Sunday, May 4, 2008

On the Other Side of the Diagnosis

After reading the post about my lectures at the University of Guam, a few people have asked me, "What did you read from your book that made the students and faculty cry?" Here is the piece. Truth be told I didn't read it. Someone asked me what was the most personal piece I'd written, and if I would read it. I can never read this piece out loud, so the professor asked one of the students to read it. It's hard to believe that this all happened only a year ago.


Thoughts of a Father

Have you ever wondered what it would be like to wait for a diagnosis of cancer? I now know. Here are my thoughts from the first day this began last week. I think he’ll be okay.


My son has a 6.5 centimeter lymph node on his neck. Ultrasound shows an 11.4 centimeter spleen – huge, upper limit of normal for an adult, much less for a six-year-old child. Blood work mostly normal, no clear diagnosis, mono test results two weeks away. Thus the recommendation to biopsy. Look for cancer – lymphoma, Hodgkin’s disease, childhood death.

I held him as he screamed yesterday, the needle entering his vein, and I thought, “I hope and pray this is not the beginning.” My sweet six-year-old child, so full of life and joy and determination and creativity and enthusiasm and lost in his plans to move up from kindergarten to the elementary classroom.

We’d take him to MD Anderson or Sloan-Kettering or wherever could give him the chance for cure. Should he be taken from us, such emptiness would be left all my days. For his sister, her life a dance with his, she just two years older, a gaping emptiness. And every day I would talk to his soul beyond, and ask for his intercession on behalf of his father, for strength and patience to make it without him.

I can imagine all this, but in my heart, it has to just be an exuberant immune response to mono, right? Please? How can my child have cancer? Diverse genetic mix, mostly vegetarian diet, clear island air, no carcinogens. It’s just not possible. I try to cut a deal with God: Save my son, let this all be a lump of nothing, make it all smaller, and I promise I will be good. In however many ways that I’m not, I’ll be good.

All my personal concerns, various worries, evaporate under the heat of this lump.

I saw my friend of long ago last year at the Hawaiian Eye Conference. “How many kids do you have,” I asked. “Two,” he responded, “a twelve-year-old and a ten-year-old.” “I thought you had twins.” “We did. One died two years ago. Lymphoma.” He talked of how this trip to the conference was the first he and his wife had been able to take. There was no time to mourn two years ago. “What can you do?” he said. “You’ve got these other kids that are alive and who need you. They need your love, your presence, your joy and enthusiasm for them. So you bury one child and try to keep moving forward.”

The universe and God I do not understand. Suffering and the suffering of the innocent, I do not understand. And at times like this, I don’t try to understand, fearing my explanation

or theory may just be false placation. It’s just the way it is, and there is nothing I can do about it. Will my magical thinking help? Will the universe still respond with “your wish is my command”? Is my son any more important, just because he is mine? Thousands of despondent parents bury their children every day – death by lymphoma, or leukemia, or tuberculosis, or starvation, or war, or murder. And the world just keeps going on. I just keep going on, thinking about me, my concerns, my pursuits, my hopes, oblivious of their pain and the fragments of their broken hearts. Why would I be so special as to receive my request from the universe, from God? I feel reticent even to ask.

Over the last few years when death would come up in conversations (your great-great grandmother died, Duke died, the cat died), Arman has so often said, “I’m scared to die, I don’t want to die alone, can you die with me, Dad?” We realized he thinks that the next world is in the ground, somehow related to the grave. “How will we be able to see each other if we get buried in different holes?”

For most of the day, I’m just doing something else. I look up from my work, and wonder what it was that was causing my anxiety? Briefly forgotten. And the knowledge rushes in, pushes the fragile calm out, my tears well up, and I sob.

(Published in World Peace, a Blind Wife, and Gecko Tails, by David Khorram, MD)


Marianas Eye said...

Two weeks later, the mono test came back negative, indicating the probability of something more serious, and the need for a biopsy.

In the meantime, the lymph node shrunk away and disappeared, and the spleen returned to normal. He's alive, and thriving. And we all returned to being distracted from the most important things in life.

Dragonfly said...

That is beautiful. Thanks for sharing that with us.

Dr. Momma Foo said...

I read the article about your practice and life in the OPH Times. Such a different practice, culture, patient population from mine in California. But the same focus on our ever- surprising patients and families.

QuietusLeo said...

I read this post while on call in the ICU. I had to ruminate for a while. We admitted a young man with severe head trauma and facial injuries. He arrived anonymous. Later, when the family was informed, I gave them an apprisal of his condition. The then asked/pleaded that I take good care of him. My answer, which should be the answer of every physician, is that I would treat him as if he were my own brother. Many families harbor the same trepidation when faced with severe illness or injury. Will my loved one be well treated? My answer is always the same, I'll treat your father as my own, your child as my own, you, as I would have someone treat me. Can any physician possibly not strive for that standard?

Saipan Kat said...

I couldn't help but cry... I am often consumed in stupid things like pride and selfishness that it has to take an event or story like yours to remind me about what's important.
Thanks Dr. K, where can I get a copy of your book?