Courage!

“I am frightened!” she said, her blue eyes wide with anxiety. Who wouldn’t be frightened when confronted with a diagnosis such as hers’ I thought.  Her face was flushed with mixed emotions. And as she uttered the words, tears welled over her lower eyelids threatening a torrent.

“Don’t be frightened.” I said to the 16 year-old, who lay in the bed like a limp doll.  I could see that fear had manifested itself within her tiny form. The three words might have had a calming effect on her or it might have been the stethoscope dangling around my neck or maybe my white coat might have projected some authority over her malady and then again it was her emotional reset. Whatever it was, it seemed to quiet her senses a bit. Her eyes stopped darting left and right looking for answers from the ghost of the future. Her stilled gaze looked right through me in search for answers. After all I had the knowledge and experience to afford those answers.

“All I said was that I felt tired, to my doctor and before you know it, here I am.” She said with agitation in her voice and visible tremors in her expressive hands, as her thumbnail were busy in a nervous ritual of ridding the demons from beneath her fingernails. “And now they tell me that I might have can…” her voice trailed into gentle sobs, unable to finish the word. All this happened under the scrutiny of the stuffed pink teddy bear that sat next to her bed in stony silence.

“I know that this nightmare will end soon and you can go on to live your dreams. I also know that your dreams will change somewhat as a result of this but it will be for the better for you and everyone else around you.” I said quietly and as calmly as I could manage without exposing my own emotions of “Why?” and “Why her?” It was important for her to feel hope. “You will have some difficult times initially but we will guide and help you through it.” I added giving her some sense of truth and reassurance.

As I turned to leave her bedside, her right hand shot up and gripped mine, her eyes pleading for something to hold on to and as she did so her eyes gazed right into mine, rooting me to the spot, where I stood.

She did not say a word while she held my hand but continued the unblinkingly stare. After what seemed a long minute her grip loosened and then with her eyes lowering she mumbled a “thank you.” I replied with a “you are welcome,” but did not know what I had done to deserve that.

The next morning her case was presented to the “Intake Conference.” Most of the medical staff was there. Some with coffee mugs and others still with bleary eyes that even coffee could not blow the cobwebs of their sleep deprivation.

She had an uncomplicated case of Acute Promyelocytic Leukemia.

 The APML was a garden-variety type with its standard translocation of the t(15;17)(q21;q12) and expression of the RARa gene. 

The only problem was that she was younger then the average patient with that disease. However, after half hour of mind melding, thoughtful criticism from the assembled group a decision was made and her treatment was started the same day.

I remember that day vividly. It was a frosty November morning. It was a kind of a virtual memory milestone, with autumn leaves covering the driveways and the lingering chilled breath of those people walking on the sidewalks. That was the day we embarked on a journey together; her in her darkened world and I with a team of others working to make her world brighter.

Nothing extraordinary happened until the third month of her therapy when she developed a fever. It seemed like an interminable time to diagnose the cause of the fever as each hour her pulse and respiratory rate rose and her blood pressure lowered, finally the clarion call of sepsis sounded through the unit and she was transferred to the ICU. IV-Bags filled with antibiotics, anti-fungals and anti-virals were pumped into her every four hours. After days of fighting the vile element, that was never identified, the slow process of healing began. She had marshaled her youthful reserves to allow her to sail the stormy seas. She had survived.

I remember also the slant bright morning sunlight of the March sun filtering through the windows as she sat in her wheelchair in the lobby waiting for her ride. A swarm of well-wishing nurses by her side joyous in their dialogue and happy in this circumstance all animatedly talking, kissing and hugging her. I stood by the window looking at the proceedings. Even though I was partially hidden, I saw her raise her arm towards the window and wave. I waved back with a smile and then it was all over. Hearing my name announced over the overhead speaker, I was back tending to the sick once again, the sight of her leaving the hospital firmly locked in my memory. It was a triumph of human resilience and courage. And, boy what a fighter she was, the best I had, had the privilege of caring for!

Two years later as I was winding down my fellowship in hematology-oncology, sitting in my cubicle with papers strewn over the table, frustrated in trying to resolve the scientific paper, I was writing. With my head in my hands the problem seemed insurmountable at that moment. A soft knock alerted me to someone’s presence. I turned to look and there stood a young woman. Her face was full of life and her blue eyes caught my attention. The slow spread of recognition in me must have shown on my face for as I stood up I must have broken out into a smile that probably ripped my ears of the edges. She smiled back and held out her right hand that I took and for a moment she did not say a word. Then after what seemed like a while she let go of my hand, “I came to give you back what you gave me two years ago and thank you for all you did.” Speechless and still smiling all I could say to her “thank you,” was “you are welcome.” And before I knew it she was gone. That same evening, I competed the article, I had been working on and sent it for peer-review.

 I have often wondered at the many blessings that come from being a physician and never has there been one that has so filled me with utter joy then the memory of that encounter. I have often wondered at what it truly was and now maybe, I think I know. It was the touch of a concerned human for another to lift her out of her despair and give her the strength to fight the fight and win. Sometimes a simple act of a smile or a touch means more than a thousand words.

also published (without images) in Oncology Times:

Voices 

Opinion articles 

Sunday, January 23, 2011Author