Healing outside the box

When Rachel Naomi Remen, M.D., spoke at the Yale Cancer Center in May about the will to live, she touched more than once on medicine’s preoccupation with control. “We may be so deeply into the pursuit of mastery,” said the author of the national bestseller Kitchen Table Wisdom, “that we may not see mystery when it happens directly in front of us.” Remen told of a patient she treated as an intern at Memorial Sloan-Kettering whose bones and lungs were riddled with cancer. During a two-week hospitalization, his lesions disappeared for no apparent reason. “Were we in awe?” said Remen. “Certainly not. We were frustrated. It was obvious we had misdiagnosed this man.” Pathologists consulted for a second opinion concurred with the original diagnosis of osteogenic sarcoma. When the patient was presented at grand rounds, the 250 physicians there concluded that the chemotherapy that had been stopped 11 months before had suddenly worked. “I sometimes wonder if too great a scientific objectivity can actually make you blind,” said Remen. “It was 15 years before I began to question this conclusion. When everyone is thinking inside of the box, it is hard to think anything new, but outside the box is often where life is.”