My intern is presenting a new case:
"The patient is a 20 year old male from Makebuko commune who is presenting with two weeks of cough and increasing difficulty breathing." He moves from section to section of the well-established presentation format. It's oddly a bit like a familiar song, and each word creates suggestions in my mind as to what this young man's problem is and what we should do for him. The intern's information is a bit scattered, since he is still learning, but the structure is like a couple of deep wheel ruts that keep him from straying too far.
He tells us about his past medical history, including a seizure disorder, for which he is on chronic medicine. He talks about a developmental delay. Then he gets to the physical exam. "His weight is 23 kilos" (about 50 pounds). 23 kilos? Yeah, he is the size of a child. Does he speak? No, he's never spoken. Does he walk? No, he's always been bed-ridden. He has some bedsores, but they are clean.
This is actually an incredible story here in Burundi. There is a bit of context that is necessary to understanding just why this is so incredible. People with significant handicaps usually don't survive very long here. In fact, I have never seen someone this disabled who has survived to this age. They are often neglected and devalued. Even if they are not, something goes wrong. They have an injury or an infection somewhere that goes unnoticed for too long. Until it's too late.
"Well," I say to my gathered team of nurses and students,"this family deserves our admiration for taking such good care of their child for so long." Actually, his family abandoned him a long time ago. He's been raised by Catholic nuns in a home for handicapped children. "Oh," I say, "then I guess we owe that admiration to the nuns. They have shown just how serious they are that every person bears God's image. Let's try and do our best to continue the same while he's under our care here in the hospital."
After we're done discussing, we head out to starting seeing our patients. We go from bed to bed. After we finish our normal wards, we head over to see an old man who has suffered a massive stroke. When the surgery ward building was built in 2016, we added 8 very nice private rooms. They each have private balconies, and the best of them are on the second floor with a gorgeous view of the Burundian hillsides. I jokingly call the top one the presidential suite. The old man's family has a bit of money, and he is hospitalized on the bottom floor.
|View of the balconies of the private rooms (on the right)|
We climb the stairs, and there, in the 2nd nicest private room, is our new patient - all 23 kilos of him curled up into a fetal position, breathing oxygen through a pair of nasal prongs. He's dressed in a nice t-shirt, and his helper is in the bed next to him. It's a truly beautiful moment, and it reminds me of two quotes:
"The church exists to set up in the world a new sign which is radically dissimilar to the world's own manner and which contradicts it in a way which is full of promise." - Karl Barth
"So the last will be first, and the first will be last." Jesus in Matthew 20:16
I shared the application of the second quote with my team, even before we left his room. I thanked his caregiver for her great work, and she smiled at her feet in obvious embarrassment. Here, in a world full of scarcity, the church (and as a confirmed Protestant, I give my Catholic brothers and sisters full appreciation for their example-setting in this arena) has taken a small non-verbal boy, who doesn't usually even survive to this age, and hospitalized him next door to the presidential suite. He bears God's image. The last has become first. The church has set up a sign which has contradicted the world in a way which is full of promise. We were there to see it. It was just a glimpse of what's to come.