Contact Information:
Sarah M. Reel, MD Categorical Pediatrics Resident Cincinnati Children’s Hospital Medical Center 3333 Burnet Ave, Cincinnati, OH 45229
He was five years old. He had a short buzz cut, mischievous eyes, and a smile that stretched from ear to ear. His laugh filled the room, and his favorite superhero was Iron Man. I first met him when I rotated on the Pediatric Surgery service as a third-year medical student. Mom had to be away from his bedside to care for her other children, and as the medical student, I had more opportunities than other providers on our team to spend time with him. We had superhero battles, played hide-and-seek (the best spot was behind the curtain), and watched movies.
He was listed for resection on a day that I was at the hospital. We looked through his scans prior to the case and talked through the methods they would use to dissect the tumor from any remaining healthy tissue. I read about his oncologic diagnosis and about the treatment course he was facing. I still remember standing in the operating room and watching the surgeon remove a large tumor. She presented it to me with both hands before it was taken to be labeled and sent to pathology. The next few days while I was on service, we would go into his room in the early hours of the morning to ask if he pooped, if he had pain, or if he liked the cafeteria chicken nuggets. He was always ready to play despite the pain and the early hours, and the other medical student and I would memorize a new joke to tell him each day.
“What is Iron Man’s favorite drink? Fruit punch!” He always laughed.
By the time I rotated back to Pediatrics later that year, I knew that I was going to be a pediatrician. I was excited to be assigned to a week of Hematology and Oncology. During that rotation, the little “Iron Man” was re-admitted. This time it was for fever with neutropenia, a common concern for patients undergoing chemotherapy. When I went into his room to see him, he was crying. His mom was holding him, rocking him back and forth. She was telling him a story about rain and the hardships we all face in life.
“The rain comes, and it might look grey and dark outside, but it is helping the flowers to grow,” she said. “When the sun comes back, the rain will dry, and the flowers will be left shining in the sun.” She went on to explain to him how coming into the hospital was a cloudy part of his story currently, but that the sun was coming. It was true – he was soon up and running around with his brother. His counts recovered and his cultures were negative. I went to see him the morning that he was going home.
“What did Iron Man say to Spider Man? Don’t bug me!” He smiled and waved to me before they left.
Our paths crossed again during my fourth year of medical school, when I selected to rotate on the Pediatric Hematology and Oncology service as an Acting Intern. This time, something was wrong. His face was puffy, and his body was weak. We ordered imaging and labs. His disease had greatly progressed. The attending came to review the scans with the team in the workroom.
“This is it,” he said with finality. He discussed the findings with the family, and we watched mom’s heart break in front of us.
The pediatric unit has a bell hanging in the hallway. It is brought to life by patients who ring it to proclaim that they have completed treatment for cancer. Our care team talked with the patient’s family, and mom expressed to us that it would mean a lot to him to ring the bell. We all agreed. On that day, many of his former providers lined the hall. We held confetti to throw as he rang the bell. Despite being swollen and bruised, his smile was huge as he rang the bell over and over. He was thrilled, and we all cried. Afterwards, I picked up a piece of blue confetti and tucked it in my pocket (Fig. 1).
I am a resident now, living the days that I dreamed of as a medical student. This summer, I will apply for a fellowship position in Pediatric Hematology and Oncology. Whenever I contemplate my career, I remember this superhero who lived fearlessly and fully to the end. It is no surprise that he gravitated towards Iron Man, someone who was brave and determined in the face of danger. To this day, I carry the piece of confetti in my wallet as a reminder that even on the hardest days, the sun is coming.