As I glanced through the obituaries the other day (yes, I have reached that stage in my life) I noticed a death notice with funeral arrangements for an oncologist I worked with twenty years ago. Of course I was saddened to hear of his passing, but what immediately came to mind was a conversation with a different oncologist that I overheard a long, long time ago–1976, to be precise.

It was the very beginning of my 2nd year at the University of Illinois School of Medicine. M1 Year had been spent buried in textbooks and anatomy lab, but with the onset of M2 Year, our class had (very limited) entre into the clinical world.

We were placed in groups of four, and each week every group had a pair of three-hour sessions in a clinician’s office. My group’s assigned physician was a busy oncologist who tolerated our being in his office but didn’t let us do much with his patients, and didn’t offer much insight either. But at least we got the vibe of being in the same general vicinity as living, breathing, patients.

At the end of one Tuesday session, our oncologist told us not to show up for that week’s Thursday session, as the office would be closed while he attended a funeral.

“Do you go to all your patient’s funerals?” the boldest of our foursome of M2s asked.

“I don’t go to ANY of them,” was the rather brusque reply.

A couple of that oncologist’s attitudes were transmitted to us in that brief exchange. “First,” he was conveying to us, “as a physician, you must keep your distance from your patients. Medicine is your occupation, maybe even your passion, but the patients are not your friends.”

“Second,” he seemed to be saying “I am an oncologist. All my patients die.”

As I said, that was a long, long time ago. I followed my talents to a medical field where I have so little patient contact that there is little risk of patients becoming my friends. Instead many of my friends have become my “patients”, the downside of being a 60-something prostate pathologist with a cadre of friends my own age.

But more importantly, oncologists no longer need to feel that their patients will die from their disease. Tumor screening (colonoscopy, mammography), leading to early cancer diagnosis, the use of genetic evaluation of tumors to guide therapy, the fantastic advances in understanding tumor immunology-these are wondrous tools that have made many cancers curable or converted them to chronic, treatable, conditions rather than rapidly lethal nightmares.

We aren’t at cancer nirvana yet. Treatments are still too expensive, life-style factors still put patients at risk. Some malignancies still baffle the best experts.

But perhaps in my lifetime, the Cancer Moonshot will succeed. And when an oncologist says “I don’t go to cancer patient’s funerals” it will be because there are none.

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