A White Coat Is My Closet (31 page)

Dr. Herbert’s features immediately softened, and she looked genuinely shaken. “Christopher isn’t progressing nearly as well as we had hoped. Despite aggressive chemotherapy, there is little evidence his tumor is responding, and on his recent MRI, the metastases in his liver appear unchanged. At this juncture, the size of the primary tumor in his abdomen is forcing our hand. It has begun to compress both his spine and his left kidney. His kidney is being compromised, and the upcoming chemo is going to be even more difficult to tolerate. We’re hoping that by removing the tumor now, we’ll be able to preserve adequate kidney function for as long as possible. There are no great alternatives. He’s got an awful disease.”

As I listened to her explanation, I felt my stomach tighten. The blood rushed out of my head and I felt dizzy. The only thing I could think of was how embarrassing it would be to pass out in front of her. I leaned forward with my elbows on my knees and rested my head in my hands. I hoped I was giving the impression of just looking pensive, but truthfully, I was trying not to throw up. I took a few deep breaths and mercifully was able to steady my breathing. I willed my eyes to focus. “Sounds like the prognosis is worse than we originally assumed.”

“A stage-four neuroblastoma never carries a great prognosis, but we had hoped he would respond more favorably to this new chemotherapy regimen. Remember our conversation when he was initially diagnosed? I told you the three aspects of his condition that were particularly worrisome were the tumor size, the presence of metastases in his liver and lymph nodes, and that the genetic markers from the biopsy showed it was a particularly aggressive cancer. We knew from the get-go that it would be an uphill climb. We were just hoping to be able to make that climb without any mishaps. Unfortunately, the results of the MRI indicate we’ve taken a bit of a stumble.” She was speaking very analytically, but I recognized the emotion in her voice. “We have by no means given up. We’ve just decided to treat fire with fire; we’re going to deal with an aggressive disease more aggressively. In addition, if push comes to shove, I’m not above using my secret weapon.” She smiled weakly. “I’ll keep my fingers crossed.” She shrugged almost imperceptibly. “A little superstition couldn’t hurt, and never underestimate the power of positive thinking.”

I shook my head dejectedly. “I’ve got to say, that categorically sucks.” I looked up quickly and immediately apologized. “Sorry, Dr. H. I didn’t intend to be disrespectful.”

“That’s okay, Zack. I couldn’t have said it better myself. The important thing is to support Christopher and his family as much as possible. This situation is more than any family should have to endure. Medical technology makes important advances every day. The trouble is that it sometimes doesn’t make them as fast as we need them.” She began to organize the papers on her desk. “We can’t get discouraged, though. There are children alive today who ten years ago we would have held little hope for.” She sat up straighter and her voice became more resolute. “Day by day, case by case, child by child, we press onward. And ten years from now, when we look back at where we currently are, struggling against seemingly impossible odds, we pray we’ll have had more successes than losses.” She looked at me intently. “And I believe we will.” She waved her hand around the room. “If I didn’t believe that, I’d just pack all this up and head home.”

I stared at the floor in front of me. “I believe that too.” My voice was not nearly as confident as I would have liked. I glanced up to see that her gaze had never left me. “I mean, I kind of have to. Working to become a pediatrician would be senseless if I didn’t truly believe my efforts would ultimately result in making a positive difference in children’s lives. It’s just that I never imagined that process could be so difficult. Though my contributions as a resident are insignificant, I’m nonetheless participating in the evolution of medical science. And as a participant, I experience it.” I brought my hands to my chest. “I feel the victories and the failures. It’s just that in this case, a failure means having to watch a precious little kid die.” I stared back down at the floor. “It just sometimes makes me wonder if participating is really worth it.”

Dr. Herbert stood up, walked around her desk, and knelt down in front of me. She gently laid one of her hands over mine. “We all wonder sometimes. But just imagine. Imagine a day in the future when a little boy like Christopher flies into the hospital wearing an identical red cape.” She smiled warmly. “Imagine that he too has a serious malignancy. And imagine that, because of our caring and perseverance, he’s eventually able to fly home—healthy and disease-free.” Her voice took on a bit of a lilt. “Ready to once again bring dastardly villains to justice. On that day, you will know it was worth it.”

I looked up into her caring and compassionate eyes. “Any tricks as to how to get from today to that day in the future without totally combusting?”

She patted my hand once more and stood. “Absolutely, Zack. Never quit caring. You have to remind yourself that Christopher was sick when he came to us. His disease is not our fault. If he dies….” Her voice became more solemn. “And I’m still not saying that’s a certainty. But if he dies, he will die in the care of someone who has grown to love him. Under those circumstances, even if his death is inevitable, it’s easier. Easier for him and his family.” She dropped a hand to my shoulder. “That’s still a success, Zack. Not nearly as sweet, but a success nonetheless.” She walked back around her desk. “Appreciate the power of caring. That’s the trick, Zack. That’s what will get you through the day. And sometimes,” she said as she looked at me over her shoulder, “it’s all we’ve got.”

I stood up and began making my way toward the door. “Thanks, Dr. H. I really appreciate your time.” Before clearing the threshold, I turned back and smiled at her. “And may I go on record right now as saying that I think you should get a raise? I’m not sure how much they’re paying you, but whatever it is, you deserve more. Being a good oncologist? Five grand a month. Being an awesome person? Priceless.” I waved at her as I left. “I’ll put it in a memo, and I’ll take it right to the top. You’ll be living the
vida loca
within a week.”

I heard her call after me. “Forget the
vida loca.
Just tell them I need new tires on my Toyota.”

I slowly made my way back to the pediatric ward. Though I understood the importance of going to check on Christopher, I genuinely felt like I’d had the wind kicked out of me. I wasn’t sure how I would be able to appear in his room and manage to look upbeat. I sat down in front of the computer at the desk behind the nurses’ station in order to review his recent labs. As despondent as I felt, I still had to ensure there were no irregularities that would jeopardize his being able to go to the operating room. I scanned down the columns of values. I saw a number of significant abnormalities but most were the expected consequence of the chemotherapy. I did, however, notice that his potassium was trending dangerously low and made changes to his IV fluids to correct it. That done, I dragged myself out of the chair and headed toward his room. The burden of my concern for him felt like a six-ton weight teetering precariously on my shoulders; threatening any second to crush me like a bug.

I was standing just outside the door of his room when I remembered something. Weeks before, I had asked Juan, the supervisor in charge of ordering supplies, if he could put in a requisition for a child-size Superman hospital gown. One day on call, I had gone to the charge nurse’s office to speak with her. While I was waiting, I happened to see a hospital supply magazine sitting on a stack of charts. I was thumbing through it when I came upon the picture of the gown and immediately decided it would be perfect to boost Christopher’s spirits. I tore the page out and presented it to the supervisor the next day. He said we had an account with the vendor and he would see what he could do. Before I knocked on Christopher’s door, I did an about-face and headed to the supervisor’s office. I was certain Christopher would be a little less apprehensive about his surgery if he went into the operating room as Superman.

I approached Juan’s office and saw him sitting at his desk, so I rapped the side of the door as I walked in. “Hey, Juan! Has the Ferrari I ordered come in yet?”

Juan looked up and smiled. “Yeah, it came in, but there was a small glitch. It was delivered to my garage by mistake.” His smile broadened. “I’ve been intending to try to get it to you, but every time I begin the trip over to your house, I get disoriented driving up the coast with the top down. I end up having to just drive back home. Sorry, I’ll have it to you in no less than three months or whenever the insurance premium is due. Whichever comes first.”

“Really? You get disoriented driving up Pacific Coast Highway on the way to my house? I can see where that could be a problem, given that Pacific Coast Highway is no fewer than ten miles away and I live just three blocks from here. Before you return the car to me, better get the navigation system checked out. Better yet, why don’t you just send the whole thing back? Who wants a $400,000 car if it can’t even get you where you need to go?”

“I was thinking the same thing. Besides, the administration is getting so picky. Questioning every million-dollar purchase from the discretionary fund like it’s not going to improve patient care. Very irritating!” He stapled a stack of papers together. “Now that we’ve settled that issue, is there anything else I can help you with?”

“Please. Listen, I know it’s not your top priority, but were you able to make any headway on ordering that Superman gown? The kid who I wanted it for is not doing great and is scheduled for surgery tomorrow. If you were able to get it, this would probably be the best time to give it to him.”

“That’s right. I’d forgotten about that. Let me check.” He turned his attention to the computer screen. “After I spoke to you, I did include it in my next order. There were a bunch of things the hospital needed from that vendor, so one more gown was an easy addition. Let me check.” He clicked a few more buttons on the keyboard, and a copy of the invoice appeared on the monitor. “Yep. It’s recorded as having coming in. Should be down in Central Supply. Item number 15-748-VM. I’ll call down and have someone pull it for you. If you wait five minutes before walking down, it should be waiting for you.”

“Thanks a lot, Juan.” I smiled. “I don’t care what everyone else says about you, you are a damn nice guy.” I headed out of the room. “I owe you.”

His laughter carried across his desk. “Wait! What is everyone else saying? Someone says something unflattering about me, you let me know. See if they get to ride in the Ferrari!”

A few minutes later, with the package from Central Supply tucked securely under my arm, I slowly opened the door to Christopher’s room. He lay in bed watching television, but his eyes weren’t focused on the screen. Yogi was peeking out from under the sheet next to him. His parents were sitting in chairs on the other side of his bed. They both looked like they’d been to hell and back. Their faces were gaunt, their clothes were wrinkled, and his dad’s hair was in complete disarray. His mom, for her part, had at least combed her hair and had applied some makeup, but it did little to conceal the fatigue and worry on her face. Christopher slowly turned his head away from the screen and looked at me when he heard me approach.

I tried to push some animation into my voice. “Hey, champ. I missed seeing you over the weekend. Did you and Yogi catch any bad guys while I was away?” I saw a subtle flicker in his eyes, but it endured for less than a second. His eyes were significantly more yellow than they had been just a few days ago, and his reaction to seeing me failed to reach his lips. He couldn’t muster even the slightest smile.

I nodded to his parents, then went over to sit down next to Christopher on the edge of his bed. I pulled the bedspread up and tucked him and Yogi tightly under it, then I ran my fingers across his forehead. “I hear you’re going to have a big day tomorrow. What do you two have planned?”

His voice was soft and defeated. “They’re going to give me an operation tomorrow, but I don’t want it.” His eyes brightened but almost imperceptibly. “Would you tell them, Dr. Zack? Would you tell them I don’t want them to give me an operation?” He looked pleadingly at me, probably hoping to have found an ally. My lip quivered slightly, but I was able to maintain a smile. I looked over at his parents, but they avoided my eyes. This was a conversation they themselves had probably already had with Christopher no fewer than one hundred times. Despite having racked my brain, I hadn’t come up with an explanation that would result in Christopher feeling anything other than dread about the pending surgery.

I looked back at Christopher and tried to look confident. “Look, champ. I know you’re scared, but you’re forgetting—you’re the man of steel. A little operation will barely slow you down. If bullets bounce off your chest, I doubt you’ll even feel something as small as an operation.”

Christopher looked soulfully into my eyes, his expression wiser than should ever be seen on the face of a five-year-old. “Yeah, but I’m not really Superman. I’m just a little boy.”

I leaned into him and hugged him. “Yes, but remember, there was a period, a long, long time ago when Superman was just a little boy too. And if he were going to have an operation, he would also have been scared. He wasn’t grown up enough to understand that when you’re made of steel, even if you’re just a little boy, you can’t get hurt.” I pulled back so I could look at him. “That’s what I came in to remind you. Even though you’re just a little boy, you’re still made of steel and you’re invincible. You’ll fly through tomorrow’s operation. No problem. In fact,” I said as I lifted the gown off the foot of the bed, “the real Superman left you this to wear tomorrow. Now everyone who sees you will know how strong you are, and most importantly, you’ll remember yourself.”

Christopher’s eyes brightened unmistakably when he saw me hold up the gown. “Did Superman really leave that for me?”

I looked back at him as if his question was ludicrous. “Of course. He was going to give you a suit just like the one he wears, but he knew all little boys in the hospital have to wear a gown. So he made this one especially for you. It’s made like every other hospital gown except”—I pointed to the insignia on the front—“it’s got Superman’s special ‘S’ and is red and blue. Who, besides Superman, would have a special hospital gown? They don’t sell these things, you know. Bet you’ve never seen anyone else wearing one.” I looked at him inquiringly. “Have you?” Christopher shook his head. “See, I knew it. This is the only one on the planet. Superman left it specifically for you.” I looked at Christopher intently. “He wanted to remind you that you’re made of steel and you’ll do just fine tomorrow.” I ran my fingers across Christopher’s head. All his hair had long since fallen out because of the chemo. His head was as smooth as a bowling ball. “You don’t doubt Superman, do you?”