Sunday, October 13, 2013

Complications: A Continuation of the Last Story

She kept getting better. But it seems medicine, and it’s providers, kept fighting against her. Two days after surgery I noticed her leg was swollen. I knew that she had a clot in it. I looked at the chart, making sure that I had not forgotten to write for the medicine meant to prevent this particular complication. No, the order was there. As well, another order was right above it, written by the surgery team, which ordered the exact same medicine. Written twice, but never given. I called the nurse, and no, that medicine hadn’t been given. “It must have been overlooked”, they answered as if it were no big deal. But it was a really big deal to me. They continued explaining, “maybe the chart was moved by one of your colleagues”, and “we have been very busy”. Finally the gasket blew (it isn’t always that firmly attached anyhow, and this episode of apathy flipped it off). I explained heatedly that I didn’t care about any of the excuses, what I cared about was if my patient got her medicines. I emphasized that she could die from this. And how I wrote those orders to prevent stuff like this. And again said that the least important thing to me is the excuses that keep coming. That explanation probably did very little to encourage my relationships with nursing, but I lacked the strength to hold it back.

In spite of her setback, she started getting better. I had one of the medicine doctors seeing her to make sure her blood clot was being managed correctly. Better and better and better. She always smiled, and it delighted me to finally see her condition catching up with her attitude. She was actually getting better. I transferred her medical care to other doctors to manage her clotting issues and her chemotherapy treatments.  I couldn’t really let her go though, I thought of her every day, so found myself going by to make sure she was hanging in there, or to have a quick word of prayer with her.

I got the final pathology back. It was a cancer that is rare, but can be very aggressive. In fact, it was the one I was hoping most against. I went to tell her. I had to make her understand. Medical terms would be lost, so I went with a more accurate description – “I was hoping it would be a type that we could really squash dead, but it is a type that is much harder to kill, and even with the treatment, it could come back”. I told her about the medicines she was going to be taking. How they were cruel to the body, but how she had to hold on, even through the hard times. Looking at her little frail body, I was surprised to hear her so excited to fight against it. And so she did. Made it through the first round of chemo weak but vibrant, and smiling as always.

About a week passed. Just a few days after she was readmitted for more chemo, I got a call from her brother. He said she was not breathing well and was confused, and that he couldn’t find a doctor. I hung up and called the medical doctor at the hospital to please go and see her. Soon it was clear. Her issues had been “lost” on the readmission. The new doctor didn’t know her well. No one was following her issues. The medicine to treat the blood clot had been forgotten. She died the next morning of a clot that moved to the lung.

I had poured my heart out into her. I cared too much. She loved it when I came to see her. She loved that I would walk through it, and hope through it with her. I loved to watch her get better. But caring wasn’t enough. It seemed that it was an avoidable death, a greater tragedy than when a loss couldn’t have been prevented. Too many things had gone wrong one after the other, leading to the loss of life. I was discouraged and frustrated. And just plain sad.

It is a hard reminder that my best is not enough. That medicine isn’t enough. Out here we need better training, better management, a better system. Our resources, including both human resources and medical resources, are stretched too thin. In fact, for most of the society here such loss of life is accepted as normal. It is not the exception. All those things really are issues. But if they were fixed, it still wouldn’t be enough. It still couldn’t make sense of the madness of circumstances that we pass through. It couldn’t make sense of our losses.

But my patient seemed to make sense of life, at least to me. In spite of her circumstance, I never saw a bad attitude. She never complained, though she certainly had reason. There was no feeling sorry for herself. In the midst of great pain, she pushed through with a smile. Over one hurdle, over another, she just kept climbing. While I was frustrated and tired from fighting on her behalf, she was just resting and trusting that God would care for her. She did want the medical care, she wanted help, but she knew that it wasn’t ultimate. She could rest in Him.

Too often I cannot rest. I am too busy fighting. I fight on behalf of my patients. I push to make the staff provide better care. I fight for the injustices I see all around. Sometimes I work as though I am holding up everything around me. Frustrations abound because I carry more than I am meant to. My grasp is a bit too tight. One day I will know better how and what to fight. One day I will know better how to rest in Him.

For this time, in spite of the struggles and frustrations, I have lost the battle on her behalf. Yet still she rests, now more completely than she ever has.

Wednesday, October 2, 2013

The Kindness of God in the Bitterness of Cancer

The greed of cancer. Taking position and strength from places it should never have gone. Invading bodily fields it was never given a right to enter. Growing and stealing from other organs without any regard to their welfare. 

Stupid cancer. 

Her belly had grown beyond the size of practically any that I had ever seen. It grew far beyond her pregnancy expectations. There was indeed a living child within. But it was getting squished and pushed more and more as the tumor grew. Eventually the child came, early, but healthy. However, the abdomen was still massive, as if many babies still rested inside.

She was a young woman, younger than me, pregnant with her fifth child. A doctor had seen the tumor in an ultrasound during the middle of pregnancy. Then, it was 7 inches in size. He stapled the report in her little booklet. But he never told her. After she delivered, she waited, wondering what was happening. There had been no change in the size of her belly even though the baby had come out. Six more weeks past. Her abdomen bulged beneath her ribs, hugely swollen, now many times it’s earlier size. The rest of her frame was like that of a refugee, frail and thin, making the protruding belly even more strangely alien. She began to have difficulty breathing, and came to our hospital for management. I was consulted since she was postpartum, at which time I found the ultrasound showing that not very long ago it was only a large, but reasonable sized mass from one of her ovaries. In only a short time, it had flourished, and now was overtaking the rest of her.

I made a plan, knowing that I was in over my head. If there were a specialist, I would have sent her to them. But there was none. The head general surgeon said that he agreed with the proposed surgery, and so we teamed up against the disease riddling the patients frail frame. The next day, too weak to move alone, she wrapped her arms around my neck as I helped to lift her off of the stretcher and onto the operating room table. Without the surgery, she would have been dead in a matter of days to weeks. With the surgery.. I couldn't know. Hope and fear were in my heart. Hope that though she obviously had an advanced cancer, that it would show itself to be a type that was treatable with chemotherapy. Fear, because decision making and surgical care for her were beyond my level of training. 

Two hours later, we closed up the abdomen. The length of the incision was almost like a jacket's zipper, running the full length from just below the chest to the pubic bone. Approximately 30 pounds of tumor had been rolled out of her abdomen, into my arms, and then dumped into a large bucket. As much other residual disease as possible had been dissected, adding to the final total weight.

She went to the ward. I went home. She uneasily rested. I worried. I prayed.

Next morning, she smiled. Finally she was able to breathe. By the next day she was walking with the assistance of a walker. She continued to improve. A set-back would come, but she would struggle through it. Better days kept coming.

I wish I could say that we were out of the woods. But we aren’t done yet. She could still die from this disease that has taken hold of her. It is likely an aggressive type. She has a long road ahead. I have done all that I can do surgically. Now she needs chemotherapy. I’ve transferred her to the care of another doctor for the drugs that she needs to help fight the cancer. Now, as her doctor, and as one who practices under the supervision of the Great Physician,  it is time to once again ask for the help of my Supervisor. He has guided us this far, and is still at work. But now my hands are done, I personally have nothing more that I can offer. It is time to kneel. Because He still has plenty that He can do. I pray that inside her – from every crevice that has a cancer cell attempting to gain ground to the deepest depths of her soul – He will work to restore all that is broken. Please pray with me. He loves to hear you pray, and He often moves His hands to heal in response to your requests. May He be glorified through this one frail, sweet woman’s life - for as long as He gives her to live. May she know the kindness of God, even in the midst of the trials and bitterness of cancer.