Dr. Maller’s Blog

Her bedroom was wall-to-wall pink frilly femininity, hundreds of stuffed animals keeping her company. It was suited to a real princess, which in a way she was. After my tour, we sat in the family room and watched videos of “J” winning competition after competition in figure skating. It was 1988 and she was 15, a pretty, brilliant only child, an 89-pound package of grace and skill who seemed sure to make the Olympics. (Think Sasha Cohen). Before that she had been a champion gymnast but “retired” when she discovered skating.
This is the story of “J”, my patient from birth, who became an angel. She never saw her 16th birthday, never skated for the USA, but became an inspiration to many who did.
A year earlier she developed a swollen knee. Her parents by-passed me and went to a high-profile sports medicine doctor who after a cursory exam referred her to a rheumatologist for “arthritis”. After two months of progressive swelling, vomiting and weight loss, she went back to famous Dr. X who tried to send her on her way with “Just keep taking the medicine Dr. Y prescribed.” “J”, not awestruck by the doctor, asked “Aren’t you going to examine me?” He patted her sore knee and left.
Four months after the trouble began I finally found out (yes, I’m still angry) what had transpired. I ordered a CT scan and the results were devastating. Bone cancer in the knee had already spread throughout her lungs.
She braved every therapy USC and UCLA’s top specialists could throw at her in a gallant attempt to save her life. She refused amputation, and rightly so. For thirteen months she did her best with the rotten hand she’d been dealt. The orthopedic doctor’s lack of diligence alone probably hadn’t cost her her life because her disease is usually fatal, but how could he live with himself?
When my last visit to her home occurred she weighed 65 pounds and looked halfway to heaven, but her indomitable spirit was intact.
Her picture reminds me every day to listen, to examine, to be a doctor my patients can trust. She is frozen in time as a teenager with every gift a girl could ask for, except life itself.

The making of a doctor takes thousands of small steps, but some are unforgettable. Cathy became a monument in my life. My residency in pediatrics occurred in a 2200-bed colossus which included a 9-story building just for kids. The patients were from all over and often had rare diseases. (Professors would often say, “When you hear hoofbeats don’t think of zebras” – but Columbia-Presbyterian was where zebras wound up. In those days we had no CT scans or MRI’s, no transplants and few wonder drugs. We worked 90-hour weeks under military-like pressure.

Cathy was 8 and I was perhaps her 30th resident and this was her umpteenth admission. Every month she’d patiently and bravely teach her new physician how and where to start her IV’s and explain what her procedures and drugs were for. As a little girl, Cathy frequently ran 105 fevers. She lived way out on Long Island and her doctor just gave her the latest antibiotic without seeking a diagnosis. Her grandmother finally became fed up and brought her by train to New York. On her first admission she was found to have almost total destruction of both kidneys from repeated infection. She quickly understood her prognosis, but she never complained, never lost the hope and trust in her big blue eyes, and every young doctor loved her.

One day half way through my residency I heard the dreaded “Code Blue”. When I arrived on scene Cathy’s frail body was being pounded on by about two dozen medical people. She had died in the elevator on the way to X-ray. I was told rather coldly by a senior resident, “You have to pronounce her dead; she’s your patient.” I could not, and did not.

I spent the next two hours in my room, crying and looking for strength to go on. I found it in the thirty other patients on the ward needing me, and in the dedication I swore to Cathy’s memory that there would never be a child in my care lost because of my lack of diligence. Every time I order a urine test I think of her. Not again – not on MY watch!