Saturday, February 1, 2014

How much is ONE worth?

When I was still a medical student shadowing “real doctors” around, there was a moment when I realized that as medical professionals, we hold a strange and uncomfortable power.  I first realized it moments before my attending physician told a man that he had cancer.  From the time we walked into the room until the moment he spoke those deafening words, I realized that we held this piece of information that would change him forever.  I also realized that we had to decide the right moment to deliver this news.  I remember that I kept thinking, “Just give him one more minute, one more minute of blissful unawareness.”

Unfortunately, this same type of unwelcomed power exists here in Togo as well, although in a tragically different way.  One must understand that the majority of cases we see here in Togo are illnesses that we have in the US as well (aside from things like malaria and a few others).  There are two major differences though: the advanced stage at which they present to us, and the availability of treatment for those illnesses.  For example: we currently have several children that have come recently with advanced cancer.  Since we don’t have a pathology lab, we sent our biopsies to the US to be read.  This process takes at least two weeks.  In the mean time, we have to decide whether or not to start treatment.  If we start treatment, but the result comes back with a type of cancer that we cannot help, we have wasted several precious vials of chemotherapy that we may need for another child in the future.  If we do nothing, and wait for the result, the patient may not survive until then.  We must make a choice.  Treating one child may prove to be the death sentence for another, when there isn’t enough chemotherapy to go around.  What do you do?

I walked into OB clinic the other day and saw a woman on the table who appeared to be carrying triplets at term.  I quickly found out that she was only 17 weeks pregnant (with 3 other children at home) and all that abdominal swelling was ascites (fluid in the abdomen that accumulates usually when your liver no longer functions well).   Due to past experiences here I said, “She has Hepatitis B”—an illness rarely seen in the US thanks to vaccinations.  The diagnosis was confirmed later that day and I sat talking with our OB doctor about the horrors of Hepatitis B and the likelihood that she may not survive to carry this baby long enough to be born.  Later that night that same doctor called me and exclaimed, “There is a treatment for Hepatitis B!!  We might be able to help this woman live!”  I felt like a thief taking his hope away as I responded: “I know, but we don’t have it here.” Sigh.  As to not complete deflate him, I told him I would ask my mom (who works in the pharmacy purchasing world) about the price of the medication and if we could get it sent over for her.  By the next morning, I continued my felony robbery spree as I told him that the cost was $100/month (and she needed a years supply= $1200).  Sigh.  I was so very impressed by his commitment to helping this ONE woman.  This was not the first, or even 10th time, I had seen this same case play out.  I sat there wondering, “After 22 months here, have I already lost sight of ONE?  This doctor knows there other woman out there with Hepatitis B.  He even knows that even if we somehow found the money to treat her, we couldn’t treat each case that came in.  But the following day, he told me that if some other labs looked promising, he was going to find a way to get her the medications.  I couldn’t help but cheer for him from within!  Even though I could hear so many arguments against it in my head.

Do you realize how many patients we could treat with that money?!
Do you know how many other Hepatitis B patients are going to expect this now?
Isn’t this a waste of resources, especially if she doesn’t get better after all?
Is it worth trying to save this ONE when we can’t save them all?

Although I truly believe that theses questions are valid, responsible and necessary, I don’t think they are the right ones when dealing with decision making around ONE patient that sits before us.

Our only true example to how to deal with this type of power/decision making/responsibility is to look at the only one who did it right, all the time—Jesus Christ.  Christ, throughout his ministry, ran his own missions hospital; or at the very least, a mobile medical clinic!  And upon looking at that ministry I notice two very important things: 1) He healed those whom God had brought to him. 2) He didn’t heal everyone in the crowd. 

Sometimes we must be sensitive to the Holy Spirit as to when he is asking us to act in an extraordinary way in a particular circumstance.  Perhaps, through the convictions of our OB doc, the Lord is asking us to “move mountains” on her behalf because of a plan He has that is bigger than you and I.  Of course, I’m no where near the physician that the Great Physician was and is.  But I am comforted by the fact that although he did have all the power in the world to heal all that came to him…he didn’t.  While it is beyond my finite comprehension to understand how and why he healed some and not others, I see that even in our ministry, we cannot do all things for all people.  But if we love the people that the Lord brings to us…love them in a way that goes beyond all understanding, and at the same time love the ONE who created all things—then and only then will we be able to use the small amount of power given to us, in a way that glorifies God and heals the nations.

Maybe the right questions are:
1) Have I spent time in prayer concerning the available resources and THIS patient’s specific care?
2) After some time in prayer, is the Holy Spirit asking me to go above and beyond my own and/or this hospital’s current resources?
3) What are the ramifications of NOT acting?
4)  Has the Lord already opened or closed doors in this situation that should be guiding my next steps?

I don’t know if we will be treating this woman or not….the jury is still out.  But if we do, it’s because the Lord brought her to us and moved in the heart of a specific doctor to say, “If we can’t treat the few cases that come to us, even if it costs that much, than what are we doing here?”  And I pray that the Lord’s name be glorified in all that we do, or don’t do.

Grace and Peace