A Ruby Anniversary
Authors: Jonathan L. Finlay
Journal: Journal of Clinical Oncology (2016)

On July 16, 1975, at 26 years of age, after almost 6 months of observing a left epididymal mass slowly enlarge, with work up for epididymal tuberculosis, I finally underwent a left inguinal orchiectomy and resection of what proved to be a pure seminoma. A subsequent lymphangiogram was reported to be normal, and I proceeded to prophylactic abdominal irradiation. All would be fine, I was reassured by my surgeon and radiation oncologist; no, there was no need to undergo sperm banking, and the radiation therapy would surely cure this most irradiationsensitive of cancers. As a young pediatric resident, who was I to question my consultants? I rapidly learned the consequences of poor communication between physicians and their patients. There I was, hospitalized on the openmale cancer ward of a large university teaching hospital, about 12 beds lined up on either side of a very long central corridor, and a great television room with armchairs at the end. It was there that those of us allowed out of bed would convene in the evenings, and when my roommates learned I was a doctor, out poured all the questions they had not dared ask of their physicians, and their physicians had not addressed with them in anticipation of their concerns. One assumed he would die of a completely resected indolent thyroid cancer, because no one had told him otherwise. Others had no idea that they even had cancer. So many colleagues and friends were supportive, from my fiancee and a few of my closest friends to the professor of surgery, who stopped by my bed and joked that because they had spent so muchmoney training me, I needed to get better fast and “earn my keep.” Other colleagues and friends found it hard to visit or even speak about my cancer. I understood their discomfort, which I, too, would most likely have shared previously; it was my cancer, and I had to deal with it, not them. I took 4 weeks off residency for my radiotherapy, helped my dearest friends with their home reconstruction, and cooked meals for us all in the evenings (they somehow knew that distracting me with mundane tasks was good medicine), and I managed to maintain my weight with a little support from metoclopramide. And then I got onwithmy pediatric residency training. Alas, my cancer had not read the textbooks. By March 1976, while undertaking a senior residency in pediatric oncology, I was experiencing significant reflux esophagitis, inordinate belching, and, after a negative work up for gall bladder disease, underwent a barium swallow. My radiology colleague supervising the study looked pale as he informed me that there were mediastinal masses squashing my esophagus and, oh yes, there appeared to be a solitary, left-lung parenchymal metastasis. Now the conversation took on a different tone. I met with a senior radiation oncologist who tried to reassure me that he did, indeed, have one long-term survivor of recurrent metastatic seminoma over the course of his long career, a bassoonist from a prominent professional orchestra, who, alas, was unable to play the bassoon any longer after they finished irradiating his lungs. With this level of reassurance, I embarked upon mediastinal irradiation and focal left-lung boost to around 30 Gy, planned my bachelor party with a circle of friends in Paris before my departure for my marriage in the United States in June, and continued to work daily as a senior resident on the pediatric oncology ward. I remember distinctly, one day during irradiation, meeting with a senior radiation oncologist who sat me down and stunned me with crucial and unexpected questions: Did I realize that I might die of this? (Of course, I had not!) Who were the sources of my emotional support? (I had not even informed my elderly parents of any of this, relying onmywonderful older sister to help me through.) I realized these were the kinds of questions I should be asking the parents of the little children for whom I was currently caring on the pediatric cancer ward, especially the 9-year-old boy with pulmonary metastatic Wilms tumor, who thought it so cool that he was receiving radiation therapy at the same time as his doc. He did not survive the experience. I made it to my bachelor party in Paris, despite an unmeasurably low platelet count and exhaustion for much of the 3 days, made it to my wedding, and returned to England on honeymoon, where I felt a lump in my right testis. Sure