relieved and somewhat confident. The father, afraid that he would lose his job, then left to return to his construction work. However, when the doctor who appeared to be in charge returned, he told Mrs. Marshall that they needed to talk and that she should try to reach her husband.

In the interim, the doctor told Jimmy’s mother that there had been increasing brain injury and that the task was to prevent the brain from swelling and “crushing itself.” Her son might die. This seemed impossible given that only a few minutes earlier someone else had seemed so cheerfully pleased.

Suddenly, a nurse rushed in to say that the doctor was needed. Jimmy’s heart had stopped and CPR (cardiopulmonary resuscitation) had been initiated. The doctors knew that the likelihood of resuscitating Jimmy was negligible but were obligated to try. The doctors subsequently had to tell the Marshalls that they had done everything, but Jimmy had died. Later, Mr. Marshall agonized that he hadn’t been told enough to realize that he should stay with his wife and boy, and he sometimes felt angry at how the neurosurgeon misled them. He and his wife got a piece of paper with information about bereavement support, but it was laid aside and then lost in all the turmoil. There was no further contact from those who were with Jimmy when he died. At least, they had qualified for “free” hospital care.

“Melissa Devane”

As children mature, their intellectual and emotional understanding of serious illness and the prospect of death evolves. This story describes the complex relationships between a severely ill adolescent and her parents and physician and the different concerns she has as she moves from diagnosis and treatment, to recurrences and further treatment, to death (Figure 3.1b). The adolescent is in conflict with her parents and physician about undergoing burdensome experimental treatment but eventually persuades them to respect her wishes.

When Melissa was 13 years old, she was an excellent softball player who hoped some day to play on the Olympic softball team. Late one summer, her knee began to hurt severely and kept hurting. When Melissa’s primary care physician thought an x-ray suggested a tumor, she referred her to Dr. Garcia, a pediatric oncologist. After a biopsy, Dr. Garcia diagnosed osteogenic sarcoma, an invasive bone cancer. As Dr. Garcia recommended, Melissa had several weeks of chemotherapy followed by surgical removal of the tumor and then several months more of chemotherapy plus physical therapy. Although the hospitalizations for chemotherapy and episodes of fever were no fun, what bothered Melissa most was losing the ability to play her sport ever again. Also, her hair fell out just as school was starting. The social worker on her oncology team helped Melissa to get a wig and, as



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