Ups and Downs

I've found that every day in palliative care is different and it's never all a good day or all a bad day. It's always both. We may do one visit where everyone is happy and then the next family we visit is grieving. Emotionally it's up and down, up and down. Today was like that.

We had two new patients referred to us last week so we visited them both today. The first visit is never good and I don't look forward to them. Our first visit of the morning was to Mary. She is a 24 year old with retinoblastoma (a cancer in the eye). She is from another county on the border of Cote D'Ivoire far from Monrovia and had come with her uncle and mother seeking treatment. She has been here five months and away from her two children who are 9 and 6.

Driving out to where she is staying was a new experience for me as it was out in the countryside. Liberia is actually a very beautiful country once you get out of the congestion and poverty of the city. There are mountains, lots of green trees (they call it the bush - we call it woods) - coming over the top of a hill and looking out over miles of green and mountains was amazing to witness. So far I had only experienced the congestion of a city of 1.5 million people.

We arrived at the village where Mary was staying and it was lots of mud and stick houses, big shade trees and, of course, lots of kids. We spent about an hour with her and her family and it was really hard. We are always the ones who have to tell them that there is no treatment for what they have and that the disease will worsen until their body gives up. There were a lot of tears from Mary and her mother.

They will be leaving on Friday to return home so we will visit again on Wednesday to bring more pain medicine and dressings for her wound. We also took a family photo so they will have a remembrance of Mary. I don't think she has long to live - she is stick thin and has pain throughout her body so it's probably metastized to other areas from the eye. Here is a photo of Mary with her mother and her two uncles.

I've posted before about this culture and their grieving process. Today I noticed something else. Whenever anyone cries, the men always tell them in harsh words to stop crying. I don't know why they do this. God made our tears for a purpose. Fortunately, no one listened to them.

We left the family and made our way to the next person who is also new. Her name is Martha and her husband met us to show us the way to the house. It was also a new area of Monrovia that I hadn't seen. We had to park a little ways from the house and then hike over a small, rocky path. Here is the view from the path.

This last photo shows the ocean in the background as well as a large burned out building that used to be the Defense Ministry building. It's a sad reminder of the war. You can also see in the forefront of this picture the framing of a new house being built. Unfortunately, all of the people who live in this area are squatters (they don't own the land - they just put up a house on someone elses land). Our translator told us the government eventually would kick all of these people out of their houses and tear down the buildings.

We made it to Martha's house and it was a deja vu from our visit to Mary. We had the same words to say - there is no treatment and your body will eventually give up. Martha was there with her husband and three of her sisters. Again, there were lots of tears from the women. And again harsh words from the men to stop crying. At times, it was a surreal experience. While these women were wailing, one of the sisters pulled a live chicken out of a sack she had been holding (because it kept squawking) and just held it by it's legs while she cried. I'm glad she did since the chicken moving excitedly around inside the sack was really distracting.

Martha has two children who are 19 and 13. They sent the 13 year old boy away to a mission school because he would cry when he saw his mom's wound on her face. When we were ready to leave, Martha asked us if we would take her children and care for them when she was gone. It was heartbreaking to say no (Jean said it, I didn't).

We didn't offer to take a family photo - Martha has a big, open gaping wound and a pretty distorted face from the tumor growing. I'm not sure if we will offer in the future when there isn't so much crying.

Our last two visits of the day were the good parts. We spent our usual time with Candy who continues to feel fine although she has lost quite a bit of weight. We have finally figured out a pain medication protocol that works so her wound care isn't very painful. She was smiling today.

We ended with a quick stop at Gracie's house. I haven't talked about her before, I don't think. She is 13 years old and has lots of growths around her neck and face. She was referred to palliative care many months ago because the doctors believed what she had was malignant. We finally had a biopsy done on her last week and, great news, it's not cancer...it's TB. I only thought TB manifested itself in the lungs but it can actually attack any area of the body. In her case, it looks like small tumors. And the even better news is that TB can actually be treated here in Liberia!

So we will be taking her to the TB clinic tomorrow to get her started on the medication - she will have to take it everyday at the same time for at least six months. I'm hoping the growths start to reduce right away so she doesn't have to wear her scarf around her head and neck everyday. Here's a photo of Gracie - she is beautiful!

The day ended with another going away party. Last night we had a going away party for my roommate Joy who left today. Tonight we had a going away party for my friend Gea who is leaving Wednesday. Thursday we will have a going away party for my roommate Amber who leaves Friday. There are an unbelievable number of good-byes in both my job and on the ship.

Peace,
Michele