Some people may not like this post and strongly disagree with me on this topic, but that’s okay, because this is why we all have freedom of speech. I personally do go to church, I consider myself a religious person, but there has always been something very hard for me to accept as a physician who takes care of children with cancer – and that is the belief that there is a God always looking out for us. For those who do not know by now, a patient whom means very much to me passed away this morning. His name was Cameron, and he was a friend who made every effort to come to Ironman Louisville this year, despite his own medical problems, show me support, and he actually presented me with my finisher’s medal at the end of the race.
Its easy on one hand, for me to have my own beliefs, but I find myself and my belief system being challenged quite often when I to come to work and watch a child dying and suffering from a cancer. Often, the only question that matters is “Why is this happening to an innocent child.” There are several projections that I’ve heard over the years – the greater “master plans,” the death was able to bring family together, or this was a means of sending the child to a better place, etc. All are reasonable defense mechanisms that may make some people less sad, but as the physician managing a child, they never take away from the underlying fact that a child is suffering, and it’s simply not fair. Handling the stress of a dying patient becomes slightly easier when I have an adult as you can frequently rationalize a cause for the cancer – someone who has smoked their entire life develops lung cancer, that makes sense. The other alternative is justifying a grim prognosis due to cancer on age. We accept that someone dying from an advanced cancer is okay sometimes if they have lived a good life. I have nothing or no one to blame for a child dying from a cancer. There is no obvious rationalization.
Now I met Cameron a little over a year ago. He had already been diagnosed with metastatic neuroblastoma, meaning his cancer had already spread and was at the point of being incurable. He had been doing relatively well. Still attending school, still riding his four-wheeler. He loved hunting, and would tell me about the great Elk hunting trip he was planning with his father. He would intermittently come into my clinic with a new area that was hurting him, we’d do a few treatments and then he could get back to being a kid. Unfortunately, he started to clearly decline right around the middle of this past summer. From then on, the poor kid spent more time in the hospital than he did at home. It seemed every week he was coming down for me to treat another area of his body that was hurting or causing problems. I’m pretty sure my own staff was ready to hang me one Friday night when Cameron came into the hospital complaining of eye pain. I knew what would happen if we didn’t start treatment to the tumor behind his eye quickly, so I made everyone stay late to get his treatments started. They worked. And fortunately, Cameron’s wonderful personality calmed my staff’s anger towards me. But, the sad thing is that he just continued to decline despite all of our treatments. I was shocked when Cameron told me he wanted to come to the Ironman. I was so worried he would not be able to make the trip, or that the heat would be too much. Ironman truly took care of him by providing the VIP access badges and putting him in the finisher’s chute where there was shade. He seemed so excited and uplifted by the whole Ironman experience, that it was wonderful to see a child whom I have always seen at his low points, smiling from ear to ear, and actually providing me with help rather than the other way around. Shortly after I finished the Ironman, and before I made it out of the finisher’s chute, his dad told me “Thank goodness for pain medicines, because otherwise Cameron wouldn’t be able to be here. And by the way, we need to come see you again ASAP.” I’ll never forget my experience with him not only in the clinic but also in my race. He was a wonderful kid, but it killed me to see him in his last few days, essentially requiring such high doses of pain medicines that the only time he was awake, he was crying from the pain, and asking to be given more pain medicine only to fall back asleep.
A famous pediatric cancer doctor named Ed Halperin (whom is also very opinionated), says it best: “For the physician who believes in a rational order to the universe, most often in the context of religious faith their is a classic dilemma: why is their evil? There is an inherent contradiction in the idea of the omnipresent, omnipotent God. If there really is a god who permits cancer in children, then is God omnipresent but not omnipotent? On the other hand, is the explanation for childhood cancer that God is all powerful but not all merciful? If so, a contradiction exists in the general monotheistic view of the Supreme Being. One could also conclude that there is no God. If this is the case, then there is no rational order to the universe, everything is random, and cancer is simply one more random event.” The old adage that everything happens for a reason and that God is always in control completely breaks down, at least in my mind, when you have child dying from cancer. Its hard to identify the lord’s work in such a situation. Now, I have no special knowledge concerning the problem of cancer or the specific implications of the impact of religion that specifically enables me to counsel others. I just simply find the death of a child with cancer very discomforting, and I also find myself angry and distressed. Despite the fact that sometimes patients might expect it, I do not know all of the answers.
One of the most lasting memories that I have from my time with Cameron were the few times that he asked me to pray with him. He would come down with pain so severe, that simply the hospital bed hitting an uneven tile in the floor would make him scream. Simply changing positions in the bed was difficult. He’d frequently begin to cry and say, “Why God does it have to be me?” He’d then ask for his father, mother, and I pray for God to take the pain away. Taking care of children with cancer is hard. For those most part, I try to leave my stress and emotions at the hospital, but I know it frequently and often follows me home. I especially have a hard time when I begin treatment on children similar in age or personality to my own children. Cameron was one of the first pediatric patients to take part in my extracurricular life outside of the hospital, and despite this year’s Ironman being a special moment because of the Ironcology fundraiser, it was even more special to be greeted at the finish line by such a wonderful kid. It sucks that he suffered so much, there’s no way around it, but I truly hope he is in a better place now, as I now he can finally rest.