JACK | Book Three (BWWM)

9. The Begining of the End

May 23, 2012
Manhattan, NY

"Talk to me, Holland," commanded a gruff voice which belonged to a tall and lanky middle-aged doctor. It was Jack's third year of his Pediatric surgery fellowship at Columbia University Medical Center, per Maren's request. She'd made the move back to New York while he was still in his residency program, taking a job offer in the city.

"Four year-old patient, presented to the ED following a GTC. Parents say it's the fifth one this month. And this," Jack said putting up an MRI results on the LED board and flicked off the lights, "This is why."

The mass on the brain scan showed the cause of the little girl's recurrent generalized seizures. It revealed that a growing glioma in the left frontal lobe of her brain was the culprit.

"Hmm... probable glioblastoma. So are we going to do a corpus callosotomy or try for the resection with chemo and radiation?" asked the lanky man, Dr. Whitman, the attending neurosurgeon on Jack's patient's case who was rubbing his salt-and-pepper beard while looking at the MRI results intently.

"It's a tough call," Jack said thoughtfully.

This was the part about Pediatrics that Jack didn't enjoy. The prognosis for a glioblastoma was poor; the typical length of survival post-diagnosis being about 15 months with treatment. And while this news would be devastating for anyone to receive, Jack always felt it hit a little harder when it was a child was on the receiving end. And making a decision about a treatment plan was no easier. It was between the corpus callosotomy, a palliative approach which would prevent, or at least decrease the severity of the seizures but would do nothing to buy the little girl more time. If Jack tried to take out the tumor she could have a little more than a year, maybe even longer. But it would be a year filled with radiation and chemotherapy and even with the aggressive approach, the risk of the tumor reoccurring was high. It would be a lot to put a child through. The decision would ultimately be the family's but it was up to Jack to make a recommendation.

"Pumping that girl with chemo meds and radiation..." Jack shook his head, taking the scans down from the board. "I mean she's 4 for Christ's sake. It's no way to live..."

"No way to live..." Dr. Whitman echoed, nodding in agreement. He led the way to the patient's room. He knocked on and then opened the door to the dimly lit room. On the bed sat a little brown-haired girl playing with Barbies on her bed, the rails of which were covered with padding. Her parents sat at the side of the bed, her mother holding her head in her hands while her father rubbed her back. A nurse stood nearby, hanging a new bag of fluids on Ava's IV pump.

"Hi there, Ava," he said waving to the little girl who's head perked up as the two doctors stepped into the room.

"Hello," Ava waved back.

"Mom, Dad," Dr. Whitman said, acknowledging Ava's parents. Her mother lifted her head from her palms to reveal a flushed and tear-stained face.

"I'm Dr. Whitman and this is Dr. Holland. I understand Dr. Peters already came to speak with you?" Dr. Peters was the pediatric oncologist who had paged Surgery for this consult.

The parents nodded solemnly. Judging from their faces, it was clear to Jack that they were taking the news pretty hard.

Dr. Whitman tilted his head towards Ava, indicating that Jack should begin his assessment.

"Hey Ava, I'm going to listen to your heart and your breathing," Jack said quietly, showing the little girl his stethoscope before pressing it against her heart.

"Okay! Can I listen to yours too?" she asked, reaching her little hands out when he was finished.

"Sure," Jack chuckled, placing the earpieces in her ears. "Right here," he said, pointing to the left side of his chest.