Kirin Gupta - Ecuador

November 30, 2011

Sex: Female.

Age: 29.

Children: 3.

Status: Married.

Income: $600 per month.

Primary/Subsequent: Primary.

Diagnosis: Tentative. Breast Cancer, Stage 4.

Recommendation: Immediate visit to oncologist, Hospital of Tena.


Filling this chart leaves me empty. My pen drops.

Because how much can you see in the statistics, even when the notes are well-enough detailed? How much does it tell you about her face crumpling and shoulders sagging when she hears the word “cancer” being whispered to me by the attending physician? Facts don’t cover the pain that welled up in thick tears as she removed her blouse and indicated the contorted, malignant bump that is growing in her right breast. And none of the notes I took are going to give her children their mother back, come one year’s time.

How painful it is, when not only are the notes useless, but one must also face the fact that there is so little medication that will help her, and even less that she will ever be able to afford. Yes, the government subsidizes basic treatment, but she has never been to see a doctor about this problem before. And now just seems too late.

— Anomaly for a woman of her age.  I note.

Dr. Sandra behind me has her hand on my shoulder, and I can feel the movement of her sympathetic headshake, reserved for only the most serious cases we see. I reach for the patient’s trembling hand, and admire her for not letting a single tear spill over.

Her youngest child is still breastfeeding, the reason she finally came to see the doctor. Just short of a year old, she is crying at her side on the examination table. The hurting mother looks at the little girl blankly, tugging at the hem of her shirt with her free hand. I watch the baby stare at her, mouth open in a constant scream, confused.

— Return for consultation after specialist visit in one week.

The patient nods, still strong faced, and I can feel the steady pulse in her wrist as we finish explaining, and she picks up her child. She says she will come back with her husband, after they go to the hospital.

I wave at the little girl over her mother’s shoulder.

One week consultation, post-tentative diagnosis.

She is smiling. This stuns me. I try to mimic that easygoing smile, but can only manage a nauseous-looking grimace.

She is smiling at her young son, and laughing at his antics as he hides his improvised gum-wrapper-toy behind red personal-hygiene bags. And she doesn’t seem concerned at all about the words in front of me on the page.

— Diagnosis confirmed. Patient to be entered into immediate care.

It was well enough that she didn’t want radiation. Her reported family income could not have supported it and the government couldn’t shell out for chemotherapy. Her husband’s face was graver than hers, but neither looked lined with worry, as I felt in my forehead and pursed lips. From whence this amazing strength to take everything in stride arises, I have no idea.

It is a result, in part, of the general attitude in Cotundo, Ecuador, I think.

She began talking to me in Kichwa, of which I could understand very little. She talked about surviving, and then she said my name. Several times, in a cluster of other words.

When our patient left, still smiling, all of her children in tow, I asked a Kichwa nurse what all of her words had meant. From under her crisp white cap, the nurse smiled sweetly.

“She said it’s okay. Be calm. She was telling you to have faith, as she does. That’s what ‘Kirin’ means in Kichwa. To have faith.“

Kirin Gupta