Day 11: Hour 264

Sweat droplets began forming along the creases in my forehead. For some reason, the heat seemed heavier this morning. In my mind, I pictured the snow that was likely blanketing my home back in Ohio. Conscious of the need to stay hydrated, I took a short gulp of water from the bottle I had tucked snugly into the side pocket of my backpack. The water came out quickly, some of it escaping onto the dusty concrete floor that supported the clinic.

The air was still and the sun was getting higher.

Kyle, Dr. Kubacki, and I sat in the exam room where we would see our patients. By now, we had developed somewhat of a routine. Breakfast, the drive to the clinic, gathering the patients around for our “discussion” time. All of this before heading to the exam room. It’s strange how even in a foreign environment we humans still grasp for routine. Today seemed no different than any other day.

I was wrong. Today would be different.

As soon as her exhausted form illuminated the corners of the exam room door, I knew she was sick. I instinctively put my water bottle away and pulled out my notebook, pen poised to write. Dr. Kubacki has a way of teaching that requires us to be ready at all times.

She could barely sit up straight on the bed. Her husband sat nearby, concern drenching his face as he began to dialogue with us. In Portuguese, he told us their story.

They had traveled 100 km on motorcycle to see us.

The road conditions likely made it feel twice that distance.

She was 39. She looked 60. Her thin frame appeared as if a small gust of wind would have the power to overtake her. Seven months ago, she began to experience abdominal pain. At the same time, she stopped having menstrual periods and started to experience fatigue along with trouble urinating.

It was getting warmer in the clinic. I reached up to wipe away the sweat from my eyes.

We gently laid her back on the exam table to take a look at her abdomen under ultrasound. It was Kyle’s turn. Together, we pulled out and prepared the machine. She looked so tired. When Kyle placed the probe over her right ribs, a dark cystic mass stared ominously back at us from the region of her kidney. We then moved to check her other kidney and found the same thing. By now, she had fallen asleep on the table, her shallow breaths exhaling noisily.

More sweat in my eyes.

Hydronephrosis refers to an engorgement of the kidney reservoirs and it usually occurs due to an obstruction somewhere along the urinary tract.

“But where is the obstruction?” I asked aloud.

As soon as the question left my lips, my heart sank. Dr. Kubacki stood behind in deep concentration and directed Kyle to move the probe to the bladder. He obeyed.

Where the bladder should have been, we didn’t see any bladder. Just a large solid cancerous tumour that consumed almost the entire ultrasound field. I was stunned. We sat. I listened as Dr. Kubacki calmly and compassionately gave them the news.

She was going to die.

And there was really nothing we could do to stop it. Due to her neurologic symptoms, he speculated that she possibly had brain metastasis on top of it. Surgery is always an option but at most it might increase her lifespan by 10-12 months. However, to even get the surgery, this couple would have to find a way to make the 10-hour drive to Lubango. Likely spending their life’s savings in the process.

I quietly set my notebook down on the table behind me.

Schistosoma haematobium is a blood-borne parasite that is contracted through contaminated water. If it makes it’s way to the bladder, it causes longstanding inflammation which can eventually produce bladder cancer. This takes place over the course of decades.

She most likely contracted it when she was a little girl. And the initial infection could have been treated with one medication.

Dr. Kubacki dialogued further with the couple, explaining that it would be best for them to go back to their village and spend the remaining months she had with each other and their family. She was trying to sit up now, her face communicating nothing but exhaustion. Her husband still wore the same expression of concern, now mingled with an unmistakable sadness and resignation.

I reached up to wipe the sweat that had mixed with tears from my eyes.

Before they left, Dr. Kubacki put his hand on her shoulder and offered to pray for them. We bowed our heads as he prayed. I couldn’t understand everything he was praying since it was in Portuguese.

There are so many things I don’t understand. Today I encountered impending death in the eyes of a young woman. And it bothered me deeply.

I was hit with a flashback to yesterday morning. Dr. Kubacki shared the story of Lazarus with the patients that had gathered around before we began clinic. Lazarus had been dead for days when Jesus arrived. Everybody was mourning his passing.

Death robs. It steals those precious people away from us. Those people that we need.

And when Jesus arrives, He doesn’t act the way we would expect God to act. Jesus knows what is coming. He knows that Lazarus will walk again. But instead of parading down in majestic confidence…

Jesus kneels down. And weeps.

The death and and suffering that we experience deeply bothers our Creator. I don’t believe Jesus was only mourning the loss of Lazarus. He was embracing the heavy sorrow that accompanies humanity. Our tears move His heart. And He enters the scene as one of us, to walk with us, to weep with us, to heal us. Whether in this life or the next.

As I rested my head in the crease of my elbow in this humid African clinic and listened to a doctor pray softly with a woman who has months to live, I faltered under the stiffening reality of life and death.

“To selflessly care for one suffering is equally as beautiful as to suffer well.” – Dr. Kubacki

I know this is really heavy…my goal is not to depress you! There are so many light and happy moments that I am experiencing here in Angola (and I am learning so many amazing things). Truly, the challenge for me is deciding what NOT to write about.

My bottom line? I want to share with you the deep moments. The ones that perhaps may resonate with you in fresh ways. The moments that might lend themselves to opening up our eyes to the millions of precious people who live around the world.

To get you to think and to feel.

Also, today I tried to write in more of a story format because I truly believe that we as humans resonate with story. It engages our minds and our hearts. It pulls us in and forces us to wrestle. And that is good for all of us.