Crutch

I sigh. I can't help it. I've seen too much. Too many children die, too often. And this is just another sad case. The nurse hands me the carnet. A seven year old who was amputated here in May during my vacation. Now he's back with tumors everywhere according to the nurses' initial evaluation. Diagnosis: metastases. I motion for the nurse to bring in the child. He practically skips into the room, if one can skip on crutches. He's almost bouncy until he looks up at me and then turns his head down and slightly to the left as he shyly looks back up with a small grin revealing two missing front teeth. He is way too cute to be dying.

I heave him up onto the exam table and first teach him how to give me five. At first he is reluctant. After all, he's been taught to shake people's hand and slapping is kind of a bad thing. But after some encouragement, he gets into it and really lays it on as his face lights up. I lie him down and pull down his shorts. His left testicle is swollen, looks like a hydrocele. His right leg is amputated above the knee and the wound has scarred down well. However, the leg above the amputation is swollen and the groin is filled with large, mobile masses. His lower abdomen also has numerous palpable masses swelling out his stomach.

My face falls. I'm about to turn to the father shaking my head to tell him there's nothing we can do but I decide to do something desperate and hope for a miracle. We do actually have one chemotherapy agent: cyclophosphamide which we use to treat Burkitt's lymphoma. Burkitt's is very common here and very treatable with a few doses of Cyclophosphamide spread out in cycles of three weeks. It usually presents with a large mass in the upper or lower jaw but can present elsewhere. After one dose, the mass usually shrinks remarkably and after 2-3 doses it is usually visually gone. Even though I'm almost positive this is not Burkitt's I figure it won't hurt to try.

The boy is hospitalized and the first perfusion given. I see him the next morning and his abdominal masses have all but disappeared and the groin masses have shrunk remarkably. He went home 5 days later much improved. Yesterday he came back and got his second dose. This afternoon I saw him and can hardly feel any mass in his groin. All the other masses have completely disappeared. I don't know what it was and I'm pretty sure our treatment shouldn't have worked. But all I really care about is that this really cute boy is getting better against all odds.