When a child is dying

Despite the progress made in curing children with cancer, we do have children who are not able to get cured. Second-line, third-line, fourth-line, ...., treatment options are available, but the chances of success and cure get slimmer with each extra round of treatment. And, the side-effects add up, the visits to the hospital, the extra costs, it becomes a downward spiral. A time comes in this quest for cure that treatment (and its side effects) are no longer acceptable. This time varies depending on the child, the family, the treating doctor, the cancer, the side-effect, the socio-economic cost and many such factors. There are no easy answers and each child and each situation is different. Earlier this week I came across this story of a 5 year old girl in the US with a progressive neurological disorder. It is in two parts and does make me emotional, both as a doctor and as a parent.
http://edition.cnn.com/2015/10/27/health/girl-chooses-heaven-over-hospital-part-1/
http://edition.cnn.com/2015/10/27/health/girl-chooses-heaven-over-hospital-part-2/
I have recently had a child who died after a long battle with her cancer. I have another where the chances of cure are close to zero. At these times, the relationship which one has built with the parents and the child is of utmost importance. What I have realised in my experience is that having a constant and honest dialogue with the family and involving the child where appropriate helps. Just by being there, whether in person, or at the other end of the phone is a relief for families.