To hear Dr. James Fanale tell it, the doctors, nurses, and staff at Warwick’s Kent Hospital have the greatest jobs in the world.

It’s a sentiment he expressed as he stood before a crowded room of his peers last Thursday, speaking with the kind of encouragement and sincerity a baseball coach employs during those chats in the dugout after a long game.

“We got the greatest jobs in the world because they impact people’s lives everyday,”  he said. “And don’t forget that.”

It’s that impact Fanale, a retired geriatrician and the former CEO and president of Care New England Health System, is now grappling with in a way like never before in his four-decade-long medical career.

For more than two years, Fanale has lived with stage 4 lung cancer, enduring what he described as a “rollercoaster” of tests and treatments – a regimen that requires he arrive in Boston every two weeks to take part in his clinical trial chemotherapy treatment.

 And for those two-plus years, the one-time healthcare executive has also gained an insight he previously never had: What it is like to be a patient.

Marrying that perspective with his medical expertise, Fanale jotted down his observations, lessons learned, and personal reflections and wrapped them into a book, “Onward: A Teaching, And A Love Story - For Physicians, And Everyone,” published late last year. (All proceeds from sales of the book benefit a caregivers’ fund Fanale established at the Dana-Farber Cancer Institute.)

“The shoe is on the other foot when you’re a provider for years and you have no idea what your patients go through with this stuff,” Fanale told The Warwick Beacon. “I was shocked and stunned.

“So one day I started writing this thing. And I’m telling you, when your fingers are numb, you can’t really write very well or type very well.”

And yet, something in him needed to get it all out on paper.

“I don’t know why,” he said. “I didn’t plan it – no. Just did it.”

In “Onward,” Fanale illustrates how his life with cancer has shone a light onto the areas of the patient perspective where doctors are often left in the dark.

“There is so much more learning and true empathy, as clinicians, that we need,” he writes.

Drawing from his writing, Fanale gave staffers at Kent a candid chat about this journey he’s been on and how they can provide their patients with so much more beyond scans, clinical trials, and tests, tests, tests.

“You think you know what your patients go through until you have to go through it yourself,” Fanale told them.

Learning to take one day at a time

He recalled that day in March 2022 when he read his own medical files to learn he had the incurable form of cancer – how he sat in his office most of the day trying to grasp what the future would hold for him and his family.

He spoke about how, since that day, all the cancer treatments “tire the crap out of” him; how he gave up his running hobby; how unpredictable side effects can truly be; and how he made the decision to shave off the rest of his hair. (“I’ve been told my head is a really good shape,” he quipped.)

Fanale also learned to take one day at a time, not to sweat the small stuff, to keep a sense of humor that’s strong and close to the heart, and, perhaps most importantly, the value of friends and family support – those personal caregivers, such as his wife, Deb.

Every cancer patient endures pain and suffering and “the caregivers are enduring it with them,” he said.

“As you see patients with chronic disease or cancers, [when] you start working with those folks, remember: There are usually two people that are being treated,” Fanale told the room full of doctors.

At other times during Thursday’s talk, Fanale urged his primary care peers to make two other considerations when treating patients with these kinds of conditions: Consider the impact of each test they order for those entrusted in their care, and remember their jobs do not end after a diagnosis.

He told them about being asked to help a colleague’s friend – a 37-year-old woman who was diagnosed with breast cancer at a community hospital in Massachusetts. She wanted to get a second opinion after the diagnosis, but was denied by her health plan and was left lost and unsure of what she should do, Fanale said.

Taking steps after a diagnosis

“The message I have to us as [primary care providers] is when your patient gets diagnosed with this, you think, and oftentimes, our job is done when they go to the breast surgeon,” he said. “I don’t know what the system needs to do to help them, but that shouldn’t be the end of our job.

“I would call my patients the night after I made a diagnosis like that to make sure they were OK. But I’d never call them again,” he added. “This poor woman had no goddam clue as to how to get somewhere where she needed to go.”

Fanale said there is no way to help patients navigate through these complexities in the American healthcare system.

“Our healthcare system is so goddamn complex nobody can figure it out except us,” Fanale said. “You know why we know how to figure it out? Because we live in it. But it’s complex as hell and it’s very, very difficult to get through.”

Fanale also pleaded with doctors and nurses to consider the implications of each test they order a patient to endure.

“Think about what you’re ordering,” he said. “Every time we order a test, there’s an impact on the patient. This may sound stupid but think about it. They got to go somewhere. They have to drive somewhere. They usually have to have a family member or somebody else to go with them. They got to wait around.

“So when we’re ordering stuff, we got to think about what’s the impact and do we need it then?”

After more than two years of tests and treatments, Fanale has, to date, defied what he said is a 20% survival rate for those with stage 4 lung cancer and admitted he has “beaten the odds so far.”

“I wake up saying, when is it you go?” he told The Warwick Beacon.

He described himself as “cautiously optimistic” these days, but explained he knows well this disease is not curable. It’s still there. It’s still in him.

But that’s not all that lingers.

Evidently, after decades of working that “greatest job in the world,” of trying to help others down their own difficult paths, and, now, turning to his peers again and attempting once more to make that impact – to change people’s lives for the better – that’s still there – embedded deep within him, too.