Anesthesia for pediatric oncology procedures is a small but powerful subset of my work as a pediatric anesthesiologist. Children need anesthesia for many aspects of their cancer care that adults can tolerate without sedation; childhood cancer requires years of extremely frequent anesthetics. We get to know many of the patients and families well, so it is one of the areas in anesthesia where anesthesiologists have continuity of care with patients.
Pediatric anesthesiologists see children sometimes as frequently as weekly for bone marrow aspirations, lumbar punctures with intrathecal chemotherapy, staging and surveillance MRIs, CT scans, MIBGs and PET scans. We see families through the major surgeries that hold so much fear and anticipation, and also through the months and years of treatment, complications and watching and waiting. We watch these children grow up, celebrating all the normal milestones with them, remembering their favorites and then the next time hearing them scoff as they’ve moved on, “Dr. Jette, Doc McStuffins is so juvenile, don’t you think?”
We sedate children for weeks of daily radiation therapy, where they would otherwise be too scared to tolerate the loud sounds, rotating machines, and restrictive radiation masks required to pinpoint tiny intracranial tumors. These children sometimes require daily therapy, so tough decisions must be made when a child develops even a simple cold.
A seemingly simple sedation with propofol and a nasal cannula never makes me more on edge in a child receiving radiation therapy, which requires a radiation mask to hold the head in position, covers the airway, and puts a lead shielded door between me and my patient, than in almost any other situation. But this anesthetic is also equally about caring and compassion. Anesthesia notes are filled with anecdotes like, “Mom says it went better last time when Emmy fell asleep in her arms while the team sang Frozen.” “Best to push the propofol quickly as she tends to panic when she feels the sedation begin.”
We care for too many children that don’t make it. While we are not a daily part of these children’s care teams, we know them well and news of the death moves through our group like a cold wind “Did you know Jose passed away?” “Oh no, I didn’t see him on the schedule for a while, and I was worried. He was such a happy little guy, even when things were tough.” Each year, faculty and staff at our children’s hospital gather with families of children who have passed away of cancer in the past year for a Day of Remembrance, honoring the kids who didn’t make it. Through all the sorrow that this day brings, it also fills me with gratitude for the amazing team I am part of who cares so deeply for these families. It reminds me of why I went into medicine.