By John Kelly
Wednesday, January 17, 2007
"The question is," Dr. Tony Sandler says, pointing to a grayish-white blob that glows on a computer screen in Children's Hospital's Operating Room No. 9, "is there tumor here?"
Behind Dr. Sandler, 6-year-old Grayson Espinal lies on a table, lost in a dreamless sleep, his small chest gently rising and falling as anesthesiologist Dr. Janelle Vaughns monitors his vital signs.
Think of all the metaphors for surgery you can imagine -- a battle, an orchestral performance, a tightrope walk -- and then add this one: an expedition. All the X-rays and CT scans in the world won't reveal exactly what Dr. Sandler will find once a scalpel is drawn across the boy's skin.
The surgical staff knows a lot about Grayson. He suffers from Wilms' tumor, a tenacious cancer that has attacked both of his kidneys. Four years ago, part of the Lanham youngster's right kidney was removed. Chemotherapy has shrunk considerably the large tumor that gripped his left kidney.
Has cancer returned to his right kidney? Has the tumor on his left kidney been reduced enough so that it can be sliced away? There's only one way to find out.
Grayson is swaddled in so many blue sterile sheets that only about a square foot of his abdomen is visible: the tiny stage on which the morning's performance will take place. Dr. Bob Kanard, a senior fellow, puts the tip of a scalpel on Grayson's belly and starts to cut. He makes an incision 9 1/2 inches long through the skin and then uses a soldering iron-like instrument called a cautery. The cautery's flat, superheated tip sizzles as it's turned on, separating deeper subcutaneous tissue and sealing any tiny blood vessels that might leak.
Because Grayson has been operated on before, it takes a while to tease away old scar tissue. But soon the surgeons have reached their first destination. Dr. Sandler slides his gloved left hand into the body cavity, running his fingers over Grayson's right kidney.
"I think that looks pretty good back in here," he says. "Lumps, bumps, little nodules -- that would be bad." The organ is smooth and disease-free.
The left kidney is another story. One end has the texture of lumpy oatmeal, not the smooth, shiny surface of healthy tissue. It looks as if about half the kidney is cancerous.
Even so, there's a chance part of it can be saved. Dr. Sandler uses a felt tip pen to draw a dotted line directly on the kidney. He uses a thin strip of Gore-Tex fabric to lasso the organ, with the tumor on one side and healthy tissue on the other.
Scrub nurse Terrence Sams prepares a near-endless supply of threaded needles, which Dr. Kanard uses to stitch through the Gore-Tex and the kidney. Then Dr. Kanard cinches the ends of the fabric strip together, creating a clear demarcation for his scalpel. He runs his knife down the line, removing a racquetball-size tumor.
Dr. Sandler turns it over in his hands. He doesn't like what he sees. The cut surface should be healthy tissue. Better to take out all of the bad and some of the good than to leave all of the good and some of the bad.
"I think that's tumor," Dr. Sandler says. "I think we'll have to take the kidney out." But first, he'll send the tumor and some other tissue samples to the pathology lab.
"We'll give pathology a chance," he says, as Grayson slumbers on.
Tomorrow: The phone call from the pathology lab.Helping a Child
Very few of us can do what I watched those doctors and nurses do in Operating Room No. 9: quite literally take a child's life in our hands. But there is something we can do that's nearly as important: We can donate money to ensure that no child will have to go without life-saving surgery.
We have just a few days left in this year's fundraising campaign for Children's Hospital. Our goal is $500,000 by Friday. As of yesterday, we stood at $357,038.94. An impossible task? Not if everyone reading this column sits down right now and makes a tax-deductible contribution.
To donate, make a check or money order payable to "Children's Hospital" and mail it to Washington Post Campaign, P.O. Box 17390, Baltimore, Md. 21297-1390. To donate online using a credit card, go to http://www.washingtonpost.com/childrenshospital.
To contribute by phone using Visa or MasterCard, call 202-334-5100 and follow the instructions.