In mid-December 2022, Dr. Cronin called me out of the blue. I had not seen him since I gave up the Cleft Palate Team at St. Joseph Hospital in 2007. I knew he had cancer. I had spoken to him by phone a few years earlier but lost touch with him over the years. I feared that in this phone call, he might be calling to say goodbye.
I was overjoyed to learn that he was holding his own against his cancer, and he invited me to review his latest manuscript. I considered it a great honor to be among the first to read his book.
My relationship with Dr. Cronin dates to when I worked at the University of Texas Medical School at Houston (now called McGovern Medical School) in the department of Otolaryngology-Head and Neck Surgery. The chairman of the department, Dr. Charles Stiernberg, had opened a satellite clinic at St. Joseph Hospital, and he assigned me to be there full-time. I had just finished my neurotology fellowship at the University of Iowa, and I was eager to get into practice. Dr. Stiernberg introduced me to Dr. Cronin, and Dr. Cronin invited me to participate in his cleft palate team. My role was to provide otologic care for these children. Children with cleft palates frequently develop chronic otitis media with effusion, and they often need pressure equalization tubes as a temporizing method until the palate is repaired and functional. I worked with Dr. Cronin and his team for ten years. During that time, I saw Dr. Cronin’s skills. transform the lives of many children. His results were far superior to anything I had ever seen before. Eventually, my path took a different turn, and the University of Texas MD Anderson Cancer Center recruited me as part of the skull base surgery team. While I tried to keep up with the cleft palate team initially, my cancer work became too much; and I had to give up working with Dr. Cronin and his team. During my career at MD Anderson, I have learned about the devasting impact cancer creates. Both of my parents died from cancer during that time. The initial diagnosis is shocking and overwhelming. The initial meeting with a newly diagnosed patient is always full of emotions. People come face to face with their mortality. Follow-up visits are equally anxiety-provoking. All patients have a nagging worry that their cancer will return. I strive to give patients the results of scans first before engaging in any small talk. The diagnosis of cancer is completely disruptive to one’s life, and it can force productive workers into early retirement or onto disability. Alternatively, it usually causes individuals to re-prioritize their lives, to realize that life is fragile and limited, and to make the most of each day.
Dr. Cronin demonstrates many of the coping skills necessary to deal with cancer. At all times, he has his wife with him. They clearly have a strong, loving bond between them. Having a family member or friend attend meetings with the physician is fundamental. Someone who is not primarily involved can help by taking notes, asking questions, and being supportive. Keeping a journal or running a file can help to keep one’s facts and thoughts organized. Writing questions down before you meet is a useful strategy to make sure your physicians address all of your issues. Having a source of spiritual support can help in moments of doubt, doom, despair, and depression.
Many patients face this diagnosis with courage, determination, and perseverance. Others react with fear and anger or sadness and depression. Some never seem to grasp fully the peril they are in. Dr. Cronin met his ‘fiend’ head-on. He educated himself by reading patient handouts and references. He reached out to family and friends for their support and help. His journey invigorated a life-giving faith that sustains him. He shares very personal vignettes in hopes that his experience might help other patients, certainly “work worth doing.” We learn that he was diagnosed with cancer at a rare location, the appendix. While the appendix is a part of the colon, appendiceal cancer is very rare compared to colon cancer. Colon cancer is one of the top 4 sites of cancer (the others being breast, prostate, and lung). Colon cancer affects about 25-30 persons out of 100,000 per year. Appendiceal cancer affects only about 1- 2 persons out of 1,000,000 persons per year (this incidence is like the incidence of ear canal and temporal bone cancer). In other terms, colon cancer occurs about 250 times more frequently than appendiceal cancer. With rarity comes a relative lack of understanding, and physicians extrapolate knowledge from common tumors, like colon cancer, and apply it to rare tumors. Cancer treatment is complex. Surgery, chemotherapy, and radiation therapy are complicated topics. A few cancer patients may have had surgery, but virtually no one has any firsthand experience with chemotherapy or radiotherapy prior to diagnosis. Of course, some patients have had family members with cancer, and their knowledge and experience with chemotherapy and radiotherapy come from observing their loved ones. It is incumbent on physicians and team members to provide information that patients can understand. However, a person can absorb, process, and digest only a limited amount of information on a given day.
We, physicians, can be faulted for providing too much information at times or information in a form that is not readily understood. This area deserves attention to improve communication and education. Dr. Cronin mentions the reams of information given to him. Even for someone with a medical degree like Dr. Cronin, clearly a well-read individual, this amount of information can be formidable. Medical care comes with trials and tribulations. Dr. Cronin was blest with a compassionate, experienced, trustworthy, and honest team of physicians, nurses, and other allied professionals, but human knowledge is limited. Cancer therapies have improved dramatically in the last 20 years, but they are not perfect. Many patients are living with their cancer as a chronic illness. Although some advanced staged cancers can be cured, the therapies have significant and occasionally life-threatening side effects. Many patients may ask themselves if the treatment is worse than the disease. Dr. Cronin worked with his oncologist to develop a treatment plan with fewer medications and reduced side effects. This type of shared decision-making is central to cancer care.
Medical knowledge is always advancing. The advance in medicine is accelerating. Immunotherapy, targeted therapy, and genetic sequencing are some of the newest tactics in the armamentarium fighting cancer. The newest therapies often come with a hefty, eye-popping price tag. Someone must bear this price, whether the patient and his family, an insurance company and its enrollees, or the government and its taxpayers. Many patients make great financial sacrifices trying to overcome and beat their cancer. Dr. Cronin writes about the medical bills he received and the costs of treatment that he and his wife received.
Books by doctors as patients are enlightening. The role reversal highlights many of the triumphs and shortcomings of medical practice. Doctors are accustomed to being caregivers and are not used to being cared for. One might think that having medical knowledge would be comforting following the diagnosis of cancer, yet the opposite is true. Physicians are aware of what an isolated swelling or new weight loss might mean. Doctors who return to practice after cancer treatment emerge with a new sense of empathy. They realize the prevalence of medical jargon in their speech and change to use common terms instead. They often take a closer look at medication side effect profiles since having suffered themselves. This book describes the ups and downs of a surgeon’s experience with cancer, a gifted surgeon dedicated to improving people’s lives. This story will be helpful to any person dealing with cancer and its treatment.
Paul W. Gidley, MD
Professor, Otology-Neurotology
Department of Head and Neck Surgery
UT MD Anderson Cancer Center
Author of Temporal Bone Cancer
Everything was copacetic as the middle of March 2016 approached. I was content with my own serene and wonderful life in Camelot. I was enjoying a uniquely diverse career in exciting times for the development of plastic surgery.
Cancer struck suddenly on March 21, 2016. This necessitated my early retirement from my fulfilling and productive plastic surgery practice.
Enjoyment of my personal Camelot suddenly changed to a battle for my very survival, vis a vis the Fiend, Cancer. Facing an unexpected diagnosis of Stage IIIC Carcinoma of the appendix was frightening and disconcerting. I imagine everyone’s experience with cancer is unique. However, I decided to write about my experience because, as a Catholic physician, I thought I might have insight different from most cancer patients. I hope that some of my experiences will benefit others with significant cancers. Since I have endured many side effects and complications, including recurrent cancer, after four years, I believe my story might encourage others to endure similar experiences more easily. I will briefly discuss my response to affliction.
Unfortunately, as I wrote this book, the subject matter changed from my cancer to “our” cancer when we discovered my wife, Candy, had Stage IV ovarian carcinoma. Our story ends with outcomes undetermined. Although we no longer live in the Camelot described in part one of this book, Candy and I know it is fortuitous that we have each other and the love and concern of our wonderful family, friends, and church. During our illnesses, we have been so fortunate to have the prayers of our family, numerous friends, and many prayer groups. We feel rewarded due to all these intercessions from the Communion of Saints. Despite our afflictions, still, it’s a beautiful life!
Part One of my story begins with relishing my “prize” of practicing plastic surgery. Theodore Roosevelt declared, “Far and away, the best prize life offers is the chance to work hard, at work worth doing.” That prize was just one aspect of a blest, utopian life that I called my Camelot. I tell the story of the planning, hard work, and good fortune that allowed me to build my Camelot. I describe the broad, fulfilling, and enjoyable aspects of that beautiful life in Camelot that my wife Candy and I were living, and I relate some recognition that I received.
In Part Two, a minacious Fiend (Cancer) decimates Camelot, leading to my early retirement in March 2016. Dangerous and destructive complications accompanied my chemotherapy treatments. Nevertheless, I completed the chemotherapy treatment in January 2017. But was I cured? And then what?
In Part Three, after recovering from chemotherapy for about six months, I enjoy a two-year hiatus of near normality. During this time, I turned my attention to writing a memoir of my 38 years of plastic surgery practice. I published The Healing Mission of Plastic Surgery - One Surgeon’s Story in 2020.
In Part Four, the Fiend returns with a vengeance. I faced multiple hospitalizations, repeated surgery, and more chemotherapy. An added catastrophe was my wife Candy’s Stage IV Ovarian Cancer diagnosis in November 2021. So, “my” cancer became “our” cancer.
In Part Five, I review the myriad difficulties and complications and discuss how I managed my afflictions.
The final chapter, Outcome Undetermined, reinforces the conviction that “it’s still a wonderful life."