The Bravery Bell

The elevator ascended to a series of chimes, the windows casting a rich brown, then green glow, and finally brilliant blue. The changing view reflected our climbing up the Treehouse, otherwise known as the Children’s Hospital. The Pediatric oncology floor is at the very top, grazing the clouds. It’s where the ice cream and cookie shop is, right across from the bee-catching floor game, around the corner from the school room and just a little away from the non-denominational chapel. If you walked past the hall of donors and went around the nurses’ island, you would find the Bravery Bell. A plaque beside it reads, “Promise me you’ll remember, you’re braver than you believe, stronger than you seem and smarter than you think.” – A. A. Milne, Christopher Robin. In children’s hospitals around the world, the Bravery Bell hangs for pediatric patients to ring out the end of chemotherapy. It is a sound that celebrates victory over cancer and sounds hope for fellow patients on the floor.

I was a second year medical student, rounding with my Principal Investigator, a pediatric oncologist leading our clinical research study, in an effort to meet the parents I would soon be interviewing. Our study sought caregiver perspectives on re-immunization post-chemotherapy. It was to be a quick interview, then I would be typing up responses. I didn’t wear my white coat – most of the team had opted out of this as well – and I had on one of my coziest sweaters with a felt sheep on the front. My concession to comfort stemmed from experience in the children’s hospital, where kneeling to give high fives and comparing how far your arm stretched over your head were common occurrences. I’d learned to be prepared for these departures from formality and to embrace the slightly whimsical. My only identifiers were my stethoscope hanging around my neck and my ID that read, “Medical Student,” in bold letters. The kids were mildly curious when I entered their rooms, but were usually more interested in the cartoons on the screens and the toys that were invariably spread about the room. The parents took the interview as an intermission in the now daily routine of a day spent with their child in the hospital. I was a somewhat innocuous guest in their space; just a student, unlikely to change the course of their stay, one way or the other.

They relaxed, allowing my observations and my questions, as I measured my tone to one of calm curiosity. I focused on injecting some degree of innocence to queries that included the date their child was diagnosed with cancer, the type of cancer, the goal of treatment at this time and the types of treatments they had completed. More than once, I felt a rise in anxiety as I undoubtedly stirred memories, still raw, of what was possibly the worst news a parent could bear. Each time I would assure the parent that we could stop at any time, and they could refuse any question. Each time, they continued. Often, we stopped to address an unrelated request from their child in the room: a new channel on the television, a different toy, something for an unrelenting itch or something better for the pain. Sometimes the child wanted to answer the questions, too, providing some input for each inquiry. We would pause for that as well.

There was no rush, the heightened sense of losing time that sometimes filled the adult floors had not seeped in here. Within the nurses’ island and in the attending conference room, the urgency of medicine remained, but outside, on the floor, there had been time for high fives, for hugs, for reassurances and for play. Time, in fact, for children to remain children in the face of cancer. I was a witness to these efforts to keep things just a little more normal. But also a witness to the understanding that it was not. Nothing about a child bound to a bed in the hospital was normal, and everyone understood that. The kids especially. They knew something was wrong, and that they weren’t supposed to be there. But they went along with it; they smiled, they played, they wanted their favorite video game and still preferred their favorite color. The butterflies and daisies painted on the walls weren’t what kept the despair of cancer away. It wasn’t the toys, the brightly colored scrubs, the clowns or the balloons. It was the children being children that made everything just a bit more bearable. More fun, more exciting and certainly more interesting.

A year and a half into medical school, I haven’t yet been swayed from my interest in Oncology, and Pediatrics has taken on a certain appeal. Not only because I love children, but because the dynamics are so unique. Questions on rounds ranged from how many more sessions of chemotherapy remained to what a collar bone is and what the best thing about dinosaurs is (their roars). We’d often talked in class about the resilience of children following illness; they recover faster and better than adults in most cases. We hadn’t really touched the other kind of resilience they have; the spirit to keep going, to keep caring, to keep being themselves against incredible odds. And then we have the Bravery Bell, to ring out the end of a regimen of chemotherapy. We have it for something even more important though; to celebrate the emotional fortitude of a child who has battled cancer.