c-Myc, Captain Spaulding, and the boat to Heaven

(sung by Nicely Nicely Johnson from “Guys and Dolls”; written by Frank Loesser)

In the summer of 1971, I landed the role of Nicely Nicely Johnson in a Catskills summer camp production of “Guys and Dolls.” My family was spending the summer at the SGS bungalow colony in Swan Lake, NY, after the death of my father from lymphoma. My father never got to see me perform “Sit Down You're Rockin' the Boat,” but I revisited that night 40 years later with a patient of mine who also succumbed to lymphoma.

Peter was diagnosed with a “double hit” lymphoma in the winter of 2011. His disease was both scientifically fascinating and clinically aggressive. When we first met, I was immersed in my role as a clinician and teacher. After my consultation, I assembled the residents in the laboratory and 5 sets of eyes peered through the Nikon lenses of the multiheaded microscope at the Wright-stained peripheral blood smear. We then reviewed the complex molecular features of this disease. A small population of t(8;14) cells resided with the large population of t(14;18) cells, thereby necessitating an aggressive approach.

The disease became the target of my chemotherapy; the patient became my friend. We discussed books, movies, history, and our families. As the chemotherapy programs increased in complexity, the office visits lengthened. This was not because of the chemotherapy per se, but rather because we had so much to talk about otherwise. When he was rehospitalized months later the residents again turned their attention to morphology and molecular biology. The small cleaved cells were now dominated by larger immature cells with vacuoles. I wanted the residents to learn about lymphoma, but more importantly I wanted them to understand patient care, so I regularly encouraged them to join me at the bedside. This type of patient care is not on the electronic medical record, or an application on their smartphones.

Peter's condition worsened despite aggressive treatment, so our conversations shifted from chemotherapy to hospice care. One day as we spoke, one of the residents entered his hospital room, followed by an aide, a nurse, and then a home care coordinator. As the room filled I turned to Peter and said that it was beginning to look like the stateroom scene in “A Night at the Opera.” Peter perked up and then proceeded to recite a series of lines from Marx Brothers' movies. He sang “Hooray for Captain Spaulding,” and when he realized I knew all the lines his smile broadened. The resident stood there somewhat confused. She was thinking, “Who are the Marx Brothers and why is the attending physician joining this patient in these antics minutes after discussing end-of-life issues?”

After his discharge home, I gathered the resident team at the computer. Many of them were from other countries and were not familiar with the Marx Brothers. I logged onto Google and pulled up pictures and clips of Groucho, Harpo, and Chico. I knew that at this point in Peter's clinical course, discussing how Captain Spaulding shot an elephant in his pajamas was more important than hyper-CVAD. Although I stopped short of donning a greasepaint moustache, I hoped the residents learned this important lesson. As Frances Peabody stated very simply: “The secret of the care of the patient is in caring for the patient.”

The following day, I went to Peter's home to meet with his family and discuss what had transpired over the past 6 months and why the focus on comfort alone was most appropriate. Peter then mentioned the Marx Brothers to his wife, daughters, and grandson, and sang a few lines. His daughter, not to be outdone, began singing from “West Side Story.” She had been in the show as a youngster. It seemed natural at this point to tell them about my role in “Guys and Dolls” 40 years earlier. Peter, tired of discussing his deteriorating health, brightened dramatically and asked which role I played. When I told him, he smiled and sang “Sit Down, You're Rockin' the Boat.” He knew every line. Laughter filled the room as my hospice visit turned into a Broadway Revue. Within weeks he was on his boat to heaven.

Correspondence: Dr Ronald Lewis Sham, Rochester General Hospital, 1425 Portland Ave, Rochester, NY 14621; e-mail: ronald.sham@rochestergeneral.org.