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“The art of medicine is to cure sometimes, to relieve often, to comfort always.”
 Ambroise Paré, physician to King François I

“Merci”, she says, in a whisper so low I can barely hear her. She extends her hand to me in thanks. I take her hand in mine and shake it gently. Her eyes stare at the ground the whole time. I can feel pricking at the backs of my eyes as tears threaten to spill over. “Don’t cry, don’t cry” I chant to myself in my head. 

How can she be thanking me? I have just told her she had incurable cancer. She had moaned and cried out in pain when I examined her. The cancer on her cervix was so friable that my exam caused her to bleed all over her pagne, her bright yellow cotton wrap she used as a skirt. In modesty, she hadn’t wanted to take it off when she slowly made her way up to the examining table, her sixty hard years of living and labouring showing in the slow and painful way she moves about the room. And now it was stained bright red with her shame and sickness. We had tried in vain to try to tie it in a way that preserved her dignity but alas, we could not. This is the only time during our whole encounter that she seemed distressed. As the translator told her the news, she hadn’t flinched. I had tried to reassure her that we would try everything we could to manage her symptoms, knowing full well that there's not much I can do. She had wanted something to stop her bleeding. There was nothing I could offer her; so I gave her some stool softeners and Tylenol instead.  Such paltry tools in the face of the suffering I know that her cervical cancer will bring her. When I ask if she or her son has any questions, she quietly shakes her head. 

When I offer her the chance to talk with one of our counsellors to further discuss her diagnosis and her thoughts and fears about the times ahead, she accepts. However when the counsellor arrives, he, the woman’s son, and my translator launch into an animated conversation. I don’t know what they are saying but I can tell the counsellor and son are getting agitated. My patient sits motionless in the corner, eyes downcast, as they discuss her. Her hands are neatly folded in her lap, covering the blood stain on her pagne.

“Her son doesn’t want his mother to know she is sick,” my translator Mohamed finally informs me. 

“But, didn’t we just explain it to her?” I ask the Mohamed. He’d translated everything I had just said. Mohamed doesn’t answer, he just spreads his hands wide in an appeasing gesture. 

“They just want to go home,” he says simply. 

“What does she want?” I insist. For my patient, not her son, had been the one to express interest in meeting the counsellor. 

“We can’t force them,” is the answer I receive. I’ve noticed here that the translators (almost all men) rarely talk to the women if their husbands are present. They only talk to or look at the husbands, sons, or whichever male relative the patient has brought with her. I am frustrated but I don’t know what to do. I don’t want to impose my cultural values on them. But I also want my patient to have the right to seek the counselling she sought. 

Before I can think of what I should do, the son speaks to his mother, and she rises to leave the room, hands still strategically trying in vain to cover her soiled pagne. I feel sick. I have just told a patient she has terminal cancer. All I’ve done is give her some Tylenol and stool softener; not even a follow up appointment, for it would cost them extra money they probably don’t have, and there is really not much else we can do for her. Due to language and cultural barriers, I have no idea what’s she really thinking, and feeling, or how I can help her. My hope of providing her reassurance through the counsellor is lost. I feel I’ve done nothing for her. Perhaps worse than nothing. And yet she thanks me. She extends her hand to me in respect and thanks. I can barely take it. I will her to understand how much I feel for her, how much I will be praying for her in the weeks and months ahead, how I wish I could do more for her. But before I know it she is gone. And I am left trying to hold the tears back. 

Interrupting my reverie is a knock on the open door I’d forgotten to close.

“When is my wife being seen?” a man demands. “We have been waiting all morning.” I squeeze my eyes shut, swallow my grief, and grab the next chart. I will myself to file my patient away in the back of my mind, somewhere she won’t intrude, so that I can focus on the next woman. But when I come home, I can’t stop thinking about her. I wonder how she is doing, what she is thinking, who she is with tonight. And I cry.