The Measure of Our Days: A Spiritual Exploration of Illness (Paperback)

~ Jerome Groopman (Author)
Key Phrases: New York, Father Daley, Marv Samuels (more...)

Editorial Reviews

From The New England Journal of Medicine

Diagnosis and treatment have always been two of the major elements of medical practice, but with the introduction of the CAT scan and other sophisticated imaging techniques, diagnosis by the laying on of hands began to lose its position as the leading challenge to clinicians. Moreover, treatment has also become much less demanding. Without denying the primacy of judgment and skill in choosing the right therapeutic option or performing a complex surgical maneuver, I believe that the most challenging aspect of medical care now lies in the obligation of physicians to form sympathetic bonds with their patients. By improving diagnosis and therapy, science and technology have facilitated good doctor-patient relationships in certain ways -- it is far easier for a physician to prescribe a cure than to deliver news of an incurable disease. But science is only of limited help to physicians in forming humane attachments with their patients. Trust, empathy, and benevolence are far too complex for scientific analysis. If kindness and altruism mystify poets, how can we hope that molecular biologists will ever clone love and friendship genes?

The Measure of Our Days tells us about Jerome Groopman's way with patients, not directly, but through stories -- the way the Bible, with its stories, grapples with the ineluctable dilemmas of living and dying. Indeed, Groopman takes his title from a Psalm of David, Psalm 39, "Lord, make me to know mine end, and the measure of my days, what it is; that I may know how frail I am." Perhaps coincidentally, the preceding Psalm, in which David petitions God for compassion, underscores Groopman's thesis. Groopman's stories recount how he follows the injunction to have regard for those without hope. He hugs them, holds their hands, meditates with them, and shares their tears.

Groopman, a hematologist and oncologist with a special interest in AIDS, chronicles the lives and deaths of four patients with AIDS, a man with renal-cell carcinoma, a woman with breast cancer, another with myelofibrosis, and a man who was successfully treated for a lymphoma, only to have acute leukemia develop. There is the boy who underwent successful therapy for acute myeloblastic leukemia, but died of AIDS contracted from a blood transfusion; the physician with hemophilia, a research fellow in Groopman's own laboratory, who had been infected with the human immunodeficiency virus (HIV) by contaminated factor VIII concentrates; the Yankee matriarch with myelofibrosis who on her first visit tells Groopman, "Well, we say in Boston that the mayor should be Irish, the barber Italian, and the doctor a Jew"; and the young woman with metastatic breast cancer who refuses medical treatment in favor of Tao healing. All she would accept from Groopman was morphine. These are not everyday cases. Some might say they are too esoteric, too specialized for general readers. On the contrary, their appeal is wide, because each tragic account illuminates the regard of patients and physicians for each other and how they conduct themselves under terrifying circumstances. They are contemporary medical metaphors of Job, who asked, "What is my strength, that I should hope? And what is mine end, that I should prolong my life?"

I don't know whether these stories happened exactly as told -- a proposition that would require Groopman to remember, word for word, numerous conversations he had with his patients. There are very many dialogues surrounded by quotation marks, but the book does not discuss their authenticity. My impression is that The Measure of Our Days, like Truman Capote's In Cold Blood, is a reconstruction of actual events. But this point is of no grave moment, because Groopman's book is more than a collection of moving stories about sick people.

Perhaps without intending it, The Measure of Our Days raises important questions about the future of medicine. One problem it presents is where future Groopmans will come from. Surely we will not run out of compassionate physicians, but I worry about a very particular kind of physician who is not only an excellent clinician and wonderful teacher, but also a gifted research scientist. Physicians with this triple combination of talents have always been in short supply, but now, sadly, they are very scarce. This state of affairs is due only in part to tightened financial circumstances. Its causes also include the ever-longer training of physicians who want to learn both a medical specialty and the latest molecular-research techniques; close-minded attitudes about the value of curiosity and scholarship to medicine; and the displacement of professionalism by craft and deal-making. In some academic medical centers, research is not just uneconomic but unpopular. Research physicians, it is claimed, are not pulling their weight in the clinic -- they are an extravagance. These are legitimate reasons for anxiety about the vanishing breed of Groopmans who can embrace a patient dying of AIDS and with equal assurance grapple with complex molecular experiments. Members of learned bodies have recognized the problem and are calling for help, but they are not realistically examining their own positions and the encrusted ways of their institutions. Recent travels to London, Brussels, Paris, and Geneva convinced me that the growing scarcity of "triple-threat" academic physicians is widespread.

Some contend that others can do biomedical research better than physicians. Besides, just leaf through the back pages of Science, where plenty of biotech companies advertise positions. All you need to qualify for a job in research on Alzheimer's disease is a bachelor's degree, and lots of companies are looking for Ph.D.s to lead research programs on diabetes. Perhaps this makes bureaucratic sense, but in an illuminating analysis, Flowers and Melmon ("Clinical Investigators as Critical Determinants in Pharmaceutical Innovation," Nature Medicine 1997;3:136-43) clearly show that clinicians make valuable contributions to drug development. They argue convincingly that the participation of physicians who actually deal with the sick substantially accelerates progress in medical research.

The Measure of Our Days raises another cause for concern -- time. Time for talking, hand holding, reassurance, and grieving with the sick and their families. Somehow, Groopman found time for all these acts of sympathy despite the responsibilities of supervising a large research laboratory, applying for grants, and writing research papers. But what about physicians who are not academic research stars, those who are deeply committed to full-time clinical practice? For many of them, medicine has been taken over by administrators who watch the clock, measure productivity, and have no way of entering compassion into their balance sheets. Will the 10 or 15 minutes allotted for a follow-up visit permit acts of kindness, or the exchange of verbal trivia that binds the healer and the sick? Will there be time for a hug? The Measure of Our Days is not just stories about how one doctor deals with extraordinary suffering. It challenges the advocates of flow chart medicine to return to the roots of techne iatriche -- the healing science of Asclepius and Hippocrates in which the personal relationship is essential for the restoration of health.

Reviewed by Robert S. Schwartz, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to the Hardcover edition.

From Kirkus Reviews

An astonishingly well written book that illuminates life's meaning without a trace of maudlin sentimentality. It is a clich‚ that life's lessons are learned in the face of impending death. Groopman goes far beyond the obvious, however, in this remarkably perspicacious book. Part medical primer, part memoir--of both the author's life and practice and the lives of his patients--the book chronicles several cases of catastrophic illness. Some live, forever changed by their reprieve from a final encounter with the Grim Reaper. Others die, although not before reaching epiphanies about their what their purpose on earth had been. Chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston and a leading researcher in cancer and AIDS, Groopman has a patient for just about every confusing question that arises at this tricky life-death juncture. He provides a perceptive view of the medical profession as well. Groopman's willingness to bare his soul and reveal his misgivings and hesitancies provide a heretofore unseen view of the hell through which dedicated caregivers pass as they treat dying patients. ``So much loss and pain in God's world,'' Groopman writes as he watches the death of his comatose teenage patient, Matt, who beat leukemia only to get AIDS from a contaminated blood transfusion. ``I looked down at Matt in a coma and, although I know there was no answer, had to ask why . . . I stood confused, still stubborn in my faith but harshly questioning it in the midst of senseless suffering. Despite these feelings of bewilderment and doubt, I prayed in my heart for God to help.'' The well and the sick alike will find much to ponder here-- this is the kind of book whose thoughts and messages linger long after it has been closed. (First serial to the New Yorker; author tour) -- Copyright ©1997, Kirkus Associates, LP. All rights reserved. --This text refers to the Hardcover edition.

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Product Details

• Paperback: 242 pages
• Publisher: Penguin (Non-Classics); 1 edition (October 1, 1998)
• Language: English
• ISBN-10: 014026972X
• ISBN-13: 978-0140269727
• Product Dimensions: 7.7 x 5.1 x 0.6 inches
• Shipping Weight: 5.3 ounces (View shipping rates and policies)
• Average Customer Review: 4.7 out of 5 stars  See all reviews (22 customer reviews)
• Amazon.com Sales Rank: #109,282 in Books (See Bestsellers in Books)

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Customer Reviews

Most Helpful Customer Reviews

52 of 53 people found the following review helpful:

4.0 out of 5 stars Not perfect, but a good book, September 11, 1999

By A Customer

As a physician also working with human mortality and fragility on a daily basis, this book resonated deeply with my experience. I found the eloquence in the lives of the 8 patients, however, as opposed to Dr. Groopman's narrative. While obviously a great man, I found his ego distracting and reminiscent of "old school" physicians - patronizing, omniscient and infallible. He alluded to himself way too many times at the expense of his patient's story.

This is not to say I would not recommend this book to a friend, I would. What the patients have to offer is priceless.

36 of 41 people found the following review helpful:

5.0 out of 5 stars Eight powerful stories., August 29, 1999

By A Customer

Jerome Groopman is familiar to many by now as a frequent contributor to the New Yorker, where at least one of the essays in the current book first appeared. Besides being a prolific writer, he also finds time in his day to be the Recanati Professor of Immunology at Harvard Medical School, Chief of Experimental Medicine at Beth Israel Deaconess Medical Center, and a leading researcher on cancer and AIDS. One wonders how he manages all this, but he does, and in the course of his work he manages also to persuades some of his patients facing life-threatening illness to sit for their literary portraits. The 8 individuals represented in this book (two of whom were personal friends of Groopman before their illness struck) and Groopman, their caring scribe, are to be thanked for this finely crafted and enthralling account of persons facing death and their relationships with their doctor. Groopman explains the doctor's side of it:

I have stood countless times...looking into the faces of a family and telling them their loved one has cancer. You steel yourself for the moment. ...You calm your face and maintain a firm voice, so that while you tell the family the truth, that the disease is aggressive and its treatment toxic, you simultaneously assert another truth, that there is a chance, a real chance, that the cancer can be defeated and the loved one saved. With this compassionate but determined show of force, you prevent the family and the patient from being overwhelmed by the ferocious surprise attack of the illness. Yes, you emphasize again that a cure is never assured. But once this is said, you move decidedly from despair to hope. You have to show that the battle already has been engaged, that you are the general of the army, that there is a strategy in place, that powerful weapons are at hand, and that no mercy will be shown the enemy. And as you mobilize your resources, of medical science and clinical experience, to fight to save this person, you look hard into the eyes of the family and search for the core of their strength. ...You need to understand this inner strength, where it comes from, how deep and resilient it is. Once you find it and comprehend it, you try to take it in your hand and fuse it with your own, because together this creates the unified forced required to sustain the patient through the hell that awaits and to carry him back to normal life.(90-91)

The book can be viewed as a study of these fusions of force. The religious ruminations of doctor and patient and felicitous metaphors lifted from other areas of life - sports, venture capital, art, etc. weave together in the intense dialogue that evolves between the two allies in the struggle, a dialogue that may be crucial to the progress of treatment or, when need be, essential to a well-managed surrender. Will appeal to: any reader, but especially spiritual highly literate readers.

10 of 10 people found the following review helpful:

4.0 out of 5 stars Compassion of a physician, December 2, 2002

By A Customer

This book genuinely portrays the dynamic aspect of a patient-doctor relationship. Jerome Groopman is an extraordinary writer and physician who is able to touch the hearts of his patients. Through his eight powerful and compelling stories, he is able to give the reader insight and capture the life lessons learned from these terminally ill patients.

Dr. Groopman leads us through the lives of eight patients with a terminal illness. The book starts with Kirk, an aggressive businessman who is afflicted with kidney cancer and is determined to fight his battle with a new chemotherapy treatment only to realize that his life has been empty. Groopman then moves on to describe a Catholic boy who underwent successful therapy from leukemia, but died of AIDS contracted from a blood transfusion. Another patient, a research fellow in Groopman's own research laboratory has AIDS from a blood transfusion because he was a hemophiliac. My favorite story is Cindy, a single woman with AIDS who boldly fights with Groopman over her fervent desire to adopt a child. Each tragic account illuminates the empathy and compassion Dr. Groopman has toward his patients. He would hug them, hold their hand, listen to them, and share their tears.

The Measure of Our Days is a powerful book and the reader gains and understanding of the frailty of human life. The dialogue between Dr. Groopman and his patients is compelling. By reading this book, we can appreciate and value our own lives and the life lessons learned from these terminally ill patients. Definitely a good book, especially for people who are interested in pursuing a career in medicine.