You were born into love. You will die into love. And you will be held in love every second in between.
The first patient I saw in clinic that day was a 60-year-old woman with abdominal pain, who walked into the exam room with her son. I ordered an ultrasound, which showed that the woman had advanced cervical cancer that had metastasized to her liver, kidneys and lungs. While she was still lying on the table in the ultrasound room, she began vomiting blood, so we admitted her to the hospital.
I finished my clinic shift late that evening, and went to the dining room for dinner. The kitchen staff had left a tuna sandwich in the fridge for me. When I sat down to eat it, I heard one of the American chaplains talking to one of the doctors. "She's not going to be with us much longer," the chaplain said.
Then she turned to me. "I think you admitted her," she said. It was my patient with cervical cancer. In twelve hours, she'd gone from walking into an exam room....to actively dying.
I left my half-eaten sandwich on the table, grabbed my flashlight, and ran to the hospital to see her.
How was it possible that a woman who had been walking and talking this morning was dying tonight? I wondered.
I found my patient lying in a bed, half conscious and clammy. There was dried blood around her mouth. Her son and daughter were in the room with her.
A Foley catheter drained urine from her bladder, and an IV in her left arm delivered fluids and pain medication. Three patches on her chest and a pulse ox on her finger attached to the monitor above her bed, which displayed her vital signs.
For a patient who was dying, she was receiving very few interventions. No oxygen mask, no blood pressure cuff, no blood transfusion, no monitor bells going off. There was nothing more to do, except keep her comfortable as she faded away. At this point, her care was more like hospice than an ICU.
Her heart rate was in the 140s. Her oxygen went down to 82 percent when she drifted off to sleep.
Her daughter kept trying to wake her mom up, calling her name, shaking her shoulders, dripping cold water into her mouth. Like me, the daughter couldn’t understand, let alone accept, that her mom and been walking and talking this morning, but tonight she was quickly slipping away.
Her daughter looked like she was maybe twenty years old, which made me think my patient was younger than sixty, but there was no way to know for sure, since most people in Togo don’t have birth certificates.
Lakshmi, a female Togolese chaplain, told me that the patient and her son and daughter lived in a village in Burkina Faso that was about three hours north of Mango.
They spoke a Burkina Faso dialect that no one in the hospital understood. So Lakshmi had called Atsu, a male Togolese chaplain and the only person in the hospital who spoke that dialect. Atsu walked thirty minutes from his home to the hospital, in the dark without a flashlight, so he could translate for the patient and her family.
The son and daughter were understandably distraught. They’d had no idea when they brought her to the clinic that morning that by nightfall, she would be actively dying. I wanted to tell them that I was surprised as they were, but instead I stood at the woman’s bedside silently while the son and daughter deliberated about what they should do.
Atsu explained that we were glad to admit the patient and continue giving her IV medications to keep her comfortable until she passed away—which would cost five thousand CFAs per day.
Or if the family didn’t want, or couldn’t afford, that option, they could take her home.
After discussing it for a few minutes, they said they wanted to take the woman home.
My heart sank.
Because here she was, lying in a bed in between clean, crisp white sheets with promethazine to keep her from vomiting and morphine to ease her pain. And I felt like maybe that was the only thing I had accomplished for her all day—to make her comfortable.
Our pharmacy didn’t have any oral narcotic pain medication, so if her children took her home, we couldn’t prescribe medicine strong enough to treat her pain. We could send her home with promethazine pills for nausea, but if she started vomiting again, she wouldn’t be able to keep the medicine down.
I was also afraid that maybe her children thought we were killing her. Maybe they believed their mom came in not-too-sick and somehow, while she was at our hospital, we had caused her to start dying.
Atsu talked with the son and daughter in their language, and then translated their words to Lakshmi and me. He said that her children were not mad at us; they were very appreciative of our care. They wanted to take her home so their friends and family could say good-bye to the woman while she was still alive, while she could still hear their words of love and praise.
They also wanted to take her home because they had spent almost all their money on one day of care, and the three-hour taxi ride would be cheaper if she was still alive.
When she saw the puzzled look on my face, Lakshmi explained that taxis in Togo are legally allowed to transport dead bodies, but they charge up to ten times more because afterward, they have to take their taxi to a marabout and an imam to have the evil spirits of death removed.
The chaplains offered to help the woman’s children find transportation. As the four of them were leaving, the daughter motioned for me to stay behind with her mom.
The woman's oxygen was dropping. Flies crawled over her face and between her lips. I swatted them away.
I pulled up a chair next to the woman’s bed and sat down. She got restless and threw the sheet off, her right hand thrashing around. I gave her my right hand, and as soon as she grabbed onto it, she settled down.
I placed my left hand on the woman’s clammy forehead and silently prayed for her. I prayed for the woman to experience joy and life and light on the other side of eternity. And as I prayed, I felt an overwhelming spiritual peace and light in the room—like a hole was opening up in the veil that separated heaven and earth, and Divine Love was pouring through.
Sounds faded away and time stood still.
My spirit felt weightless.
Without any effort on my part, all negative thoughts and memories and emotions simply ceased to be.
Centuries ago, the Celtic Christians called this the Thin Space, the place where the division between earth and heaven, between the visible world and the invisible world, becomes almost nonexistent. The Thin Space is the place where we get a taste—an infinitesimal taste—of what awaits our souls on the other side of eternity.
I had heard about the Thin Space before, but sitting in that hospital room in Togo on that muggy Monday night, I experienced it for the very first time in my life. Instead of being repulsed by the presence of death, which was rapidly consuming the body of this woman who was dying before my eyes, I found myself being drawn closer in. I was drawn to this place, drawn to this woman’s bedside, longing to go deeper into this miracle, wanting to steep my soul in the depths of this mystery.
Her inevitable death did not seem horrific to me. Instead, it was infused with hope, because sitting at her bedside I experienced the other side of the Thin Space, and I knew that for the rest of eternity, she would be held in hands that were much stronger and gentler and more loving and knowing than mine could ever be.
I looked at the monitor above her bed. Her heart rate was now in the 180s because she was rapidly losing blood from hemorrhaging tumors in her abdomen. Her oxygen saturation dropped to 75 percent.
She was fading fast. It was time to say good-bye.
I didn’t know if she could hear me or not, but with my left hand on her forehead, I whispered, “Mama,” with the accent on the second syllable. maMa. My translator had told me it was a term of endearment for older Togolese women.
“Mama, you were born into love, you will die into love, and you will be held in love every second in between.”
I blinked away tears as I traced the sign of the cross on her clammy forehead with my thumb.
“Whenever you’re ready, you can go to God,” I said. “You can go home to God.”
Her eyelids fluttered, but she didn’t open them. Her heart rate accelerated and her oxygen saturation dropped even lower. I wondered how long her poor body could keep going before it finally gave out.
I sat there holding her hand in the still, sacred, peaceful Presence until her son rushed into the room. He and the chaplains had flagged down the cab, and it was waiting at the hospital’s front gate.
The nurse offered him a wheelchair to transport his mother to the car, but he shook his head. Instead, he scooped up his mother’s nearly lifeless body in his arms. I gently kissed her forehead, and then stood there with tears in my eyes as I watched him carry her away.
The son called the Togolese chaplain the following morning to inform him that the woman had died in the backseat of the taxi, when they were halfway home.
This is an excerpt from my upcoming book WELL, which is available for pre-order now. Order your copy wherever books are sold.