A CHILD'S PAIN

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The problem might be solved by long-acting local anesthetics. Berde and his colleagues at Harvard and the Massachusetts Institute of Technology have patented time-release beads that contain a commonly used drug, bupivacaine. Injected into a surgical incision, the microscopic beads may block pain for a week, possibly reducing or even eliminating the need for opiates. The hope is that they will enable patients to recover sooner. The beads are being tried on patients overseas, and Berde expects testing in the U.S. to begin soon.

He is also working with other researchers to develop long-acting local anesthetics from toxins found in some fish, shellfish and algae--the same toxins that cause poisoning victims to feel numb and weak all over. Berde is pursuing the toxins because they work for two or three days and seem free of the side effects of existing drugs, which occasionally cause convulsions or disturbances in heart rhythm.

Important as research is, Berde does not let it keep him from taking care of patients. "One of the best things he does is care for kids who are dying," says Pauline Scopton, a nurse who has known Berde for 17 years. "He is a master of the chemistry, of mixing the drugs to keep them comfortable." For families who wish to keep a dying child at home, she has known him to spend hours on the telephone with pharmacists and home-care nurses to come up with the right pain medicines.

Berde questions the widely held belief that doctors and nurses become inured to their patients' suffering. "You don't distance yourself," he says. "It's not realistic, the notion that you don't develop a connection. Do I get sad? Yes. It's sad when a kid dies. But feeling that I can do something for them helps. At times it's hard, but that doesn't make me not want to do it. Having my own kids makes me understand the impact of illness even more, and I admire the courage of these families even more."

It is not unusual, says Scopton, for Berde to go home to say good night to his children--David, 12, and Anna, 9--and then return to the hospital to take care of a child who needs help, particularly one who is dying of cancer and in great pain. It is also not rare for him to get a 3 a.m. phone call from, say, India for a consultation about some young patient in pain. "He has worked almost every day of the week almost since I've known him," says his wife Evelyn.

Seven years have passed since Alex Uihlein was treated at Children's Hospital, but Berde remembers him well. "He arrived in severe pain, essentially confined to a wheelchair, and if anyone moved his legs or touched them, he would cry and scream," Berde says. "He was withdrawn and just in very, very bad shape." Alex viewed Berde warily. "I was sick of dealing with doctors who didn't understand," Alex says now. But he found Berde different. For one thing, Berde listened. "He did understand," Alex says. "He believed in me, so I believed in him."