David’s Journey 

It is December 2009 and we all have much to be thankful for. We live in the most wonderful place and we live in the best of times. We also enjoy the best health care on the globe.

To be a physician takes years of discipline and dedication. Most people don’t realize it takes four years of college excelling at each step in order to be accepted into medical school. The competition is intense and each course is important to get to the next step in the journey. Medical school is another four years broken down into two years of sciences including anatomy, physiology, chemistry, etc.

The basics are driven home over and over again.

Learn the body, be disciplined, stay on task.

The last two years are clinicals where one studies under attending physicians in different specialities.

It takes vision to get through.

After medical school comes a one year internship in a hospital setting followed by two to six more years of training.

It is important to know all of this in order to understand the journey of David.

David is a 16-year-old sophomore in high school. He comes from a good home and is happy and optimistic. He has no awareness of time. He, like all boys, thinks about girls, sports and cars.

One day he develops back pain that persists. We all get back pain. The pain lingers and he is seen in the office. It is a dilemma. Why does a child get back pain? Does one mobilize resources at great costs or observe and tell him that the pain will go away.

The decision is made. He is sent for an MRI of the back. The MRI machine is a multimillion dollar machine that requires huge support including a radiologist, radiology technologist, clerical support, an office manager.

It requires dictations and faxes, cell phones and E-mails.

The MRI is performed and the film is then read by a radiologist who has prepared a lifetime for moments like this.  He has spent the first 30 years of his life in training and he is disciplined. His name is Dr. Sevigny.

The radiologist is alarmed when he reads the film and he makes the call that he doesn’t want to make.

“I believe it is a Ewing’s sarcoma”. The presumptive diagnosis is Ewing’s sarcoma, the most notorious cancer of childhood.

What follows is a sequence of events that is more complex and superior than anything else known on the globe.  What follows is the mobilization of every resource known to man.

The clock starts. We all know that round silver clock from grade school where we all wanted the time to go by fast so that we could run and play.  In this case we want the clock to stop.

Everything in health care revolves around the clock. What happens to people is described as morbidity (disease) and mortality (death) and all the studies are determined by the time of diagnosis.   It’s the clock and it’s ticking.

We are thus able to predict to some degree what will happen to people who get disease.

Ewing’s sarcoma is one of the worst.

The clock is running.

There is only so much time now. It is a child. Everybody makes room on their schedule for a child. Within hours multiple calls are made, dictations go out and the sense of urgency is heightened.

It is determined that the child needs to go to a regional center where they know how to treat this and they have seen it before. Most physicians won’t see a Ewing’s sarcoma in a lifetime.

It is a dangerous tumor. Calls are made to Shands and patients are displaced and taken off of the schedule. It is a “child”.   When you say it’s a child then mountains are moved.

The child is brought before Dr. Gibbs at Shands the hospital in Gainesville, the premier medical center in the South, if not the United States. This doctor has seen this before and he is an expert in this tumor.

Within 24 hours the child is taken to the operating room and operated under general anesthesia by yet another physician. The diagnosis is confirmed and within hours chemotherapy is begun.

Chemotherapy is intense toxic drugs which are given in doses that identify and kill cancer cells and yet leave healthy cells alone, for the most part.

There are side effects which are profound at times including nausea, vomiting, anorexia, depression and fatigue.

Most boys at this age think about girls and sports and cars but for this child it is now a fight for his life.

There are now multiple physicians involved. There are nurses and nurse’s assistants. There is administrative support. There are diagnostic tests. There are invasive procedures. There are CAT scans and MRIs and he is now bathing in health care and he and his family are afraid of the unknown.

The clock is running.

The chemotherapy is intense and that is only the beginning. What comes next is worse. The child is next subjected to proton radiation therapy where his body is pounded daily.

It is all intense and fraught with emotions.

Nobody is allowed to drop the ball.

Nobody is allowed to show or express doubt or apprehension.

Nobody is allowed to delay treatment.

Failure is not an option.

The child and his parents are very aware of and sensitive to every word spoken around them.

It is a team approach,  it is real life drama in health care and it is life and death.

It all began on May 31, 2006 with a simple visit to the primary care office and one year later after hundreds of thousands of dollars David was deemed cured of the most notorious tumor of childhood.

David was able to graduate magna cum laude from Seabreeze High School and is now a student at the University of Florida.

We live in a wonderful world that is full of enlightenment, goodness and grace and we all have much to be grateful for.

Peace be with each of you at this time of the year.