Vignette #1

A girl crossing from gaza to israel with a colostomy because of metastatic ovarian cancer was told to take everything off and to have the feces-containing-bag examined by female soldiers in case (recalling the example of a gazan being treated at the beer sheva hospital in southern Israel who tried to blow herself up). A system needs just one example of something and a new set of circulars and instructions and laws are set in place (to wit the 100 mls fluid limit on planes); she became fed up and told the soldiers ok so I will go back to gaza and die – I don't care I am dying anyway; from the mouth of a 20 year old girl the shock of truth, or the concern of bad publicity and they let her through and since she was coming every week they eventually stopped checking her for bombs but started talking to her, encouraged by her interminable cheerfulness and positive demeanor and wishing her well with the chemotherapy and when she was losing weight they told her she did not look too well and that she should feel better and when she no longer crossed they noticed, and they asked. She was the same age as the soldiers.

At the israeli hospital she made friends with one of the jewish girls who was religious who instead of doing army service did national service. In this case two years serving food and as a general odd-body on the oncology ward. She befriended this same muslim-gazan girl such that when she was admitted to another ward even on her day off she came in and visited and was asked by the ward doctors if she could translate arabic and she said of course not and the doctors asked why are you visiting?

Vignette #2

Another gazan girl was dying in an Israeli hospital where humanity trumps vitriol. The fervently religious mother did not cry and was not shocked since she had known already for a week (longer than the doctors) that her daughter's time on earth was nearly run and she prayed for hours reading and reciting the holy verses and when she was too tired and she knew she had to preserve her strength for her child she stopped praying and forced herself to rest and when the doctors explained there was nothing else to do she said it is god's will that her daughter would die and that doctors were human; she suffered so much here on earth already by age 18 that she would certainly be admitted to heaven and the mother was a devout believer as was the girl and in fact when the girl was semi-comatose towards the very end the mother noticed that the index finger of her right hand was outstretched which is part of the daily islamic prayers and the mother took this as a sign that even when delirious and near the end god was always on her daughter's mind and was further comforted, and shortly after we started a morphine infusion and the mother entered her room and recited the belief of the prophet and the oneness of god and begged forgiveness of her daughter for any sins inadvertent or otherwise and on her daughter's behalf begged forgiveness from god, and the social worker wept for the love of a mother for a child and for the mother's powerful belief that is both so difficult and so child-like.

And the mother was certain she would meet her daughter in heaven however the mother did not wish to die although there had been many rumours of imminent war with the israelis and if she should be killed she said it would not be so bad. And she spoke with her husband and 5 children in gaza sometimes several times an hour and the father was to bring them all together that night and tell of the deterioration and imminent gathering unto her forebears.

And the mother's composure was tightly controlled until the doctor pressed one time too many and asked how the patient's identical twin sister would be told and how she was coping and the mother said there was a special bond and the mother cried and wept for she looked into the future without her beloved child and thought how each time she would look at the surviving twin she would be painfully reminded yet one supposes paradoxically comforted at the miracle that are monozygotic twins.

And the mother decided not to wait until the child died for it was just before the weekend when the muslims stop on friday and the jews stop on saturday and no faxes will be read or transmitted and there will be no coordination between the children of abraham just as there was ill-communication between ishmael and isaac and later between the dizygotic twins esau and jacob (also known as israel) and hence she would have to wait from thursday evening (the anticipated time of death) until sunday lunchtime (by which time bureaucracy would have completed the paperwork) to cross back into gaza. Two and a half days unburied in a fridge and she figured it was better to decease in the ambulance en route home than wait days for a burial which custom has it should be done as soon as possible after death. (On a curious anthropological note it is likely that burial is performed post haste in hot countries such as the middle east in order to avoid early bodily decay, in the days before refrigeration; whereas in the frozen winters of northern europe graves were dug in autumn in anticipation; or else the bodies were left frozen outside awaiting the thaw of spring).

The dead in gaza are prepared at home where the men are wrapped in a white cloth with their faces exposed but the women are covered entirely and religious people come and recite spiritual verses which is psychological caring and then the body is carried to the mosque for prayers and men only bury the dead and only men who could not marry the girl according to social prohibitions, are allowed to accompany her to her resting place in the soil; and she had not known a man's love but she had known a mother's love which they say is the prototype of all love and she had also received the graceful kiss of morpheus the greek god of dreams.

The mother was a religious woman who wore a full burka in gaza but only a hair-covering in israel to avoid unnecessary security tensions and make the passage easier. They had to walk the last few hundred meters to the crossing point (the patient in a wheel chair) lest the car or ambulance be disguised as a bomb (as has happened before) but at least she was allowed to leave and at least she could access a first world health system and at least someone paid for her but most of all at least she had the love of a mother.

And the patient had been asked to return to the first world health system after 3 weeks home in gaza in order to assess progress with an experimental tyrosine kinase inhibitor for a massively advanced neuro-endocrine cancer. Notwithstanding the pills of hope she had deteriorated with concentration-camp like cachexia and a large pleural effusion and admitted to be tapped and then to be sent home with the understanding that the disease had progressed which was a reasonable decision at the time however the tap caused a pneumothorax which caused a sepsis which precipitated her decline all within 3 days and the reasonable decision turned out to be a problematic one but maybe the mistake in the fork of the decision-making tree was to offer her a case-report-based therapy in the hope, since the mother already knew (though we did not know that she knew because we did not ask) but the mother was not terrified because of her belief in god who is the great healer.