Fighting Hepatitis in Cambodia: Yellow as a Duck

Theresa is a doctor currently working with MSF at a hepatitis C clinic in Phnom Penh, Cambodia. 

The man lying in the ICU bed opened his eyes at the sound of his son’s voice.

“This is the doctor,” said the son, pointing to me. The man in the bed made a weak attempt to greet me with his palms pressed together in the traditional Cambodian manner.

“Hello,” I said, “may I listen to you?” He said yes. I listened to his faint breaths. He dozed off despite my prodding, the lids drawing like curtains over his yellow eyes.

I remembered the words an old attending physician of mine used to describe a remarkable case of liver failure: He’s yellow as a duck. So was the man on the bed in front of me, who was jaundiced from his head to his knees. This is a grave finding in liver cirrhosis, a condition in which the liver is gradually replaced by scar after many years of hepatitis C. Severe jaundice in a cirrhotic patient often signals death within a few weeks unless a liver transplant is immediately available, which is never the case in Cambodia.

And then, in the middle of the crowded ICU, I was transported to a moment in my own past: the day I found out my life partner was dying. Looking at the expression on the son’s face, I remembered what my own face felt like when I waited for the bad news I knew was coming. That tension at the edges of your mouth when you want to ask when? how? how long? But you don’t trust yourself to say anything, so you brace yourself and wait for the doctor to tell you, because you know the truth is coming no matter what, no matter how much you want to throw yourself on the floor to keep the bad news from leaking into the life you thought you’d built so strong around yourself and the person you love the most in the world.

“I’m so sorry,” I said, and to me my voice sounded like it was coming from a long way back. “I’m afraid your father is close to death. I wish I could give you better news.”

The patient’s son looked me in the eye. He smiled the sad, resigned smile I might have smiled that day so many years ago. “Thank you, doctor,” he said. “I already knew things were bad for my father, but I hoped--“ He stopped before he expressed the hope, as if it had disappeared in the thin air before him.

“I’m so sorry,” I said again. I explained that we would make arrangements for Douleur Sans Frontieres, a global palliative care organization, to help take care of his father at home. I touched the patient’s hand lightly before I left, but he didn’t awaken.

A few hours later, my Cambodian colleague told me the son broke down and wept after I’d left. “I think he was trying not to cry in front of you.” Which is just as well, because if he had, I probably would have cried, too. I’m like that, always have been. The biggest weeper in my medical school class.

For all of us who dream of fieldwork, it’s important to remember that you bring all of your experiences with you, no matter how far from home you go. So if you think you’re going to turn into a great big, impartial, unshakeable vessel of compassion when you join MSF, think again. In the middle of an ordinary day, full of ordinary tragedies, your old friends Pain and Heartbreak will creep in and tap you on the shoulder. Sometimes they guide you to do better work, and to live a better life, which is why I’m sitting here with them looking over my every word, telling you this story.