I met one of the most memorable patients of my medical career in 1981 when I was an intern at Vanderbilt Children’s Hospital. Her name was Wanda, a beautiful, skinny 7-year old with an aggressive form of acute leukemia that required frequent admissions to the hospital.
Her family was poor and unable to stay with Wanda in the hospital, so the nursing staff became her surrogate family.
In those days, interns were responsible for drawing blood and starting IVs. With Wanda, this was a huge challenge as she was petrified of needles. She was so ill that she needed blood work daily.
Every morning, she engaged me and her nurse in a lengthy and skillful debate about the necessity of having her blood drawn. Then, she insisted on negotiating the nuances of every step of the blood-drawing procedure in excruciating detail: how tight the tourniquet was on her arm, how much blood was drawn, the size of the needle and so on.
I showed a lot of patience, but in the end, the ordeal usually evolved into a screaming tantrum as I prevailed in obtaining a blood sample. One morning, as the usual debate started, Wanda blurted out: “I should get to draw your blood, Dr. Barnard!”
Initially taken aback, I quickly and astutely (so I thought) reasoned that permitting her to draw my blood might prove a valuable therapeutic strategy by which she would resolve her needle phobia.
I agreed to let her draw a blood sample from my arm. With her nurse in assistance, this girl went through all the requisite preliminary steps by applying the tourniquet, swabbing with alcohol and then proceeded to deftly draw my blood with the all the skill of an experienced phlebotomist.
Unfortunately, this exercise did nothing to end her fear of needles, blunting my enthusiasm for a career in pediatric psychiatry, but impressing me with how much children really absorb from the daily routine of their medical care.
This curious bonding experience established Wanda as one of my favorite patients.
Wanda died of acute myelogenous leukemia about 18 months after her diagnosis. The cards were stacked against her from the beginning, as 5-year survival rates, the statistic most commonly used to describe the outcome of cancer treatment, were about 30 percent for AML in the early 1980s.
I am distressed and disappointed to report that 30 years later, the 5-year survival rate is only slightly better than 50 percent. That’s not a statistic parents want to hear.
All physicians and scientists working in the field of cancer research are frustrated by the lack of major progress in the treatment of certain types of cancer such as childhood AML. Notwithstanding, we are exceedingly hopeful – now more than ever – that we are on the cusp of major breakthroughs.
The hope rests in research that employs sophisticated genetic approaches that describe in exquisite detail the characteristics of an individual child’s cancer.
High throughput screening methods for drug discovery and testing will shorten the timeline required for clinical trials that will determine the best possible treatments.
This type of research is exceedingly expensive, but a customized treatment protocol designed to cure each child is truly an achievable goal. Beautiful children like Wanda deserve no less.
Used with permission from The Columbus Dispatch – originally published 9.16.2009
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Dr. John Barnard physician and scientist |
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