Agraphia Medical Tragicomedy


Juan Pablo

He was 5, and had been turned away from 3 different ER's over the last month. Undifferentiated stomach pain, vomiting after eating, generally listless. We reviewed the charts from his previous ER visits and nothing stood out. Blood counts, electrolyte counts, liver and pancreas functions, all normal.

He looked almost dead to me when I first saw him. His eyes were unfocused and vacant, skin pale, stomach distended and grotesque, lips chapped and cracked. His younger brother, wide-eyed, was sobbing inconsolably. Mom and dad both seemed detached, as if this was just another hurdle they had to get over. Get through the terrible two's, go to daycare for the first time, get admitted to the hospital. Grandma, on the other hand, had a look on her face that bespoke grief and fear. Aside from the docs, I think she and the brother were the only two who realized how serious things were.

Our workup revealed the worst presentation of Burkitt's lymphoma any of the docs on service had ever seen. Over the course of the next week he fell victim to intestinal resections, a splenectomy, rounds and rounds of chemotherapy, and steadily worsening vital signs. He was put on a mechanical ventilator after day 2 of his hospitalization. He looked scared when I went in to say hi.

The grandmother cornered me the day after his admission, her face stained with tears and exhaustion. I'll never forget the words she spoke to me - "Please, doctor. Just tell me my grandson will live. I love him so much... he is my angel". She was begging for a ray of hope that I could not give.

I looked at her for a few moments, and finally said the words I never thought I would hear myself speak. "I hope so, but the cancer is bad, and it is spreading. I can't promise that he'll be ok, but I can promise that we will do everything in our power to save him". I meant it. He died a week later.

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  1. Quelle triste histoire. Such a sad story. Why do you think the other EDs missed it? The Burkitt’s, it is very aggressive, yes? Would there not then have been some sort of measurable disturbance in his — comment le dire? — his metabolism, his kidneys in the month before coming to you so very ill? Très triste.

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