15 July 2014

Where There Is No Hospice

**I wrote this post over a month ago, but couldn't bring myself to finish it, let alone publish it.  I have detailed heavier cases . . . shared events I find more devastating.  But for some reason, this was just too difficult at the time.  It's happened before, just doesn't usually take a month to process.**

Our Little Girl of Peace passed away early Thursday morning.  Her burns were just too severe for her little body.  And her battle was over.  We just don't have the resources here to change certain outcomes.

That afternoon I sat next next to a mom who was cradling her frail child.  Pressed against her mother's chest, this precious one looked to be four, maybe five years old.  Her skin hung from her boney frame, eyes hollow and deep.  AIDS had ravaged her little body . . . malnourished and weak, the doctor admitted her, hoping to do something to ease her suffering, but recognizing the prognosis wasn't good.

On Friday, our last patient of the day presented to the gym with an atypical concoction of symptoms.  'Stroke' had been listed, but it became quickly apparent that the history I was getting was not what had been given to the doctor.  And as I transferred M. from the wheelchair to the treatment mat, the back of my hand, which was sandwiched between her left arm and her chest, could feel the enormous mass in her breast.

What started off as a localized cancer, had spread to her brain causing her potpourris of symptoms.  A quick chat back with the doctor--there wasn't much we could do.

My first thought as M. was wheeled through the door of the gym, was that she would have made a great WNBA star!  She was quite tall, and the wasting evidenced in her arms and face indicated that she had once been very strong and very beautiful.

But the cancer had taken over . . . her brain lost its ability to effectively communicate with her limbs, she had great difficulty speaking, and she was here as a very last hope.

Her family had taken her to other hospitals in her own country to the south.  But no one had any answers for her.  She had been vomiting up everything she ate or drank for two weeks and I sensed she was running out of her will to fight.

The more I listened to her hodgepodge of symptoms, the more clear it became that by being in the gym she was in the wrong place.  We weren't going to be able to help her until the cancer was addressed . . . and the cancer was so advance our options were: hydration, nutrition and (some) pain management.

 In the West, there is an expectation that hospitals function in order to save a vast majority of the sick and dying.  We have ambulances that bring people to Emergency Rooms and Intensive Care Units chirping with expensive monitors and life-support machines.  We have fancy diagnostic technology and a highly trained army of experts fighting to do all that is possible.

And then, on those occasions when a diagnosis is just too strong and a patient has fought her last battle, we have hospice.  Specialized pain-management . . . specialized care for when the burden of disease is just too much . . . specialized services to hold a family's hand through deep sorrow.

It took me two years after moving to Niger to come to terms with the reality that our hospital does not exist to heal everyone who comes through our doors.  We save those we can . . . we tend to as many as possible . . . and we do make a difference.

But the reality is, when women like M. show up in my gym, it's not the faces of those we've helped that parade through my mind, but the flood of those we sent home to die . . . and those who never made it out of their hospital bed.

There is a struggle that doesn't seem to go away . . . the struggle between what is seen and what is unseen.  The struggle to determine what is for us to heal and what is beyond our capabilities.  To know when Best Practice means we stop and pray . . . to tell a patient and her family that where our efforts end, there is One who is in the business of miracles.  And that while we can offer little in terms of pain relief, He offers a peace that eases the deep suffering of the soul and makes sense of what we cannot understand.

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