Thanksgiving With an IV Tube

It’s not that Dr. Kathleen Sakamoto was avoiding Thanksgiving. The 38-year-old pediatric cancer specialist just didn’t know when she would get a chance to celebrate.

At the hospital until midnight Wednesday overseeing a bone marrow transplantation on a 7-month-old girl, she was back at UCLA Medical Center by 7:30 Thursday morning, with more than a dozen children to look after and goodness knows who might be rolled into the emergency room, there being no holiday for disease.

At 8 a.m. on 3-East, the pediatric oncology and hematology ward under her charge, turkeys made of brown paper bags and colored construction-paper wings hang here and there from the ceiling. Turkey dinners are scheduled to be served around the nurse’s station in the early afternoon--for family members, because the children tend to be on restricted diets.

Among the patients Sakamoto checked in on was Jeff Salby, a sports-crazed, bald (for now), bright-eyed 12-year-old with leukemia.

“Why do you want the line out?” Sakamoto asked Jeff as she stood at his bedside early Thursday. The “line” is an IV tube for injecting medicines that has been attached to his chest these last eight months of treatments.

“So I can play hockey!” he explained. “So I can roller-blade! Play football!”

“I used to be afraid of football,” said his mother, Mary Ellen Kirchberg, also at his side. “But now that he’s gone through cancer, football doesn’t seem so bad.”

Jeff says he loves Thanksgiving because he loves to eat--his mother confesses to having smuggled pizza and hamburgers into the hospital--but he won’t sit down to a Thanksgiving feast until he goes home to Simi Valley in a week or so. “‘Mom, I feel fine. You go home and eat turkey,”’ she recalls him saying.

“And,” she says, “I started crying.”

In some ways, Jeff is emblematic of both the promise and the mystery of caring for children with cancer. Promise, because he is doing so well that Sakamoto and his mother fully expect him to lace up his skates any day. Mystery, because this is his second bout with acute lymphocytic leukemia in nine years.

Children with that type of leukemia, if treated early and aggressively, live more than five years--the benchmark for success--60% to 80% of the time, Sakamoto said. But Jeff’s wholly unpredicted relapse “clearly shows that we don’t know enough about this disease,” she said.

“I like the challenge of taking care of kids who are sicker,” she said, explaining her preference for the monumental nature of cancer as opposed to the smaller crises of earaches and acne in run-of-the-mill pediatrics.

A UCLA assistant professor and staff member of the Jonsson Comprehensive Cancer Center, Sakamoto says she spends 80% of her time doing research and 20% taking care of patients. She studies how different blood cells respond to hormones and other chemicals that communicate with cells; cancer is partly the result of a crucial breakdown somewhere in that chorus of signaling, a glitch that sets off the wild cell growth that is malignancy.

“So much to learn,” she said, glancing at the dozens of snapshots of patients and former patients on a bulletin board outside her office.

“The kids are really special,” she says. “They go through so much, yet do everything possible to live a normal life. It’s inspiring to me. I so admire their determination to live life to the fullest, their courage. But it’s agonizing for the parents. They’re the ones who really suffer.”

The way she describes caring for the children, it can be painful, tragic, sad--but not grim. “I’ve always felt the optimistic side of things. One hundred percent of these kids would die without treatment. I feel I can do some good.”

For a scientist who has coauthored papers in such impersonal venues as the Journal of Biological Chemistry, she has a feel for patients, and they seem to respond.

On her Thursday morning rounds, she examined Dwayne Freeman, a 13-year-old from Santa Monica with sickle cell anemia. He burst out laughing when she felt the lymph nodes under his armpits.

He’s taking four different medications, and she urges him to “drink, drink, drink” to avoid dehydration. “If you drink five cups of water,” she said, “you can go home today.” He should have no trouble following doctor’s orders. His T-shirt says: “I’m So Smart Sometimes It Frightens Me.”

His aunt, Bernice Compton, said they probably wouldn’t have turkey once they got home. “He’s a picky eater,” she said. “He likes junk food.”

Sakamoto, a second-generation Japanese American and Los Angeles native--her father is a gardener, her mother a homemaker--breaks into serviceable Spanish when speaking with the mother of 2-year-old Rebecca, who was found a week ago to have acute leukemia. Rebecca, an IV line taped to the back of her hand, is undergoing intensive chemotherapy now, and will be on “maintenance” therapy for another two years. She flinches when Sakamoto approaches to examine her, but then gives in and clutches her doll.

Sakamoto struggles a bit with the Spanish, then asks Rebecca’s mother, Carmen Quesada, if she’s doing anything special for “the day of thanking.”

Quesada understands that the doctor is referring to the official American holiday, the day off for football and gorging on turkey. But she prefers to answer the question quite literally, and puts some of the old, simple, original spirit back into the somewhat blanched occasion.

“I’m thankful that she’s in a good hospital,” Quesada said of Rebecca. “I’m thankful that she’s doing well.”