"One reason it came about was when my brother-in-law came down with a rare form of cancer, and everything I had come to know about being a doctor was suddenly thrown into question," he says.
Stein's training taught him to keep his emotions at a distance, to stand apart. But he could only guess at what his brother-in-law was experiencing emotionally, and at times, he had trouble finding the right words to offer him.
Another reason he decided to write the book was because prior to that time, admits Stein, he had never taken the opportunity to understand what illness was like for his patients: "I knew people sometimes wrote about themselves, keeping a kind of memoir of their illness, but I wanted to write something from a slightly different vantage point, explaining what it's like to be a doctor trying to get inside the heads of his patients. I wanted to try something I thought had never been done before."
According to Stein, "health is comfortable, predictable, unnoticed. But suddenly, illness seems to come out of nowhere. It's become the unknown, and we're all frightened by the unknown."
And when illness seemed to "come out of nowhere," Stein noticed that many of his patients became physically unavailable for some time to some degree. Their bodies had betrayed them, and they were devastated, almost unbelieving, and then unwilling or even unable to speak about their true feelings.
"Why me?" he said was a constant refrain. "And I think loneliness is a word that captures the inward spiritual condition. I talk about illness as being individual, not a team sport. By its very nature, it excludes others. The patient begins to feel out of place, lonely, and loneliness is made worse by the severity of illness."
When It All Hit Home
Chronicling his brother-in-law's cancer and its progression throughout the book, Stein also relates stories of other patients he has treated.
"Early in my career, with the repetition of seeing 20 patients a day in a small exam room, I became like one of my ill patients. I had entered a world of black-and-white, a world without nuance, with only a two-word language — 'sick' and 'well,' " he writes.
The book gives patients, along with their families, a new understanding of the hardships of illness that can alleviate the alienation, and hopefully, bring people closer together. He suggests that his work will open a new dialogue about the expectations of health, sickness, fear and mortality.
After graduating from Harvard College, Stein worked as the American correspondent for the journal Nature before completing medical school at Columbia University. Aside from his literary endeavors (he's also written four novels), he is professor of medicine and community health at Brown University Medical School. He also teaches a course on literature and medicine in Brown's English department.
The main message in The Lonely Patient, emphasizes this physician, is to try to give caregivers an understanding of what patients are going through, to listen carefully to what the patient has to say, and to become more tolerant, loving and understanding of the situation.