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 canceled 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.

“gcs15” is a neurosurgeon who blogs at Mothers in Medicine.

 

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