When a child dies from cancer, doctors grieve too

Optimistic: Dr Luciano Dalla-Pozza, head of The Cancer Centre for Children at The Children's Hospital at Westmead.
Optimistic: Dr Luciano Dalla-Pozza, head of The Cancer Centre for Children at The Children’s Hospital at Westmead. Photo: Michael Amendolia

The word “optimistic” might not be the first that comes to mind when thinking of children’s cancer wards. But that’s how medical staff feel about them, Luciano Dalla-Pozza, the head of the Cancer Centre for Children at The Children’s Hospital at Westmead, says.

“Cancer wards, for us, are very optimistic – we expect to cure patients,” he said. “Our approach is, why would we fail? We’re not going to fail.”

But even with the best medical teams and facilities, not every patient can be saved. The heartbreak that hospital staff can experience on losing a young patient was poignantly described by a New York surgeon last week, in a post that prompted an outpouring of support.

The Humans of New York blog is sharing stories from the Paediatrics Department at the city’s Memorial Sloan Kettering Cancer Centre, including that of chief paediatric surgeon Michael La Quaglia, who writes of his devastation when a child in his care dies.

“It’s only happened to me five times in thirty years,” he writes. “And I’ve wanted to kill myself every single time. Those parents trusted me with their child. It’s a sacred trust and the ultimate responsibility is always mine.”

The post has attracted 10,000 comments on Facebook. Many are from his former patients or their families, thanking him for saving their lives and for his dedication and care.

“This man is an angel,” one woman wrote. “He gave my brother a shot when every other doctor in the country turned him away. Sadly, my brother is one of those five children that were lost but I can guarantee him, there are no hard feelings … ”

The sense of responsibility felt by Dr La Quaglia is something shared by Dr Dalla-Pozza.

“It’s such a unique area where you take a child, a young patient, and their lives intersect with the prospect of cancer,” he said. “You have to accompany them on a journey – one path of which could lead to death and dying – and it’s impossible to remain detached from that process, particularly when you’re supporting families. There’s a lot of trust that they give you.

“There’s always choices you make along the way. Every member of that family and every member of staff struggles to make the best possible decision with the information they’ve got, and you’ve got to protect them later from beating themselves up, saying, ‘I should have done that, I should have taken that advice.’ ”

There were 182 new cancer referrals to The Children’s Hospital at Westmead last year, while the Sydney Children’s Hospital at Randwick sees 110 new cancer patients a year.

Though some survivors will suffer ongoing problems due to the cancer or their treatment, the survival rate for childhood cancer is 80 per cent.

“We don’t get it right 20 per cent [of the time],” Dr Dalla-Pozza said. “When you fail, there are down moments. If things go wrong, you do think about it. And the fact that you cure 80 per cent … doesn’t save you. I think you have to grieve.”

Dr Dalla-Pozza said those moments were made easier by “the sense that you are actively contributing. You helped someone and that’s probably one of the core things of being human.”

It was also important to accept that certain things are inevitable, he said.

“You can’t cure everyone. There are some things you can’t do. Some things are out of your control.”

While Dr La Quaglia has understandably been lauded as a hero by those he has helped, Dr Dalla-Pozza said patients and their families tended not to acknowledge their own crucial role in overcoming cancer.

The courage and resilience of his young patients was inspiring, he said.

“I haven’t met a child who wants to die. It’s not on their agenda. That’s not in their scheme of things. [They say], ‘What are you doing next? Bring it on.’

“People underestimate exactly how much strength they bring to the situation and how important that is,” he said.

“The heavy lifting is done by the family and the child. It’s wonderful to be paraded as the person who saved [a] child’s life but the truth is the child’s family did it. They don’t know that, but they did.”