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A Piece of My Mind
November 26, 2008

Bodies and Spirit

JAMA. 2008;300(20):2348-2349. doi:10.1001/jama.2008.735

I first met him in the pediatric intensive care unit, his long arms and legs tied securely in restraints and his endotracheal tube taped neatly to his face. His father leaned over, whispering urgently into his ear as the monitors beeped. Jason was a university student finishing up his first year when he was felled by a series of cardioembolic strokes believed to be secondary to his history of recurrent metastatic nephroblastoma. Multiple electroencephalograms had revealed minimal cognitive function, but despite this fact I had been consulted for possible open biopsy of Jason's remaining kidney and for severe hemorrhagic cystitis. I touched the smooth skin of Jason's hand as I told his father that based on the results on computed tomography, which showed diffuse lymphadenopathy and multiple enhancing renal masses, a percutaneous biopsy of the kidney would be less hazardous for Jason, but I didn't feel that was even indicated given Jason's advanced disease. This was my recommendation as a surgeon, an objective bystander, an unemotional witness, and a stranger.