Hold Someone's Hand  Fred Epstein, M.D. and Joshua Horwitz, Excerpt from If I Get to Five: What Children Can Teach Us About Courage and Character (Henry Holt, New York)

We can do no great things;
only small things with great love.
--Mother Teresa

I was at the top of my field. I ran one of the world's premier pediatric neurosurgical services at New York University. I'd earned a national and international reputation by figuring out how to operate on tumors in children's brain stems and spinal cords -- two areas that had previously been considered inoperable. My peers had elected me president of every major organization in my field. In sum, I had all the status and material perks that come with being a star surgeon in a medical star system.

I was headed for a fall. I just didn't see it coming.

All my life I'd been mesmerized by technology. I was never much of a student, but I always had an affinity for machines. As a boy I loved building elaborate model airplanes. When I grew up I remained enchanted by cars, planes, boats, and trains. I liked to unwind from the stresses of surgery by playing with remote-control cars or trains in my backyard. (One of my favorite grown-up toys is a scale-model electric train set that runs outdoors, even in the rain.)

When I trained in neurosurgery, I became intrigued by the technical obstacles to operating in the brain stem and spinal cord -- and by the tools that might make it possible. The brain stem of an adult is only about the size of your thumb -- in a child's brain it's even smaller. This tiny portion of the brain controls all our basic life functions -- consciousness, breathing, balance, blood pressure, temperature control, eye movement, hearing, and swallowing. It's also the main crossroad for all the major nerve pathways running to and from the cognitive and sensory areas of the brain. For some reason that we don't understand, children develop more tumors in the brain stem than adults do. But because it's the seat of so many critical functions, there's precious little room for error during surgery. The same goes for operating on tumors inside the spinal cord, which is filled with fragile nerve pathways connecting the brain to the rest of the body. One wrong move and your patient is paralyzed.

Before the 1970s, we simply didn't have the tools or the techniques to operate in these areas with any margin of safety. But like so much of medicine in the past few decades, neurosurgery has been revolutionized by technological advances. New imaging techniques like CT (computerized tomography) scans and MRI (magnetic resonance imaging) transformed our ability to identify and locate tumors. The operating microscope magnified viscous white and gray matter into identifiable tumor structures. The stainless-steel scalpel gave way to high-vibration wands that could liquefy and suction out tiny tumors; then came focused radiation scalpels like the Gamma Knife that could perform even finer work in sensitive areas.

All these advances created opportunities for attacking tumors in locations where surgeons had never dared to venture. For someone like me, who felt most in command when I had a machine in my grasp, this was a terrifically exciting time to be a neurosurgeon. During the 1980s I came up with new uses for existing surgical technologies and created innovative procedures for resecting tumors that no one else wanted to touch. I virtually lived at the hospital, operating on hundreds of brain and spinal cord tumors a year. I couldn't get enough of it. I became the consummate technologist, thoroughly enamored of the beauty and power of medicine's high-tech tools. And why not? They enabled my team to increase our cure rate from 20 percent to Over 50 percent in just twenty years. Solving some of the technical problems of pediatric neurosurgery gave me everything I'd ever wanted from work: intellectual challenge, the recognition of my peers, financial security, and, most of all the chance to save young lives.

My success made me arrogant enough to perceive technology as an end in itself.

My wake-up call came in the form of a letter from the grave, written by a seventeen-year-old boy who had been my patient. Chris Lambert was a wonderfully talented and bright teenager -- he had charisma and smarts and a big heart. And he had a malignant brain tumor that wouldn't quit. I took it out; it grew back. I took it out again; it grew back again. Chris had the kind of tumor I came to hate -- a rapacious, malignant growth that was sucking the life out of him. In the end, I ran out of medical options, and Chris ran out of time.

A short time after he died, Chris's mother mailed me a copy of a poem he had written two weeks before his death. As I read it, I could hear Chris's voice in my head:

I have for many useless hours contemplated eternity.
I have prayed in the night
By the cold and lonely side of my bed
For the peace and strength of our living God.
And I still wonder. Will I be saved?
I wait with hope in my heart.

I am struggling, 0 Lord, to stay alive
I am losing my sacred strength
I am living a life of confusion
And death is very near.
I ask you reader, who ever you may be,
Take my trembling hand and warm it with care and sympathy.

I believe that love is the sole purpose of man' life
And without love life is sterile and without meaning.

But with love life has wonder.
With love life has color and beauty.

Reading that poem demolished me. It still does when I read it today. I had failed him. I had done everything I could to save his life, but I had ignored his deepest emotional need -- to feel loved. His words haunted me: "I ask you reader, whoever you may be, take my trembling hand and warm it with care and sympathy." I hadn't heard his plea until it was too late. How many other children had I turned a deaf ear to in their hour of need?

I realized that by working single-mindedly for decades to become the consummate medical technologist, I had traveled down a blind alley. I had lost sight of what was most human in my patients -- their need for comfort. Why hadn't I seen that even the best technology can't soothe a child's fear and loneliness?

It had been so easy for me to fall in love with medical technology. It seemed to solve so many problems. Why had it been so much harder for me to give that love to a dying child?

I went into a tailspin. Losing a patient was always devastating, but it came with the job description, and I'd learned to buck up and go back into the OR. This time was different. I hadn't just lost a patient -- I had lost my balance. I had spent my whole career putting technology on a pedestal - a pedestal I'd gladly shared -- and now it had been kicked out from under me.

Excerpted from the book If I Get to Five: What Children Can Teach Us About Courage and Character  by Fred Epstein, M.D., and Joshua Horwitz (Henry Holt, New York, 2003)

Copyright © 2003 Fred Epstein, M.D., and Joshua Horwitz. All Rights Reserved. Reprinted by permission of the author.

Fred Epstein, M.D., is the founding director of the Institute for Neurology and Neurosurgery (INN) at Beth Israel Hospital in New York City. His groundbreaking surgical techniques and his commitment to humane patient care have saved thousands of children's lives and earned him a reputation as one of the world's leading pediatric neurosurgeons. Dr. Epstein lives with his wife and children in Greenwich, Connecticut. Joshua Horwitz is the president of Living Planet Books, a book-packaging firm in Washington, D.C., where he lives with his wife and three daughters. He is the coauthor of Wrestling with Angels, and the author of several children's books. For more information, go to www.henryholt.com.