Rethinking heroism

For Elly

I have mentioned in previous essays here that I do not treat pediatric patients–that I learned that I don’t have the temperament for it–but I never said why.  The meeting in Boston brought back a flood of memories from the early days of my career, and it is time to revisit some of them.   Every year my professional organization honors one or two or three of its own, for exceptional lifelong service.  This year, Dr. Robert Cassady was one of the honorees.  During my residency, he was the Chairman of the Department of Radiation Oncology at Boston Children’s Hospital and I had the good fortune to rotate on his service.  He taught me a lot about compassion, and how to approach difficult problems.  But one lesson I failed to learn was how to mask my feelings for the good of the patient, and the family.

In 1985, I was asked to see a two year old boy with Stage IV neuroblastoma.  This is a malignant tumor which develops from nerve tissue, occurring in infants and children.  Most neuroblastomas begin in the abdomen, in the adrenal glands or next to the spinal cord, or in the chest.  The disease is most commonly diagnosed before age 5, and the incidence is 1 in 100,000.  In most cases, the tumor has already spread when it is first diagnosed.  The little boy that I was asked to see had failed numerous rounds of chemotherapy and radiation.  There was nothing more that we could do.  Somehow, I found myself in the uncomfortable position of telling his young mother that her firstborn child was going to die.  She started to cry.  And then I started to cry and I could not stop.  When Dr. Cassady offered me a job at Boston Children’s a few months later, I declined.

At the meeting, I had time to reconnect with an old friend who had been one of my very first residents.  She is an exceptional physician who has had more than her share of tragedies in her own life.  Her husband, who was a prominent child psychiatrist, died young leaving her as a single parent with three children including a fifteen month old boy who will never know or remember his father.  She has spent her career in New Orleans, and after getting through the nightmare of losing her husband, she had to deal with Hurricane Katrina in 2005, which flooded her department, depriving her of a job, and which completely unhinged her eldest daughter  during the formative years of high school. The family was displaced to Florida, their futures uncertain.  My friend recovered from these challenges and losses with incredible courage and dignity.

I sat with my friend at dinner last Monday night, as the winds and rain of Hurricane Sandy raged outside our hotel.  Her family is doing well now, and to my complete surprise, since she made her own career treating gynecological cancers, she told me that she has become the pre-eminent pediatric radiation oncologist in the great rebuilt and revitalized city of New Orleans.  She told me that she loves it—taking care of kids with cancer. I was incredulous—I asked her how she could stand it.  She told me that with what she herself has been through, she feels that she can truly help other mothers and children in crisis.  The triumphs, in her mind, significantly outweigh the tragedies.  She is a “glass half full” kind of person.  She is my new hero.

After spending a few days in her company, I have been rethinking pediatric radiation oncology.  Maybe, it just takes a little bit of life’s hard knocks to be able to be helpful when the unthinkable occurs.  Maybe you just have to be older, to learn that it is indeed possible to “ride on through it .”  And maybe, just maybe, we are ALL capable of a lot more than we think we are.