Though it is tempting to view "Vital Signs" as yet another entry in the how-I-licked-cancer-and-found-God sweepstakes, the temptation must be stoutly resisted, and for several reasons: Its author, Fitzhugh Mullan, is himself a doctor and thus brings to his book a unique perspective; he declines to sentimentalize either himself or his response to his illness; he has some uncomplimentary but useful things to say about doctors and hospitals; he is a clear, interesting writer.
It was in the early spring of 1975 that Mullan, then working in New Mexico as a physician for the U.S. Public Health Service, discovered entirely by accident that he had a "pint-sized cauliflower" in his chest: a malignancy that "in a space of five minutes . . . had come out of nowhere to become the focal point of my life." He flew at once to Bethesda and turned himself over to the care of the National Naval Medical Center. He was 32 years old, married, the father of a young daughter, on the brink of a useful and productive career; suddenly all of this was jeopardized by a "massive" growth of which he had had no warning, no symptoms.
Not only that, but he didn't feel in the least bit sick. It was only after the removal of the tumor--an operation with complications that caused severe damage to his chest--that Mullan realized the gravity of his condition:
". . . No longer was I able to appear hearty and brave. In spite of the mental weight of the disease in the preoperative period, my body had continued to function unflinchingly with scarcely a hint of the problems inside. That was all changed after surgery. The post-thoracotomy patient is extremely sick regardless of the underlying diagnosis. My breastbone had been split, several ribs were cracked, my heart had been manipulated and was subject to failure, and my lungs had been literally manhandled. Pneumonia, fluid and electrolyte imbalance, congestive heart failure, internal bleeding, and infection were all possibilities. Superimposed on these threats was pain--pain caused by breathing, moving, and, above all, coughing."
The cure turned out to be worse than the disease. Removal of the tumor and subsequent treatment got rid of the cancer, but the condition of his chest in the aftermath of the operation was so grave as to threaten his life all over again. Just when he had been released from the hospital and had begun to ease himself into a new job as an administrator at the National Health Service Corps in Rockville, Mullan developed further complications and had to return to the hospital for extensive, prolonged repairs to his besieged upper body:
"I was a captive of technology gone awry--a victim of an iatrogenic, or medically caused illness. While the therapy had apparently licked the cancer, it had destroyed my anterior chest. One treatment begot another and, in an effort to patch the chest, my side had been transplanted upwards with the assist of my arm. Now, arm stuck to side, side stuck to chest, and chest refusing to heal. I was an iatrogenic catastrophe."
But it is a story with a happy ending. The complex plastic surgery on Mullan's chest at last was successful, and his scarred, battered body recovered. He is now well past the cancer danger period, since "a five-year survival is about as close to a definition of a cure as anyone can come." He has held a number of responsible jobs, the most recent being that of a senior medical officer at the National Institutes of Health. He and his wife had a second daughter while he was undergoing treatment (she had become pregnant just before the discovery of the cancer), and they later adopted a son.
Mullan has come all the way through this with his head screwed on in the right direction. He is not ashamed to describe the despair into which he fell when his future seemed so short and bleak, the tears he shed in uncontrollable fits of crying, the anger that often swept over him. He declines to make his an inspirational story: "I was neither missionary nor saint. The egocentricities that had been mine a year earlier had survived the ordeal intact. My personality was alive and passably well, but it was definitely not 'born again.' "
He does concede, though, that this terrible experience did not leave him unchanged. He believes that he "developed skills of patience and resilience that will stay with me in other crises," and that he acquired a greater sympathy for and understanding of the problems faced by other cancer patients. He received, however involuntarily, an education in the "depersonalizing" nature of the "modern medical center" that should serve him well as a practicing physician. So, too, should his new understanding of the function of the physician:
"My sense of doctoring, I found, had been significantly changed by all that had happened. From medical school on I believed that medicine was something finite and specific, a marathon multiple-choice test in which, as a physician, I was continually struggling to discover the correct diagnosis and match it to the right treatment . . . While I still appreciate accuracy and precision, my illness forcefully broadened my expectations of doctoring. A good physician was one who saw the patient as a whole person, a complex human being, rather than a series of organs in various states of repair. This was not an argument against knowledge or even specialization, but rather a recognition once and for all that good physicians are something more than Midas muffler dealers. Generalist or specialist, family practitioner or plastic surgeon, a good doctor needs to love his patients at least a little bit. He needs some curiosity, a touch of fervor, a belief that most people are good and worth knowing."
Certainly that seems true of Fitzhugh Mullan, who has written an exceptionally candid, thoughtful, instructive book about what it is like to be deathly ill and then, with the help of one's own dogged persistence and the love and skill of others, to recover. And for his fellow doctors, it should be required reading.