AndyPeckham.com

June 24, 2009

The word “cancer” is a scary word.  I don’t know what you think of when you hear it, but I usually think of it as a terrible thing that is incurable.  It doesn’t seem like something people want to talk about if they have had it.  I would not have associated it with a lot of joy or hope.  Until this last week.

“I’m not going to be working for the next month,” I said, “because I’m volunteering at two different cancer camps.”  “Well that will look good on your med school application,” someone said.  Yes, it probably will.  That remark bothered me though, because I had been trying to convince myself that I was doing it for all the right reasons.  I won’t deny that part of the reason why I have volunteered at these cancer camps or with hospice is so that I can add them to my list of experiences which have prepared me for med school.  Of course there is a part of me that thinks about how what I do will make me look, and I want to be seen as an altruistic person.  But I believe I had some genuinely good motives as well.

I have spent several years volunteering in all sorts of different camping and ministry programs at Camp Bighorn while I was doing my Outdoor Ed degree, and found it to be something that I really enjoyed, something really rewarding.  Most importantly, I learned that when I am working in a team which shares the common goal of serving others, I am the most satisfied with my work and feel the most purpose in my life.  I have also discovered that when I sense that someone has a major need or is hurting deeply, I empathize with that person and want to do whatever I can to help.  It is interesting, because it seems like there is some sort of threshold that must be crossed before that response is triggered within me.  For example, if I feel like someone is just complaining or overreacting, my response is to want to tell them to suck it up or get over it.  When I do empathize though, sometimes it is overwhelming, especially when there is nothing immediate that I can do to relieve the suffering that someone else is experiencing.  For example, when I see images of starving children in Africa, sometimes I am moved deeply, and want to devote my life to helping them.  The problems of the world are so big that it feels hopeless, like I could never actually accomplish any lasting change.  Cynicism or realism tells me any effort would be futile, and that there is not much I could accomplish in the grand scheme of things.

The times when I have experienced the most satisfaction have usually not been when I can look at some big recognizable accomplishment that I have done, but rather occur when I am able to break free from my self-serving existence and do something purely for the sake of someone I care about.

“How was camp?”  I’m still trying to figure out the answer to that question.  Part of the answer is that it was a ton of fun.  And that is true.  I especially enjoyed getting to know the other volunteer staff.  Creative, funny, high-energy, compassionate, smart, smart-alec…  Part of the answer is that it was really tiring.  More emotionally draining than physically.  I’m still trying to learn how to be friends with young children, going along with their games one minute, and then be the authority figure the next when things get way out of control.  Trying to walk with one or two kids on each arm and leg is also difficult.  I did feel like a bit of an outsider coming in at first, because the majority of the staff had been coming to camp for several years beginning as kids with cancer and then returning as counselors.  Half of the families were regulars who knew each other from the previous years.  For several of these families, this was their last year, because their children who had cancer were ten, which was the upper age limit.  It was a small enough group that after a few days I felt like I had known everyone for much longer than I had.  The last night that we were at camp, there was a time of sharing what had been the highlight of the camp, and there were many tears as people shared how this one week was the highlight of every year, and the one thing that the kids looked forward to the most.  One parent noted that after what the families had all been through living with cancer, the cold weather and rain that week didn’t even affect anyone’s ability to have fun.

To me, getting to be a part of the camp was quite inspirational.  Each kid who was there, and each of the families, was quite amazing.  In many ways, the people were just like any other “normal” people.  The kids liked to run and play games, they didn’t always share the toys, and the families had the occasional times of disagreement.  But they looked out for each other and had a strength gained from experiences which I cannot relate to.  It was neat to see attitudes of thankfulness, joy, and hope.  We were on a hike and one of the young boys was scrambling up on some rocks, and another parent told me that his mother wasn’t going to stop him from doing anything, because he wasn’t even supposed to have lived this long.  His treatment had not been working, and the doctors had said there was nothing more that could be done for him, and he wasn’t going to make it to his tenth birthday.  But then they found a clinical trial which he qualified for, and the experimental treatment was working really well.

That was the crucial moment for me.  That is when it all hit home.  This  kid—who had helped me make my nametag the first day, and who had been very active, catching a garter snake among other things, and had shown me a little house he had made in the woods—he was not even supposed to still be alive.  On the one hand, it was incredibly encouraging to hear how well the new treatment was working for him.  On the other hand, I knew that he may not still be alive next year.

During the cancer camp last week I was able to forget myself for a few moments.  In those moments, I was no longer aware of how ridiculous I looked in my superhero costume or how silly the song or game we were doing was, because only one thing mattered:  there was a precious child who needed to be loved, needed to laugh, needed to forget about the next round of chemo they were about to be starting, or just needed someone to pay attention and listen to them.

Getting to interact with specific individuals is what had the most impact on me.  This was a much-needed change of pace for me.  I am in the midst of finishing up my med school application, and have kept myself busy with work and play.  Having to write a personal statement explaining why I want to be a doctor has challenged me to examine my motives and whether it is what I really want to do, and think about whether I would make a good doctor.  I feel the need to be challenged, and to do something significant, something that makes a positive, lasting impact.  Sometimes this need is just to feed my ego, but thankfully there have been times such as during this cancer camp when my perspective on life is briefly adjusted and I realize what does and what doesn’t really matter in the end, and looking good or feeling happy don’t really matter.  Caring for another individual matters.  I’ll be the first to confess that usually even when I am doing something “loving” for someone else, there are selfish motives mixed in.  It is only by God’s grace that we are sometimes able to love another person in a selfless way.

I just finished reading Tracy Kidder’s Mountains Beyond Mountains, about Dr.  Paul Farmer, while on a plane after the camp was over.  Farmer defies conventional wisdom about cost-effectiveness by spending an entire day hiking to a village to see one individual patient.  Farmer views every patient as equally important, and says he won’t stop fighting the “long defeat” because others want to give up on some individuals.

I am thankful for the opportunity to have gotten to learn a little from those who have had cancer, and from those who have lived with family members with cancer.  Having cancer doesn’t mean your life is over.  Many cancers are in fact curable.  I now know people who have been through cancer, and are more beautiful people because of it.  This has helped renew my determination to study medicine so that I can use whatever abilities and the short time I have on this earth for a purpose greater than serving my own needs and wants.

But alas, I so quickly return to being caught up in my own self-absorbed world of to-do lists, books, and back-to-back activities.

“We need to stop the CT and get him out of there right now—his O₂ sats are dropping too low!”  We entered the room, pulled him out, and tried to prop him up higher.  The nurse had warned that he couldn’t be laid flat.  I did not notice what his O₂ sats were at that time, because I was preoccupied with looking for the oxygen tank that we had brought with the patient’s bed.  There was only one oxygen supply tubing in CT, so the patient was on high-flow O₂ via non-rebreather mask, but in ICU he had also had a nasal cannula.  Not finding the oxygen tank, I returned to the patient.  The nurse was obviously very concerned. “He’s going to code on us—call the crash team.”

The nurse had been trying to schedule a CT scan for her patient all morning, and finally a spot opened up.  The patient, an elderly man, was almost completely unresponsive, only responding to painful stimuli, such as when an NG tube was being inserted through his nose.  I had steadied his head and tried to explain what we were doing, but I don’t think he had any idea what was going on except that it hurt when the tube was being shoved down one nostril and then the other after it didn’t go all the way in. During this procedure, his vagus nerve was stimulated, causing his heart rate to drop to 35, and his oxygen saturation to drop to 87 percent.  The other nurses noticed this drop in heart rate, which set off an alarm on the computers.  They suddenly appeared with the crash cart and some atropine, but his heart rate started to rise again so it was not needed.  After a DuoNeb bronchodilator treatment and the addition of a nonrebreather oxygen mask on top of his nasal cannula, his O₂ sats eventually returned to the upper 90s.  He needed a CT scan to get a better view of his lungs, because an X-ray had shown some problems.

While the nurse called for a code, and requested several other people be paged immediately, her voice was raised, and she spoke with a strong sense of urgency, but she remained calm.  “He’s DNR and DNI” she stated.  I understood that DNR meant that there were written orders in which he had agreed beforehand that if he ever went into cardiac or respiratory arrest, he did not want resuscitation efforts done.  I guessed that DNI meant he would not be intubated.  I found the oxygen tank I was looking for, and connected a nasal cannula to it, and brought it to the patient to provide as much oxygen as possible.  Many people started showing up in CT in a short amount of time, and one of the other nurses from ICU arrived.  “Oh, look at him—he’s agonal breathing.”

There were several of us crowded around, but I was pretty oblivious to what the others were doing.  I was intent on monitoring the patient, who was going for longer and longer periods of time between labored gasps for air.  “I don’t think he’s—” I started to say anxiously after a very long pause, but I was interrupted by another gasp.  I tried to palpate a radial pulse, but was not feeling anything.  I felt around, thinking I must be missing it.  I heard a sigh, and I sensed that the people around me had stopped what they were doing.  It hit me then that this man was going to die right there in CT.  I stopped feeling for a pulse, and held his hand instead.  The oxygen mask was taken off of his face, and I was confused momentarily, because he was still gasping occasionally after very long pauses.  The vitals monitor was facing away from me, but I assume his heart had already stopped.  Agonal breathing can continue even after the heart has stopped, but I did not remember this.  Finally, he breathed no more.  Between five and ten minutes total had passed since we had first put him in to get scanned.

After a brief silence, the various medical workers looked at each other, and some laughed softly.  “I’ve been working here over seven years and I’ve never had someone die in CT.”  “Let’s prop up his head more so his eyes will close.”  “Do we need to cover him?”  His monitor was covered with a towel, but his face wasn’t.  “I’m sorry George,*” his nurse said, touching him.  An entourage of us pushed him quickly back through the halls to the ICU.  We got a few looks, and someone whispered “Shhhh…”  It was an odd procession—sad, and yet slightly comical in a way because of the strangeness of the situation.

“That just shows how sick he was,” the nurse told me, commenting on how quickly he died.  “I hope I die like that,” another nurse said.  “At least it was quick and didn’t seem painful,” I agreed.  I was still a little bit stunned, trying to register what had just happened.  “You’re not allowed to help transport patients anymore,” the unit clerk joked.  I laughed.  I felt more sadness when I heard the nurses say they weren’t able to contact his wife, and they were going to request a police officer go to her home to tell her.  I was relieved to hear that at least his wife had come in to see him that day, and had been told that he was not doing well.  Having a patient suddenly die in front of me made me realize that even though I knew better, I was still taking it for granted that patients shouldn’t die while good care is being given to them.

*Name changed