Anjali Vidya Varma
New York University School of Medicine, United States
I have always felt a particular affection for children. During family gatherings and holiday parties, as the adults sipped wine and discussed the hardships inherent in their work, I would slip away to read a book to the little ones. As the story unfolded I would delight in their fascinated facial expressions, their illuminating smiles and the sparkles in their eyes. Children have an enviably low threshold for joy, and I have always been impressed with the enchantment that they derive from daily activities, such as reading a book, drawing a picture, stacking blocks, building a fort, or playing a board game. Exuberantly laughing after hearing a simple “knock-knock” joke, they exude a particular brand of positive energy so earnest it seems to permeate an entire room.
Upon meeting my first oncology patient—now as a medical student on my pediatrics rotation—I revisited this long-felt affection. She was a beautiful three-year-old girl, playing energetically with the many dolls and stuffed animals co-inhabiting her crib. She wore a magenta dress with silver sparkles and a smile that extended from one rosy cheek to the other. First explaining the exam as I listened to the patient’s doll with my stethoscope, I then repeated the process on the newly intrigued patient—just as I had learned over the course of the rotation.
I performed the remainder of the exam in this fashion. She laughed and grinned throughout the playful exercise, her eyes darting back and forth between the doll and herself. This became our daily routine, the game that we played to gauge her health status every morning. Somewhere in my head she became associated with all those other children I had played with over the years, another effervescent toddler radiating inner joy. Her diagnosis of a rare brain tumor and the obvious alopecia that was a consequence of her chemotherapy were but minor details in this image that my mind had created of her—a footnote to be read and acknowledged at the end of a paragraph, but not the essential part of the story.
A few days later, it was time for my patient’s stem cell harvest. Her cells were to be collected and then returned to her at a later date as part of her chemotherapy regimen. I went into her room to observe the procedure being performed. My eyes immediately went to the seemingly gargantuan piece of machinery in the middle of the room, with blood-filled tubing coiling serpiginously in and out of it. The oncology fellow proceeded to explain how the machine worked, pointing out how the central centrifuge separated out the different components of the patient’s blood. Listening to the fellow’s description, I was fascinated with the brilliance of this technology and the elegance of its operation.
My patient had been transported into a blissful, Benadryl-induced slumber. Yet I felt uneasy and disheartened gazing at her peaceful appearance lying before this ominous machine. Her footnote had become the headline. My mind’s image of her playing jovially with her dolls came crumbling down, replaced with the harsh realization that her livelihood was jeopardized by the massive tumor found in her brain. Other three-year-old children were attending day care facilities and nursery school, but she was in the hospital and hooked up to a machine, facing a stringent course of chemotherapy in her future. Would she live to see her fifth birthday? Her 10th? How many times would she have to be hospitalized for chemotherapy, neutropenic fever, or some other complication? Would she continue to smile jubilantly each morning and exhibit the qualities that I had always associated with children, or would she gradually lose her spirit as the condition progressed?
Later that night as I grappled with this experience, I realized that the role of the pediatric oncology medical team encompasses much more than ordering chemotherapy regimens, tracking CBCs, and treating opportunistic infections. The team has the power to play a supportive role, providing a different form of therapy that addresses the needs of the patient as well as the family. We accompany the family on its most harrowing journey and provide comfort and compassion in its most difficult moments. We work with the patient’s family to preserve the essential elements of the patient’s childhood, allowing them to derive pleasure and joy from the same activities as their peers for as many years as possible.
Though my patient carries a serious medical diagnosis, she is still very much a playful and effervescent toddler. The image of her playing with her dolls, wearing a pink dress and a wide grin, will forever remain etched into my memory. As physicians, our mission is not only to safeguard the health of our patients, but also to protect our patients’ true essence and spirit.
ANJALI VIDYA VARMA is a fourth-year medical student at the New York University School of Medicine (class of 2012). She earned her BA cum laude from Yale College in 2008, where she majored in the history of science and medicine. During medical school, Anjali served on the board of student organizations ranging from the Caring for Kids club to the Global Medicine club. Anjali also conducted research on health disparities among the Asian Indian American pediatric population as well as the impact of malaria on hematocrit levels in the Peruvian Amazon. She is currently in the process of applying to residency programs in internal medicine.