The Story of K

When I first met K, we were both much younger. I was a first year fellow, fresh from residency, just beginning to learn how to take care of kids with cancer. K was 12. He was a typical American kid… he played soccer, he worked hard in school, he had many friends. He came to see us because of a painful swelling of his thigh. Several months before, he had injured himself playing soccer, and it never really got better. An x-ray done at the time of the injury didn’t show anything, but a second one, done the day before we met, showed a “small lytic lesion with significant periosteal elevation surrounding it and an osteoid formation in the soft tissue in a sunburst pattern.” That is a series of buzzwords that can mean only one thing: osteosarcoma, or bone cancer.

Over the next few days, K underwent a series of procedures to confirm the diagnosis, to determine whether or not the cancer had spread, and to place a central line to allow us to administer chemotherapy. This was when he received his first good news – the cancer was localized to his right thigh. It hadn’t spread.

Next came the treatment. Two months of chemotherapy before the first surgery, removal of the tumor and placement of an artificial knee. It didn’t end there, though. More chemotherapy followed, and it wasn’t until December, 9 months after we met, that the treatment was completed. Unfortunately, K’s story does not end here.

Over the summer, there was a suspicious test result. In the fall, the radiologists were pretty sure the tumor had returned. A biopsy proved it, and in late November, almost a year after completing chemotherapy, K had to have an amputation of his right leg. He took the news well, considering that when I told him that we had to do this, he was only 14 years old. There were a few tears, as expected, but no “Why me?” no feeling sorry for himself… just a simple, mature acceptance of his fate and a strong desire to do whatever it takes to get well. K adjusted well to his prosthetic leg, and was up and walking faster than anyone expected. He even did well with the 6 months of chemotherapy that followed the amputation, a precaution to be sure that the tumor never came back again.

Not all precautions are successful. A CT scan the following August, 3 years and 4 months after his initial diagnosis, showed a tumor nodule in his lungs. The conversations that followed were intense. K was getting older (now he was 15 and had definite opinions about how his treatment should go), and he had already been treated with every chemotherapy drug known to be effective. We spoke many times, for many hours, and finally decided to go with surgery alone. The surgery would remove the tumor from his lung, and we would hope that this would be enough. K did well with the surgery, and stayed only 3 days in the hospital.

It seems K made the right decision. The tumors have not returned. He did have to have another surgery, this time to fix a problem with his amputation site. Throughout it all, K continued to live a normal life. He finished high school on time, and was an equipment manager for the football team. He performed in school plays. He went to prom. He learned to drive. And he went to college – an Ivy League school, no less.

K graduated from college this month, and I was invited to his graduation party. A happier moment you can’t imagine. K has been through more in his 21 years than most of us will go through in our entire lives. And yet he came through it all so totally normal. He did stand-up comedy on weekends during college, telling jokes about chemotherapy and amputations. He started a website with some classmates, and their business is going so well he’s doing it full time after graduation.

Why do I tell this story? So often, people think that taking care of kids with cancer must be the most depressing job imaginable. Far from it. Who else can say that they have taken care of a patient for 9 years, watching him grow up through such extreme adversity, and still make such a success of himself? No… pediatric oncology may have its hard moments, but patients like K are the reason I keep going… they inspire me, and I hope his story will inspire anyone who reads this post.