Giving Grayson a Fighting Chance

Grayson Espinal, 6, is undergoing chemotherapy for Wilms' tumors, a cancer that affected his kidneys.
Grayson Espinal, 6, is undergoing chemotherapy for Wilms' tumors, a cancer that affected his kidneys. (By John Kelly -- The Washington Post)
By John Kelly
Thursday, January 18, 2007

The fight to save Grayson Espinal's left kidney has moved from Operating Room 9 at Children's Hospital to the pathology lab one floor below.

Here Dr. Atif Ahmed moves a slide under a microscope. He peers down at a thin slice of tissue taken from a tumor Dr. Tony Sandler and Dr. Bob Kanard removed from the Lanham boy's kidney.

What he sees is good, if unexpected. There are cancer cells, yes, but they're all dead, killed by the chemotherapy Grayson, 6, has undergone.

"Now we're really in a quandary," says Dr. Sandler. "We can see ghosts of the tumor, but no viable tumor."

Dr. Sandler returns to the operating room to prepare to save what remains of Grayson's left kidney. But a few minutes later, the phone in the OR rings and Dr. Sandler is called back to pathology to look at samples removed from elsewhere in Grayson's organ.

This time, the news isn't so good. "Bob," Dr. Sandler says when he comes back, "I looked at the pathology and I'm 100 percent certain we have to take the kidney out. There's classic blastoma in two places."

And so the roller coaster lurches again. A feeling of disappointment permeates Operating Room 9. Both of Grayson's kidneys were invaded by a type of cancer known as Wilms' tumors. Part of his right kidney was removed when he was 2, and now Dr. Kanard removes his left. It's hard to predict what the future will hold for Grayson. Dialysis? A transplant?

If the five hours of surgery so far have been like climbing a mountain, now it's time for the descent. Circulating nurse Bennyama Joseph and scrub nurse Terrence Sams count all the instruments -- all the forceps, clamps, needles and pads that have been used over the course of the operation. ("How many sutures do I have?" asks Terrence. "Sutures? You have 53," answers Bennyama. "Fifty-three," says Terrence. "That many?")

After Dr. Kanard closes the incision in Grayson's belly, anesthesiologist Dr. Janelle Vaughns and Elenora Mazover, the anesthesiologist assistant, start to wake Grayson from his sleep. Dr. Vaughns removes his breathing tube, then puts a mask of pure oxygen over his face.

"Can you squeeze my hand, Grayson?" she asks. "Grayson, you're just waking up now. You're doing great."

He squirms and a single tear rolls down his cheek.

Six Weeks Later

That was in late November. Last Friday I saw Grayson again. We pulled up some chairs in the Children's Hospital lobby. The kindergartner was assembling a Lego figurine as deftly as Drs. Sandler and Kanard had disassembled his kidney.

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