The Burden

by carlocmd

she was 40 years young, a single mother, admitted for evaluation of an enlarging abdomen.

she worked as a call-center agent to provide for the needs of her son. her husband had long ago left her for another woman. her son appeared weak, and a thorough evaluation showed he had a hole in his heart. she had been saving for the operation to close the hole, and would achieve her financial goals by december. she was cheerful, light-hearted, and happy with a faith buoyed by her mother and the community where she belonged.

then, for some unknown reason a month ago, her tummy began to grow bigger. her gynecologist did a transvaginal ultrasound. she had a lot of water inside the abdomen. her female organs were normal. her liver and kidneys were normal. her heart was normal. she was told to consult an internist because they couldn’t figure out why she was getting bigger with all that water inside.

within 24 hours of admission, she underwent an abdominal tap. we talked about tuberculosis as a possibility because she received treatment for this some years ago. we spoke of tuberculosis as a great mimic, having seen some cases that appeared to be cancer, but eventually turned out to be tuberculosis. we broached the idea of cancer, saying that as her physicians, we would always tend to think of the worst conditions first. this to make sure we do not miss anything in the evaluation.

but she continued to deteriorate. the abdominal tap findings pointed to the possibility of tuberculosis, nephrotic syndrome… or cancer.

after clearance from her nephrologist, she underwent a CT scan of the abdomen. aside from the water, there now appeared several lesions in the liver. there were a few enlarged lymph nodes in the abdominal cavity… consistent with a granulomatous infection like tuberculosis… versus a cancer of unknown primary.

we dialogued with the family, explaining our findings and our thoughts. we expressed our unease with not knowing what is happening. we recommended a biopsy be done of the new liver lesions, for lack of a more obvious target.

she began asking for more pain medicines. she began to lose appetite. she began to waste before our eyes despite nutritional support.

it was her birthday when the biopsy report came out. it was a mucinous cancer. various immunostains could not pinpoint its origin with confidence. it was not likely from her ovaries. it probably came from the bile ducts, the pancreas, the breast, the stomach… organs that did not appear abnormal in the scans.

the news hit her hard. she cried and grieved for herself and her son most of all. i cried with her, twisting my hands in frustration at being unable do anything beyond what we had done so far. without a primary, we were preparing to treat her with everything we had. like bringing a shotgun to a fight, aiming in the dark at an unrecognized enemy, hoping for a hit, with a real chance of hurting instead of helping.

although she did not voice it out, i asked heaven why so many bad things happened to such a gentle soul.

i said that God did not give us problems He knows we couldn’t handle.

she smiled despite her pain. but i felt like a callous fool for saying it. this was the story of present day Job, with me as a witness.

“no more,” she began. “i would like to go home. i would like to hold my son and tell him i love him.”

she went home today. we said our goodbyes. she thanked me for the care, and shushed me when i started telling her how sorry i was that we could not do more.

it is not our place to question why things turn out the way they do. but i questioned relentlessly nonetheless. i railed and stormed and raged at the unfairness of it. i spent many sleepless nights, tossing and turning, trying to find something we had missed, something that had gone wrong.

so i write this… in deep pain… my heart in torment… my mind in shambles… my faith shaken… to lift her up… to claim help for her and her son as she carries this burden…

there is power in prayer, dear reader. when two or more gather, will not our petitions be heard? with a million of us, in communion with each other, praying together, asking that if there is still good to come out of this, may the good happen today?

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