Can You Diagnose a Miracle?

By Dan Lane MD

When it comes to children with cancer, Dr. Jon Bock is a relentless advocate; he never gives up the fight. But its not an easy job with pain and death regularly involved. Its been frustrating watching children die of cancer. He and the other doctors in the group can only hope for a miraclea cure for childrens cancer.

A new type of toxic combination therapy is developed to treat a malignant cancer that Dr. Bock has never cured before. Challenged by a colleague to bring him a miracle, Bock and his associates use the new therapy on eight-year-old Teddie Thompson to destroy all evidence of the cancer in the face of life-threatening complicationsand they succeed.

Was Bocks first cure of the cancer a miracle? Despite mixed opinions among his associates, he returns to the colleague who challenged him and asks, Can you diagnose a miracle?

Based on observations of cases and colleagues during the 1970s, Can You Diagnose a Miracle? demonstrates the early frustrations of pediatric cancer treatment and the strides that have been made in the field today.

• Language: English
• Publisher: iUniverse
• Release date: Jul 26, 2011
• ISBN: 9781462019120

Dan Lane MD

Dan Lane is board-certified in pediatric hematology-oncology with special interests in psychological care of children with cancer. His career spanned the era of cancer therapy described in Can You Diagnose a Miracle? Semi-retired, Lane does private consulting and writes about the history of Texas, where he currently lives.

Book preview

Can

YOU

Diagnose a

MIRACLE?

1.jpg

DAN LANE, MD

iUniverse, Inc.

Bloomington

Can YOU Diagnose a MIRACLE?

Copyright © 2011

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the publisher except in the case of brief quotations embodied in critical articles and reviews.

This is a work of fiction. All of the characters, names, incidents, organizations, and dialogue in this novel are either the products of the author’s imagination or are used fictitiously.

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Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Thinkstock.

ISBN: 978-1-4620-1910-6 (sc)

ISBN: 978-1-4620-1911-3 (hc)

ISBN: 978-1-4620-1912-0 (e)

Printed in the United States of America

iUniverse rev. date: 07/20/2011

Contents

Introduction

Chapter

ONE

Chapter

TWO

Chapter

THREE

Chapter

FOUR

Chapter

FIVE

Chapter

SIX

Chapter

SEVEN

Chapter

EIGHT

Chapter

NINE

Chapter

TEN

Chapter

ELEVEN

Chapter

TWELVE

Chapter

THIRTEEN

Chapter

FOURTEEN

Chapter

FIFTEEN

Chapter

SIXTEEN

Chapter

SEVENTEEN

Chapter

EIGHTEEN

Chapter

NINETEEN

The Epilogue

Introduction

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Children with leukemia and cancer were still dying, as they always had, and doctors still weren’t saving their lives. Sitting in a meeting room while a research colleague described how every new treatment they’d tested had failed to save a child’s life was like traveling on a one-way railroad trip to hell with each new failure pounding on his head like the chugging of a steam locomotive. No longer able to stand hearing about their failures, Jon said, Missy, I feel like I’m attending a funeral as the deceased. Everyone here knows that nothing we’ve tried for sarcomas has been effective. Let’s discuss new treatments which might save a life.

Without pausing, Doctor Missy Patterson said, Doctor Bock, please be patient and wait until I’m through.

Ignoring her comment, Jon said, What should we be discussing today? A new sarcoma protocol or a necrology of our past failures? No child with a sarcoma, treated according to the old protocols, has been cured. It’s time to move on.

Doctor Jack LeBeau, the Committee Chairman, quickly interceding, said, Jon, let Missy finish her report.

Despite her comment, Missy was glad Bock had interrupted, giving her a reason to stop. Jack, Jon’s right about the old treatments. There’s nothing worth reporting. Let’s talk about the new sarcoma therapy.

As soon as Missy said new, LeBeau knew immediately that any interest in hearing Missy’s reports had been killed, but as a last effort, he said, That’s being very cooperative, Missy, but please finish your reports.

Besides her own lack of enthusiasm, Missy Patterson knew that Jon Bock wouldn’t shut up if she tried to finish. Persistence was Jon’s middle name. He never quit voluntarily and he never forgot anything. If children with cancer were involved in any way, Jon was relentless, period. An admirable characteristic for pediatric cancer specialists, which Jon and Missy were.

Smiling at the old friend with whom she’d trained, Missy said, Jon isn’t making me stop. Let me summarize the results of our last sarcoma studies in one word. Negative.

With a confrontation avoided by Missy’s agreeing to end her report, Jack said, Thanks, Missy. Tom, would you present the new sarcoma protocol so we can start a discussion about the next study?

Tom Woods, who’d been Bock’s friend and fellow pediatric oncologist for almost as many years as Missy had been, stood up and said, Jon’s so eager to hear about a new protocol that I’m almost afraid to get started.

Then, turning to Jon, You don’t happen to have a patient waiting for a new sarcoma protocol, do you, Jon? I know how much you like to be the first to admit a patient to a new cancer study.

No matter what the truth might have been, Bock would have denied his having a new sarcoma patient, but this time he really didn’t have one. Tom, I’m happy to say that I do not have a patient ready for admission. The last treatments were so bad that just the thought of treating a new sarcoma patient is like a nightmare. A long and very bad nightmare.

Well, Jon, this new rhabdomyosarcoma study may end your nightmare. There’s a chance, at least a small one, of curing a rhabdo patient, although the treatment regimen will be very toxic one and we may lose patients due to the therapy. The combined side-effects of chemotherapy and radiation will substantially increase the possibility of dying due to therapy.

My God, Tom, are you actually talking about curing a child with a rhabdo?

Jon, from what we’ve heard about the experiences of the other pediatric cancer study groups using similar regimens, the possibility of cure is a real one, but the complications will be hard to manage. The treatment course will be long and difficult for both the patient and us.

That comment got everyone’s attention, so Tom said, Sit back, keep quiet, and listen while I tell you how we’ll be treating children with rhabdomyosarcomas, if our new protocol receives the NCI’s final approval.

Why would a physician decide to spend his or her life watching children die of cancer? Jon had asked himself that question many times. Decades ago doctors caring for children with pneumonia knew that one out of four of those children would die, but penicillin had changed that long ago. A few of the old polio docs who’d taken care of the paralyzed children in iron lungs were still around but children weren’t dying of polio, at least not in the United States. Polio vaccines had eliminated the deaths and paralysis due to polio was a rarity. However, cancer in children was a different story. No one knew what was causing the cancers and no drug or vaccine had been found to cure the cancers. Besides that, instead of having just one organ or tissue where cancer could develop as with polio and pneumonia, children developed several different kinds of cancer.

All a pediatric oncologist could hope for was that a cure for children’s cancers was on its way, even if it was a miracle.

Chapter

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ONE

And a woman who held a babe against her Bosom said, Speak to us of Children.

And he said:

Your children are not your children.

They are the sons and daughters of Life’s longing for itself.

They come through you but not from you,

And though they are with you yet they belong not to you.

Kahlil Gibran, The Prophet

With his usual apprehension, which increased with every step he took, Jonathan Bock, M.D. and his new fellow, Robin Banks, M.D. walked down the hall toward the Radiology Department to review his patients’ new X-rays before seeing them in the Pediatric Outpatient Clinic. Good news was rarely found when Jon went to Radiology, so all he’d hope for was that no new and life-threatening problem had developed in a patient. Upon entering the Department’s viewing room, Bock began to turn on the view box lights while Robin picked up the new x-rays for Herbie Madison whom Jon had treated for Wilms’ tumor starting a year ago. Despite the severe side effects from chemotherapy, his course had been relatively benign since completing his initial treatment, at least until just a few weeks ago when he developed chest pain on deep breathing. Chest pain was not a good sign in a Wilms’ tumor patient. All too often, pain was the first sign that the tumor had spread to the lungs.

After picking up the x-rays, Robin first put up the many previous chest films on the lighted view boxes after which, Robin placed the new chest x-rays directly in front of Bock. It only took a quick look at the X-rays for Bock to find out why he was having chest pain. The source was obvious, but the problem was more complicated than just his pain. Two new tumors were present in the right lung, one against the chest wall which was the source of the chest pain on deep breathing but the other out in the lung tissue.

Jon exploded, Well, shit! Another recurrence with lung metastases! And in a Wilms’ tumor patient. This kind of crap gets to be awful tiresome, especially when a patient has done so well after a tough course of chemotherapy.

Robin stood quietly by while Bock was carefully examining the chest films. Finally, she said, What should be done next, Doctor Bock? I remember that Wilms’ tumors can be cured by removing the lung metastases. But what if there are two tumors in different places in the lung? Can that much lung be removed safely by surgery?

Still absorbed in evaluating the new findings, Jon continued to stare at the x-rays on the viewing box without acknowledging her question. Suddenly, he turned and said, The first step to take is to get more X-rays of the lungs. If the tumors in Herbie’s lungs can’t be located, the surgeons won’t talk to us. Talking to the surgeons will be the easy part. Telling his mother that the tumor has spread to his lungs will be the hardest part. New tumors in the lung probably means another year, possibly more, of chemotherapy, even if the tumors can be removed. Explaining what had been found and would have to be done to Ellen Madison is sure to be pure hell. Even more, I absolutely hate starting chemotherapy all over again. The difference between the first course and a repeat course after the tumor has recurred is that our chances of saving his life are significantly decreased.

Trying to be helpful, Robin said, I’ll talk to his mother if you want me to.

Jon turned and looked into Robin’s clear blue eyes, normally bright and happy, but clearly showing the pain she now felt. The desire to make her mentor’s difficult task a little easier was understandable, but after she had more experience, Robin wouldn’t be offering her help in similar situations in the future. She’d have as little enthusiasm for performing the very unpleasant task as Bock now had. Slowly, he smiled and said, Robin, I wish turning the job over to you was possible, but it just doesn’t work that way. Herbie has been my patient for over a year and I’ve spent a lot of time with both him and his family. We’re past the point where he’s just a child with cancer and I’m his doctor.

Suddenly, the door from Radiology offices swung open and Doctor Charles Woodward, Head of Diagnostic Radiology, walked into the Viewing Room. Upon seeing Jon, he quickly said, Saw those films and thought about calling you. But I knew you’d be up to see them even if I called, so I decided to wait until you got up here.

Jon gave Charles a rather grim look, then said, Charles, I’m afraid that a Board-certified radiologist isn’t required to read these chest films. You’d have to be blind to miss these lung tumors.

Charles nodded and said, The metastases are very discrete so maybe they’ll be easy for the surgeons to remove. You’d have a better chance of curing the patient if they’re removed.

Jon turned around and looked at Charles very intently without saying a word, obviously deep in thought. Then, just as Bock began to speak, Charles said, You know, Jon, it’ll be a miracle if you save one of these children with high-grade solid tumors, especially if the kid has tumors in his lungs.

Woodward’s sarcastic comments about his patients usually dying despite every effort Jon could devise were not the first such comments Bock had heard from other physicians. But Charles’ comment provoked Jon, who hated to get angry even when physicians said something inappropriate about a child dying of cancer. Too often their comments reflected how insensitive they were to the complex problems Bock faced while treating childhood cancer patients. Trying not show his anger, Jon quietly said, Charles, can you diagnose a miracle if I bring you one?

A little taken aback by Bock’s question, Woodward said, What do you mean, ‘diagnose a miracle’?

The dictionary’s definition of a miracle is ‘an extraordinary occurrence that surpasses all known human powers or natural forces and is ascribed to a divine or supernatural cause.’ Like an Act of God or a Divine Intervention, whatever those are.

Charles hadn’t meant to hurt Jon, but it was obvious he had hurt him. Most of Jon’s patients responded poorly to therapy and Woodward knew that finding new lung tumors had created a difficult and unpleasant task for Bock, so he said, I don’t think if I’ve ever seen, much less diagnosed, a true miracle. Bring me a miracle and I’ll try to make the diagnosis.

Looking at Charles, Jon said very softly, I’ve been doing my best for years and I still don’t have a single miracle to show for my efforts. But, believe me when I say that I’m going to perform a miracle if such exists. And, after I’ve performed a miracle, I’m bringing the evidence here and see if you can diagnose a miracle.

Then, Bock turned around and walked out of the Viewing Room with a very subdued Robin following closely behind.

Jon and Robin walked quickly up the stairs to the Pediatric Outpatient Clinic, just a floor above the Radiology Department. Neither of them said a word while climbing the stairs. Jon was trying to figure out a gentle way to tell Mrs. Madison what had just been found and why additional surgery followed by an extensive course of chemotherapy would be required. Robin had already learned not to interrupt Doctor Bock at times like this. The only response would be a frown if she got any response at all. No answer to a question or comment would be given. Bock’s immediate reaction to bad news about one of his patients was always the same: a retreat into a detached, distracted and silent world all of his own. Nothing would bring him out of that silent world until the bad news had been digested and a decision had been made as to how to deal with another long and difficult battle, one which he almost certainly would lose. There was no way to tell how long Jon would stay in his silent world. Sometimes, it was a very long time.

Bock’s retreat into his own distracted world after finding that a child’s cancer had progressed made evaluating him very difficult. Physically, he was an attractive, almost handsome man of slightly above average height, thin with a full head of dark brown hair and clean features. Obviously in good physical condition, neither too thin nor too fat, due to his working long, hard hours, not from exercising or playing athletics. By quickly moving about from one place to another, Bock’s high level of activity created an elusive physical presence which was one reason why Jon was a difficult person to access.

When you finally gained access to Jon Bock, understanding what created the activity wasn’t possible until you looked in his eyes. Then you could see the real Bock. First, you saw how expressive the eyes were. They sent a message that made you feel as though just looking into his light brown eyes could tell you what Jon was thinking. No matter what his physician’s words of the moment or what his body were saying, Jon’s eyes told you how and what he was feeling. Concern, compassion, pain, consternation and even success were readily visible in his eyes. And that made people around him feel comfortable, because they felt: here is a man you can communicate with, here is a man you can come to know, here is a man who cares about you, and, most importantly, here is a man you can trust.

That is, you were comfortable with this man, Jon Bock, until you saw the fire in his eyes and realized that he was a man on fire. The flames could almost be seen, flickering up and down. A fire had been started and Jon was ablaze. As you watched the fire, you slowly came to understand the determination that Doctor Bock brought to his work, especially his commitment to working with children with cancer. Jon was on fire with a flame that would not be banked easily. Then, after you had come to know Jon much longer and much better, you realized that Jon Bock would eventually burn himself out unless he learned to control the conflagration within himself.

Jon and Robin walked out of the stairwell to find Mrs. Ellen Madison, waiting for them. Before she said a word, Jon said, My goodness, Ellen, you never give us a chance to think. Let me get down to the Outpatient Clinic and check the chart before I see him.

Ellen looked at Jon Bock, then quickly at Robin, and said, That tells me what I wanted to know. Bad news. You’re always ready to talk if the news is good but you refuse to talk right away if the news is bad. I’ll meet you in his room.

As Ellen Madison walked away, Jon turned to Robin, Am I that predictable?

Robin nodded her head, Pretty much so.

It seems like there’s never a time when I can prepare for what I want to do. I’m always interrupted by another crisis. Come on. Let’s go to work, Jon said as he started to walk toward the outpatient clinic area

As she walking with Bock, Robin said, His mom always seems to know where you are. That’s sort of unusual. Sometimes Ellen Madison just stares at you as if in a trance. Is that something all the patients’ mothers do?

Bock glanced over at Robin to see if she was teasing him, saw that she wasn’t, and said, Let’s make a deal that every time I go into the room to talk with Mrs. Madison about Herbie, you come with me.

Raising her eyebrows Robin said, Oh, one of those kinds of deals.

Having arrived at the Clinic desk, Jon stopped and said, Yes, one of those kinds of deals but it’s not the last time you’ll see the same behavior. You’ll also have the same thing happen to you someday, too.

Gotcha, Chief. I’ll keep my eyes open and warn you when I see another one, Robin said, who then began to look through the stack of charts for young Madison’s chart.

As blind as I act sometimes, I ‘m really not blind to that type of response. If he was my child and might die of cancer, or anything else for that matter, I’m sure that my feelings for the person who might save my child’s life would be pretty strong, too.

Knowing that he’d need help with Ellen Madison from Mary Anne Powers, R.N., the Clinic Head Nurse, after leaving the clinic, Bock walked over to her office to tell her about the new tumors. The next few hours would be difficult for everyone involved. There was no part of his professional life as a pediatric oncologist that was more difficult for Jon Bock than times like this. Ellen Madison would be facing her son’s receiving more life-threatening treatments for his tumor and would need all the support she could get, especially since the father wasn’t available. Besides that, Jon didn’t like to tell parents that their child’s cancer was growing, then leave them to see other patients. Fortunately, every member of the Pediatric Oncology team tried to serve as his surrogate in relieving the stress that was created for the parents. Jon was especially proud of his oncology team’s work with the patients’ families and Mary Anne Powers was a major source of support in the Outpatient Clinic.

Upon reaching the clinic office, Jon knocked softly, was told to come in and opened the door to find Mary Anne sitting at her desk, staring at him. She obviously had been waiting for him and, before Bock could say a word, Mary Anne said, Well, here comes the bearer of bad tidings.

What makes you think I bear bad tidings? Are you clairvoyant now?

No, you don’t have to be in this job. Actually I looked down the hall and saw Ellen Madison confront you coming out of the stairwell. It only took a second to figure out I might as well go back to my office and wait. You’d be coming here next.

Your observation was correct. Herbie’s tumor has spread to his lungs and we’ll have to admit him to the hospital for a work up and probable surgery, if that’s possible. Basically, we’ll start the therapy process all over again, almost from scratch. Discouraging to say the least, but we still have a chance to cure him. If you’ll start the admission process, I’ll discuss the problems with Mrs. Madison about re-admission and treatment but it will not be pleasant. I need your help, as usual, Jon said.

Looking at Bock, Mary Anne said, You mean right now?

Nodding his head, Jon said, Yes, but you can leave to call the Unit and Admissions Office after I tell her. Both he and his mother would appreciate having a familiar face around when we talk about his re-admission.

You know that’s not my favorite job to do, dear Doctor Bock.

It’s goddamn sure not my favorite job, especially when a patient who has been doing well turns up new tumors.

Mary Anne smiled and said, Did you know the only time you curse or use bad words is at times like this?

That caught Jon off-guard because he tried not to curse in front of the nurses and patients, but this new problem had upset him more than most did. She was right. He’d get mad and curse. I try not to curse, but these Humpty-Dumpty fell off the wall situations piss me off. It’s easier to go ahead and cuss, even though it doesn’t help much.

Well, Doctor B, considering the way you continue to attract new problems, bad words haven’t changed anything, but if it makes you feel better, go ahead and curse. I’m way past being offended.

Motioning for Mary Anne to follow him, Jon said I’ll try to do better but promising not to do it again would just be lying. Let’s go talk to the Madisons now because I still have several other patients to see.

With an obvious lack of enthusiasm, Mary Anne rose from her chair and followed him out the door. Being present when a patient or a family was told that a cancer had recurred despite treatment was the only part of her job that she truly hated. She would probably be depressed for a week because Herbie Madison was worse and might die. In fact, Mary Anne had decided that she must be masochistic because no rational human would put themselves through these very demanding experiences time and time again. She hadn’t reached the point of not working with childhood cancer patients, but when her time came, she would stop because she couldn’t stand to hear more bad news about a child. For now she dutifully followed Doctor Bock down the hall to where another confrontation with reality would lead to more stressful work for everyone on the pediatric cancer team.

By the time Jon reached his room, Robin was already there, talking to a crying patient. His