You can't hide your kid from cancer

It's amusing to witness the various types of parenting styles that exist in the world. One of my previous calls I admitted two patients that particularly stood out in my mind. One was a college freshman who likely had meningitis. His symptoms weren't that bad, but the mom was so concerned that she actually wanted to follow him into the scanner to make sure he was ok. What if he has a contrast allergy, she asked. What are you going to do if he does? I responded. But I suppose it's better than the likely more common alternative of parents that just don't care.

Another patient that was admitted that night was a little over 30, but had lived with her father her entire life. He did everything for her, and treated her like his little baby girl even then. The innocent smile on her face and the way she timidly laughed at herself when her history and physical exam revealed how forgetful she was on account of her underlying pathology reinforced how beautifully unscathed her spirit was from the ugliness of the world. In addition to this man who did everything for her, she had her boyfriend, soon to be fiance who everything else. Don't tell her the gravity of the situation, he pleaded, she's never had to deal with anything hard before in her life, she won't be able to handle the truth. I often hear those words in the hospital, more often on the pediatric service, but sometimes with the elderly or dependent as well. They won't be able to handle the truth, they way. Maybe, or maybe it's you who can't handle how they'll respond to the truth. Is it really protecting the patient or is it protecting the family from the tears and heartache that will ensue. But I digress.

The patient ultimately was informed of her diagnosis. Brain cancer. No, we don't know what kind. No, it doesn't look like your typical malignant type, but we can't be sure until we have a tissue diagnosis. Yes, she'll need surgery. Yes she may have neurologic deficits including paralysis and loss of language, but we make sure that doesn't happen by careful preoperative planning. I consented her and her family, and told them it would be fine, that she would be fine. The day of her surgery was my day off, so I wasn't there during the operation. A little part of me died when I went to examine her the next morning and saw the frustration and fury from her eyes. The operation went well, but postoperatively she could not speak. Given the nature of the surgery and post op scans it was likely only transient in nature, which we explained to her, her comprehension still intact. She didn't believe me, or if she did, the overwhelming helplessness at being unable to speak when only 24 hours previously her only symptoms were headaches and vomiting, drowned out any reason we tried to feed her. She glared at me, and I'm sure she was yelling inside - you told me it was going to be ok, how the hell is THIS ok?

We were confident she would regain more of her communicative ability, but obviously it looked worse to the family than it really was. I'm not sure what exactly ensued, or what the boyfriend was thinking, but the night after the operation he decided that he would propose. She gave a thumbs up. Now, the cynics may argue that he did this to get the easy 'yes', after all, all she could really communicate was a thumbs up, and inappropriately for both yes and no at that. Other more chauvinistic types may argue that he just landed the gold mine, the woman he wanted to marry, but now unable to yell at him to do the dishes or take his feet off the table. But I'd like to think that this was again one of those small slivers of goodness that still remains in this downtrodden world. No thinking, no calculation, only knowing that she may be dying, that he wanted to spend the rest of his life with her, and that he wanted the rest of his life to start as soon as possible.

She's doing better, speaking more, and will likely leave the hospital on her own two feet, with many more years added to her life, and an upcoming wedding to plan.