22 Jan 23

As is so often the case here, the scars showed the location of the patient’s pain before he said anything. All over the 6 year old’s swollen abdomen, small groups of a few linear marks cut parallel to each other showed that traditional treatments had already been attempted for his abdominal pain. The pile of lab and imaging results and pharmacy receipts that his father pulled out of a worn Manila envelope showed that he had "done the tour" of all of the centers of western medicine available to him, too. Blood tests, ultrasound, CT scan. What could be left that we could possibly have access to here that he hadn’t already done?
I could at least interpret his results for him, in case he hadn’t understood the diagnosis given after all the tests in the capital. The CT scan and ultrasound reads agreed, kidney tumor, likely nephroblastoma with metastasis to his liver. Stage 4-5 cancer. Had he seen an oncologist? Had they offered chemotherapy? A surgical solution alone wouldn’t be a solution, I explained. We couldn’t take out both of his kidneys and liver in a place without dialysis. And even if we did, without chemo and/or radiation, the tumors would come back. The most common childhood abdominal cancer. Up to 90% survival rate with modern medical care. A 10% survival rate 50 years ago. In Chad we’re living at least 50 years ago as far as cancer management. I explained the diagnosis and the limitations to what could be done curatively without chemo or radiation. We couldn’t get rid of his cancer with the resources we had available. The father looked me in the eyes and thanked me. The other doctors had all hedged and talked around the diagnosis and refused to give him a straight answer. Now he had the information he needed. It was in God’s hands, he said.

Sometimes we don’t get to see our patients healed—to "fix" them. Sometimes our job is to stop doing harm, to release them from throwing all of their time and resources into a sometimes painful endless search for answers or operations or magic pills. Sometimes our patients are grateful just for honesty, for a willingness to sit in that painful realization with them when we admit that our best efforts won’t cure them. When we admit that their ultimate outcome isn’t in our hands and point them to the only Physician who can really claim that power. As our patients like to say, Inshallah.