This Easter Sunday, I sat with my family at The Paulist Center in Boston, my mother’s Catholic Church. The pastor in his sermon told the story of Bishop Oscar Romero, the Salvadoran Bishop, who spoke out against his militant government’s violence, and whose visionary voice was silenced when he was assassinated in 1980. Ultimately, his vision did lead to a more peaceful El Salavador and an end to that repressive government. The world continues to remember Bishop Romero as a great champion of social justice and peace. His is a story of resurrection, of a rebirth of peace and justice from tragedies and structures of violence and repression. He teaches us the core value of Easter: a firm, resolute belief in the possibilities of resurrection in a harsh world.
In a modern world that is so violent, wasteful, and unjust, what are the possibilities of resurrection? My thoughts, as is often the case, turned toward the hills of Achham. Our patients and their families teach us of resurrection, walking for hours and even days on fueled by the hope of health. Community members teach us of resurrection as they go about rebuilding a society only six years out of a brutal Civil War. My long-time colleague Bibhav Acharya eloquently and perceptively documented this on our blog several months back. I try to remember these possibilities of resurrection in moments, such as the last past week, of disappointment. Nyaya was rejected from two good-sizedsizeable grants that we were very close to getting. The laboratory and surgical renovations have been stalled, and our first surgeries and microbial cultures, long-since promised, remain elusive, far-off goals. Wrong tiles, wrong laborers, wrong timings, wrong prices. Still no surgeon in sight willing to work in Achham. Untimely and unfortunate departures of two of our physicians. Team members over-worked, over-tired, over-stressed. Seeming impossibilities of effective communication across languages and time zones. Six years in to this work, and we continue to hit the same roadblocks, cross experience the same interpersonal conflicts, confront the same internal, psychological, and spiritual demons, and commit the same mistakes. That is, of course, the nature of the work. The possibilities of resurrection do not make the art of resurrection easy. Resurrection is not inevitable nor an act of grace. In fact, part of the resolve that we try to find within ourselves is in seeing the challenges, the apparent impossibilities in the possibilities of resurrection, and knowing that if we don’t continue to fight, those possibilities will not be realized.
At the level of individual patients in the practice of doctoring, the transformative power of medicine, rests on possibilities of resurrection. It is the idea that an illness can be intervened upon and an individual’s health can be restored. This is one of the most exciting aspects of medicine. Diabetic ketoacidosis (DKA), a condition in which high levels of glucose and acid build up in the bodies of undiagnosed or otherwise uncontrolled patients, is a deadly disease, conferring 100% mortality if not treated promptly. When I am not working in Achham, I am a physician in Boston. Recently, working at Children’s Hospital Boston, I admitted a five year old boy with DKA. Children’s Hospital has an amazing electronic system that informs all providers, from nurses to doctors, about precisely what tests, and medicines, and intravenous fluids to dispense. This includes electronic order sets that reminds us about expected complications, the best management based on current medical thinking, and safety mechanisms in case we forget to order the right tests or medicines. There is nothing inherently routine about DKA, but the system at Children’s systems puts things in place to make resurrection the near-absolute rule for this deadly condition. That is the power of effective healthcare management systems. We’re not there quite yet at Bayalpata Hospital, though, thanks to one of our wonderful physician-volunteers, Dr. Michael Polifka, we do have an excellent DKA protocol.
In other settings, the transformative power of medicine is not about fixing problems, its but is more generally about deeply valuing life. These are some of the most profound moments in medicine. Recently, I’ve been working in an inpatient hospital setting at Children’s that takes care of children with severe developmental disabilities from cerebral palsy or genetic syndromes. Many of these children are blind;, most are non-verbal;, most receive their nutrition through a tube in their stomach. Caring for these children is an immense privilege. As a parent myself, the parents of these patients teach me about commitment and advocacy. Every parent, everywhere, needs to fight tooth-and-nail for their children, for the best quality of life. Their children, against all odds and disabilities, attend school, participate in sports, work, and live meaningful lives. They teach us about the daily, personal process of resurrection, of waking up each morning and fighting for a healthy day for ourselves and our communities.
I admitted a fourteen-year-old boy with severe cerebral palsy a few weeks ago. It was two o’clock in the morning when he arrived to at our ward at in Children’s Hospital. What immediately struck me was his finely parted hair. The nails, skin, teeth, hair of any child, or adult, who is dependent on the twenty-four hour care of others provide a window into the amount of love and attention they are receiving. These children are at risk for bad dental disease, skin ulcers and infections. Their parents, to ward off these maladies, have to, in the words of one, be “dragon parents: fierce and loyal and loving as hell.” His mother, dressed in a Pan Mass Challenge fleece (the PMC raises money for Dana Farber Cancer Center – another hospital in Boston), almost certainly up all day and night caring for her son, still seemed sharp and positive and ready to advocate. She described to me with pride the ins and outs of his feeding regimen, his daily activities, how he expresses pain and pleasure despite being unable to speak or write. As I often do for these parents, I thanked her for the amazing care of her son. Somewhat hubristically, I took the liberty in his admission note—an unusually bland medico-legal document describing my findings as a physician to my colleagues—to sprinkle. In describing his physical examination, I called him a “gentleman with finely parted hair” with “impeccable skin”.” In my social history (details of the patient’s home, work, daily life), I talked of the “exquisite care” provided by his mother. Usually, we do not use such flowery terms in our admission note, but, selfishly, I felt compelled to document and articulate the inspiration I gained from this boy and his mother. They reminded me again of the possibilities of resurrection which we can experience every day through love and hard work.
The relative health of this child also stood in stark contrast to the status of individuals with disabilities in rural Nepal. The love of parents is universal; their capacity to provide the care their children need, however, is sadly so often dependent upon economic and political forces far beyond their control. At Bayalpata Hospital, we don’t see fourteen year olds with severe cerebral palsy; most have died of medical complications within one year of life. That, to me, represents one of the possibilities of resurrection posed by our work in Nepal: that we can be part of a transformation that enables families with food, medical, and economic security to provide the care for their children they so desperately desire. That transformation, in Nyaya’s view, is not one of traditional paternalistic charity, but rather one of creative problem-solving with communities, of solidarity and bearing witness to injustice, and of building new infrastructure and systems.
And so it is that we look towards our leaders, teachers, parents, and patients who show us that another world is possible. That was the meaning of resurrection I took away from Easter this year. I hope that, in moments of doubting about the direction of our world and dismay at the intense, seemingly intractable suffering of our communities and patients and families, I can call upon the strength to believe in the possibilities of resurrection and fight, like Oscar Romero and Dragon Moms, to help realize those possibilities.
Duncan Maru, MD, PhD is a co-founder of Nyaya Health. He is currently a resident in the Internal Medicine – Pediatrics program and fellow in Global Health Equity at Brigham and Women’s Hospital and Children’s Hospital of Boston.