Sunday, October 24, 2010

The Newest Angel

The OR was hushed on Friday.

Normally, it is a loud, busy place. The staff and surgeons are almost like a big family; we chat with each other and banter cheerfully with patients to help get their minds off the imminent ordeal of surgery. Chaplains pray with patients and families. Sometimes there are disagreements, as in any workplace. But everyone cares about everyone else.

Because of that caring, it was hushed. Instead of talking, people touched hands or embraced. The chaplain's prayers could be heard more clearly than usual.

Thursday night, a colleague's daughter had died. She was 4 years old.

She had been diagnosed with a childhood cancer over a year ago. We had followed her progress through treatment on a Web page her family set up. At first, we thought things would be fine; so many children can be cured these days. The survival rates were encouraging. Her dad, a talented young surgical subspecialist, carried on as usual after the initial shock.

Then the cancer spread. It stopped responding to treatment. One morning we came in to find her dad's cases cancelled at the last minute. Word spread surreptitiously: "She's had complications, and she's comatose now. It's not looking good." In the following weeks, hope slowly evaporated.

Strange; we all live with the presence of death every day. Patients code in the hospital. We make critical decisions about patient management; we do brain death exams and organ harvests. We live with its inevitability and yet find ways to go on. How unexpected, then, the pain when it happens to one of us, even when we know it's lurking just around the corner. No matter how much we know, we are never prepared for its intimacy when it comes. When it's a child, it's so much worse.

This is why I couldn't do pediatric neurosurgery. They see the worst of the worst; head injuries, abused children irretrievably damaged, malignant brain tumors that can't be cured. When I did that rotation in residency, my son was 18 months old. I couldn't help superimposing his face on patients about his age. It was unspeakably difficult. Admittedly, it can be very rewarding, because children do have such amazing capacity for healing. But many don't, and they broke my heart. I have such respect for those who can do this work, and for pediatric oncologists, too.

There must be a way to offer comfort to parents who have lost a child like this. I still don't know what it is. All I can do right now is hug my own son, smell his hair, and watch him sleep as if he were small again. I'll go back to the OR this week wishing I could repair my colleague's wounds like those of my patients. I'll be thinking about his daughter's Web page, purged of all the news of suffering.

Last Friday morning, that page had just one sentence: "There is no cancer in Heaven." Seeing that, we knew the newest angel had arrived.




    There's much in the world that you can't explain.
    It's revealed for you to remember
    by the whispering voice of a distant train
    or a midnight rain in november.

    Horizon within! You can always find
    the keys to Enigma. Let's mention
    one basic Truth: of spirited Mind
    is Nature naught but extension.

    Internal expanses! In dreams, ridden
    by fear and longing you roam
    that deep Southeast in your soul hidden
    ...on your random journey back home.


    As a native Swede, I am particularly proud of my love poetry suite Sonnets for Katie.

    My Poems



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    - Peter Ingestad, Sweden

  2. Cases like that are why I could not do peds onc. I have a hard enoigh time with the 20 year olds with refractory disease. I keep pushing and pushing with the hope that their young bodies will be resilient enough through the toxicity to come out cancer free on the other side.

  3. I spent three months doing peds path in training and we had oncology conference every other week. I was responsible for presenting the path after the oncologists presented the case. I spent a ridiculous amount of bath time palpating my daughter's abdomen for Wilm's tumor, during those three months - she was 1.5 years. I don't know how those ped oncs do it either - they are truly special.

    Once again you have my eyes blurry on my day off in my morning coffee. Reminds me of your day in the life post. If I was in my old house, I'd be in the exact same spot as when I read that one! Thanks for sharing.

  4. gcs-

    I wish I could see a way to leave this comment privately, but I don't.

    My son Henry died in February 2009 from a medulloblastoma. He too was 4 years old.

    You asked what to do for your friend. Sadly, there is not much. The vast part of this path is something that you have to walk alone. My best advice to you as a friend is to not be afraid of her grief. So many people are. So many good friends avoid it, either physically or emotionally. It is now part of her, forever.

    My blog, as a family physician, changed abruptly when Henry was diagnosed in October of 2007. My experience with his illness and death is catalogued there. I do not know if reading it will be helpful or hurtful for your friend, as it is far from rosy, and I have not found any answers. But, if you care to offer it to her, it's at


  5. Kellie (general surgeon)October 26, 2010 at 5:47 PM

    So sorry to hear about your friend. Death is hard, death of a child is nearly impossible for me to fathom. I have a 4 year old and am sitting here in tears.

    Dr. Smak, hugs to you.

  6. Dr. Smak,

    I am so sorry for what your family has had to go through.

    I read your blog last night and was profoundly touched. Thank you for the advice - no one knows better how to help than one who has been there. My thoughts will remain with you as well as with my colleague.

    If you ever have anything to add privately, please feel free to email

    Blessings to you!

  7. Reminds me of your day in the life post. If I was in my old house, I'd be in the exact same spot as when I read that one! Thanks for sharing.I like your blog.

  8. So heartbreaking.

    I worry about my capacity to deal with things like this, going into pediatrics.


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