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Natural Selection

Jeremy Shatan

By the time my wife and I reached Hospital B’s exam room, early in the afternoon, we’d already put in a very long day. 

Across the room, which was no bigger than a galley kitchen, stood three doctors. One–I’ll call him the Chief–was the bearded, bushy-maned head of the pediatric oncology program. His explosion of salt-and-pepper hair made a startling contrast to his posh British accent. With him were Dr. Transplant, a small, kind-faced woman who specialized in bone-marrow and stem-cell transplants, and Dr. Nice, a genial young pediatrician with a Midwestern accent.

We were there with our fourteen-month-old son, Jacob. A week earlier, he’d had brain surgery at one of the city’s internationally recognized medical institutions. It had revealed a malignant brain tumor.

As my wife and I talked with the doctors, we struggled to wrap our heads around all the new terminology and medical professionals we’d encountered upon entering the world of childhood cancer. Meanwhile, as his grandmother watched, Jacob explored the books and toys in the hospital’s well-stocked, sunlit playroom. He was happy to be out and about after his recent confinement in the ICU and a day recovering at home.

We’d started the day much earlier by visiting Hospital A, which was affiliated with the institution where Jacob’s surgery took place. There we had consulted with Dr. Mustache, who had a wonderful, warm presence and who sat with us and answered all our questions with patience and optimism. He was one of the two co-architects of the standard treatment for Jacob’s type of tumor, and we felt no doubt that he possessed the expertise and experience to give our son the very best medical care. 

Unfortunately, in order to get to Dr. Mustache, we first had to make it through Hospital A’s intake system.

The ordeal began in the waiting room, with its prison-like gray walls and rows of industrial seating. In such a setting, it came as no surprise that the receptionist treated Jacob like a number–literally. She assigned him a numeral the minute we walked in, and thereafter the staff called out Jacob’s number to summon us to various stations for the weighing and measuring procedures needed before Dr. Mustache could review his case. 

While we met with Dr. Mustache, my mother stayed with Jacob in the waiting room, doing her best to keep him entertained without letting him get out of his stroller. 

“I wouldn’t let even a healthy child down on this floor,” she whispered, pointing to the grungy linoleum.

It was an environment that seemed purposely designed to be depressing–to remind you with crushing finality that you, or someone you loved, had cancer. At this it succeeded completely.

Still, as drab and dreary as Hospital A was, my wife and I agreed that if spending weeks or months there would get Jacob well, we were steeled to sign on with Dr. Mustache. 

Before making our final decision, though, we had this second hospital visit to get through.

Hospital B featured the Chief, the standard treatment’s other co-creator. He gave us a brief overview of the protocol that he and Dr. Mustache had developed. Called Head Start, it was designed to avoid radiation, which might stunt Jacob’s brain development, while still delivering aggressive cancer-fighting agents. To accomplish this, he and his team would use several cycles of ultra-intense chemotherapy, plus a stem-cell transplant.

Dr. Transplant described the steps involved in the stem-cell transplant, which would enable Jacob to recover from the “lifetime dose” of chemo he’d get during treatment. The final, overwhelmingly toxic dose of chemo would devastate Jacob’s bone marrow. This could only be revived by administering his own stem cells, which would be extracted prior to the final cycle of treatment. 

The idea of flooding our beautiful little boy with lethal chemicals was almost too much to bear, but we found Dr. Transplant’s calm, matter-of-fact approach reassuring. 

Dr. Nice was up next. He focused on the support they would give Jacob along the way. They’d used this protocol with enough children to have learned its pitfalls and dangers, and for each one they’d developed an intervention, whether it was pre-hydration to protect his kidneys, better anti-nausea drugs or extensive mouth care to prevent sores. 

Dr. Nice spoke enthusiastically about their accomplishments and even verged on the pushy as he described the ways in which their institution’s approach differed from others’. For a moment, I almost felt we were being given a sales pitch–something I’d never before experienced in a medical setting.

The three doctors seemed to understand how overwhelmed we felt. Like Dr. Mustache, they spent a long time with us, answering my wife’s many questions and giving me time to write down the information in a notebook. (We’d bought a new one for the purpose. Our two earlier notebooks–one for pediatrician visits and one called Jacob’s Ins & Outs, where we recorded his nursing sessions and what filled his diapers–belonged to another era, when he was normal and healthy. That time now seemed long-gone and painfully quaint.)

Feeling a bit dazed, we left the exam room.

One such hospital visit in a day would be a lot for anyone to take, and we’d endured two. But we had to choose a treatment center quickly: Jacob’s situation was too urgent to wait. We didn’t have much time to mull over the two centers’ pros and cons before coming to a conclusion. 

As it happened, though, we didn’t even need to discuss it. We knew we’d be bringing our son to Hospital B.

Our minds had been made up even before we met Hospital B’s three doctors. In fact, the deal was sealed by the first words a friendly nurse spoke when we walked in:

“And this must be Jacob.”

About the author:

Jeremy Shatan is the communications and operations director for Hope & Heroes Children’s Cancer Fund, the exclusive charity for pediatric oncology at Columbia University Medical Center. He has written fiction and poetry since he was a child and is currently working on a memoir about his experience with his son, Jacob, who died due to a brain tumor in 1999. Jeremy lives in New York City with the love of his life and his two surviving children. Besides writing and reading, he is passionate about music (, movies, baking and skiing.

Story editor:

Diane Guernsey


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