Perhaps the important things about cancer doctors can’t learn from textbooks. I hope I did eventually manage to cotton onto some of them from my patients in 30 years of clinical practice but this novel manages to do the job equally well in the space of a few hours. It is an exquisite example of how the humanities can reach deeply into essential parts of medical education that the comparative objectivity of science cannot.
As the Shakespearean allusion in the title suggests, The Fault in Our Stars is about two highly articulate teenagers, who, although not typical of any teen patients I have ever met in their philosophical and literary awareness, certainly convey powerfully the inside story of what it’s like to have cancer and challenge some of our common misconceptions. As Hazel Grace, the novel’s 13-year-old narrator with metastatic thyroid cancer, tells us on the opening page ‘depression is not a side effect of cancer. Depression is a side effect of dying’. She may be confusing side effects with complications and from a purely scientific viewpoint is probably wrong, but we see what she means.
The effects of having cancer on family and friends are nailed with heart-breakingly evocative metaphor. When Hazel muses on why she shrinks from her new boyfriend Augustus’ touch, she suddenly realises it is because she is afraid of repeating what his previous girlfriend Caroline did to him — namely dying. ‘Caroline Mathers had been a bomb and when she blew up everyone around was left with embedded shrapnel.’ The realisation that, as another dying teenager, she can ultimately only inflict pain on those who love her makes Hazel then withdraw from her parents too. ‘I’m a grenade’ she tells them.
Relationships with healthcare professionals speak volumes to the medical reader. Dr Maria is a good oncologist because she doesn’t bullshit you. Alison My Nurse is a good one because she is a rebel and gives Hazel some extra ice chips in ICU. On the other hand, the surgeon who crassly tells Isaac, a 17-year-old with recurrent melanoma requiring enucleation of his one remaining eye, ‘Well the good news is you won’t be deaf’, is understandably the subject of considerable ridicule from both Hazel and Isaac himself. However, as GPs, who of us haven’t demonstrated our own inadequacies by uttering such inanities?
Predictably death hovers over the book from beginning to end, yet the book though tear-jerkingly sad, is life-affirming rather than depressing. Two elements contribute to this; firstly Hazel’s indefatigable black humour: when she and Gus first meet at their cancer support group in the Sacred Heart church, the defensive piety of Patrick, the group leader, causes him to reiterate empty religious platitudes reminding the group that they meet literally in the heart of Jesus, Hazel retorts, ‘Someone should tell Jesus. I mean it’s gotta be dangerous storing children with cancer in your heart’.
The second life-affirming theme is the unwavering love of the parents of all three of the central characters, Hazel, Gus, and Isaac. After Hazel shares with her parents that she feels like a grenade, they first wisely give her the space to be alone and work through her feelings. Later though they go together to her bedroom and her father tells her ‘You are not a grenade, not to us. Thinking about you dying makes us sad, Hazel but you are not a grenade. You are amazing ... the joy you bring us is so much greater than the sadness we feel about your illness’.
As a GP, the saddest funerals of patients I have been to are when I have been almost the only mourner. We all have to die and it’s when there is no one close enough to be hurt by our passing that surely our lives are the poorest?
- © British Journal of General Practice 2013