Today has been one of the rainiest days since I arrived at Tenwek. It was raining when I walked to work this morning, raining as I traveled home for lunch, and raining as the day came to a close. And did I mention that it was also raining in between? Fitting weather to match my mood after a tough week.
One of the reasons I love the field of urology is that there are many conditions which are very well treated, bringing about significant improvements in quality of life. In addition, most patients recover completely without major complications. But most medical specialties at one time or another have to deal with some difficult, incurable diseases. Urology is no different.
Today, for the second time this week, I crossed paths with a patient suffering from a very unfortunate illness. These two almost identical cases left me with a heavy heart from not having the answer to my own question of “why?” Both of these patients were young Kenyan men in their early fourties. Both had initially presented to outside medical facilities with pain in the side of the abdomen. As with many patients at Tenwek, both of them had come to this referral center for a second opinion, hoping for a more encouraging prognosis than they had been given previously. Sadly, both of them had unresectable, incurable, cancerous growths in the kidney.
Metastatic, inoperative diseases are not new to me. In my young career as I urologist, even before practicing in Kenya, I have cared for patients with disseminated cancers of almost every urologic type. The disease processes are not so different here. The circumstances are.
In the states, most patients are able to find exceptional care and seemingly unlimited resources within a short drive. And for patients who deem the closest facilities unsuitable (which would epitomize the term “relative”), there are a number of internationally renown centers that specialize in cancer management. Services for patients with metastatic cancer include hospice centers, access to the latest chemotherapeutic drugs and high-tech radiation therapies, free enrollment into clinical trials testing novel treatments, and myriad analgesic medications to ensure pain-free disease progression. Not so here.
To its credit, I will say that Tenwek Hospital does a wonderful job involving chaplains and hospice personnel in the care of terminally ill patients. And I really don’t think that there are many, if any, places in Kenya where patients can get the degree of surgical care that is provided here. But as a whole, palliative options for patients with metastatic cancers are limited.
So back to my patient today. A young man and his brother had made the four hour trip from Nairobi to the western highlands with a glimmer of hope. Before introducing me to these two gentlemen, my resident (PAACS general surgery trainee) sat me down to review the patient’s CT scan. What I had originally heard was that the patient simply had a tumor of the kidney, which I felt confident could be resected. But as we scrolled through the images, I saw the cancer in his lung and spine. Unresectable.
My medical tool box seemed so feeble compared to what I had known in the states – no chemotherapy to discuss, no contact information to provide on hospice centers, no clinical trials in which to enroll the patient, no specialized pain clinic to refer the patient to when his spinal tumor becomes symptomatic. Just a sinking feeling from being the one to extinguish his flame of hope.
Parenthetically, urologists in training in the states learn very early in residency about the “too late triad” (Google it if you’re interested). The “triad” portion of this phrase describes three symptoms that can accompany patients with kidney cancers: flank pain, blood in the urine, and a palpable abdominal mass. The “too late” part implies that if a patient presents with these three findings, it is almost always too late to provide a cure.
“How can anything good come out of this visit?” I thought to myself as I concluded my explanation of his disease and its prognosis. I inquired about his family, his social support, and his faith. The encouraging news was that he was a follower of Christ. The discouraging news was that he had a wife and young children who would soon learn the details of his prognosis.
I did the only thing that I know to do in a moment like this. I asked if I could pray for him. It’s difficult to describe the humility and deep dependence on the Lord that are felt when the eternal intersects the temporal in this way. I certainly don’t deserve to be part of such an encounter, but whatever His reasons, the Lord has given me these opportunities.
Asking God to do the communicating, I put my hand on his shoulder and began to pray. During my pauses, as I waited for the resident to translate to the patient in Swahili, I began to discern the subtle sniffles. Seeing tears on a Kenyan face is a very rare occurrence, and in this moment I realized that my patient was broken. Perhaps it was discouragement from his prognosis. Perhaps is was fear of the unknown symptoms yet to come. Perhaps it was the weight of having to convey the news to his wife and children. “Lord,” I thought, “in a people who are already broken from so many other challenges in life, why more breaking?” My hope is that his tears were overflowing emotion from knowing that “the Lord is close to the broken-hearted and saves those who are crushed in spirit.”
I reflected back on our encounter, where for a few minutes time seemed to stand still, and the Lord reminded me of Tenwek’s motto … “We treat, Jesus heals.” My patient will be healed. Not because he underwent extensive surgery and not because I could offer him some new chemotherapeutic agent. Rather, he will be healed because he knows Jesus. Whether on this side of eternity or the other, a cure lies ahead. Satan may hand us the “too late triad.” And to that I say Satan, here’s the “never too late triad” – Father, Son, and Holy Spirit.
As a doctor on the mission field, it helps to remind myself that when the dust settles at the end of the day or at the end of a life, Jesus heals those who have put their faith in him. Please pray that as we direct our efforts toward curing earthly diseases, we will always remind patients of the hope that can be found in the one who offers eternal healing, and that those who do not yet know the Healer will know Him soon and know Him well.