David Biro, a physician, practices with his father and is an Asst. Professor at Down State Medical College (State University of NY). Several years ago, at age 31, he suddenly developed "minor" symptoms that eventually led to a diagnosis of PNH, a rare disease marked by the destruction of red blood cells. Medication can help relieve symptoms but cannot cure. In severe cases, a bone marrow transplant may be considered.

In his book, Biro describes the move from a moment when life — marriage, career — was bright and promising through the anxieties of diagnosis, treatment, and recovery. His story develops around a series of contrapuntal tensions — mostly within — between doctor and patient, knowledge and ignorance, acceptance and denial, hubris and despair.

Initially, Biro dismisses the symptoms as minor. Gradually, he realizes that something is genuinely wrong. Subject to endless tests and the pain of waiting, the "patient" reports his impatience " "I want answers;" the "physician" remarks on his insensitivity when ordering tests for others. The answers are slow in coming. When they do, he doubts what he is told. PNH is, after all, a very rare disease (about one chance in a million). So, Biro the physician takes over. "Doctors," he notes, "love a good zebra." (p.28), i.e. they prefer the interesting to the routine (the horse); the case that can be reported in Grand Rounds or written about in medical journals.

But finally, the diagnosis cannot be denied and the problems of treatment must be faced. Here Biro is torn between two doctors, an Italian and a WASP, both in the same hospital and both specialists in dealing with PNH. The former advises a conservative course of treatment (medications and time).. The latter recommends a bone marrow transplant, which has, as he tells Biro, a 70% chance of cure. Biro describes his internal argument: his affinity for Italian literature and art moves him toward the courtly specialist; his impatience with the irresolution of the conservative path leads him toward the transplant. Inevitably, wife, family, friends and colleagues get into the act. Ultimately, impatience with indecision leads him to opt for the transplant.

The headlines ignore the complexities of transplant. We settle for the language of miracles. But behind the headlines there is the need for a compatible donor, the preparations that can be as painful as the disease, and the follow-up that can be life-long, complicated, and expensive. Biro’s dual presence as patient and physician illuminates this process and the struggles it presents. He describes the ups and downs, the mood swings, as the treatment seems to be working and then not working. He reports the frustration of a month of bed and isolation in a small hospital room to avoid infection. As he writes, "I’ve been living in a semi-vegetative state, oblivious to everything, exiled from the world." (p.220) Discouraged by his weakness and debility, he welcomes and resists the return home. And then the months of recuperation and the years lived in doubt!

He concludes with the comment that there is no conclusion. Back in practice, he notices that he is more tolerant than before and yet, paradoxically, more intolerant when confronting the patient with "minor" complaints. And he adds, ". . . before Nemesis, I was invincible . . . I am more tentative today . . . the story of my bone marrow transplant continues without end." (p. 289)

This is a readable, fascinating and important book. While not technical, professionals would benefit from it too. In deceptively simple prose, Biro conveys the realities of medicine, moving between the subjectivity of the patient and the subjectivity of the physician. It is no less important for its description of the surroundings; the doctors, nurses, technicians who try to pay attention to the patient in a time when rising costs, market practices, and growing populations subvert them.


HOWARD B. RADEST, PHD, is Adjunct Professor of Philosophy at The University of South Carolina-Beaufort. He is Ethics Consultant to Hilton Head Hospital and Chair of its Biomedical Ethics Committee. He is the Dean Emeritus of The Humanist Institute, a member of the Council of Ethical Culture Leaders and of the Highlands Institute for American Religious and Philosophic Thought. Dr. Radest was the founder and chairman (1983-1991) of the University Seminar On Moral Education, Columbia University. He is a member of the Board of the North American Committee for Humanism. From 1978-88 he was Co-Chair of The International Humanist and Ethical Union. He is on the editorial boards of The Humanist, Religious Humanism, and Free Inquiry. His books include Toward Common Ground (Ungar, 1968), Can We Teach Ethics? (Praeger. 1989), The Devil and Secular Humanism (Praeger, 1990), Community Service: Encounter With Strangers (Praeger, 1993), Humanism With A Human Face (Praeger, 1996), Felix Adler: An Ethical Culture, (Peter Lang, Publishers, 1998) and From Clinic to Classroom (Praeger, 2000}.

Dr. Radest received his B.A. at Columbia College, his M.A. in Philosophy and Psychology at The New School For Social Research and his Ph.D. in Philosophy at Columbia University. He is listed in Who’s Who.

Categories: Memoirs, Philosophical