Op-Med is a collection of original articles contributed by Doximity members.
As I was getting ready to leave the hospital, within the commotion, my phone rang. The hospital operator connected me to the caller on the other end, and all I heard was someone wailing. Confused about what to do, I was about to hang up when a man spoke, “This lady is in an urgent care, and they just told her that her child has cancer? Can you help her?” This was the first new diagnosis I was going to deal with as a fellow. After recovering my wits, I jotted down the patient’s information so I could talk to the physician and make arrangements for transfer.
A little while later, they arrived. As the stretcher rolled past me, our eyes met. A thin frail boy with beautiful curly hair and big brown eyes; the eyes of a dreamer; the face of an angel. In that face were eyes asking for help to ease all the pain with a thin faint smile that was trying to hide all those questions behind it. A tall beautiful lady walked behind him, sobbing and holding his hand while trying to assure him that all would be well.
“This could be an infection right?” the mom exclaimed at the outset. My inclination would have been to dodge the question by saying the go-to doctor phrase ”until further testing.” Instead, my attending looked into the mother’s eyes, held her hand, and said, “This is leukemia. I have looked at your child’s peripheral blood smear.” Then, she repeated, as if the mom had not heard, “Your child has cancer.” The mother became wracked with sobs. Her world had been shattered.
The next day I performed my first procedure as an oncology fellow; our patient had a bone marrow and spinal tap. As it turned out, we could not sedate the patient due to a mass he had which posed sedation risk.
As I entered the patient’s room with a cheerful smile on my face, I explained the protocol and reviewed every detail, risks and benefits. Before I handed the consent to the mother, she looked me in the eye and asked, “Doctor, how many of these have you done?” I was not expecting this question. Even though I had tried my hand at a few during residency and medical school, doing it on someone not sedated was uncharted territory for me. “None,” I wanted to say, but caught myself. I quickly said, “Well, I have done a few, but my attending has done innumerable, and she will be supervising me.”
“Will it be painful?” the son asked. The mom gave me a questioning glance. “Probably yes, but we will give you local anesthesia and some pain medicine prior to the procedure.” I said. The young boy began to sob.
I arranged my armament: a spinal tap kit, drapes, needles, tests tubes, bone marrow slides and chemotherapy which needed to be injected into the spinal fluid during the procedure. My attending took her place by my side, and I quickly revisited the steps of the procedure in my mind. Cleaning, draping and local anesthesia, all went well. Then I picked up the needle, determined not to cause any pain. As my needle pierced through his skin, his back crunched in pain. I kept going, and then could not go any further. “Move the needle; you will be fine,” my attending advised. I tried right, left, up and down, trying to get to the spinal fluid, but my needle would not move. Meanwhile, the little boy was writhing in pain, and his mom was in tears. I looked at them and withdrew my needle. My attending asked me to try again. My hands shook, but I was determined to get it right this time. As my patient hugged his mom tighter, and his cries increased in intensity. The patient’s mother interjected and asked for me to leave the room and never see her child again.
In the weeks and months that followed, I was not allowed to do his procedures or be a part of his care. I wanted to respect her wishes, but that did not stop me from being a part of his care. I would place all his orders prior to his appointment, make arrangements so that his procedures were as comfortable as possible, ensure he had ample distraction during the procedures, and peek at him while he was in clinic.
Weeks passed as I continued to work in the background with no upfront involvement. He completed his first round of very intense chemotherapy and was now awaiting recovery at home. One weekend, at nearly 9pm, I was heading to my car when my phone rang. It was the mother was on the other end, crying. “His surgical scar, his abdomen, is opening up. It is red, and it’s getting wider and wider.”
This was not good. As I rummaged my brain for answers, I asked if she was at home and told her I would send the air ambulance, and told her “do not worry” — a phrase often used in my field and easier said than done. As I arranged his travel and informed my attending and the ICU, my phone rang again. “They will not let me ride the ambulance, I will be driving. Will you stay by his side until I get there? Please Doctor, do not let him be scared.” I took a deep breath and absorbed what I heard. I was fighting tears. I was fighting fear; the fear of losing my first oncology patient. “Of course I will, you drive safely,” I reassured her.
They airlifted him in less than 30 minutes. I spat out orders to the staff: IV fluids, antibiotics, intubation… whatever was needed to save him. His mom was not there yet, but we needed to intubate him. With my knowledge of his condition, I knew he would not make it. Was it worth taking him through the ordeal of intubation? Should we wait for his mom, so that she could hear his voice for one last time? I called the mother to ask how far she was. She was fighting traffic. “Will he make it?” she asked.
“We are doing everything in our power, but we may need to intubate him. Is that ok?” I tried to sound as calm as possible.
“Of course it is fine; do whatever it takes and whatever you think is right. I trust your judgment.” As the weight of her words bore down on me, I realized the responsibility I had just been handed. What was the right decision? What was my judgment?
We decided to intubate. I held his little hand in mine and hugged him one last time, reassuring him that it was going to be okay as he was sedated and those beautiful brown eyes saw the light for the last time. By the time his mother got there, he was sedated, intubated and transcended into oblivion. His mother chose not to resuscitate him and instead make his journey as comfortable as possible. Life support was removed the following day, and he rested in his own sweet world where there was no suffering, no more pain.
Days passed; weeks passed, and years passed. I often wondered what would his mother was doing. I wanted to pick up the phone and call her. But what would I say? I want to say, “I’m sorry,’’ as I could not save her child, but would that help? I did not know. But her son’s short life left an imprint on me. His big brown eyes often remind me of my reasons for choosing this profession, its sacredness, and why we need to keep moving forward.
Surabhi Batra, MD is a pediatric hematologist-oncologist at Robert Wood Johnson Barnabas health system and Newark Beth Israel Medical Center in New Jersey. She specializes in complex benign and malignant blood disorders of children and young adults.
This post has been edited for length and clarity from its original appearance in The Chronicles of Women In White Coats.