In the book of Genesis we learn that Terach, Abraham’s father, took his children and grandchildren with him “to go to the land of Canaan: They arrived at Haran and settled there.” Terach died in Haran and never made it to Canaan.   We know that Abraham did. This, Rabbi Jonathan Sacks explains, is the first biblical account of what all parents desire.  A father setting out on a mission that he hopes his children will complete even if he can’t. As parents we all have hopes and dreams that our children will do what we haven’t been able to.   That they will succeed where we couldn’t and have opportunities that we didn’t.

We were asked to place a Broviac catheter, a large intravenous silastic catheter used to administered chemotherapy, in Sherry for treatment of her malignant bone cancer. This wasn’t unusual. Broviac placement is one of the most common procedures pediatric surgeons perform. Sherry was 15 and in the final, losing stages of her fight against bone cancer.   The tumor had spread rapidly and she now had large, painful bony lesions all over her body. Her face was grotesquely deformed by lesions over her eyes and forehead. I didn’t understand why we needed to subject this child to another procedure when she obviously didn’t have long to live. Her oncologist explained that the tumors had made her life unbearably painful and the catheter was for administration of pain medicine, not chemotherapy.

The next morning her father stayed by her side while we wheeled Sherry into the operating room.   Every bump or turn caused her to wince in pain. Transferring her to the operating room her father gave her a kiss and said goodbye as I walked him out of the room.  As soon as the door closed behind us he collapsed, exploded in tears and begged me to take care of her.

When I returned to the operating room the anesthesiologist was sorting Sherry out, placing her monitors and connecting her to an IV. I assured her she would be fine as I held her arm.   Weakened by the tumors and the pain medicine she was getting, she could barely speak.   She asked me if her father was okay and told me how hard it was for him. With her last bit of strength she told me that she was worried about him and asked that I please take care of him.  She wanted to make sure he didn’t worry about her.

The case went well. I went home and cried most of the night.

Sherry died two days later with her father by her side. She was an only child and her mother left years ago. She was her father’s whole life.   He wasn’t just losing his daughter. All his hopes and dreams for a better future died with Sherry.

We never know why people and situations are put into our life.   I knew Sherry less than 24 hours. Her grace and dignity were remarkable. Her life could be described as tortured and yet she was more worried about her father than herself. She understood her time was coming to an end and that her father would suffer more than she. Meeting them is as fresh a memory today as it was when it happened more than 15 years ago.

Watching a child die has always been the hardest part of my job. Now that I have children of my own, it’s unbearable.   I would like to think that meeting Sherry had a purpose or meaning. It was supposed to happen.   Everyone we meet, everything we go through is for a reason, it makes us better, it makes us who we are.   Here’s the thing; I have seen enough terminal pediatric cancer patients die. I would have been fine if I didn’t meet one more.  I’d be ok if I didn’t have to watch a sweet child being physically tortured during her last days in this world. I wouldn’t have minded if another surgeon had been assigned to this case.

I would have been fine if I didn’t have to open the chest and perform open cardiac massage on the three year old boy whose uncle accidentally ran over him when he was backing out of the driveway. Or the six year old girl who died in a car accident, or the seventeen year old who died from advanced Rhabdomyosarcoma, or the one year old girl who hadn’t learned to walk or talk yet and died from recurrent neuroblastoma while her mom was six months pregnant. Or any one of the dozens of other children I saw die. I didn’t really need to go to any funerals or make shiva calls for children whose parents sat in a catatonic state for seven days. I didn’t need to be thanked for all my hard work by parents who had just gone through the unthinkable. Parents whose hopes and dreams died with their children. I didn’t need any of it. I don’t see the benefit of it and I am not sure it was an exercise in growth.

In tehillim (psalm) 23 King David wrote, “Yeah though I walk through the valley of the shadow of death, I will fear no evil for thou art with me.” My old mentor, Dr. Frank Spencer, explained that understanding this psalm is essential if you want to be a good doctor. Not a good surgeon, a good doctor. People don’t mind dying, they mind dying alone. They don’t mind that their doctor didn’t cure them, they will mind if you gave up on them.

There was a room full of doctors and nurses that took care of Sherry in the operating room. There were oncologists, residents and nurses who participated in her care.   All of whom I am sure were as touched by Sherry as I was; or at least they should have been.  They needed to be there.  And maybe that’s the point.  It’s not about me. Sherry needed us to be with her.  Her father needed us.  They needed us and we needed them.

About the Author
Marc Arkovitz is the head of pediatric surgeon at Ha'emek medical center in Afula, Israel. He is an associate professor of surgery and pediatrics with more than 20 years experience working in both Israel and the US.
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