“With the chance of a remission so slight, are you sure it’s worth subjecting Michelle to the side effects?” Charles was speaking more calmly now, but he had a terrible vision of Elizabeth during those last months, the violent nausea, the loss of hair… He closed his eyes.
“Yes, I do,” said Dr. Keitzman firmly. “I think it is well established that we have made significant advances in treating childhood leukemia.”
“That’s absolutely true,” confirmed Dr. Wiley.
“There have been advances,” agreed Charles, “but unfortunately in types of leukemia other than Michelle’s.”
Cathryn’s eyes darted from Charles, to Keitzman, to Wiley. She expected and wanted unanimity on which she could build her hope. Instead she could feel nothing but dissension and animosity.
“Well,” said Dr. Keitzman, “I believe in aggressively treating all cases, whatever the chances are for remission. Every patient deserves a chance at life, whatever the cost. Every day, every month, is precious.”
“Even if the patient would rather end her suffering,” said Charles, recalling Elizabeth’s last days. “When the chances of a remission—let alone a cure—are less than twenty percent, I don’t know if it’s worth subjecting a child to the additional pain.”
Dr. Keitzman stood up abruptly, pushing back his chair. “We obviously view the value of life very differently. I believe chemotherapy to be a truly remarkable weapon against cancer. But you are entitled to your opinion. However, it seems evident that you would prefer to find another oncologist or handle your daughter’s therapy yourself. Good luck!”
“No!” said Cathryn, leaping to her feet, terrified at the prospect of being abandoned by Dr. Keitzman, who Dr. Wiley had said was the best. “Dr. Keitzman, we need you. Michelle needs you.”
“I don’t think your husband shares your view, Mrs. Martel,” said Dr. Keitzman.
“He does,” said Cathryn. “He’s just distraught. Please, Dr. Keitzman.” Turning to Charles, Cathryn put a hand on his neck. “Charles, please! We can’t fight this alone. You said this morning you weren’t a pediatrician. We need Dr. Keitzman and Dr. Wiley.”
“I think you should cooperate,” urged Dr. Wiley.
Charles sagged under the weight of his brooding impotence. He knew he could not care for Michelle even if he were convinced the current approach for her particular disease to be wrong. He had nothing to offer and his mind was overloaded, an emotional jumble.
“Charles, please?” Cathryn pleaded.
“Michelle is a sick little girl,” said Dr. Wiley.
“All right,” said Charles softly, once again forced to surrender.
Cathryn looked at Dr. Keitzman. “There! He said all right.”
“Dr. Martel,” asked Dr. Keitzman. “Do you want me to serve as the oncologist on this case?”
With a sigh which suggested breathing to be a great effort, Charles reluctantly nodded his head.
Dr. Keitzman sat down and rearranged some papers on his desk. “All right,” he said at length. “Our protocol for myeloblastic leukemia involves these drugs: Daunorubicin, Thioguanine, and Cytarabine. After our workup we’ll start immediately with 60 mg/m2 of Daunorubicin given IV by rapid infusion.”
As Dr. Keitzman outlined the treatment schedule, Charles’s mind tortured him by recalling the potential side effects of the Daunorubicin. Michelle’s fever was probably caused by an infection due to her body’s depressed ability to fight bacteria. The Daunorubicin would make that worse. And besides making her essentially defenseless for a host of bacteria and fungi, the drug would also devastate her digestive system and possibly her heart… besides that… her hair… God!
“I want to see Michelle,” he said suddenly, leaping to his feet, trying to stifle his thoughts. Immediately he became aware that he had interrupted Dr. Keitzman in mid-sentence. Everyone was staring at him as if he had done something outrageous.
“Charles, I think you should listen,” said Dr. Wiley, reaching up and grasping Charles’s arm. It had been a reflexive gesture and only after he’d made contact did Dr. Wiley question its advisability. But Charles didn’t react. In fact his arm felt limp and after the slightest tug, he sat back down.
“As I was saying,” continued Dr. Keitzman, “I believe it is important to tailor the psychological approach to the patient. I tend to work by age: under five; school age; and adolescents. Under five it’s simple; constant and loving supportive therapy. Problems start in the school-age group where the fear of separation from parents and the pain of hospital procedures are the major concerns of the child.”
Charles squirmed in his seat. He didn’t want to try to think of the problem from Michelle’s point of view; it was too painful.
Dr. Keitzman’s teeth flashed as his face momentarily contorted, then he continued, “With the school-age child, the patient is told no more than he specifically asks to know. The psychological support is focused on relieving the child’s anxieties about separation.”
“I think Michelle is going to feel the separation aspect a lot,” said Cathryn, struggling to follow Dr. Keitzman’s explanation, wanting to cooperate to please the man.
“With adolescents,” said Dr. Keitzman without acknowledging Cathryn, “treatment approaches that of an adult. Psychological support is geared to eliminate confusion and uncertainty without destroying denial if that is part of the patient’s defense mechanism. In Michelle’s situation, unfortunately, the problem falls between the school age and the adolescent. I’m not sure what is the best way to handle it. Perhaps you people as parents might have an opinion.”
“Are you talking about whether Michelle should be told she has leukemia?” asked Cathryn.
“That’s part of it,” agreed Dr. Keitzman.
Cathryn looked at Charles, but he had his eyes closed again. Dr. Wiley returned her gaze with a sympathetic expression that made Cathryn feel a modicum of reassurance.
“Well,” said Dr. Keitzman, “it is an issue that demands thought. No decision has to be made now. For the time being, Michelle can be told that we are trying to figure out what’s wrong with her. Before we go, does Michelle have any siblings?”
“Yes,” said Cathryn. “Two brothers.”
“Good,” said Dr. Keitzman. “They should be typed to see if they match Michelle’s HLA and ABO loci. We’re probably going to need platelets, granulocytes, and maybe even marrow, so I hope one of them matches.”
Cathryn looked at Charles for support but his eyes were still closed. She had no idea what Dr. Keitzman was talking about but she assumed Charles did. But Charles seemed to be having more trouble than she was with the news.
On the way up in the elevator, Charles fought to control himself. He’d never before experienced such painfully conflicting emotions. On the one hand he could not wait to see his daughter, to hold her and protect her; on the other he dreaded seeing her because he was going to have to come to terms with her diagnosis. And in that sense he knew too much. She would see it in his face.
The elevator stopped. The doors opened. Ahead stretched a pale blue hall with pictures of animals affixed like decals directly on the paint. It was busy with pajama-clad children of a variety of ages, nurses, parents, even hospital maintenance men grouped about a stepladder fixing the lights.
Dr. Wiley led them down the hall, skirting the ladder and passing the busy nurses’ station. The charge nurse, seeing Dr. Wiley from behind the chart racks, scurried out and caught up with them. Charles glanced down at the floor and watched his feet. It was as if he were looking at someone else. Cathryn was beside him with her arm thrust under his.
Michelle had a single room, painted the same shade of pastel blue as the hallway. On the left wall beside the door to the lavatory was a large, dancing hippopotamus. At the end of the room was a shaded window. To the right was a closet, a bureau, a night table, and a standard hospital bed. At the head of the bed was a stainless steel pole supporting a small plastic bag as well as an IV bottle. The plastic tubing snaked down and entered Michelle’s arm. She turned from looking out the window when she heard the group enter.