After 20 years have passed, I no longer remember his face or his name. I do remember the clinical examination of his abdomen—protuberant, firm, tympanic with a virtual road map of superficial dilated veins. His color was an uncomfortable yellow, almost ashen. I also remember his diagnosis—metastatic hepatoblastoma. If he had survived his illness, today he would be a young man in his early 20s.
I was well into my month-long rotation as an intern on the oncology service when I met him and his mother. I had been a passive observer of my attending dispensing bad news many times this rotation, and she seemed to have it down to a science. She would speak in a quiet, gentle voice, allow for the inevitable moment of grief, and then occasionally make some reassuring form of physical contact. The conversation would then change direction to one of hope and next steps. This time, however, was different. The mother’s eyes were blank after hearing the diagnosis. She did not shed a tear. She became very matter-of-fact, almost robotic in her approach, as if we were explaining to her some mundane task such as the process of opening a bank account. She seemed inconvenienced. My attending made no physical outreach this time, reading the mother’s cues.
I left that room in disbelief. Who was this woman with no semblance of maternal instinct or emotion? My frustration soon dissipated into anger, and I felt the need to distance myself from this unsettling situation. I wanted to go home, but unfortunately I was stuck at the hospital on call that evening.
Later that night, and well after midnight, I was called to the oncology ward to evaluate another child. As I made my way down the dimly lit, quiet hallway, I passed by the room of my patient with the hepatoblastoma. My curiosity caused my eyes to glance into the room. In the darkness, the only light coming from the moon entering between the opened window curtains, I could see the silhouette of this mom. She was alone, sitting in a chair, her head in her hands. She was rhythmically rocking to and fro, as if the purposefulness of this motion would some how save her. I could hear her exhausted whimper. I backed away, not wanting to violate her privacy, and sat down in the empty hallway. I felt so ashamed of my previous rush to judgment. I felt so naïve and alone. Was I cut out for this career? Could I endure the sadness of grief and dying inevitable in medicine? I realized at least that I did not have the emotional fortitude or spiritual reconciliation to become a pediatric oncologist.
This was only the beginning of my journey into medicine, and one of many quiet moments of understanding. I never saw this patient or his mother again, but that brief encounter will stay with me forever.