The Lady from Afghanistan

When I was doing the first rotation at Coney Island Hospital, in Obstetrics residency training, I saw a woman in the clinic one day, swathed in drapery and veils, who was pregnant with her 5th child.  She was in her 8th month, and I was getting her first history and physical done, although there were no translators available, and it appeared that she had come to the hospital without a family member to help her with the language.  All we knew was that she was from Afghanistan, and had recently come to New York.  She knew I would be putting her up in stirrups, and doing a pap smear.  As I looked at her cervix, I was overwhelmed with worry, because I saw a cancer on the upper outer right cervical area, about an inch by a half-inch in size.  It was fungating and white, like a small piece of cauliflower, stuck on the cervix.  

I called the supervising doctor over to confirm what I was seeing, and then asked who we could get to translate for her.  There was no one who spoke her language.  Her baby was growing appropriately and the rest of her exam was normal.  I went through all the possible things I could think of, in trying to figure out how to get her to know and understand the seriousness of the situation, and that we thought the best thing to do would be to take the tissue out after she delivered the baby, but it meant she needed to come back to our hospital  when she was in labor, and where we would put all of this in the notes.   Since we did not have an early ultrasound, and I had held up my fingers to ask her how many months pregnant she thought she was, as I pointed to the swollen belly, we would not want to deliver her until she went into labor, trying to avoid an unnecessary premature delivery of the baby.  

Finally, I took her by the hand.  She could see by my face that I was very concerned for her, and that I had made a big deal talking about her with the attending doctor.  We went up to the postpartum floor, from the clinic.  I could not even tell her how to get there, so I took her there.   I asked the nurses if anyone who had had a baby in the past few days was from Afghanistan.  There was one woman, who was in the last room at the end of the hall.  I kept holding her hand, and walking her toward that room.  When we got there,  I asked the woman if she could speak some English.  She nodded.  I told her that this woman was from Afghanistan, and asked if she could understand her enough to communicate with her and translate for me.  

What joy it was, as they tentatively began to speak; and then faster and faster the flow of language between them went,  with laughter like cousins meeting by chance, like a fountain revving up to full glory!  YES, the mother with the newborn said, “ it is amazing, a miracle, I am from the same corner of the country and we speak the same language!” 

After a little getting to know each other, they looked at me.  I said that it was so important that we had found this woman, her new friend,  to translate; because there appeared to be a cancer on her cervix, which the doctors believe we should remove after the delivery of the baby.  She needed to know, to give consent, and that we can put this consent,  now, witnessed by her friend,  in her chart, so that if she delivers at a time there is no one to translate, the paper work would be done.  

It was done!   About a month  later, she delivered a healthy baby, and we were able to get the surgery done, and she was able to get the proper follow up.  She did not have complications. 

Lately, I have laughed to myself about the millions of times I wish I had kept notes, to be able to remember later, so many cases, so many miracles, and amazing wonders like waterfalls in those early years— too many, happening too fast to absorb them all.  Now I have the time to remember, but not that many cases have come up out of the mist for me.  This one did, for which I am grateful; and it was about Afghanistan, as we were ending the war there, and my thinking went back to what I have learned about the country, and its people.  

The need for care for women all over the world, and especially for the risk of cervical cancer, which at that time was still one of the highest causes of death of young women, remains one of the things I have carried with me, from the Peace Corps, until now.