Script and Scalpel

In my short career as a physician I have offered to pray with countless patients.  I remember feeling a bit apprehensive about this in my early years of medical training.  Would he be offended?  Might she say ‘no’?  What if a nurse (or worse yet, my preceptor) walked in while I was praying with a patient?  But very quickly, those moments of solitude and connection with patients and their families became my own refuge.  I would look forward to opportunities to provide this gift of prayer to those who desired comfort and peace in some of the most lonesome days of their lives.  And since that very first day that I, a timid medical student, sat at the bedside of a terminal patient and prayed a quiet prayer, not one patient or family member has ever declined my offer.  I believe there’s a message there!  Particularly in the medical world, prayer opens doors and creates a space that is safe, accepting, whole and impartial.  Prayer allows for the most unique opportunity to commune with the One who makes all things new, whether in body or spirit.  Now that I’ve transitioned into this life of medical service in a mission hospital  you’d be correct to assume that the opportunities to pray with patients are countless and precious.  My challenge at the start was to learn how to pray in a new language and meaningfully express what I could easily articulate in my own language.  I still find myself paying close attention during prayers in church or when I’m working with one of our hospital chaplains as they comfort a patient.  There are certainly times when my Tok Pisin words are not enough, but thankfully, God hears prayers in all languages, including those of the heart.  In the last two weeks it seems that I’ve encountered some of my more sweet moments of connection with patients and I hope that these glimpses into my clinic exam room will serve as a reminder to pray for our work in the hospital as we minister to both the physical and spiritual needs of our patients.

Maria came to my clinic room with her son one morning.  As she entered the room, I hoped that she might share that she was here for an antenatal visit.  Unfortunately, this was not the case.  She was not pregnant.  For several months now she had slowly been accumulating fluid in her abdominal cavity and she also complained of right-sided pain.  She had been seen in several other medical facilities and at the last hospital where she was evaluated, she was told she likely had abdominal tuberculosis.  As I heard her story and examined her full-term-sized abdomen, the diagnosis of abdominal tuberculosis rose to the top of my differential diagnosis.  However, as I got her comfortable on the ultrasound table and moved the probe over her right-upper quadrant, the abnormal appearance of her liver suggested that her diagnosis was unlikely Tb and more likely chronic liver disease.  I had hoped it was tuberculosis, because we have treatments for this very prevalent disease.  Chronic liver disease in this middle-aged woman will come with many doctor visits and likely hospitalizations as well.  She’ll be on diuretic medications for the rest of her life and eventually this disease will likely claim her life.  I prayed with Maria that morning after sharing this news with her.  I prayed a prayer that I pray with most every patient.  “Papa God, stap klostu Maria. (Father, be near Maria.)”  In my own heartache and desperation, I’ve found that closeness and communion with my God is the only thing that brings peace beyond measure.

Nenspe is a sweet old papa who was led into my exam room by his two adult children.  He used his bamboo walking stick to lower himself onto the chair.  Nenspe’s daughter shared his story. For two months he’s been having increasing difficulty swallowing.  At first it was hard to swallow rice and kaukau, but now water won’t seem to stay down either.  He vomits after most meals and says food seems to get stuck in his chest.  He has been losing weight and can hardly climb small hills, let alone the mountains that he could easily manage before.  The rest of his story, my exam, and his chest x-ray confirmed what seemed most likely from the start.  Nenspe most certainly has esophageal cancer.  His children were realistic about his diagnosis and his daughter even said that Nenspe himself felt certain he had cancer.  I referred him to a nearby hospital for a barium swallow study to help confirm the diagnosis and I prescribed some mild pain medication.  The family is Lutheran and Nenspe has given his life to the Lord.  His son, who was present, is a pastor and felt so privileged that I would offer to pray with them.  They all prayed aloud with me and I believe the Lord heard our prayers and will answer our request for peace that passes understanding.  I asked if I could take a photo of Nenspe to share with my family and friends who will also be praying for him.  I’m grateful for the lack of privacy laws in PNG that in any developed nation would prevent me from sharing these stories and photos.  This family was thrilled to know that others would pray as well.  After I took their picture, Nenspe’s son insisted that I get in the photo as well so that he could take one with his phone and share it with their village.  Nenspe knows that this cancer will claim his life one day, but he testified that God claimed him first, so he’ll rest easy in that promise.  What a beautiful story of the surrendered life!

Matlyn was especially quiet as she made her way into my room with her grown daughter and brother. As I asked about her symptoms and what brought her to Kudjip that day, her daughter asked if she could tell the story for her mom.  About seven months ago, Matlyn felt a small lump in her tongue.  She ignored it at first because it was small and not all that bothersome.  But over the last few months her tongue has become more sore, firm and now she can hardly talk or swallow.  As I listened, I wondered to myself what I would find when I donned my gloves and asked her to open her mouth.  The few times that Matlyn spoke were mumbled and she had difficulty controlling her saliva.  My exam revealed what I feared…advanced tongue cancer.  The entire right side of her tongue was a solid mass which had grown into the soft tissues below, tightly tethering it.  She could not move her tongue more than a centimeter at the very tip. Unfortunately, Matlyn was not from our province and any biopsy or treatment (which was unlikely) would have to be done at the next provincial hospital. Her prognosis is dismal, but once again, I was allowed to enter into a beautiful time of prayer with this family.  As I began to pray, the daughter asked if she could share one more thing.  Matlyn is a mother of eight children, but only five are now living. Matlyn’s oldest daughter proceeded to share that Matlyn’s 17-month-old daughter passed away last week after complications from tuberculosis.  I could hardly contain my sadness as I allowed this piece of news to sink in.  In those moments, I prayed for God’s infinite grace to settle over this family and for His spirit to comfort the deepest reaches of their souls.  And what a blessing to know that those words are not empty, nor do they fall on deaf ears.  In this place, where death and tragedy are daily occurrences, I often remind patients (and myself) that God does not promise to bring complete and miraculous physical healing (although He is able), but he DOES promise to abide with us and weather the storm with our hand tightly grasped in His.  The storm may rage around us and threaten to swallow us, but our God remains a firm foundation, the hearer of our prayers.