“Iam frightened!” she said, her blue eyes wide with anxiety. She was just 16 years old, but who wouldn't be frightened when confronted with a diagnosis such as hers?
“Don't be frightened,” I said. I could see that fear had manifested itself within her tiny form. The three words might have had a calming effect or it might have been just the stethoscope dangling around my neck or maybe my white coat. Whatever it was, it seemed to quiet her senses a bit.
“All I said to my doctor was that I felt tired, and before you know it, here I am. And now they tell me that I might have can…” Her voice trailed off, unable to finish the word. All this happened under the scrutiny of the stuffed pink teddy bear that sat next to her bed.
“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.”
As I turned to leave her bedside, her right hand shot up and gripped mine, her eyes pleading for something to hold onto and as she did so her eyes gazed right into mine, rooting me to the spot. After what seemed a long minute, her grip loosened, and she mumbled a “thank you.” I replied with “you are welcome,” but truly did not know what I had done to deserve that.
The next morning her case was presented to our “Intake Conference.” Most of the medical staff was there. 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 this patient was younger than the average patient with the 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, a frosty November morning, 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 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 the privilege of caring for!
Two Years Later
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 questions related to the scientific paper I was writing, the problem seemed insurmountable.
A soft knock alerted me to someone's presence. I turned to look and there stood a young woman, a face full of life and bright blue eyes. 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 off the edges.
She smiled back and held out her right 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 was “you are welcome.” And before I knew it, she was gone. That same evening, I completed the article and sent it off 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 such utter joy as the memory of that encounter. I have often wondered at what it truly was and now maybe, I think I know—the touch of a concerned human for another, an attempt to give the strength to fight the fight and win. Sometimes a simple act of a smile or a touch means more than a thousand words.