other lives - including mine. To each who was in my care I mouth a promise: "I will not forget you."

My time in the woods is therefore a lovely sorrow, a walk filled with thoughts about the beauty of the afternoon and of the disease that pervades this time of year. I suddenly have a vision of an empty chair placed in the midst of this dense forest, waiting to rest a weary traveler. Many have found an end to their suffering by stopping here. Today I walk on, through the timbers and into the meadows beyond. I know the chair remains in the woods, among the dead leaves. Perhaps someday my journey will lead to it. Until then the work and the daydreams of the oncologist carry on.