The New York Times (Well blog), 23 November 2010
I recently had the opportunity to spend a week as the doctor at the Imus Ranch for Kids With Cancer in Ribera, N. M., founded by radio personality Don Imus and his wife, Deirdre Imus.
Camps for children with cancer have been around since the mid-1970s. Thanks in part to Betty Ford’s courageous public discussion of her breast cancer diagnosis in 1974, people with cancer had begun to talk more openly about their disease. Although children with cancer had always met on the wards, and social workers talked with them and their families about their cancer, these encounters only scratched at the surface of these life-changing experiences. Today there are over 70 such camps worldwide.
Although each of the camps has special characteristics, they all seek to allow children with cancer to attend a genuine camp, let them meet peers with similar experiences and get them away from overprotective parents and doctors, who tend to shield them from new endeavors. Paul Newman’s Hole in the Wall Gang Camp in Ashford, Conn., perhaps the best known, wants campers to “retrieve some of their lost childhood” and “raise a little hell.”
Some of the camps encourage children to discuss their experiences with cancer, but most let these sorts of interactions occur naturally. One survey of 50 children who attended a camp found they had discussed topics like treatments, medical procedures and prognosis. Nevertheless, many of these camps have shifted the focus away from disease and onto activities like making friends, swimming, sailing, horseback riding and crafts. A 2005 study of 34 campers found that the experience helped them “navigate the challenges of adolescence as a cancer survivor.”
The Imus Ranch, which opened in 1999, is free to children who attend and runs largely on philanthropic donations. And like traditional cancer camps, the ranch discourages a focus on disease and promotes activities that the children have never previously experienced. But unlike the others, woe to the person who calls the Imus facility a “camp.”
It is a working ranch, replete with cowboys, cattle and horses. Although there is a swimming pool, pinball machines and a pool table, “fun” is not the primary objective. Rather, the children themselves — who have either had cancer or are “healthy siblings” — serve as ranch hands, learning to ride horses, participate in a rodeo and do chores. The point? They can do anything that their healthy peers can.
Mr. Imus makes this philosophy abundantly clear when he welcomes kids on the first day. “This is not Camp Happy Face,” he told our group. “We will not be sitting around the campfire discussing our feelings.”
Nor is there McDonald’s food, candy or ice cream. Instead, there’s chemical-free hearty vegan fare, which some of the kids loved and others just tolerated. A week at the Imus Ranch is full of lessons and reality checks. For example, only 2 of the 10 children who attend each weekly “go-round” win prizes — one for the best overall time in the rodeo, and one for displaying the best attitude during his or her stay. “In life, everyone isn’t always a winner,” Mr. Imus told his new ranch hands.
In some ways, being a doctor at the Imus Ranch wasn’t all that different from what I usually do as a physician who treats “walk-in” patients. After long days spent working, the kids came to me with a series of minor ailments ranging from rashes to stomachaches to headaches. Having been given summaries of their medical histories, I was able to make the proper treatment recommendations.
But I also was in charge of something that I never normally have to do: watch my patients take their daily medications. One or more times a day, I would fetch the children’s pills and make sure they took them. Most interesting is that I periodically forgot to do this — a good lesson for me about how difficult it is for patients to comply with every dose of prescribed medications. Fortunately, the children, all veteran patients, would remember, informing me that, “Doc, I took my pills!”
I was also, I must admit, the water boy, always present when the children were working in the barn or competing in the rodeo, and making sure they did not become dehydrated. Although I didn’t need extensive medical training to perform this duty, it did enable me to interact frequently with the children and get to know them better. This was pretty fun for me. I am not a pediatrician, and my own teenage children are at the age where they generally prefer not to speak with me. But here were a group of children who laughed at my silly jokes and seemed to like and respect me.
And it was hard not to like and respect them, whether they had gone through cancer themselves or had a brother or sister with the disease. I was curious to ask them about the details of their cancers and how they had survived such an ordeal, but I followed the ranch rules and did not.
Still, it was possible to see some of what their bouts with cancer had left them with: a quiet resilience and maturity that most other children their age probably do not have. They were also incredibly comfortable speaking with me and the other ranch staff, perhaps because as children with cancer they are used to interacting with lots of doctors and other adults as they fight their disease. It was hard not to be impressed.
Fortunately, there were no medical emergencies during my stay at the ranch, especially no bites from the snakes that lurked in the desert brush. The one child who got sick while I was there responded to a little extra medication and a lot of TLC. That is something I frequently prescribe in upper Manhattan.
At the Albuquerque airport, where the children and I were waiting to board planes home, I did my own quick outcomes research. “So what did you think of the Ranch and the Imuses?” I asked.
All of the kids said they were glad they went, although they could have lived without weeding in the hot sun and getting up at 6 a.m. Caring for their own horses was a highlight, as was learning how to rope a plastic calf. They clearly loved Deirdre Imus, their surrogate mother, who spent much of her day assisting them, attending to their problems and warning them against the evils of junk food. And while Don Imus, true to his radio persona, was curmudgeonly at times, the kids gradually bonded with him as well.
I ultimately concluded that a randomized controlled trial wasn’t needed to ascertain the value of camps — or ranches — for children with cancer. Parents need to do their homework, making sure that the establishment is reputable and has excellent medical facilities. But there is little not to like about giving children who have had a rough ride a week of something totally different that caters to them exclusively. But don’t send them to the Imus Ranch unless they are willing to work!