Cancer Doctor Draws Back The Curtain: A Book Review From A Radiation Oncologist

Hello! I’m Dr. Charles Hayter, a radiation oncologist

A medical historian, and award-winning playwright based in Toronto, Canada. I have good memories of doing part of my radiotherapy training at the Royal Marsden Hospital, London.

My new book Cancer Confidential: Backstage Dramas in the Radiation Clinic offers a rare glimpse into the behind-the-scenes world of radiotherapy and oncology – but it’s not a book about radiation technology or techniques. Rather, it shares stories of patients and their families dealing with the emotional fallout from a diagnosis of cancer.

I was prompted to write the book by my awareness that my formal medical training had left me ill-prepared for the emotional reactions and ethical dilemmas I witnessed every day as a practicing oncologist.

This awareness began in a personal experience.

Shortly after I qualified as a cancer specialist, my father was diagnosed with metastatic prostate cancer. My training had equipped me with the knowledge to understand his illness, but had not prepared me for the emotional roller-coaster that followed. Over the months of his illness, I experienced waves of sorrow, anger, desperation, and fear. I often coped by retreating into the shell of my medical persona.

As my career progressed, I saw my emotional reactions mirrored in those of my patients and their loved ones. They too rode a roller-coaster of emotions which often resulted in surprising, even erratic behavior.

In my book, I share fourteen stories of cancer patients and their families

These families are dealing with the emotional aftermath of a cancer diagnosis – some through avoidance, denial, and conflict, others as shining examples of quiet courage, resilience, and humour.

The stories are all based on real situations encountered in my practice, but I have fictionalized the patients to preserve confidentiality. You’ll meet such characters as: Betty, an elderly woman who adamantly refuses radiation, the only treatment for her advanced skin cancer; Otis, an overbearing retired judge with relentless demands to go to the front of the queue for radiation; Peter, a highly educated professor who turns his back on conventional treatment to pursue an unproven remedy; Sam, whose impending death from stomach cancer tears his family apart;  Sandra, a grieving daughter who demands to have the DNR (Do Not Resuscitate) order reversed on her dying father; and Christie, whose stoical reaction to the news her cancer has spread blindsides me.

In each of these stories, I probe the emotions that underpin the characters’ behavior. Is it fear that makes Betty so reluctant? Anxiety, that makes Otis so bullying? A need for control that compels Peter to chart his own course? Do I detect long-standing resentments that rip Sam’s family apart?  Is it desperation that makes Sandra cling to her father’s life?

"I was deeply touched by his acute sensitivity to the emotional dramas of oncology which arose not just from his acting training, but also from his experience with close family cancer and death"

Lord Michael Cashman, CBE

I also examine my own responses to the challenges posed by the situations.

Do I allow Betty to go away with her cancer untreated? Do I give in to Otis’s demands? Can I allow Peter to pursue an unproven remedy? How can I help heal Sam’s family and give him the peaceful death he deserves? Why am I so anxious to break bad news to Christie? Why is she braver than me?

These stories and others are tied together by the personal story of my father Russell’s journey with prostate cancer, a story which sees my own unfulfilled yearning for connection with him turn into desperation, and, as in Sam’s case, sees my family fracture. 

They contain a rich supporting cast that includes my fellow oncologists, sometimes belligerent surgeons, and many therapeutic radiographers and nurses - often the best and wisest guides for me out of sticky situations.

While not a book strictly about radiation, my purpose was also to give a human face to radiation therapy.

One in three cancer patients will receive radiation therapy, yet it remains a feared, poorly understood, and often maligned area of medicine.  I wanted to show that despite its public image as a highly technical field, it is a very human endeavor, carried out by individuals who possess great skill in understanding and supporting the emotional and psychological needs of cancer patients at this vulnerable and life-threatening time of their lives. Unlike other fields, patients are seen daily over several weeks during their treatment and the bonds that form between caregivers and patients can be very strong.

The book also offers a plea to return empathy and understanding of emotional distress to their rightful, central places in cancer care. In the hurly-burly of everyday oncology practice, it’s easy to slip into a routine of processing patients as though they were faceless cases and overlook their complex emotional and psychological needs. I argue that the only way of restoring empathy is for doctors to shed their professional masks and connect with their patients on an authentic level, as fellow human beings.