Caring for the Caregivers
Written by Dr. Kim Grahl, Internist and Trip Chaplain/Acompañante
I’m writing this in the late afternoon on our second day of surgeries. Low-hanging clouds in deep shades of blue and gray have rolled in after days of unseasonably hot weather, the narrow sidewalks of Sucre are buzzing with rambunctious groups of children scurrying home from school before the rain starts, and both of the operating rooms at the Instituto Chuquisaqueño de Oncología (ICO) are in full swing.
US Missioners, Jessical Waldo RN, Jodi Grahl, and Gay Garrett MD pose for a photo with their ICO colleagues before a surgery.
In one OR, Dr. Gay Garett is working alongside ICO general surgeon, Dr. Wilfredo Campos and his team to perform breast surgery on women with locally advanced breast cancer. In another OR, Dr. Erin Stevens and the ICO’s extraordinary team of gynecologic surgeons are caring for women with cancers of the cervix, uterus, or ovaries. Our major focus in gynecology this year is to support the ICO team in honing their capabilities to perform laparoscopic surgeries. This way of doing surgery can be a game-changer with regard to true access to surgery in Bolivia. The biggest advantage of laparoscopic surgery, from the patient’s perspective, is that the recovery time is much quicker than with traditional ‘open surgery.’
Serving as the chaplain/acompañante for this trip, I have many opportunities to meet and get to know our patients and their families—in consultation rooms with the surgical team during pre-operative assessments, before and after their surgeries, and on home visits with Marizol Mamani, Puente de Solidaridad’s phenomenal social worker.
On these home visits, our patients graciously invite us into the places where they live—a profound act of trust, I realize—and introduce us to their families. We meet husbands, teenage children, brothers and sisters, and on one particularly sobering visit, we saw the simple bed in the far side of a darkened room where our patient Elizabeth’s disabled, entirely bed-bound mother rested. More often than not, it is on these visits that a patient lets go of the stoicism they’ve mustered during their consultation appointments.
Dr. Grahl and interpreter Isabel meet with Elizabeth and her daughter
Elizabeth, a young woman with advanced breast cancer, sits on the concrete stoop just outside of her mother’s room, holding a loose red jacket around her torso despite the hot weather, concealing the disfiguring mass on her left breast. She leans over as if to try to fold in on herself. Her eyes hold fear, disorientation, sadness, and I feel as if she is showing us the crushing weight of her predicament. Elizabeth has not told her mother, who already has high blood pressure, about her cancer. She doesn’t want it to frighten her. Her 16-year-old daughter is standing nearby— she will be filling in for her mother cleaning houses and caring for her grandmother after school until Elizabeth recovers enough from her breast surgery to lift a bucket of water and change bed clothes again.
As all of these details are revealed to us during this visit, I’ve come to understand why the most common question asked by patients is: “How long will it take for me to recover?” Nobody has asked about how much pain they will have, only one woman (who has asthma) expressed concern about complications of anesthesia. And throughout these home visits, the women have not focused on concerns regarding prognosis.
“How long will it take me to recover?”
The women we care for are themselves caregivers—they are mothers, they are daughters, they have jobs that put food on the table. Time recovering from surgery means less food on the table and more burden on their families. Until this trip, I must admit that I never fully understood the profound difference that access to minimally invasive laparoscopic surgery can make in allowing a patient to pursue treatment.
As I finish writing this, the rain has come and gone, the sun shines brightly in the sky, and both surgical teams have completed their work for the day. May our patients and their families sleep well tonight, knowing that they are cared for, knowing that we will be here again tomorrow, come rain or shine.
Post Script from the Solidarity Bridge Office:
Elizabeth’s surgery was successful, and she will be going home on Thursday. Social worker Marizol Mamani will accompany her in a taxi and make sure that she settles comfortably at home with everything she needs to recover. We have even arranged a supply of adult diapers for her bed-bound mother in hopes of alleviating some of the family's stress, allowing Elizabeth to focus on the rest she needs to best recover in the coming days.