Friday, May 15, 2009


Kulno came to us about 2 weeks ago from the Jimi (far away). She complained of weakness, abd pain, some vaginal bleeding, and fever. On exam she was found to have a large pelvic/abdominal mass and a hemoglobin of 4. She was admitted, transfused blood, and we got Jim involved to see if he wanted to take out this mass. Through further diagnostic tests Jim was concerned that she may have a metastatic choriocarcinoma. Jim consulted me to see if I could give her some chemo, as I have become the resident oncologist in Bill's absence. Her initial pregnancy test was negative, but the rest have come back strongly positive. She has pulmonary and liver mets as well as her large pelvic tumor. I discussed our options with her and her husband and started treatment.
Her husband, Mark, has been a great blessing to her, truly serving her as Christ has the church. He is always attentively caring for her, serving her, and helping her. Almost everyday he tells me that if we can't do anything further he wants to know so he can take her back to the Jimi. Getting back to the Jimi is hard enough, but to take a dead body back is even more difficult. Despite never treating choriocarcinoma before, everyday I have reassured him that I understand his concern, but feel that we still have a shot with this and will let him know when I feel otherwise.
Today, I had to tell him it was too late. I had given her a series of methotrexate injections to try and shrink the tumor to see if it would respond to the chemo and to see if we might get things smaller so Jim can do surgery. She seemed to tolerate the chemo ok despite having some hemoptysis (blood in her sputum) and anemia which required transfusion, and even said she thought the swelling in her abdomen seemed to have gone down. Today, however, things were different. I was rounding with Jessica, a student we have here now, and as we were seeing a different patient, I was distracted as I was watching Kulno laboriously breathing and sweating, and seeing her husband gently sponge her with cool clothes. She didn't look good. When I got to her, I found her with a high fever, an increased respiratory rate and heart rate, and worsening abdominal pain. I was concerned that the tumor might have hemorrhaged causing the worsening abdominal pain, but thankfully the ultrasound didn't support that. However, she is still quite sick.
I told Mark that he had wanted me to tell him when we can't do anything so he can take her home, and today I had to tell him that I was really concerned about her today and I thought she could die. However, it was too late to take her home, as she might even die on the way. I told him I didn't know if what I have to offer is going to make her all better, but I wanted to try. He agreed to stay here and do what we can for her.
I am thankful that I am not the one who decides when folks live and when they die. I am thankful that God is sovereign and in charge of all of that. I am thankful that Mark and Kulno know the Lord and that Mark trusts God with her life. I am thankful that for some reason Mark also trusts me to take care of her to the best of my ability. It is days like today where I realize how much I too trust, and need to trust, Him to guide me and give me wisdom as I care for patients, and how little ability I have without Him.