that final decision

When I was in university I performed in the medical revue – sort of a skit based comedy show with a loose theme running through it. It was great to get out, ‘tread the boards’ and make a complete arse of yourself in front of classmates or future bosses. In between the skits, when the next scene was being set up they would usually do some form of ‘funny’ voice-over to keep the laughs running and ensure there wasn’t any ‘dead air’. One such voice-over occurred to me yesterday at work.

‘Cancer…Go on say it…cancer…after all, it’s just another word for growth!’

‘Brought to you by the Australian Cancer Council.’

That was it. Simple, got a few laughs, filled the short gap before I was back on for another scene. I didn’t really think too much about it from then on. In the intervening years, I’ve dealt with hundreds of patients with cancer, terminal or otherwise. It’s affected our family and still I never really thought about what it meant to have cancer; I have retained some measure of distance from the realities of the diagnosis. Until yesterday.

In St Elsewhere’s children’s A&E a large proportion of the state’s oncology patients come through our department before being admitted to the wards. We were sitting at the doctor’s desk writing notes from patients I had seen earlier, when movement caught my eye. Ambulance officers were wheeling a breathless, pale form through the department. The stereotypical bald head and pallor made me automatically think ‘ok, another Oncology patient, probably with a fever who’ll need to be started on broad-spectrum, strong antibiotics fairly quickly’. The nurses asked me to come straight in and see him. He was/is (not sure which at the time of writing to be honest) a 15 year old boy in severe respiratory distress. He had oxygen running through his mask at the highest possible rate, and his oxygen level was still dangerously low. Dad, a young, normal looking guy sat in the room. His red-rimmed eyes told me that there was probably more to the story than I anticipated.

Chatting to Dad, it seemed that he had been diagnosed with a brain tumour 10 years ago and had been treated with surgery, chemotherapy and radiotherapy since. The last few months had seen a dramatic deterioration leading to him being largely bed-bound. In the last 24 hours his breathing had become increasingly worse until he required assisted breathing from the ambulance crew that came to pick him up. I examined this 30 kilo fifteen year old. Barely a shell of a person. He could tell me that he had pain, but not much else. The tumour had paralysed the right side of his body and he was plainly exhausted with the effort of breathing. He was clearly dying. Dad asked me to step outside.

‘Ah doc, I thought I should let you know before you do anything that he’s asked me to let him die.’

I was stunned, but I suppose not surprised. His father was barely holding it together.

‘Ok, I understand. Let me chat to the Oncology team. I know they like to be informed whenever any of their patients come into hospital. Have you got anyone else coming in, is there anyone you’d like me to call?’

‘His mother’s on the way in with the other kids…Is this it?’ He looked at me searchingly

‘He’s very very sick. His breathing is laboured and his oxygen level is dangerously low. We’re giving him as much oxygen as we can at the moment and making sure that he isn’t in pain, but I’m not sure if he’ll survive. Have you and your wife discussed what you would like to do in the event that he does actually deteriorate?’

He just shook his head, looked around the room and apologised for being upset.

‘I should let you know that there are options in this situation, like placing him on life-support, on a breathing machine in the Intensive Care Unit…but I have to say, I don’t think that us putting him on the breathing machine is ultimately going to be the best for him, I don’t think it’s going to help him survive, and I don’t think it’s going to improve his quality of life.’

‘Well he hasn’t got much of that anyway…No, it’s not what he wants…’

‘Ok, I’ll make sure that we keep him as comfortable as possible.’ His dad turned and walked back into the cubicle to continue his vigil beside his panting son.

We moved him and the rest of his tearful family up to the Oncology ward. It sounds paradoxical, however the Oncology ward is a depressingly cheery place with some of the sickest children possible lying in rooms with garish murals on the walls and ‘clown doctors’ occasionally wandering around the ward doing magic tricks. I hate it. We formed some sort of sick, quasi procession led by a small broken teenager who should have been double the height and weight and anywhere but there, being followed slowly by three generations of his family.

When I last saw him, he was lying in a quiet back room of the ward barely discernable from the sheets surrounded by his family. I wonder whether they think Cancer is another word for growth?

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~ by Dr Ben on October 1, 2007.

8 Responses to “that final decision”

  1. Ouch. What an amazing kid to have that kind of maturity – I suppose he didn’t really have any choice – that sort of thing matures you.

  2. And the writer is back.

    Very well writen. You are a good writer, a really good writer. I’m not sure how long it took you to compose and edit this story, but every second was well spent.

    From an emotional viewpoint, I’m glad I’m not a parent yet. That is a horrible way to watch a child die.

    Thanks for writing this one.

  3. amazing post, i had to wait about 10 minutes before i commented as i had tears in my eyes. I’ve been thinking lately, having sent through all my applications and passed all exams etc that if psychiatry doesn’t turn out to be my calling- oncology probably would. making the last moments bearable.

  4. Day – Amazing maturity. I just couldn’t imagine being that way myself, but I suppose after 10 years and now being bed-bound he’d probably had quite enough. It’s another thing to be able to articulate it though.

    Clare – Thank-you for your kind comments. Ummm, it didn’t really take me long to write, half an hour or so. I think, when you have such remarkable people to write about, it pretty much takes care of itself (can’t really write dialogue though!)

    Eliza – From what I’ve seen and read, you are going to be brilliant. Psychiatry is hard, it tests the patience and the nerve, but is intellectually very rewarding. Oncology is tough. Small gains and lots of marginal outcomes. It takes a stronger person than me to do it. I am happy with acute medicine, I can’t deal with the long grind as it were. I have every faith in you.

  5. I have read this post three times now.

    This child has taken on the one challenge that we as adults universally fear. He has accepted the injustice of his situation out of necessity and he has rationalised, endured and suffered whilst he should have been dating, going to school and playing soccer with his friends.

    Breathtaking post.

  6. You know, I didn’t think anyone would post a comment on this post. I thought it would be too harrowing, and they’d just move on.

    So I’m surprised to see everyone here – I suppose that after reading the post you want to be with other people. I think that’s what made me comment initially.

  7. Guess what? Your blog is amazing! I can’t remember when was the last time i’ve overcome such a good blog that almost all articles/posts were interesting and wouldn’t regret spending my time reading it. I hope you will keep up the great work you are doing here and i can enjoy my everyday read at your blog.

  8. Ah! You are a tease, Come on it’s december 13 now and there have been no new posts since october 1st.
    I know you are a busy person, nevertheless…. you have readers who enjoy your stories!

    Merry Christmas, hope you don’t have to many drama’s in the hospital over silly season.

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