I hesitated at the door. Reviewing my normal script for introducing myself to patients didn’t feel quite right. I should probably exhibit a more somber tone, considering the circumstances. What if the mother is in tears? What if she asks about outcomes? I took a deep breath and entered.
Pink playdough littered the exam table, sink, counter and floor. In a flash, a thin child, all elbows and knees, jumped athletically from the sink counter to the exam table and then to the floor, stomping over my feet in the process. She was covered in pink from head to toe, including a pink hat covering her bald scalp.
“I made this pizza for you!” hollered the patient. I’ll call her Tiffany.
I introduced myself and attempted to begin a physical exam, but I was quickly roped into a make-believe game of Pizza Hut. Tiffany seemed to know every diversion in the book, and she commanded her make-believe game. Nothing got by her, and it was playtime.
I shot her mother a desperate look. Bemused and exhausted, she laughed.
“That’s Tiffany. All the time. Chemo didn’t even slow her down. Is there anything you guys can do to help me get some sleep?”
I wondered, was this cancer? This was certainly not the picture of cancer I had been expecting. Tiffany wasn’t frail or weak. She was strong, and full of life.
Over my weeklong elective in pediatric oncology, I spent time diligently working as Tiffany’s pizza cook. She was feisty and confident. She was one of those kids that already had a fully developed personality packed into her little body despite her age. And she did not care about her cancer. She knew as much as one could at four years old, but the aggressive cancer was powerless against her indomitable spirit.
Critical care wasn’t my thing, but medical school has an impersonal way of pushing you. Of backing you right into that corner you’ve been avoiding and forcing you to grow, adapt and change. For me, it was the ICU. All I saw walking through the ICU on nephrology or neurology consults was suffering and drawn out death. Sure, I wanted to be a doctor, but I wanted to treat children – healthy, young, happy children with their entire lives ahead of them. As it happened, I spent two weeks at the tail end of my third year in the pediatric ICU.
I scrolled through the list of patients, hoping to find some diagnoses that weren’t too complicated for my novice ICU experience. And then I saw Tiffany’s, and her diagnosis list was as long as a grocery receipt. So many superimposed infections with fungi I had never heard of. Her medication list was endless. I knew enough to know her outcome would be poor, but I was still too inexperienced to predict when and how quickly the tragedy would strike.
I wondered if I should add her to my modest list of patients. Would it be too painful for her to be reminded of when she was well, playing with me? Would it be too painful for me? Would she even remember me?
I visited Tiffany each morning before rounds. I sat on the edge of her bed and we stared at the clouds through the window. She no longer had the energy to man her pizza kitchen. She couldn’t even get up out of bed by herself. Her mother’s previously exhausted face had become defeated. Even still, she was quick to correct my zoological interpretations of the clouds. Her arms had grown even thinner and her sunken eyes had aged her. Her pink light-up shoes and matching outfits lay tucked away in the corner, replaced on her thin frame by her hospital smock. Now it wasn’t a question of whether or not to use my somber voice.
Is this cancer?
Over the weekend I checked her chart incessantly. I knew how things would end, and yet I was desperate to find out how.
Then my brother called. My grandmother, who herself had been battling cancer for over two years at 92, had taken a turn for the worse. She was in hospice back home, thousands of miles away.
I wasn’t going to make it in time. And by the next morning, she was gone.
On Monday, I was back in Tiffany’s room. My voice faltered as I told her how proud I was of her, and how I admired her spunk and wit, unable this time to maintain the practiced somber timbre. I was furious that her life was being cut short. I felt guilty that I couldn’t say goodbye to my grandmother. I was thankful I could say goodbye to Tiffany.
It’s difficult, given the setting of the hospital, not to elide Tiffany with her cancer. In fact, most of her life she had been cancer-free. My grandmother had lived 90 healthy years before getting sick.
Maybe the tragedy of death is counterbalanced by a greater share of unconquerable life. Tiffany proved that, small and young as she was.
Image credit: “” (CC BY-NC-ND 2.0) by Rich Minear