My pediatric rotation thus far has been nothing short of an emotional rollercoaster. Within the same day, there have been beautiful moments spent playing with the absolute cutest babbling, bubbling, drooling bundles of chub - where it takes every ounce of self-control not to reach in and squeeze those plump rosy cheeks. And then there have been the moments of heart-wrenching world-shattering sadness. Standing over a crib, listening to the senseless beep of heart monitor and eeg's, and knowing that even if this cherub makes it past her next seizure, past this night, or even past this year, that she may not live past her 5th birthday; it could have been enough to make a saint question what good there is in this world.
"Amanda" was a 10 year old previously health girl that had started feeling short of breath recently. Her parents had noticed a mild cough and given her some robitussin to help get her past the cold they thought she was having. When her symptoms persisted, Amanda was brought to her pediatrician. X-rays revealed a massive pleural effusion that nearly whited out the entirety of both lung fields. As part of the ID team consulted to initially evaluate Amanda, we reassured her and her mother through the Spanish interpreter that she was in the right hands. Only able to speak one word at a time before she was out of breath, Amanda was still visibly frightened. A couple stories and a few jokes put her at ease though. We thought she would be fine.
Later that day, Amanda was sent to IR to get a chest tube put in. Overnight she drained more than 2 Liters of fluid from her lungs. Like fog settling over a bloodied battlefield, an X-ray the next morning revealed 2 glaring lung nodules and a massively widened mediastinum. A CT later indicated metastasis, biopsies had not yet been taken.
We walked to Amanda's room in slow motion, attending, fellow, residents, students, nurses, translators and all. Our white-coated gang cornered Amanda's mom and began the difficult process of explaining our suspicion of cancer and the need to transfer to Heme/onc. Amanda, the only other bilingual in the room, was unfortunately made to hear each carefully worded sentence twice. We think it may be cancer, but... Pensamos que puede ser cáncer, pero...Not understanding at first, mom was silent. But as pieces of the puzzle settled into place, her face reddened, her eyes swelled, and a wave of emotion was unleashed upon the room.
I sat at Amanda's bed side after the other white coats had left and tried to hold her hand again to tell her that she'd be fine. Looking into her teary eyes and seeing her trembling lips, however, I lost composure, and had to fight back my own tears while drying hers. We didn't know what would happen, no one did. We didn't really even know if there was cancer for sure, but we were scared together. Not wanting my fear and concern to elevate theirs, I left the room fairly quickly.
I've seen cancer diagnosed before in adults and I've seen kids with living with cancer before, but something about explaining cancer to a child and her parents smarted like a fresh cut. I'm not sure yet what I would have done differently as this happened only very recently, but as I continue to follow Amanda, I will continue to reflect on our interactions.
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