A Doctor's Ordinary Labor Can Provide Extraordinary Mercy

March 15, 2012

Body

The successes in pediatric oncology over the last 4 decades have been among the marvels of modern medicine. Across the board, we are now able to cure approximately 75% of children diagnosed with cancer. Ours is a much happier field than you might imagine. In spite of this, we still have a substantial number of children whom we cannot cure. I think of them often.

Near the end of my first year of training, late at night, my intern gave me a call: “Steve, I think he’s dying now.” “He” was a 3-year-old boy with Down Syndrome, which in addition to its well-known complications predisposes children to developing leukemia. He had been treated, initially successfully, for acute myeloid leukemia, a rare cancer in children. Unfortunately, his disease later relapsed, and we were not able to put the leukemia back into remission. With no realistic opportunity for cure, his family had decided to pursue no further chemotherapy treatment, and he was receiving hospice care at Texas Children’s Hospital.

Though I was on pager call for the hospital, I was about to go home for the evening. But there was no way I could leave now. You see, I had gotten to know this family over a period of months, through stays in the hospital, through clinic visits, through trips to the emergency room with serious infections. So I told the intern, busy covering the needs of several dozen patients, not to worry about seeing this child just then — I’d take care of checking in.

When I entered the room, the boy truly was dying. His breaths were infrequent, shallow gasps that we try to euphemize as “agonal respirations.” His parents and grandfather were sitting there, hands on his frail body, quietly frightened. But this fear was mixed with another emotion that I could not anticipate.

“We’re so glad you’re here, Dr. Simko,” his mother said with relief. “He’s not going to die alone.”

I sat with them for a time. His breaths came less frequently now. But the pages from were starting to come more frequently. I had to step out for just a moment.

No sooner than I had walked out of the room than my emergency contact phone rang. It was this boy’s primary attending physician.

“Steve, how is he?”

“He’s dying. Now. How did you know to call?” Mind you, this is almost midnight. Doctors don’t normally call to check in at midnight unless they’re prompted to do so.

“Um, I didn’t. I was just calling to check in. Really, he’s dying now? I’m coming in.”

She did. And so did another one of the boy’s physicians. At midnight.

They sent me home, knowing I had a long night of answering other calls and pages, knowing that I couldn’t be there for the family to the degree that was warranted at the time. The boy held on for many hours more, finally dying early the next morning. The other physicians never left his side. At his funeral, however, his family was still thanking me for being there. In that bleak moment, my simple presence had meant a great deal.

This child wasn’t going to die by himself — he was surrounded by loving family the entire time. And I hadn’t come unbidden from home or performed a heroic medical deed; I had simply gone in to check on this child as part of my everyday course of work. But sometimes our ordinary labor, administered in the right dose at the right time, can provide extraordinary mercy. And in our world, our patients — and especially their families — never have to fear facing their darkest hours alone.

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