In the Darker Vein: Being a Pediatric Oncologist
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osteomyelitis. That redeems the lost pride until we encounter the next set of “D” questions.
One pediatric specialty which can use some light in the darkness is pediatric oncology. There is also the fact that pediatric oncologists deal a lot more with veins. This makes it appropriate that I represent the community, writing about the perils (and of course the rewards) of being a pediatric oncologist in a light yet darker vein.
We are not the only breed of professionals dealing with oncology who undergo this transformation. The pathologist becomes the hero when he detects the malignant cells in the seemingly innocuous ‘pus’ of a psoas abscess which is actually a lymphoma. Still, we live in constant dread of the words ‘inadequate’. Like the infamous duck analogy (for those who don’t know- please google ‘five doctors on a duck hunt”) where the pathologist says that the specimen was inadequate even when we think we provided the entire duck. Unlike the clash of egos between pediatricians and pediatric surgeons, pediatric surgeons and pediatric oncologists make a happy couple and they know what we want to keep us happy. ‘The case of the missing node’ is an extremely rare incident when the draining lymphnodes required to be sampled for staging are missed!
Despite being a different species in the broad genus of pediatricians, the role of pediatric oncologists is little understood. On a personal note, try explaining that to your relatives. “Pediatric Oncology? Do kids get cancer?” -A middle aged uncle who was a casual visitor to my outpatient clinic asked (despite the board outside clearly stating the fact that I am a pediatric oncologist).”They do. But the outcomes are far better compared to adults”, I replied. “Must be very depressing to see kids dying of cancer”. “Yes it is. But eight out of ten kids survive cancer”. And the conversation goes on a loop until one of us gets tired. I chose the road less travelled by and it has made all the difference in my life - the difference of thinking zebra when you hear hoof beats (Yes, I borrowed that from the Immunodeficiency Foundation).
I wish the phrase Primum non nocere (first, to do no harm) applied to parents as well. The guilt of not being in control of their kids’ illness makes parents take extreme measures like pouring gallons of papaya leaf extract juices for thrombocytopenia down the throats of unwilling kids with leukemia. Then there are parents who display an ostrich attitude. I recall a case of a child with febrile neutropenia brought to us leisurely on the third day of fever (when actually it is a medical emergency). On being questioned, the parent replied, “You asked us to bring him if he had ‘persistent fever’, but his fever subsides with every dose of paracetamol”. I still cannot fathom whether it was a case of denial or that I needed to improve my communication skills.
Amongst our fellow pediatricians who are considered benign, we are looked upon as malignant. In our defense, I like to think we are malignant only to those who are malignant (now, that sounds l
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