The Forest Ranger in a White Coat

Stuart Spigel wanted to be a forest ranger. His mother…well, she had other plans.

Dr. Stuart Spigel would become Nashville’s first oncologist. Though not the rustic wilderness he’d dreamed of exploring, cancer in the 1970’s was an uncharted field.

In a conversation with son and fellow oncologist, David Spigel, you’ll hear candid insight into the ever-changing landscape of cancer care and how becoming a patient himself forever changed Stuart’s relationship with those he treated.

Stuart Spigel wanted to be a forest ranger. His mother, well, she had other plans. Dr. Stuart Spigel would become Nashville's first oncologist. Though not the rustic wilderness he'd dreamed of exploring, cancer in the 1970s was an uncharted field.

In a conversation with son and fellow oncologist David Spigel, you'll hear candid insight into the ever-changing landscape of cancer care, and how becoming a patient himself forever changed Stuart's relationship with those he treated.

In my senior year of high school, my mother had me tested in New York City, and I did three days of testing.

To see what you would be in life?

Yes. I wanted to be a forest ranger, the only Jewish forest ranger.

But at the end of the three days, there was a counseling session. And the counselor said, ma'am, your son is cut out to be a social worker or a forest ranger. And my mother grabbed my wrist and said, my son is going to be a doctor. And that's why I became a doctor, to be honest with you.

I knew I wanted internal medicine. And with each of the rotations, I was disappointed. Then I rotated in oncology. Wow, oncology. I had two exciting teachers, and they were doing exciting things. It had just been shown that Hodgkin's disease could be treated successfully and perhaps cured with chemotherapy. And that was really exciting for me.

It's interesting, because I'm an oncologist, and to me, right now feels like the most exciting time in the history of medicine, not just oncology, with the things we can do, the discoveries being made, the pace of development. And I look back to even just 20 years ago, and I think, boy, there really wasn't a lot to do there. And so you're talking about 1969, 1970, you felt like then you were doing a lot of great things or things were happening, and it was exciting as well.

In 1969, we began to treat women with widespread breast cancer, and we sought to publish our experience with 25 such patients. And we submitted that article to the Journal of the American Medical Association, the New England Journal of Medicine, the Annals of Internal Medicine.

Did you author that? You were the first author?

Yes, I was the lead author, and it was rejected by everyone. The editorial comment from the Journal of the American Medical Association was, our readership is not interested in cancer. We don't believe cancer is a treatable disease. Now you pick up any medical journal, and at least 50% is devoted to oncology. It's incredible.

So I want to fast-forward to Nashville.

Believe it or not, there was no medical oncology at the time in Nashville, and I became the first trained medical oncologist in Nashville, Tennessee.

And I remember as a child, your day didn't stop. You were the only one going to the hospital. I just don't know how you did it.

I don't either. I wasn't getting home until late. And so finally, in 1979, I started my own practice.

So that same practice today is now 89 physicians, one of the largest in the United States. That was the group you started.

Yes.

That feel weird?

Yes.

Did you enjoy it? Or the joy--

No.

Oh, you didn't.

It was joyless. I mean, I worked from dawn to late at night, and my marriage dissolved. And in large part, it was because of my work.

When did things change for you, where being a doctor became gratifying?

When I hired help, and we began to have the time to enjoy life a little bit.

It is gratifying for me now, walking in the same hall as you walked in, doing the same things. And it's rare for me to encounter a patient who doesn't confuse me with you because "You took care of my grandmother," or "You took care of my mailman's mother." And I have to tell them, no, that's the other Dr. Spigel.

Noah, my son, who's 13 right now, I brought him to the hospital, and I had to run back to see a patient. And I left him at the nurses' station on a stool. Then I came back, and the clerk there had been there when you were working. And she said, David, that was you on that stool with me all those years ago. And it's just kind of interesting because I do remember I used to round with you probably at Noah's age. Those were memorable moments for me.

I did want to shift a little bit because something happened in your life when I was an intern at Indiana. You were 53 at the time, and you had been diagnosed with prostate cancer. I thought maybe I'd ask you about that time in your life and how it's been since.

I really have never paid much attention to my own health. But as I reached that age, my primary care doctor began to do the PSA, the Prostate-Specific Antigen. And it came back 7. The norms are 4 or less.

I had a needle biopsy of the prostate, and that came back as malignant. And within, oh, 10 days, I underwent surgery, and my PSA fell to undetectable levels, and all was well for a period of time. And then in 2003, my PSA became detectable and began to climb. And long story short, on the premise that a recurrence could take place in the prostate bed, I had radiation therapy.

That must have been a difficult time to pause and figure out, OK, I've got to worry about me for the moment.

I'd only had one day off because of sickness in my life, up to that point. So yes, that was a big deal.

How was it to walk into a room with a patient, even if they didn't have prostate cancer, but they had any cancer, did anything change for you?

It did. It made me more empathic. And sometimes it would actually help the patient, because I could say, I have cancer too. And I'm not asking for your sympathy. I just wanted you to know that I've walked where you've walked, and I've had the same anxieties you've had and still have. And that, I think, made me a better doctor.

So you are 75, and yet you just retired.

Yeah, I retired.

And so you're in Maine. You live on an island, off an island, where you, I think, have always wanted to be, in a great beautiful place that's outdoors without a lot of heat.

Yeah, I could be a forest ranger at last.

David follows in his dad's footsteps, blazing trails in oncology to discover new treatments. The Spigel family donates to Conquer Cancer to bring those new treatments to patients sooner. Join them and be part of the most exciting time in medicine by making a gift at conquer.org/donate.