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Memoirs from a Pediatric Oncologist

  • Writer's pictureJackie Wiermaa

A famous poem used at weddings says, “ Something Olde, Something New, Something Borrowed, Something Blue” This poem was derived from an Old English rhyme in the Victorian Era from Lancashire, England. The idea of continuity in “Something Old” is balanced by the idea of a new chapter or optimism about the future in “Something New.” The circle of life is apparent in this example.

Mary (name changed) was twenty-five years old when I met her. She had a very large, aggressive brain tumor called an atypical teratoid rhabdoid tumor. The tumor type was rare in childhood and almost unheard of in adults. Therefore I was her oncologist since the adult oncologists had no experience with this rare pediatric brain tumor. Mary had surgery across the country at a hospital in the city where she was living and working after graduating college. The surgery saved her life. However, the large tumor had drastically changed her physical abilities, memory, and cognitive functioning. Therefore her parents were again caring for Mary, just like they did when she was a young child.

Mary needed to undergo chemotherapy and radiation; even with these treatments, the prognosis was grim. All the while, Mary needed to learn to walk again, read, and perform the activities of daily living. It was a long, arduous journey for Mary, but one thing was consistent - Mary was always exceedingly optimistic. She would greet me with a bright smile and compliment me on how she liked the scarf I was wearing, or she would tell me I had a pretty smile. From week to week, Mary often didn’t remember that she had already met me or that I was her doctor, so each visit was delightfully engaging and fun as we “met” each other repeatedly. She didn’t remember her independent young adult life as the memories of the last several years of her life had been wiped out after her surgery. Mary seemed content with her new lot in life, however. She didn’t express loss or disappointment but only seemed to take each day as it came with a very sweet innocence and optimism.

Due to her poor prognosis, Mary’s parents inquired if they could use alternative treatments besides conventional chemotherapy and radiation. Since Mary was an adult and the prognosis was so poor, we worked out a treatment plan that could be safely done by combining both alternative and conventional approaches. Mary’s parents added Chaga tea, vitamins, Essiac tea, and a strict diet to Mary’s routine.

Instead of having the clinical course of rapid progression and death that I had anticipated, Mary continued to get better and better. She stayed in remission month after month, year after year. I was so amazed at how well Mary had done that I investigated alternative treatments more seriously. I had always been interested in foraging, gardening, natural herbs, and treatments for my own health. Still, Mary’s phenomenal progress sparked my curiosity to explore this more on a professional level. With each check-up visit, Mary and her parents were overjoyed at the success of their treatment approach. We would share pictures of new mushrooms we had foraged, and we discussed what we were learning about plants in our environment that could be consumed to promote health. I even decided during this time to enroll in a formal training program in functional medicine to gain more knowledge on holistic health.

Mary continues to be a long-term survivor who has beaten the odds as she passed the five-year remission mark several years ago. She continues to improve and make progress in regaining her ability to read, walk and gain strength and coordination. Mary may never live fully independent; however, she keeps moving forward with her upbeat attitude.

Many things have changed for Mary because of her brain tumor. The memory loss, lack of balance, and struggle with reading are all new challenges for her since her cancer diagnosis. She has to be flexible and creative with her current limitations in order to do her normal activities, but she is finding ways to thrive. Mary’s optimistic attitude persists despite these challenges. Her family informed me that this optimism was a primary characteristic of Mary before the brain tumor, and it grew even stronger after the cancer experience.

My experience with Mary helped me gain a new appreciation for alternative and holistic treatments. Just as Mary was learning to walk and read again, I also learned new skills as a holistic provider. I started a new path in my career by adding formal functional medicine training. At the same time, I retained my “old” optimism and appreciation for research and scientific studies that are so beneficial for patients. Mary and I started on this journey together, and we are both keeping the best of what we have that is old and adding on new skills to thrive moving forward. After caring for patients like Mary, staying inspired in this journey is easy.

  • Writer's pictureJackie Wiermaa

Let’s face it, grief and loss are unavoidable parts of life. Life seems to be an up and down journey of good and bad times, flowing along like a winding river. As a pediatric oncologist, I witnessed these aspects of life daily at work. There was the thrill and joy of a child finishing chemotherapy and ringing the bell at the infusion center to indicate that the treatment had been successfully completed! Immediately, the next patient appointment informed a child and family that treatment had failed, and there was evidence of another relapse.

As I have navigated my own lost dreams and disappointments in life, I often reflect on the families that have lost children to cancer in my career and how they coped. Many couples have divorced or become almost lifeless, just going through the motions because acceptance over the death of their child escaped them. Others are thriving, stronger, and even more cohesive after the death of their beloved child.

I see this pattern in my own life. Sometimes I face loss and heartache with acceptance and end up stronger in the end. Other times the loss has remained painful, like a festering wound, and the grief just doesn’t seem to heal. I wonder what the differences are between the two scenarios and the two types of coping patterns?

It may be different for everyone, but I suspect that foundations are crucial. A firm foundation will withstand the storms of life, while a foundation built on sand will not withstand these severe storms. The loss of a child is about the worst storm one can endure, so the soundness of the foundation becomes apparent quickly. A foundation built upon truth and unshakeable hope are necessary for the bad storms in life.

Scripture describes this beautifully, “And the rain descended, and the floods came, and the winds blew, and beat upon the house; and it fell not: for it was founded upon the rock.” Matthew 7:25 (KJV)

These storms often come abruptly without warning. Is your foundation solid enough to withstand the storms that may come in life? We need to be preparing now, making sure our foundation is sure and solid.

  • Writer's pictureJackie Wiermaa

Heather (name changed) was an eighteen-year-old college student. She had already moved away from home and independently pursued her dreams at this young age. Heather was a remarkable young woman, and everyone sensed it immediately. Heather was beautiful, athletic, intelligent, and a model student. Heather was very popular in school because of her outgoing personality. She had a way of making everyone around her feel accepted and happy. It was natural to feel optimistic and upbeat around Heather. She was always the one chosen to be class president, prom queen, team captain, etc. because she was also humble and gracious.

I met Heather when she presented with respiratory symptoms due to a complex, large, rare tumor encompassing much of her right lung, ribs, and chest wall. Due to the size of the tumor and the complexity of its involvement in nearby structures, I knew her prognosis was dismal. Successful surgery is necessary for long-term survival because chemotherapy and radiation alone are not curative with this tumor. Surgery would be virtually impossible in this case. Despite the odds, Heather underwent intensive chemotherapy, radiation, and surgery. She fought hard and wanted to live more than anything else. She had so much to live for!

I was years into my pediatric oncology career at this point. I knew that every child that died took a piece of my heart, and I had only a few pieces left at this point due to the stress of the job. To preserve my heart a bit longer, I decided to keep my emotional bonding with Heather less than I would have earlier in my career when I had more reserve. However, I still wanted to bless Heather in some way during her chemotherapy treatment plan. So, I started asking Heather some key questions to see how I could bless a person that seemed to have everything in life. What gift could I give Heather, especially if her life was cut very short due to her cancer?

Heather had a large number of close friends. She had a loving, supportive family. She had experienced vacations, clothes and gifts, educational opportunities, and everything else I could imagine. She had everything except for her health, which I feared would escape her. I couldn’t find my opening to give her a gift, so I kept praying and seeking the Lord’s wisdom.

One day I asked Heather in a casual conversation about their Easter plans coming up. She shrugged and said her family didn’t attend church or celebrate Easter. The conversation flowed naturally, and I realized that Heather wasn’t yet secure in her spiritual beliefs and didn’t have a sense of peace or assurance of what would happen after death. She was fearful in this area and didn’t want to talk about it. Therefore, after this conversation, I started praying regularly for Heather to spiritually enter a place of peace so she would not fear death. I pray for my patients often, but since I had been searching for a way to bless Heather, I started praying for Heather daily regarding this request.

I wasn’t sure if my prayers had made a difference, but at her funeral, I learned that Heather had discussed her spiritual concerns with her best friend, Jamie. Thankfully, Jamie’s father was a trained pastor and was able to share a scripture that comforted Heather and reassured her of eternal life. Jamie described in tears at the funeral how Heather beamed with joy and excitement the last week of her life as she described her newfound faith. There was no fear or anxiety in her final days. Instead, there was peace.

I left the funeral with tears of joy in my eyes, knowing Heather was at rest in the arms of my Savior and that she left this world with the peace of God. God is amazing to work out every detail and make everything work out for good, even when we have nothing of value to give from our tired hearts.

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