I am starting, in preparation for retirement, packing books, CDs, papers and so forth in my room in the clinic. For the past 17 years, there have been many items left unused. A file of case reports has appeared from a corner of bookshelf. I have summarized interesting as well as important cases whom I was on charge in the inpatient ward at the med school hospital I served residency.
It was over 30 years ago when I made those summaries. But each case comes up in my mind so vividly. One of my most impressive cases was a 5 year old girl. She was diagnosed as acute leukemia, which was not classified either lymphocytic or myelocytic. The surfce markers or the genetic markers were not available for the further lineage diagnosis at that time. The supervisor doctor told me it was unclassifiable undifferentiated leukemia. I was on charge of her from her admission as a fresh leukemia case to the end of her death at age 7.
She was a skinny fair skined girl. She has had much agony from the illness itself but also from the procedures for diagnosis like bone marrow tap etc. She has been in a room with her mother all the time. She never smiled at me or the other medical staff except for the day I mention below. The trial of a series of remission induction treatments has never been successful. It resulted only in pancytopenia causing infection etc. She has survived with blood transfusion at regular interval. Those despairing treatments might make her so indifferent to the medical staff including me. She looked gremaced whenever I entered her room.
We have run out the treatment protocols for remission induction. Without treatments, blastic cells increased which could make her fall in peril. We have chosen a maintenance treatment to slow down the blast proliferation, that is, small doses of Ara C in continuous infusion. Fortunately, it has given her an Indian summer. The pancytopenia was not so marked as the former protocols. I could not forget the scene when, entering her room for a round one morning, I was given a brilliant smile by her. I felt as if she had recovered from that cruel illness. We even talked something at that time. Her voice was cheerful as well as peaceful even though I don't rememver what we talked then.
That peaceful period has not, however, lasted long. Her blasts were getting resisitent to any treatments. The pancytopenia has let pathogens invade her all around. She has finished her short life at age 7.
What was her life meaning? What did I do for her? Only giving her more agony than the illness itself? I could hardly answer to these questions. I remember of her with a pain. There are absurdities in our lives which we could hardly accept. It was still one of them for me even when I am reaching the end point of medical career. Maybe, she has given me a lesson that there would be so many difficult things for me to answer or accept in my life all the way. We still should go on with the world full of absurdities. I should not compromise with the fact but should go on facing it with internal pain.
I was feeling thankful to this girl for reminding me of that and quietly closed that summary file.
I will put an end to my doctor career in a month and 18 days.