When Words Break Hearts: My First Experience With a Devastating Diagnosis

It was a Saturday afternoon, and I was sitting in the corner of the room, documenting patients' histories in summer of 2024. 

A family entered the office—the mother, father, grandfather, and grandmother, along with their two daughters. The oldest, a 7-year-old girl, looked pale as a ghost, though she otherwise appeared healthy, save for a few scattered bruises, known as ecchymotic lesions, across her body.

Her 3-year-old sister was also present, but she seemed normal. Frightened by the doctor, she quickly left the room with her mother to wait outside.

The patient was the 7-year-old daughter. She had undergone an appendectomy two months ago, a procedure that was successful. However, routine tests performed afterward raised concerns. Her blood indices were alarming, leading to a recommendation for a bone marrow aspiration. At first, I thought this decision was harsh and unnecessary, as she appeared to be a lively, energetic child. But that was before I saw her blood results.

The doctor began a thorough physical examination. Initially, she was afraid, but with the doctor’s gentle communication and friendly tone, he was able to put her at ease and complete the examination. She complained of abdominal pain, and as noted earlier, she had multiple bruises on her body. Although she was pale, there were no other immediate concerns.

I still vividly remember her innocent plea, “Please do not hurt me.”

I could only imagine the fear and pain she must have endured during the bone marrow aspiration.

After reviewing her history, which included symptoms like recurring fevers, I initially suspected B symptoms commonly associated with lymphoma. However, the doctor explained that such symptoms are typically seen in Hodgkin lymphoma, a much rarer condition. When I finally reviewed her blood indices, it was clear that the situation was grave. The fever aligned with her troubling blood results.

Her blood levels were as follows:

• White Blood Cells (WBC): 2,400 (normal range: 6000- 11,000)

• Hemoglobin: 8 (normal range: 10-12)

• Platelets: Critically low

Ultimately, the bone marrow aspiration revealed a devastating diagnosis: 90% of her bone marrow consisted of blast cells, confirming that she had Acute Lymphoblastic Leukemia (ALL) and required immediate treatment.

With about six people in the room, the doctor asked who should be the primary recipient of the news. He began solemnly:

“We are sorry to deliver the following news…”

As soon as the words left his mouth, the father, overwhelmed with emotion, took his daughter’s hand and left the room. It wasn’t to shield her from the news but because he couldn’t bear to hear it himself.

The grandparents stayed, and the doctor continued:

“We regret to inform you that your granddaughter’s bone marrow contains 90% blast cells, which are malignant. We can confidently say she has leukemia. She needs immediate treatment and should be admitted to the hospital today.”

I watched as the grandmother, on the verge of fainting, managed to hold herself together. The grandfather, though initially shocked and visibly shaken, quickly composed himself and listened carefully.

After explaining the treatment process, the doctor addressed their most pressing concern: whether she would respond to chemotherapy....

The grandmother instantly stood up and asked if her granddaughter could be ever treated? 

“Fortunately,” the doctor continued, “she has a very high chance of responding well to chemotherapy. She doesn’t appear to have any risk factors that would hinder her treatment.”

I, too, felt a sense of relief. At least there was hope.

The most disturbing part of the conversation was watching the father repeatedly peek through the door, his face wet with tears, trying to gauge his parents’ reaction to the news.

He finally re-entered the room, his eyes still filled with tears that he struggled to conceal. Overwhelmed, he stepped out again almost immediately. His mother followed him, likely explaining everything outside. When they re-entered, he was still wiping away his tears.

Finally, he spoke, asking how long the treatment would take.

The doctor explained that she would be admitted to the hospital for at least a month and would need to take six months off school to avoid infections, as her WBC would be nearly zero, making any infection potentially life-threatening.

The entire treatment process, including induction, consolidation, and maintenance chemotherapy, would take about two years.

Before leaving, the family was advised by the doctor to remain calm and not show weakness in front of their daughter, who would soon begin chemotherapy, to avoid affecting her emotionally. However, I doubted they would be able to do so.

Arrangements were quickly made for her to be admitted to the hospital that very day so that treatment could begin immediately.

The family left, thanking the doctor respectfully. The little girl, still as cheerful as when she arrived, seemed unaware of the gravity of the situation. The doctor, maintaining a friendly tone, waved goodbye, and she waved back with a smile.

This was the first time I had witnessed the delivery of such devastating news to a family, especially one with such a young child. Although I’ve never seen similar news being given to an elderly patient, I can confidently say that there’s something uniquely heartbreaking about informing parents that their 7-year-old daughter has a life-threatening illness.