When I was about ten years old, swimming on a Texas swim team, I remember hearing that the child of one of the local coaches had been diagnosed with leukemia. The idea of a kid dying of an untreatable disease was so foreign to me that I am sure that I have blocked out most of the details. I do know that the child died, and it didn’t take very long. In the fifty years since, the landscape of childhood cancer has changed dramatically for the better. Today, most children diagnosed with acute lymphocytic leukemia—the most common type—survive. But in the past, we oncologists significantly underestimated the cost of that survival.
For the last six months, I have been taking care of one of the earliest survivors of childhood leukemia. In her late forties now, she was treated with life-saving combination chemotherapy when she was six years old. A couple of years later, she relapsed with leukemic cells in her brain and spinal cord, and received cranio-spinal irradiation—radiation therapy to her entire brain and spinal cord, a toxic treatment associated with short stature due to reduced growth of the spine, lowered IQ, and a depressed immune system. Again she survived, and grew up to be a teacher of disabled children—the ultimate in “giving back.”
In 2005, she was diagnosed with breast cancer, likely a consequence of the radiation exposure she had as a child. She underwent a mastectomy, and then did well until last fall when she noted a lump in the medial aspect of her breast reconstruction. A staging work up revealed a benign appearing brain tumor which, again, was likely a late effect of her brain irradiation. Since she had no symptoms from her brain tumor, her medical oncologist forged ahead with chemotherapy for the breast cancer, followed by removal of her reconstructed breast and its residual cancer, followed by radiation to her chest wall and lymph nodes given by me. All of this she bore without question, without complaint.
I saw her in follow up on Friday and she was doing well, but she knew she needed to undergo more testing for an enlarged and nodular thyroid—possibly a thyroid cancer, also radiation induced. She also needed to have a follow up MRI for her brain tumor, to be sure that it is not growing rapidly. She was matter of fact about the inconvenience, not to mention the anxiety, of having multiple additional tests and procedures over the next few weeks and months.
I am continuously amazed by her grace and equanimity. I said to her, “You are my hero. How do you just keep going, day after day, month after month, year after year, dealing with cancer, one cancer after another?” She said, “When I was a child, dying was NOT an option. My parents never even mentioned the possibility, so I was never afraid. I just did what I had to do. Now it’s the same thing—I know that this is the price I have paid for the wonderful life I have led. I just keep putting one foot in front of the other, one day at a time. I know that I will be okay.”
Here’s the thing about oncology folks: It puts everything else into perspective. If this brave woman can take the lemons life has given her and make lemonade, so can you and I. This is the crux of the matter; this is what has kept me going in this field for over thirty years. If this woman considers herself lucky, so should we all.