Reviewer: Alan J. Lippman, PhD
March 21, 2021
On the football field, the quarterback has the principal role of calling the plays, directing offensive strategy, and executing the maneuvers that result in scoring touchdowns and winning the game. At the same time, the quarterback learns the importance of leadership and teamwork in striving toward and achieving a successful outcome.
As a former Georgetown quarterback, David Fajgenbaum utilizes his sport expertise and his introspective skills in a prolonged struggle to successfully—at least for now—overcome the existential challenges that confronted him when, as a medical student at the University of Pennsylvania, he developed symptoms of unusual fatigue, night sweats, enlarging lymph nodes, and “cherry hemangiomas.” These premonitory indicators soon led to a syndrome of severe and life-threatening multiorgan failure, wasting (he lost 50 pounds), profound anasarca, and delirium, threatening his very survival.
Although it was initially elusive, following many weeks of hospitalization, testing, numerous specialty consultations, and intensive care, a firm diagnosis of idiopathic multicentric Castleman disease was ultimately established.
Castleman disease is an uncommon lymphoproliferative neoplasm with features placing it somewhere between a malignancy and an autoimmune disorder. The condition is sufficiently rare, so that at the time of David’s initial presentation, little had been known of its natural history, clinical behavior, and possible treatment. The distinguishing histopathology was first described by Benjamin Castleman, a Boston pathologist, in 1956. (Benjamin Castleman is recognized as the long-serving editor of the familiar clinicopathological studies featured for many years in the New England Journal of Medicine.) But even after a half century of experience, little progress had been made in understanding the nature of the disorder and overcoming the challenges presented by this aggressive and uniformly fatal illness.
In desperation, but coupled with intellectual curiosity, David strives mightily to learn everything he can about Castleman disease and to seek all the professional expertise he can muster, as he carries the reader along to share the drama of his personal journey, against near-overwhelming odds, to regain his health. The author’s narrative is compelling.
Further, David leads an initiative to organize and run the Castleman Disease Collaborative Network (CDCN). In partnership with one of his personal physicians, Dr. Frits van Rhee, an international expert on Castleman disease, he helped to establish what is now widely recognized as a respected global organization dedicated to accelerating research and treatment for Castleman disease and to supporting patients and families dealing with its tragic vicissitudes.
In his dual role as “physician-scientist in training,” as he calls himself, and patient, David is compelled to examine the available evidence, engage others—family, friends, and professional colleagues—and vigorously pursue research opportunities, in his quest to understand and to conquer an implacable adversary that gravely threatens his otherwise promising future as a clinician and research scientist. In so doing, he exemplifies leadership qualities and an appreciation of essential teamwork in much the same way the quarterback approaches his task on the gridiron.
This engaging and highly readable 241-page book will appeal to medical historians drawn to the concept that “hope should inspire action,” as the author expresses it, and demonstrate how medicine, science, and individual determination can altogether provide enormous opportunities to surmount seemingly overwhelming obstacles.