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Sunday, August 1, 2010

Renal Cell Carcinoma

Her coworker, Debra, drove as they passed through the countryside, and the new nurse sat and stared at the form in her hand. Diagnosis: Renal Cell Carcinoma. The cancer that killed her baby brother had attacked one of her patients, and now it would be her job to help him die, not in the way that she helped her brother die, but it would fall to her nonetheless.

She blinked back tears as she wracked her brain for a path to strength, searched deep for the ability to put a smile on her face, a real smile, not just one pasted on for the benefit of her patient. He would doubtless see though it anyway. The dying have x-ray vision, she thought to herself.

The drive to his home would take three quarters of an hour, and since Debra was prattling on about purple crepe myrtles, it was hard to think, almost impossible to concentrate.

True, this new patient is 30 years older than her brother had been when he died at 45. But somehow there was no comfort in that knowledge. It was the same disease that sent her and John - that was her brother’s name - to Memphis for three weeks of alternative treatment at the end of his life. She thought she could will her brother to stay alive, that if she didn’t want him to die, well, he wouldn’t. Denial is deeper in health care professionals that in anyone else, she had decided.

She was planning to write a book about her brother’s short yet remarkable life but had been put off by her desire to keep that wound closed. After 10 years, it was still simmering under the surface of her psyche, and she was unsure, in view of her husband’s death just a year ago, that she was emotionally and psychologically capable of taking on that task without throwing herself back into the deep and dangerous depression that still haunted her.

What to do? She decided on the direct approach. She would tell her patient up front that she had lost her brother to the disease that was now killing him. Unsure of just how she would negotiate those whirling waters, she knew she needed to tell him.

So much so soon, she mused to herself as her Debra pointed out every fucking color of crepe myrtle they passed. Why is it that life has to jackhammer me at every turn? Why can’t life ease its punishments on me? God knows there have been enough of them. Do they all have to be hurricanes? Can’t some of them come quietly like a much needed shower of rain in the 98ยบ heat of this day?

And then, there they were, at the patent’s house. Still without a firm plan in mind, she followed the Debra into the house, and much to her own surprise, asked her partner to handle the visit, volunteering to take vital signs and do the physical assessment only. Incredibly, Debra locked eyes with her and there was understanding and compassion in them. She knew. For training purposes, Debra had taken only a supporting role in the previous visits, but she remembered her fellow nurse’s tragic history with renal cell carcinoma and seamlessly moved into the leadership role.

As the visit came to an end, Debra offered to pray for the patient. She did that a lot. So, she prayed for a while, covering all her bases with Jesus and the Holy Spirit, asking for strength and guidance and all that. The patient punctuated her words every now and them with a “yes” or and “amen.” The patient’s brother was visiting, and he also lent his voice to the “amens”

The new nurse was quiet, remembering all her unanswered prayers for her brother’s recovery. All that praying had just brought him to a place where his heart and lungs, filled with tumors, got too tired to go on.

After the praying was over, Debra sang a hymn to the patient, and when she finished, the brother looked at the new nurse and said, “You need prayers, too. There is something in you that makes me know you are hurting.” And that is when she, in a hesitant voice, admitted her very personal connection to renal cell carcinoma.

So they prayed over her, too.

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