How Do You Treat Cancer In A Patient Who Has Not Even Been Born Yet?
Sam Blackman was about a year into his career as a pediatric oncologist, when he got a page on Friday afternoon. It was from a doctor at the Beth Israel Deaconess Hospital across the street.
“They said, we want you to come over to the maternal fetal medicine unit. I said alright, let me make this more clear: I’m a pediatric oncologist, and neither maternals nor fetals really fall into my remit.”
After determining that this wasn’t a case of mistaken identity, Sam headed across the street to see what this was all about.
When he arrived, they pointed to an ultrasound image on a screen and said, “there’s your patient.” It was a 35-week-old fetus.
“They pointed to a bright spot on the outline of this child’s spine, and they said, that bright spot should not be there.”
It appeared to be a tumor invading the spinal canal. Sam’s specialty was taking care of children with cancer, but he had never before worked on a newborn, much less an unborn fetus.
“I did what most normal people would do, I went to Google,” he said. “And Google spit out a bunch of references to papers on fetal spinal cord tumors. Unfortunately most of them were in Japanese, so … Google Translate!”
Sam learned that this would be a highly complicated procedure for all sorts of reasons. For one thing, basic stuff like getting a bone marrow biopsy are difficult when working with a newborn and his flexible, still-mostly-cartilage bones. And then there was the chemo.
“Chemotherapy drugs in general excel at killing rapidly dividing cells. Newborn babies are all rapidly dividing.”
The baby was delivered by Caesarean Section, he got a name -- Henry -- and tests and treatments began immediately.
“This little baby got chemotherapy on his very first day of life.”
To Sam’s amazement, the baby responded remarkably well to the treatment. After several rounds, the tumor seemed to have disappeared. But Sam knew that was only part of the equation. Now it was about quality of life for a child who would likely have paralysis.
“It was clear the tumor had compressed his spinal cord a lot. His legs were unbelievably floppy. My bigger concern beside just shrinking the tumor was that he was going to have A lifetime of neurological defects to contend with,” Sam said.
Fast-forward a year-and-a-half, and Sam was hosting a fundraiser at his home for his oncology practice program. And who should answer the invitation, but Henry’s parents.
Sam said he was delighted to see them, and asked about Henry. They told Sam that Henry was there with them, too.
“Oh, great! Why don’t you wheel him in!”
But Henry did not roll in in a wheelchair or a stroller. Instead, he tramped in on his own two toddler legs.
“I turned, and he walked. He was walking in. And I’d never seen him walk before. He just had this radiant smile. … Every single step for him was a privilege, and you could tell.”
That was almost 15 years ago, and Sam said he kept in touch with the family. Now Henry is an active teenager who not only walks, but runs and plays lacrosse.
Sam called it one of the most joyous episodes of his career.
“There are times in oncology when you win the battle and lose the war … [but] this child, he walked! And it was miraculous. And I say that with the full meaning of the word invested there.”