If you look at this page, you’ll notice I’ve recently edited a photography book that’s being sold to raise money for pediatric cancer research. My Significant Other, Lisa, is a pediatric pathologist. She diagnoses kids with cancer all the time and, unlike many pathologists, she does Fine Needle Aspiration (sometimes called “needle biopsy”) to get cells for diagnosis, which means she meets the kids in person, rather than simply looking at slides with tissue samples. Many of her friends are pediatric oncologists and surgeons who also deal with kids who have the most dire prognoses.
To me, and, I think, most people, this immediately raises the question of how they mentally handle dealing with children who are facing the possibility — sometimes the certainty — of death. My S.O. specializes in some of the most aggressive and deadliest of pediattric cancers, so she doesn’t tend to bring many stories home. Too many of them have unhappy endings. But over the years I’ve heard enough to piece together some small inkling of what must go on in the minds of the people who have what it takes to do this simultaneously heartbreaking and gratifying work.
A major part of the psychological strategy has to involve maintaining some emotional distance when you know the prognosis is bad. When a child gets cancer, the parents are always completely shocked: Cancer is thought of as an adult’s disease. Kids don’t — shouldn’t — get cancer. Except that sometimes they do. And the surprise hits like a hammer blow.
When pediatric cancer specialists get a new patient they can usually narrow down the possibilities of what’s wrong almost immediately. Which each succeeding step in the process of examination and diagnosis they get closer and closer to the nature of the disease they’re facing and almost always get a feeling early on as to how bad it’s going to be. Thus, they get to brace themselves in advance, gradually, for the ultimate truth. Though they care deeply for the kids in their care, they don’t get bad news completely unexpectedly, and that’s part of how they cope.
Here’s one of the few stories Lisa brought home from work that I did get to hear:
A pediatric oncology surgeon was bringing up some slides for Lisa to look at, so they could get an official diagnosis and begin treatment. Even when your other doctors are 99.9% certain you have cancer, you don’t officially have cancer until the pathologist says so — and identifies exactly what kind it is. There are more kinds of cancer than you can possibly imagine, all with tongue-twisting polysyllabic names and, more to the point, often vastly different treatments. You want to be sure you know precisely what kind of cancer you’re dealing with because treating the wrong kind can be worse than no treatment at all.
In this particular case, the surgeon was in a good mood because the case was a kidney tumor, which in children usually means a Wilm’s tumor. These used to be about 95% fatal, but years of research, spearheaded almost single-handledly by pathologist Bruce Beckwith, has turned the mortality rate around: They’re now about 95% curable. The surgeon knew it was statistically most likely to be a Wilm’s tumor and from examining the patient and taking the biopsy he knew it bore all the clinical signs of being a Wilm’s tumor, so he came into Lisa’s office with a smile on his face and she set to work.
It’s actually amazing to watch Lisa at work at the microscope, working the slide’s position and the focus adjustment on the scope. It’s very much like seeing the hands of a talented musician on an instrument. Also like a musician is the degree of mental focus she directs at the task. Though she can talk to the surgeon or oncologist about what she’s seeing, all her visual attention is directed into the microscope and the tale the cells on the slide have to tell.
And in this case the tale was an unusual one. The cancer wasn’t a Wilm’s tumor. It was something extremely rare: Only a handfull of cases had been seen before and had been no survivors. She worked through all the slides and everything she saw confirmed the diagnosis. “I don’t know what else to tell you” she recalls saying.
And at that moment, the other doctor became just another human being, completely blindsided by news no one wants or expects to hear. When Lisa took a moment to look up from the microscope, this experienced professional was sitting before her with tears streaming down his face.
The National Childhood Cancer Foundation can be found at www.curesearch.org.
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