by Bram Geller, SOM ’11
Honorable Mention 2009 Gerald F. Berlin Creative Writing Award
I looked back from our van as we drove down unmarked dirt roads, and I smiled to myself as I watched the familiar sight of children chasing our car. I had no idea where we were going, and neither did the children, but they would chase us until their legs got tired, just for the thrill of running. I was on my way to visit a man who was on a sort of hospice, somewhere in central Malawi. The man lives in a small village about an hour’s drive from the nearest paved road, isolated from any town or outside influence. In the late 1990s the man was diagnosed with HIV, and in 2000 a tumor began to grow over his right eye. He has been on antiretroviral drugs for a few years; these have controlled the HIV’s progression, but not the tumors.
The tumor is now the size of a loaf of bread and extends throughout the right side of his face and neck. The skin over the tumor oozes blood and fluid, and is covered with a makeshift dressing. The dressing, like everything else in this part of the world, is coated with a thin layer of dust. Trying to keep the wound clean is a real challenge. The patient was told years ago, during a visit to the district hospital, that there is nothing doctors could do for him. He now lies on a ‘mattress’ in a one-room hut with no electricity, no bathroom, and not much in the way of material possessions. The entrance to the hut was covered with a rapidly deteriorating green fabric, and except for dirty clothes and some cooking utensils, the hut was bare. The hut’s mud walls and thatched roof seem to keep in the odor, heat and bugs. The air was thick, as if the sweaty smell and circulating flies were not a big enough barrier to breathing normally.
The patient takes nine morphine pills twice a day. The medication is supplied by a local NGO with international funding, and no local governmental support. The patient is now too weak to move, and too weak to speak above a faint whisper. Since speaking is difficult, he communicates largely with tiny facial expressions and eye movements (on the left side). His wife and children left him when he could no longer provide for them. He is cared for by his mother; except for occasional visits by this NGO, he receives no medical care. I was told he eats something, but it’s not much and doesn’t seem like enough to sustain him. His body was covered by a blanket to comfort him despite the warm weather, but his face conveyed an unimaginable pain. At first I was in awe of the size of his tumor, but after some time I shifted my attention from what most people would describe as a grotesque and inhuman growth, to his left eye.
I gazed into his eye and felt some kind of connection. We had an understanding, even though I could never claim to begin to understand how he feels. Unlike most villagers he wasn’t awestruck by the white color of my skin, but instead we interacted on a basic human level. A level removed from race, money, and status, but a level based on what brings us together, our human nature.
I took his hand in mine. His hand was lifeless and limp, while at the same time powerful and moving in what his hand communicated. His fingers were frail, and it was clear he had no muscle strength left to support his own arm. At first I was frustrated that I couldn’t speak to him, but even if I did know the local language, or he knew English, what would I say? I began to be grateful we didn’t share a spoken language, because it allowed us to share something stronger. I held his hand and could see in his eye that my touch meant something. I tried to channel strength and compassion in that touch, and I could feel in the small movement of his fingers, and his weak grasp of my hand, he was receiving it.
I don’t know what human suffering really means. People are suffering all over the world, and people are suffering in US hospitals everyday, but this was another kind of suffering. This suffering was less guarded, and less hopeful. He is hopeless to ever get better, and hopeless to ever be comfortable or pain free. He is hopeless to feel settled in his heart, and hopeless to hope. I was able to give him something through my touch, but he certainly gave me so much more. He’s 34 and will die any day.
In meeting this patient, I learned more than lessons in suffering and the plight of countries plagued by HIV, hunger, and war. The most valuable lesson I learned was that I can make a difference. I happen to be a medical student, but I didn’t need to be involved in healthcare to make a difference. I just needed to be willing and compassionate. Years of medical education can’t teach someone either of these qualities; they are things we must foster in ourselves. While I work on developing these qualities in myself, I hope they will spread to others. There is so much suffering in the world, but a little compassion can go a long way. It’s something none of us can afford to forgo.