The Most Unforgettable Patient

I still have a file of summaries of inpatients whom I have been in charge of in my resident days. Not all was recorded. But they were memorable and important patients to me as not only a pediatrician starting career but also a human being. 

In it, there is a record of a patient with acute leukemia I have cared for a year from 1978 to 1979. I was starting residency then. I was interested in hematology and was curious about this case at first. I have learned how to tap bone marrow with her and how to read the cytological findings. She was not given exact diagnosis of leukemia. Only categorized as undifferentiated acute leukemia of unknow origin. It was still the era when leukocyte/lymphocyte surface antigens were not discovered. T lymphocyte was identified only with sheep red blood cell rosette formation. Undifferentiated leucocyte/lymphocyte was impossible to be categorized. It was quite difficult for us to treat her. For the year, it has been impossible for us to lead her into remission even once.  

The summary says she has born at a town in the mountain area and has spent lively life as a small child as stated below. She has developed tiredness, bruising and pallor. Being diagnosed acute leukemia, she has undergone a various protocol for leukemia whch turned out ineffective. Without chemo., the violent leukemic cells have increased so badly that we could not stop giving chemo. 

She has been agonized with drip infusion and side effects of chemo. Whenever I went into her room, she was gremacing or weeping. Only once she was smiling when the chemo protocol was not severe with a single drug, which was believed to induce differentiation of leukemic cell. She was brightly smiling at me when I visited her. It won't last long, though. That treatment was not effective, either.

I was not in the position to determine the treatment plan. The more harsh unendurable the series of chemo became for her, the more often I wondered if there was any other choice than chemo for her. Even though I have never asked my boss about that. There were very few hospices in our country at that time. I have never heard of that for children. At present, those patients and their family members have the other choice of treatment. This girl could have spent happier and more meaningful days even if she won't be brought into remission. I am truely sorry for her and for our incapability to treat her. She has become more than a patient for me in the end. I have learned so many things from her. 

She was originally from a spa town in the mountain area I drove the other day and posted about it on Oct 21st. My short resume says she had attended a kindergarten until she became ill. She might spend happy days there. Too short life. Getting through that old town, I could not help recalling of her and her parents. Her mother has become mentally ill at last. I wondered if that couple was still living there. If they were still there and the girl was entombed somewhere there, I would visit her at the tomb. With what she has taught me as a pediatrician and a human, I could go through my life, I would tell her. It might not be possible, though.

She has died on Nov 21st in 1979.