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Think of Dr. Bernard Cummings as the accidental trainee who came for a few months in 1972 but ended up staying 40 years.
The fledgling cancer specialist, who trained in both clinical and radiation oncology in Christchurch, New Zealand, needed to fill a 10-month gap before starting a fellowship at the Royal Marsden in London, England. His chief advised him to head to North America to gain overseas experience and placed the phone call that proved life-changing for both Dr. Cummings and Princess Margaret Hospital (PMH, now cancer centre).
Dr. Cummings went on to become the Head of Radiation Oncology, and Professor and first Chair of the Department of Radiation Oncology at the University of Toronto from 1991-2001. In 2011, he received the prestigious Gold Medal from the American Society for Radiation Oncology (ASTRO) for outstanding contributions to the field of radiation oncology, including research, clinical care, teaching and service.
Still, it almost didn't happen. Dr. Cummings recalls a decidedly rocky start.
"We had six weeks to pack up and get here," says Dr. Cummings, who is set to retire on Dec. 31. "This was no easy task with a four-year-old and a 20-month-old.
"We had never been to North America. We landed in Los Angeles in a miserable heat wave and were booked into what must have been the only hotel in the city without air-conditioning. Our four-year-old got dreadfully sick. All we wanted to do was turn right around and fly home again. And we would have if the distance had been any shorter! Mercifully, an American colleague rescued us and we moved to a different hotel for a few days."
On to Toronto, where the young family was put up in a Charles Street apartment. "It was on the 17th floor and we were absolutely terrified the kids would fall off the balcony, so we never went out and hardly relaxed."
Things did get better, fast. Within four weeks, Dr. Cummings was offered a staff position in radiation oncology at the old PMH on Sherbourne Street.
Eventually, he specialized in head and neck cancers and gastrointestinal cancers (GI) – particularly rectal and anal cancers. He is renowned for his research on the role of radiation therapy in the management of these lower GI cancers.
"I was always interested in gut things. And I wanted oncology because cancer is endlessly interesting and challenging, the figuring out what's going on."
Dr. Cummings's initial interest in radiation oncology was piqued when he was a resident reviewing sample exam questions from previous years that were provided to medical students to help them prepare for their own finals.
"There were questions about machines I'd never seen, so I decided to go down to the department to find out more," he says. "I guess the radiation oncologists sensed my interest, because they started inviting me to attend interesting cases.
"It was very subtle, but they got me hooked!"
Reflecting on the arc of his career, Dr. Cummings says the biggest changes in radiation oncology have been enabled by tremendous progress in engineering and computing.
"We are now routinely doing things we couldn't even dream of just a few years ago," he says. "The ability to tailor the volume of tumour treated to spare normal tissues and the evolution of combined modalities (chemotherapy, radiation therapy, surgery) have meant separate disciplines have come together to great benefit for patients.
"Understanding the complexity of oncology is the key to putting treatment modalities together in a planned way, as opposed to the sequential treatment we used to have to do, and technology helps enable it. So now when we decide to treat sequentially, it's intentional."
Dr. Cummings is quick to add, however, that technology is not the be-all and end-all.
"It's great that technology has rightly standardized many techniques," he says "But my advice to trainees is to always be sure of the validity of the evidence regarding what you're doing and why you're doing it. Look, ask why, and look again."
He describes his style with patients as "sympathetic but arms' length because the best judgments are rooted in knowledge, not emotion.
"But I always tried to learn something about the family, not just the patient, and I would put it in my notes so I would have a conversation starter at the next visit," he says.
Dr. Cummings is especially proud of continuing to see many of his treated patients annually, now cancer survivors for more than 30 years.
"I never discharged a patient unless the patient wanted to leave (for follow-up with a family physician), which means I've been able learn a lot over the years about the late effects of treatment," he says. "It's been interesting to find out that some things got worse and then better again."
During the late 1980s and through the 1990s, during his tenure as department head, Dr. Cummings was heavily involved in the design and administrative decisions about the new Princess Margaret at 610 University Ave.
"The move was so complicated," he recalls. "We had four (radiation) machines at Mount Sinai Hospital as a satellite while the new units were being built here, and six units still running on Sherbourne Street. The physicists really took the brunt of all this planning and did a tremendous job."
Over the years, Dr. Cummings published 160 peer-reviewed papers and 115 book chapters and other publications. He figures he trained about 250 radiation oncologists and surgical fellows from dozens of countries.
Among his many professional affiliations, he is a Fellow of the American Society for Radiation Oncology, an Honorary Member of the European Society for Therapeutic Radiation and Oncology, and a Life Member of the Association of Radiation Oncologists of India. He is a former President of the Canadian Association of Radiation Oncologists, and of the International Society of Radiation Oncologists. He is a former member of the Board of NCIC (clinical trials group) Canada.
Dr. Cummings has long been involved in organizing and participating in teaching programs in radiation oncology in developing countries, including serving as an advisor to the World Health Organization on patient safety in radiation therapy, and to the International Atomic Energy Agency on radiation therapy for rectal cancer in developing countries. He has also been actively involved in the development of treatment guidelines for gastrointestinal cancers for Cancer Care Ontario. He is a Fellow of The Royal College of Physicians and Surgeons of Canada, The Royal College of Radiologists of England, and The Royal Australia and New Zealand College of Radiologists.
Although he's retiring, Dr. Cummings will return a day or so a week to work in the palliative radiation outpatient clinic and also continue to teach part-time at the university.
On the topic of legacy, Dr. Cummings will say only that it is for others to decide, but when prodded, describes himself simply as "a reasonably good doctor who put his patients first, held fast to principles, and was always fair:"
He recalls returning from a sabbatical year taken after he finished his decade as department head: "I was in clinic and introduced to a new person who said 'Oh, didn't you used to be someone important once'?" And that, says the ever-modest Dr. Cummings, is a great leveler worth remembering in life.
And about that original fellowship at the Royal Marsden that brought him here for a few months in the first place?
Dr. Cummings completed the fellowship the following year and returned to the Princess Margaret permanently in 1974. The family settled in Don Mills and then in the midtown neighbourhood of Bennington Heights, where a third child came along, and where Dr. Cummings still lives. His wife Kathleen, his sweetheart from their first year at university in New Zealand, passed away a few months ago. The proud father of three – Michael, a cardio-thoracic anesthetist in Kingston; Jessica, a psychotherapist in private practice in Stouffville, and William, a law student at University of Western Ontario in London – and grandfather of four, looks forward to having more time to indulge in three particular passions: reading mystery novels and books on current affairs, listening to opera, and getting back to building model trains.
Comments about Dr. Cummings
You don't find doctors like this gentleman any more. He is a credit to his profession, brilliant, kind, sensitive and sweet. PMH was so lucky to have him and so were all his patients. He will be truly missed after his retirement.
-- Dr. Cummings is the kindest smartest doctor. He is one of a kind. A brilliant man who saved my life and gave me quality of life.
He is an amazing specialist & human being, both, in my humble opinion. He was the radiation specialist at Princess Margaret for me when I was treated for cancer in 2004. I used to look forward to my appointments with him, not just for whatever good news he might share with me, but because I simply liked the guy. I have since learned that he has entered into a period of semi-retirement, which is -- selfishly! -- my personal loss. I'm going to miss him very much
-- I don't know where to begin to tell you how wonderful this doctor is. His expertise is incredible. What an amazing doctor you are Dr. Cummings. Thanks so much for your care. We are truly blessed to have had you as our doctor.
From colleagues, past and present
"Bernard is a skilled and experienced leader. In 1991, he became the inaugural Chairman of the newly established independent Department of Radiation Oncology at the University of Toronto. However, even before that he held a number of leadership positions and was a respected expert in the management of radiation oncology programs. He served as an expert advisor to many institutions -- professional, governmental, and volunteer organizations. He is best known for his leadership in Canada, but he also was the President of the International Society of Radiation Oncology and has received many international honours and awards. As people appreciate and remember him for his clinical skills, it is important to note that he was an important ambassador for Canadian radiation oncology worldwide."
-- Dr. Mary Gospodarowicz, Medical Director, Princess Margaret Cancer Centre
We often speak of patient-centred care – and Bernard was an exemplar of that – he had an incredible clinical sense and judgment. He was always the go-to clinician from whom other radiation oncologists would seek advice, particularly for weird and wonderful cases. His ability to dissect a case and focus on the key issue was renowned, and he always gave advice clearly, succinctly, and accurately. He had an encyclopedic knowledge of clinical oncology (including surgery; and he was unfailingly generous in sharing his knowledge and providing advice.
-- Dr. Fei-Fei Liu, Head, Radiation Oncology; Chair, Department of Radiation Oncology, University of Toronto
I've known Dr. Cummings since 1977 and as a young Radiation Therapist I learned clinical skills from him as he would ask me questions about the anatomy of the patient while reviewing an X-ray. He never made me feel stupid or incompetent, and would clearly explain the right answer. I have so much respect for him. He is compassionate, empathetic and a very kind, humble individual. I have never seen him angry or raise his voice.
-- Lue-Ann Swanson, Manager, Clinical Operations, Radiation Therapy
We always had a full onslaught of patients in our Thursday morning GI clinic, but no matter what, we always took a break for tea at 10:30. We set a table for four, and Dr Cummings, me, the volunteer and patient flow coordinator took a moment to catch our breath and catch up with each other. Fifteen minutes later, we would be back at it, fully recharged.
-- Sabrina Bennett, Specialized Oncology Nurse; Patient Care Coordinator, Hematology
Dr. Cummings is an outstanding teacher who taught personalized radiation therapy well before it was a hot topic, challenging me to think "outside the box" as a resident, always putting the patient first – from the technical details of radiation therapy to the chemotherapy specifics and supportive care tips. As a junior faculty, Dr. Cummings supported my efforts in developing a liver cancer radiation therapy program at Princess Margaret, when many others were skeptical. Today, despite being a radiation oncology luminary and one of the few Canadians who has received the ASTRO Gold Medal, he is a regular participant at rounds and always available to discuss challenging cases. I will miss working beside Dr. Cummings in the GI clinic, but have no doubt that his positive influence on patients will live on.
Dr. Laura Dawson, former trainee, GI Radiation Site Group
In addition to admiring Bernie Cummings for his extraordinary skills as a caring and compassionate doctor I have a secret envy of one forgotten aspect of his talents. Bernie Cummings knows how to use a slide rule!!! For those of you reading this article who do not know what a slide rule is.... I quote Wikipedia in educating you that ... "The slide rule, also known colloquially in the United States as a slipstick, is a mechanical analog computer. The slide rule is used primarily for multiplication and division, and also for functions such as roots, logarithms and trigonometry." Slide rules are like narrow lapels.... keep the suit long enough and the style returns. When you next see Bernie ask him to calculate the fourth derivative of a log function... and watch in amazement as his nimble fingers provide the answer before your Mac has got to its Homepage.
–- Dr. Bob Bell, Deputy Minister of Health, former President & CEO, UHN, former Chief Operating Officer, Princess Margaret Hospital