I saw a patient a few weeks ago who has really stuck in my mind.
Sean is 31, a gentle, kind person. Amy, his wife, looks like a kid to me. They have been married for only three years.
Sean started having pain in his left leg in October. Strange, because he hadn’t injured it, but it got worse and worse. Finally, he couldn’t sleep, and it was difficult to walk. He decided to get it looked at.
He brought the X-ray to us several weeks ago. Certain X-rays give you the chills. A poorly defined hole in his tibia, just above the knee. Ragged edges, hard to say where it began and ended. The thick walls of the bone eroded from the inside out. X-ray experts, the radiologists, call this a permeative lytic lesion. In all but the luckiest of circumstances, this equals cancer.
The only way forward is to get answers, a biopsy. This is a surgery, where we take a piece of the tissue and surrounding bone, and send it to the lab, where the pathologist looks at it under the microscope. We got his report back, and asked him to come in to the clinic to discuss the results.
His pathology report was grim. Sarcomas are a rare form of cancer. In orthopaedic surgery, in the US, a surgeon would see a few in his or her career. Here at Kijabe, we see several a month. All sarcomas are cancerous, and most require amputation of the affected limb, as well as chemotherapy and radiation therapy. Survival rates are not high for some sarcomas. This is among the worst I have ever seen: a high grade, very malignant cancer. My gut feeling is that he has several months to live. I would love to be wrong.
There is no good way to give a person bad news. As I looked at this young couple, I had information in my head which I knew would devastate them. I wished I could just make it go away, just not tell them. But the horrible truth was real, was in their world, they just didn’t know it yet.
A trivial analogy: When Ann and I were first married, Ann moved from her beloved Ireland to Bend, Oregon, USA. Nothing could have been more foreign to her: long chats over a cup of tea were replaced by bragging over a long run or epic ski session. She felt isolated, alone, a foreigner.
Bucci was a mutt Border Collie mix, the most gentle, quirky, loving dog you can imagine. My beautiful old yellow lab, Betsy, had died, and Ann had gotten Bucci from the Humane Society to ease my grief. It worked! Though I’ll never forget Betsy, Bucci was comic relief, an insanely smart and nutty little rascal. Amazingly, Bucci also eased Ann’s transition to life in the US. He was her constant companion, easing her loneliness as she adjusted to West Coast culture after living in Africa and Ireland her entire life. He became our “fist born”, a beloved member of the family, before we ever had children.
My mom was sick with cancer at the time, and we went down to Florida to visit her. We put Bucci up at a doggie resort, where dogs could play all day and rest comfortably in their quarters at night. We were so infatuated with this little dog, that we missed him and decided to check in with the kennel owners from Florida. Cell signal was poor on the little island where my mom lived, so we had to stroll down a sandy lane as I rang the kennel.
“Hi, it’s Mike Mara, just calling to check on Bucci.” “Oh, sorry to tell you, he jumped the fence, got hit by a car, and died yesterday. We were going to call you.”
Shock. Grief. Then the realization that I had this devastating news in my head, and Ann, walking by my side, did not.
I remember wishing I could just keep the news inside my head. By speaking it out, it becomes a reality, causes shock, harm, pain, suffering.
As I said, a trivial example. A dog versus a man, a son, a husband, maybe someday a father. I’m not comparing the two situations. Just the idea that you wish some things didn’t have to be said.
Of course, the reality pre-exists the knowledge. Sean had cancer before we did the biopsy, before the biopsy result came back, before he or I knew he had cancer. But the devastating news doesn’t enter his reality until I speak it to him.
As I spoke the grim news to him, I could see that I wasn’t getting through. My swahili is poor, but his English was excellent, so I couldn’t figure out quite what was wrong. I asked one of our Kenyan residents to come in and try to help me communicate this news.
It turns out, the word cancer can be interpreted different ways here in Kenya. It isn’t quite as clear as I would have thought. We had to carefully and painfully explain that the problem in his leg had the potential to spread to his lungs, his brain, other bones. That it could shorten his life. That treatment would involve chemotherapy, maybe radiation therapy, and amputation. Cruelly, the only way amputation would not be necessary was if he had such a short time to live that amputation would not be helpful.
How does a young couple receive such devastating news? I can’t imagine. I wish I didn’t have to.
We made practical steps. I phoned a colleague who had connections with a top oncologist in Nairobi, one who welcomed Kijabe patients regardless of ability to pay. I wrote a referral letter, and carefully explained to them what the next steps would be.
Then, with the practical matters addressed, the real issues sit before us. A young, recently married couple, dreams of a life and family together, cataclysmically interrupted by a visit to the clinic.
We sat together for a few moments. His head on the examination table, cradled in his arms, crutches by his side. Her crumpled over, wide eyed and disbelieving.
We prayed. Together. We prayed for healing, for strength, for Amy to be a strong support as Sean went through treatment. We prayed for Sean, that he would be healed, whether miraculously, which is rare, or through surgery, chemo, and radiation therapy. Almost equally as rare. We prayed because that is all we could do, to turn to a compassionate God who watches and suffers with His children.
I don’t know what will happen to Sean, or Amy. But they know they are loved, by the staff at Kijabe, by a God who suffers with them, by a God who knows suffering. I am grateful to serve at a place where prayer, love, compassion, and kindness are expected, not mocked. Please join me in praying for them over these next few months.