When Blood Breaks Down

December 9, 2019
This fascinating debut from Sekeres, director of the Cleveland Clinic’s leukemia program, follows the stories of three composite characters based on real patients he’s treated during his career. Joan, a 48-year-old mother and surgical nurse, is informed she has a white blood cell count “over 15 times higher than normal.” David, a 68-year-old grandfather, is told that the cure rate for his age group and type of leukemia is fewer than 10%, while Sarah, a 36-year-old in the second trimester of her pregnancy, faces making choices both for herself and her unborn baby. Through reconstructed conversations with the patients and their families, Sekeres explores the different factors that go into cancer care choices, including quality of life and considerations for one’s loved ones. He also looks at how physician opinion influences patients’ decision-making and at how the high cost of medical care can be a deterrent to getting sufficient treatment. Tracing the characters’ progress, Sekeres shows them gaining hope during remission, and experiencing despair at setbacks. Their different outcomes allow him to examine various treatment options, from ongoing chemotherapy, to bone marrow transplant, to hospice. This is a powerful look at a disease that forces patients to make “decisions that no person should ever have to make.”

February 15, 2020
Three patient stories illuminate the "malignant golem" of leukemia. "People are both terrified and fascinated by leukemia in all its forms," writes Sekeres, the director of the Leukemia Program at the celebrated Cleveland Clinic. "It is a monster...that grows out of control and invades the organs within our own bodies. It is metastatic at its genesis." The events described are real, but the accounts are composites drawn from the author's patients. Joan is a 48-year-old surgical nurse; David, a 68-year-old retired factory worker; Sarah, a 36-year-old pregnant woman. Each has a different type of leukemia, but their symptoms all reflect the uncontrolled growth of cells in bone marrow, which contains the cells that give rise to the red blood cells that carry oxygen, the white blood cells that are part of our immune system, and the platelets that aid in blood clotting. When the white cell progenitors become cancerous, they proliferate rapidly, crowding out red blood cells and platelets. However, the white cells do not mature, remaining functionless. Consequently, leukemia patients become anemic from lacking red blood cells, risk internal bleeding from loss of platelets, and suffer from a weakened immune system, making them prone to infection. Standard chemo treatment to kill the cancerous cells comes with side effects such as hair loss, skin rashes, nausea, and vomiting. What makes this narrative so compelling is the author's ability to bring readers with him on his rounds as he meets each patient and family member, discusses treatment options, and follows them through weeks of treatment, reviewing lab results and bone marrow biopsies, and, when necessary, discussing next steps such as bone marrow transplants. These plot points, in addition to an epilogue, allow Sekeres to review leukemia research, including immunotherapy and the potential for more personalized therapies targeting specific genetic abnormalities. Nevertheless, leukemias remain among the most complex and difficult-to-resolve cancers, with no obvious causes and often brutalizing treatments. That three patient narratives should prove so effective a lesson is a tribute to Sekeres as both storyteller and physician.

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April 1, 2020

Drawing on extensive clinical experience working with people diagnosed with leukemia, Sekeres (director, Leukemia program, Cleveland Clinic) writes an accessible book exploring both the scientific knowledge of and patient experiences with leukemia, or cancer of the body's blood-forming tissues. With grace and fluency, Sekeres offers more than a scientific portrait of leukemia; he also includes personal stories about the origins of the disease; the complexities of the doctor-patient relationship; and how leukemia treatment, such as chemotherapy, can impact patients along with their families. Sekeres combines literary substance with significant medical information and data. He also details leukemia treatment past and present, offering a historical analysis of how the condition has been managed over time. Lastly, he introduces doctors and nurses, mostly based in the United States and Europe, who specialize in the condition. VERDICT The engaging stories in this book, both personal and scientific, make it a good choice for readers interested in solid literature on medicine, especially cancer research.--Aaron Klink, Duke Univ., Durham, NC

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