Abstract
A
A girl stood by the fire. At first I thought she was who I was meant to see, as she was the only one in the room who remotely looked like a woman in her 20s. But she was too healthy to be the patient I was supposed to see. She had skin that did not reveal the outlines of her ribs, and cheeks that had some chubbiness in them. I learned she was the patient's sister.
Finally, in the darkness I saw a tiny figure that I thought could not be my patient. She looked too old. But I ask you, what do numbers matter to one who has metastatic breast cancer that is far too evident just looking at her? Without touching, I could see the irregularity of her left breast. I could see the cause of why she hurt all over; why she had been in too much pain to move for the last six months; why she could not make the trek on the narrow overgrown footpath that wandered past small dwellings here and there; why she hadn't been able to find transport on the rough road we had arrived at after finding a lady who knew the way to the patient's dwelling—a road so rough that our driver was currently working on finding the pieces that had come off our vehicle near where the path started; why she couldn't come to the palliative care clinic to obtain morphine.
I noted her white teeth as I examined her, as I wrote in her small patient book, as her sister looked on attentively and listened carefully to the instructions of when and how to administer morphine. The teeth were not damaged like her body. Though her smile was weak, it was not weak like her legs clearly were. Though her eyes were tired, her expression was not nearly as weary as her circumstances would suggest.
She was a mother of three children. I asked the palliative care nurse, “Where are her children?” She told me, “They are with her husband six hours away. He has a job in a mine that far away.” I was thankful she had family to try to care for her, but I was filled with sorrow that she could not see her children.
While we were putting the medicines away and preparing to leave, I noted that the nurse and the sister were speaking back and forth. The family did not have money for the morphine. Although morphine is affordable for many, it was not for this family. No one in this world should have to die in that much pain. The cost of morphine for the month was less than what many pay daily for a cup of cappuccino. The patient received her morphine for the month without payment.
How many more patients are not seen in countries without mobile palliative care programs? How many more suffer in death? I know the obvious answer and the answer is one that is extraordinarily difficult to accept.