In Nicaragua, we serve as physicians in a situation of scarce resources, tests undone for lack of funds, and treatments and medicines that come too late, or do not come at all -- simply because there is not money for them. Josie is a little girl whose diagnosis of a brain tumor came very late during the course of her illness. There is no one person, or one doctor to blame -- there is only an unjust system of health care that favors those who can pay, and leave those who cannot with what is leftover.

By the time Josie came to us at AMOS, her brain tumor was very advanced. We have a limited budget, so friends from church helped us to pay for the tests she needed. Fortunately, once she was diagnosed with a brain tumor, the government hospital was able to take over her case, and the pediatric neurosurgeons will be operating on Josie to remove the tumor and hopefully give her a chance -- even though this chance at survival is very slim.

In medicine, there are times that there is nothing more we can do than wait, and to be there for your patient and her family.

In the hours we spent with Josie and her mom, we came to know her story, and her mother's love in a way that I can only express in a poem, so that you too can know a little bit about Josie, and to pray for her and her mom and dad, and for them to find hope and strength in God's love for all of us and that God is listening to their prayers.

A poem for Josie                    

"A shadow the size of a lemon,"  

the doctor explained,

"If we operate, she might die.

If we don't, she will."

My breath is taken away

by words,  as if punched.

And I catch a sob in my throat

because I don't want to know…

Josie, you already know this story

because it's your favorite one.

How we tried 14 years until you were born,

and then you came too early,

so that you barely fit in my two hands.

I thought we would lose you

because your cry was only a whisper.

But once we brought you home,

you grew quickly,

to become queen of the house,

all four years of you.

 Last year when you began to shake

And then go limp

With your first seizure,

there were tests to be done,

and medicines to take,

that we couldn't pay for.

You asked me every day

where your brother and father were,

the whole time they were in Costa Rica

cutting export quality melons

to pay for the pieces of your illness,

that the government hospital could not.

And now the doctors say you have cancer,

and all I can think of is

how the 8 beds in this room come with no sheets,

and all of us mothers have brought our own,

inhabiting small corners of grief with our children,

leaning upon each other, even though

it feels like there is nothing there to hold us up.

I tell myself that it is God's will,

And the doctor says to trust in God, come what may.

But it's hard to trust in God when I see you slipping away,

the whole right side of your body paralyzed,

so that even your little smile is crooked.

You barely fight back even

when they put in the needle for your medicines,

and your eyes close so heavily, even in the day,

when before I couldn't stop you from running.

You call out mama, mama, and reach for me,

With your still good hand, that is now starting to shake.

And I hold you tight, breathing you in,

wanting to believe that this is still better

than not having you at all.

I pray to God to give me strength,

but it seems that you are not there to listen to my prayers,

and I want to believe that God is still good,

even as you fall into whispers and shadows,

in the darkness of this hospital.

*name changed to protect patient confidentiality