“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.
“Hello, peanuts,” said Dr. Wiley brightly. “Look who I brought to see you.”
At the first glimpse of his daughter, Charles’s dread of seeing her vanished in a wave of affection and concern. He rushed up to her and scooped her head in his arms, pressing her face against his. She responded by throwing her free arm around his neck and squeezing.
Cathryn stepped around the bed to the opposite side. She caught Charles’s eye and saw that he was struggling to hold back tears. After a few minutes, he reluctantly released his hold, lowering Michelle’s head to the pillow, and smoothing out her rich, dark hair to form a fan about her pale face. Michelle reached out for Cathryn’s hand and grasped it tightly.
“How are you?” asked Charles. He was afraid that his precarious emotional state was apparent to Michelle.
“I feel fine now,” said Michelle, obviously overjoyed to see her parents. But then her face clouded and turning to Charles, she asked: “Is it true, Daddy?”
Charles’s heart leaped in his chest. She knows, he thought with alarm. He glanced at Dr. Keitzman and tried to remember what he had said about the proper psychological approach.
“Is what true?” asked Dr. Wiley casually, coming to the foot of the bed.
“Daddy?” pleaded Michelle. “Is it true I have to stay overnight?”
Charles blinked, at first unwilling to believe that Michelle wasn’t asking him to confirm the diagnosis. Then when he was sure she didn’t know she had leukemia, he smiled with relief. “Just for a few nights,” he said.