Prayer, Medicine, and a Mother’s Love
By Mark Zimmerman*
… and Jesus gave him to his mother.
Rama’s daughter and son were admitted to Patan Hospital on the same day in April. It’s usually a hot, dusty time in the Kathmandu valley, but this spring’s persistent rains prompted us to wonder if the monsoon had arrived early. Radha came to the hospital because of a miscarriage and went home the next day. Madhav, however, had acute pancreatitis.▪
Pancreatitis is usually caused by too much alcohol or by gallstones—either of which can damage this hand-sized organ located behind the stomach. Most cases of acute pancreatitis respond to two days of intravenous fluids, analgesics, and a nasogastric tube, but Madhav’s condition was complicated.
Dierdre Zimmerman (right), a missionary serving as a nutritionist at Patan Hospital in Nepal, is from Ireland. PHOTO: MARK ZIMMERMAN
After three days in the Intensive Care unit (ICU), the doctors in the ICU transferred the 28-year old to the care of my medical ward team. Though lingering inflammation had wrecked his appetite, at that point Madhav still had a muscular body sporting a variety of tattoos.
Rama was a heavy-set, no-nonsense woman of about 50. From the start, she made it clear to us that she didn’t have money to burn. Her husband had walked out on her 10 years earlier, leaving her with four kids, ages 2 to 18. She’d worked as a cleaner in a hospital but had to leave that job because of bad knee pain.
Here in Patan Hospital, anticipating a shortfall of funds, she’d insisted Madhav be taken out of the ICU earlier than that doctor advised. She was a constant presence at Madhav’s bedside and, in a raspy voice, snapped out accurate updates about his condition whenever we came on rounds.
One afternoon about 10 days into his time with us, I circled back to see Madhav. He looked sick—anxious and sweaty. His blood pressure had dropped, and he had a high fever. I took Rama outside the room.
“Madhav has gotten very sick,” I said. “We must put him into the ICU. He may not make it otherwise. I’ll talk to Social Services about charity support.” I was surprised when she readily agreed.
After patients are transferred from our ward to another specialty team (like surgery), I usually stop seeing them. But something drew me back to Madhav and his mother. From a young age, he was living a wild life. He was a driver who’d spent his weekends binge drinking, and he’d already been in and out of rehab. He had the look of a rough character, yet, toward us he was always polite, almost timid, seemingly embarrassed by the situation into which he’d fallen.
Dr. Mark Zimmerman (back row) with his Nepali medical students at Patan Hospital in Nepal. PHOTO: COURTESY MARK ZIMMERMAN
Rama spent every night in the hospital, sleeping on a piece of thin carpet padding—either beside Madhav’s bed or in the hallway outside the ICU. She confided to me about her ongoing efforts, sometimes with strategic tears, to raise funds—but she never asked me directly to contribute.
It seemed that whenever there was a glimmer of hope—Madhav’s starting to eat, having less pain, his fever gone—it would soon be dashed by another complication. I came into the ICU one morning expecting to see progress and instead Rama’s face was a beacon of distress: “Look—now he’s bleeding!” she said and pointed disconsolately to the bright red column coursing down his gastric tube.
Ten days later, as Madhav recovered from this major operation, the same thing recurred. As they again wheeled him into the operating room, the senior surgeon muttered to me, “I don’t think he’s going to make it this time.” But he did.
By July, the real monsoon had taken hold, unleashing its daily downpours ending in sun-spangled cloudscapes and crisp air. Madhav grew emaciated. The periods of gastric drainage or fasting after two operations had cut deeply into his body’s nutritional reserves. It was hard enough for Rama to pay for antibiotics; the cost of IV nutrition packets would have been exorbitant.
Two more weeks went by. He finally left the surgical ICU and began to eat a normal diet. These feedings were followed by fresh attacks of abdominal pain. The ultrasound showed that he’d developed gallstones, reigniting his pancreatitis. One day I found him curled up in pain and breathing hard. This time Rama motioned for me to follow her outside. We walked out onto a ramp, where the air in the space between two buildings was misty from the morning’s rain.
“I can’t take any more of this, doctor! I can’t stand to see him suffer this way. He neither gets better nor dies—just hangs somewhere in between. If this is his time to go to salvation, then so be it. It’s salvation time!”
My well of encouragement was nearly dry. Maybe we had kept Madhav alive for our own sakes. But, then, there was no simple way to end her son’s medical care. “Madhav has pulled through before. He doesn’t have a terminal illness. I know it’s hard, but let’s hope once more.”
So Madhav went in for his third operation, removal of his gallbladder, and then his deep abdominal pain finally began to subside. By August, my updates on his condition were a regular item over our family’s dinner table. We prayed for him and also asked friends to contribute their prayers. I started looking in on Madhav first thing each day, searching for Rama’s faded orange kurta dress among the crowd of patients’ relatives.
One Saturday, my son Benjamin and I dropped by and found the two of them locked in an argument. Rama turned to me. “Doctor, this is the rudest person you can imagine! He won’t even look at me, addresses me in low form, and generally treats me as his servant. Aren’t I the one who’s been caring for him? Right now, I’m ready to take him home and let him die. I’m sick of this hospital and of his disrespect!” Two people standing beside the adjacent bed murmured in agreement.
We went outside to sit and talk. “Rama, in all these years, I can’t remember a patient who suffered as much as Madhav, nor a mother who looked after her son so faithfully. Can’t you take a break, get someone to come and watch him one or two nights?”
A mountain scene in Nepal. Even today, getting to the hospital, or anywhere in Nepal, can involve long journeys by foot across the countryside. PHOTO: ALEX TREADWAY
I often prayed with the two of them but wondered how these were being answered. Finally, I asked them if someone from our church could come and pray, “a prayer specialist” I said, perhaps to break the impasse. They readily agreed. Our friend Arun came with his wife Indira, and they prayed with them at the bedside.
Who knows how illnesses take their course? But a week or so after this, Madhav’s appetite steadied. His surgical wound began to close. He was able to walk to the hospital canteen. I came by one afternoon and found him sitting alone on the edge of his bed, a hunched-over, reed-like figure. As I walked around beside him, there was a steaming plate of chow mein. He barely gave me a nod, focused as he was on the business of carefully spreading spicy chutney sauce over the fried noodles before devouring them.
In October, after the hospital had written off most of his bill as charity, Madhav and Rama went home. Later, I was in the clinic seeing patients when my cell phone rang: it was Rama. When they came around, I was relieved to see that Madhav’s face was filling out. Rama said that he’d gained 5 kilograms as she pulled up his shirt. Madhav even briefly smiled at me, saying he was thinking about looking for work, kaam saam, he called it.
That day after work, I cycled home through the light afternoon air. The heat of a long monsoon had finally given way to autumn. Cumulus clouds were heaped high at the edges of the valley and kites floated in the cobalt sky.
▪Names of all patients have been changed.
*Dr. Mark Zimmerman (Missionary Support Code: 10908Z) has been working in Nepal since 1986—initially as a hospital-based clinical doctor (1986-1998), as medical director of Patan Hospital (1998-2005), as director of the Nick Simons Institute (NSI), and currently as an internal medicine specialist at Patan Hospital. Dr. Zimmerman is from Pennsylvania. He and his wife Dierdre Zimmerman (Missionary Support Code: 13171Z), a nutritionist from Ireland, also a missionary, have two sons, Benjamin and Zachery.