The following essay was written by a someone who attended several of our inner city mission trips in years past. Today, she serves as an RN/Missionary for.... in .... well, I probably shouldn't say. I'm honoring her request to keep her location secret. I think you'll see why...
It's an honor to share a part of her faith story.
Here's what September 20th was like for her. She calls it "Twenty."
She walked into my office alone. A small frame, dark skin, no smile. She was just discharged from the hospital. Our clinic referred her there. She had an injury to her left ring finger. It would not heal. She sold some of her nicest clothes and everything she could afford to do without in order to see a quack (traditional doctor). They could not make it better. Finally one of them told her she needed to go to the XYZ clinic for help. By this time her finger was black, the blood flow stopped and gangrene replaced the life that had once been her cells. It was amputated in a not-so-clean concrete room by a man who did not even speak her language. She did not tell me, but I imagine she was scared, confused.
She walked into my office alone. I think this a bit odd because in the deeply conservative Muslim culture here young, unmarried women do not go places alone. She was wearing a simple black burka and her hair was completely covered. Her face was a perfect thin oval, high defined cheek bones and eyes piercing brown. At first she only looked at the ground.
Do you remember when you were twenty? Maybe already working. Maybe going to university. Maybe already starting a family. I have to admit that I was very lucky because I had never really experienced sickness first-hand at this age. I was even one of those kids lucky enough to not have broken a bone somewhere along the way. My sister did and I always thought it would be cool to have a purple cast for people to sign. When I was twenty I felt like life was just beginning. The world was mine to discover. I was already working in a hospital ER as an EMT and beginning my nursing programme at university. I was dreaming of this, what I am doing now. No time to waste. Grab life by the horns (after all, I am a Texan). Laugh in the ups, cry in the downs, and then get up and try again.
She walked into my office alone. I looked down at her medical booklet. [Name withheld], 20-year-old female. I opened the book. In scribbled notes of a surgeon's hand I read, 'Amputation….blood glucose high…..fever….generalized body aches....' The expatriate doctor that I work with referred this woman to me. He told me that she was young, recently diagnosed with juvenile diabetes, recently had her finger amputated due to gangrene. I listened to his words as he gave me her history but I did not really hear them. I did not picture her, this women sitting in my office, in my head. I only pictured another patient, another counseling session, another day.
She walked into my office alone, and I immediately remembered his words – 'she is YOUNG, she has diabetes, RECENTLY diagnosed…' I had to take a second look at her. Was this real? Even with all that I know, all that I have seen first-hand, there are moments like this that just take my breath away and steel my strength. She walks in alone and I feel her strength entre the room. She holds it in the hand that now only has four fingers. I compose myself as I have been trained to do. I quickly ask God that I might give her some hope as she has already given it to me by her mere presence. I take a conscious, pausing, deep breath.
She walked into my office alone, where she was referred to me because she was being released from the hospital and we had never had a patient with juvenile diabetes before. My co-worker asked what I thought about the situation and I agreed with him that since she was so young, she had no access to health care, she has a poor quality of life – we must do something for her. I was there to teach her about diabetes and to teach her about the insulin injections she would be giving herself. I must say, while I do not do this kind of one-on-one education often anymore, it always brings me joy. Nursing. Teaching. Sitting face-to-face with a patient and learning from each other.
We arranged to buy her insulin (a vial costs about 12 USD which she could never afford) and gave her a small, circular, red ice-box to store it in. We asked her if a family member could come each day to have the ice replaced (it only lasts 24 hours). We talked about the importance of cold chain for the medicine to continue working. We talked about her diet, strangely making sure she understood that she should not eat sweets, drink sodas, or drink the ever so popular instant 3-in-1 coffeemix. I say strangely because I imagined that she is too poor to even consider buying these things. Even so, I have to be thorough. No potatoes, less rice, more whole wheat, more chapatti, more sour fruits, more leafy vegetables and fish.
The insulin syringe has numbers written in English. She does read any language. The local dialect of [withheld] she speaks is not a written language. Her family was probably too poor to pay for the school fees here in [location withheld]. This makes things tricky. We teach her how to count the marks on the syringe so she can measure to give herself 2 doses of insulin a day. It is the fasting period, Ramadan, for Muslims so I ask if she is fasting since this would change her dosing schedule. She explains that she is not, she has been too sick and always feels weak. I explain that she gets the bigger dose in the morning because she will eat throughout the day, which will increase the amount of sugar in blood. We talk about blood sugar, how to test for it, how much it should be, what happens if it is too high, if it is too low. We talked about her hands and feet – how since she has diabetes she cannot heal as well as some people. She needs to be careful if she gets injuries.
She begins speaking to my assistant, telling a story. She said that no one in the hospital explained all of this to her. She said that for several months she had problems with her finger. One quack cut the skin open with the stem of a plum and said that would make it better. It only got worse from then. She did everything she could to make it better. She went to every Muslim doctor she knew. She sold everything she could to afford to pay them. Her voice sounded like it would crack. That is when my heart broke. That is when it clicked in my mind that she had never been diagnosed before. She was 20 and had no idea that she was living with this terrible disease. When I was 20, I was carefree, and here she was sitting next to me with shoulders weighted down but head held high. I had to take another one of those deep breaths. I had to fight back the tears. I had to concentrate on her strength, so that I too could be strong. I once again felt anger and frustration in this world of inequalities we live in. The extreme injustices in this country that has been my home for the past year. Thankful that most in the US will never have to be in her situation.
Diabetes counseling continued and then I began to assess her amputated finger. It was healing well and the surgeon did a good job. I felt her forehead and was a bit concerned that she might have a fever. It was 39° C. I continued my assessment and felt her pulse. At first I thought my fingers must be misleading me, but I felt again and they were not. Her pulse rate was 160. At this point I decide to take her blood pressure and begin asking her some more questions. Upon placing the cuff around her upper arm I again am puzzled at how so many things can go wrong in one persons life. Her arm is thin. I could put my thumb and forefinger completely around her upper arm without effort. Her MUAC (middle upper arm circumference, a basic tool to assess nutritional status) was 176mm. She was moderately malnourished. I asked how her appetite was. She said it was good. I noted one abnormal finding after another on her chart. I wondered if we would really be able to help her. I decided we had to at least try.
By the time our visit was over my co-worker was back in the office and I called him to take over. She had so many things going on, so many abnormal findings, my work was done. She understood her disease. She understood the treatment. She understood that it was not her fault. She did nothing wrong. It is genetic (although she does not understand what means). Now XYZ, the doctor I work with here, had to take over and put the puzzle pieces together.
I smiled at her and told her that I knew she was going to do just fine because she was such a strong, smart, beautiful young woman. I told her if she had any problems or any questions she could come see me anytime. She looked straight at me and I felt her words even before they were translated to me. "Shukriya. Thank you, for taking the time to speak with me. Thank you." Then she walked out of my room, alone.
When she walked out I sighed. I wondered how I got so lucky to be here, doing this, and meet incredible people like her. I wondered if she would ever understand the gift and joy she has given me. If she will even remember me in a few months when I have left [location withheld] and she is hopefully still taking diabetes medicine and feeling better. I am certain of one thing, she walked into my room alone, but she will remain in my heart forever.
An excerpt from Sojo:
