Best of the Cheerful Oncologist: Reflections of Autumn - and Cancer

[Editor's Note: In honor of the first day of October (and by request) here is a brief essay first posted the C.O. in 2004. In honor of the practice of improving one's prose, I've asked him to re-write the thing, to which he has grudgingly agreed to.]

Last weekend I got off the couch and took a long walk through the crisp forests of Missouri, a journey long overdue. As I tramped along, the bronze and yellow-gold giants of autumn towered over me, lightly swaying in the October breeze. Fall is a poignant time for many people, representing turning points that are deeply embedded in the psyche, such as the end of summer swimming and the beginning of dawdling down the sidewalk back to school. It is a time for craning the neck to scan the brilliant colors draped across the countryside. As an oncologist autumn reminds me of something else, too: my profession. It announces the death of summer, when green life slowly transforms into dark, skeletal corpses. Such allegory is all too familiar to doctors, who often see the same changes take place in their patients. As I stepped on a vast carpet of fallen oak leaves I continued to notice the irony. These leaves, which once shimmered under the blue dome of a hot July afternoon, now rested quietly on the undulating floor, creating a distinctively gloomy conceit on a cool but sunny October day.

I considered my patients, some doing well and some struggling to live, and wondered how many of them would soon like the scene before them float downward from life and lie on a shady hillside, joining the limitless pile. Leaves are delightful when turning color, but once on the ground they are briefly remembered as a weekend chore, then forgotten forever. No one recalls upon which branch they once hung, and therein lies the contrast. Unlike the crumbling leaves, my patients touched the lives of others and leave others behind long after they are gone, family and friends who are unafraid to turn toward the sinking sun and whisper: "I will not forget you."

My time in the woods is a lovely sorrow, a walk filled with the beauty of the afternoon and with thoughts of the disease that perhaps is perversely inspired by this time of year. I suddenly have a vision of an empty chair sitting in the midst of these dappled shadows, placed here to rest the weary traveler. Many have ended their suffering by stopping here. Today I walk on through the timbers, hoping to reach the meadows far beyond, leaving this chair behind to guard over the dead leaves. All of us who tread with vigor now will someday return to this spot, but until then let the solitude resonate with the sound of our footsteps.

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This post reminded me of a passage in my own journaling through treatments.
"I hear the ticking of time here. Fleeting away like the leaves, slowly falling off tree tops, gliding in slow motion onto the ground below. Falling ever slowly, drifting, then spinning, cascading to our final destination."
Not a writer, such as you. Just a patient struggling to make sense of all that was happening.

Odd that you wrote this in October of 2004, I was finishing up treatments and had an overwhelming sence that I'd entered into autumn. My mantra at that time was the closing lines of a Thomas Dylan poem
"Do not go gentle into that good night.
Rage, rage against the dying of the light."
Your post reminds me of that time in my life.

Knocks my socks off every time I read it.I hope you don't mind, but I have shared this piece often with some of the hospice patients in my care as well as friends struggling with cancer.God bless you dear C.O. and all of the patients in your gentle and tender care.