Eulogy versus Resume Virtues

When a doctor dies, do we do right by him?

Over the years, I have been saddened to see several colleagues die. Recently, a famous physician passed away. I did not know him well. The Department honored him with an in person eulogy. A powerpoint show was loaded on the screen, and several doctors spoke.

Here is what I learned.

He:

“Had appointments in 3 divisions.”

“Was an expert in team building, with over 50 people in his laboratory.”

“He gave every person in the lab their own project”

“His lab was continually funded by the NIH.”

“He was an assistant professor by 32, associate by 40, and full professor by 46”

“He was director of this center, and associate director of that one”

“He was PI or Co-Pi on 27 grants, and chaired a cooperative group.”

“He was a scientist, trialist and start up founder.”

“He had 317 publications to his credit, averaging to 21 publications per year, nearly two per month, every month of every year.”

I felt uneasy. A good man was dead, who cares about these statistics.

Where were the stories I wanted?

About the time you were stranded at a hotel in the rain and he came and picked you up. About the inappropriate but piss-your-pants-funny joke he told. About the time he worked the audience at a talk, going around asking people to introduce themselves, and riffing on everyones’ interests with witty banter. About how he used to bring his dog who had cancer to his office, so she wasn’t alone, in her final days. I’m borrowing these stories from people I know, but you get the idea. I wanted to know who he was as a person. Instead, I watched a man reduced to his h-index.

The “eulogy” troubled me in the days after. I wanted to quit my job. I prayed that no one would prepare a powerpoint of my accomplishments when I died. Prasad was a full professor by 39. His h-index was 54. He had 192,000 YouTube subscribers.

I would much rather they put me in my place even in death. Once, I found a copy of my first book at my mother’s house. It was covered in dust. The spine cracked when I opened it, as if I were the first person ever to look inside. I confronted my mother. “Did you read this? It looks like you never even opened it.”

“Oh honey,” she told me, “I love you, but I can’t read boring things.”

I laughed, and couldn’t argue. That’s the m-index. The number of things you wrote m, such that your mom actually wanted to read it. Mine might still be 0.

A student of mine gave me the vocabulary to describe my unease. He said there are eulogy virtues and resume virtues, and the presenters had confused the two.

Eulogy virtues about how we treat others and who we are as a person, while resume virtues are statistics showing our productivity. My colleague didn’t get an obituary, he got a final update on his resume.

My colleagues’ eulogy made clear to me how brainwashed we have become in oncology. We, of all people, are confronted with death all the time, and, we of all people, should understand that gravity of man’s life. Yet, in our own moment of loss, we could not give a good man a eulogy he deserved. We have lost our humanity, and replaced it with the indices universities use to define our worth. The only thing worse would be if they added:

“He died with an average of 7,200 work RVUs a year.”

Academic oncology has lost it’s soul. Our faculty are burnt out spending all day on Zoom calls working as the NP for pharma-run studies. Our universities have buildings named after Pharma companies or in the case of University of Chicago, the entire cancer center. Our faculty dream of making and selling a start up company. Our fellows aspire to sit on ad boards like the professors they work with, stuffing their pockets with pharma cash. We don’t debate controversies, like cancer screening, or the FDA’s relentless zeal to approve unproven cancer drugs, at our meetings, we just praise the latest uncontrolled phase 2 trial. It is always another “game-changer.” that should change practice.

We deal with death and dying constantly, but we talk only of metrics and productivity and research and money. We can’t even eulogize our own properly, we read their resume when they die.

I worry that, as we give more and more costly drugs with less and less evidence, as we accept the results of unethical trials to change our practice, we start to dehumanize our patients. After all, it is easier to accept the failings of oncology, if you dehumanize the people who bear the costs.

But then, as with all betrayals, we eventually start to dehumanize ourselves. We become our academic rank and h-index. We are our titles and promotions. Perhaps, with time, when we look in the mirror, we even stop seeing ourselves, aging and tired, standing naked on the bathroom tile, and see, instead, ourselves in a suit, standing and giving the oral presentation at ASCO.