My Son’s Second Birthday

Nicolas Batty, M.D.

When I first began my training in clinical leukemia,I had just completed my internal medicine residency.

Truth be told, the knowledge base of hematological malig-nancies was colossal but I took a genuine interest to absorb itdespite a bit of struggle. Yes, it felt like a great deal to beappointed to this clinical position. I cared mostly for patientswith chronic leukemias at first. Subsequently, I rotated onthe inpatient service and was really shaken at the atrociouscruelty of refractory acute leukemias.

It was an early April morning and my team had just takenover the inpatient service. I gently knocked on my new pa-tient’s door and said, ‘‘Hello, good morning, sir.’’ ‘‘Morning,’’fuzzily replied a frail young man. Briefly, I introduced myselfand promised to return later. Soon after, upon reviewing hiscase, I learned that he was an unfortunate young man, only 25years old and from south Texas, who had failed his inductionchemotherapy for acute myeloid leukemia. He was beingenrolled on a new experimental study protocol of therapyand, mostly, of hope. Sadly, his teenaged wife had just sepa-rated from him a week earlier and took away his almost-two-year-old son. I felt frustrated. His story was painful, and yes,awfully unfair.

He looked a shadow of his picture on file. The aggressivechemotherapy entirely knocked him out and left him disabledwith severe mucositis and intractable diarrhea. For days hespent most of his time in the bathroom. He kept a calm de-meanor, though, and a very faint smile.

When he felt somewhat better, he begged my attending tolet him go to celebrate his son’s second birthday. We ar-ranged with his father for an ambulance to take him home sohe could be present at his son’s second birthday. However,he was transferred back to our emergency departmentwith harsh signs of sepsis and required admission to theintensive care unit. I saw him the next day. He lookeddisheartened, felt lonely, and was scared of tomorrow. Histherapy had been judged to be unsuccessful and he declinedspectacularly.

Upon seeing him the next morning, his diet had been re-stricted to ice chips. With a desperate smile, he asked foroatmeal. I explained that this would be unsafe due to thecondition of his bowels. He was looking worse every morn-ing. I felt at times that I couldn’t fake a smile anymore so Iwould sometimes stand by his beside quietly and hold hishand for comfort. He used to tell me before I left the room,‘‘Thanks man, I appreciate it.’’

The last time I saw him was a sad sight of him tremblingand clammy; his bed was covered in stools and diarrhea hadblasted the entirety of his room. I told him that I would comeback, then asked how he was feeling. He could barely open hismouth because of the pain but he mumbled, ‘‘I’m fine andyou?’’

The next day I was in his room, rushing to finish my notesbefore presenting his case on our morning rounds. I waswearing a gown, gloves and hiding my face with a mask, as hewas under isolation. It was then that his room phone rang, so Ianswered it because he wasn’t able to reach. It was his mothercalling, and then asking if he had died. I responded ‘‘NO,’’ andinquired why she would ask that, before handing the phone toher dying son. He was tearful as he told his mom that thedoctors weren’t sure how long he had to live. I had to holdmyself and stay strong; I was tearful too and felt frustratedthat this young man would have to suffer such a fate.

With mixed feelings of hopelessness and helplessness, theteam met with his father and judged that we had used all ourweapons. We had to explain that his son’s leukemia was re-fractory and there were no more therapeutic options availableat that point. In spite of himself and his usually silent de-meanor, the father expressed his sorrow and cried. He was sodistraught by his son’s impending death that he reported ourmedical team to the patient advocacy board. He felt that we didnot do a good job, as we had offered his son an experimentaltherapy at the salvage round of chemo. We met with the fatheragain; he was very sad, tearful, and did not have much to say.

The next day was my day off. My colleague sent me a sign-out list of patients the day I returned. When I did not see mypatient’s name on the list, I asked what had happened. Shesaid that the family decided to transfer him to south Texas sothat he could pass away peacefully at home. Two days later Ifound out that he had expired. It was only two months fromhis diagnosis to his death. This sad experience greatly im-pacted how I would view tomorrow. Later on I told this storyto one of my attendings. He answered me, ‘‘Don’t mourn yourpatients, they have their families to be sad about this.’’ Headvised me to fight their cancer and try to cure it through hardwork and by advancing science. This was especially heart-breaking, since my attending himself was battling an ad-vanced cancer.

I am not sure what more I could have offered. Sometimes,when I smiled and held his hands, I felt that my patient ap-preciated my attempts to comfort him more than my routine

Roswell Park Cancer Institute, Buffalo, New York.

JOURNAL OF PALLIATIVE MEDICINEVolume 15, Number 11, 2012ª Mary Ann Liebert, Inc.DOI: 10.1089/jpm.2012.0188

1275

work. This experience has changed the way that I will cele-brate every event of my life, especially the second birthday ofthe son that I hope to have one day. What I have learned fromthis patient is that though tomorrow may never come, it isalways worth fighting for. As I think of his two-year-old boy, Iwish for my patient that he rests in peace and wish his son afuture where we have found a cure for all cancers.

Address correspondence to:Nicolas Batty, M.D.

Roswell Park Cancer InstituteElm and Carlton Streets

Buffalo, NY 14226

E-mail: gbatymd@gmail.com

1276 PERSONAL REFLECTION