Zimmerman Letter 4-2-2018
Kathmandu, 2 April 2018.
Dear Friends, "Go everywhere and announce the Message of God’s good news." Mark 16:15
It was a glorious March morning as I cycled along the still-quiet streets to Patan Hospital. Having sent the boys off on their new 7am school bus, I was hoping to get an early start to a busy day in my new role of helping the hospital develop nutrition ervices for patients. The air was filled with birdsong and bright sunshine that quickly dismissed the early morning chill, and the sense of spring in the air was palpable. So strange, I thought, to be surrounded by such light and hope when a shadow had just loomed over our heads. Arriving at the hospital, I was soon busy supervising the preparation of nutrition supplements in the kitchen and checking individual patients who were to receive them on the wards. Nevertheless thoughts kept popping into my head as to what the coming weeks, or even months, might hold for us.
For years, Mark had been aware of a brown patch on his left forearm, often exposed to sun while hanging it out car windows. Recently he had wondered if it was changing colour and one morning in early March decided it had gone dusky red. The next day, between two busy clinics, he had Chief of Surgery Dr. Sanjay remove it, leaving a seven-stitch incision. Dr. Sanjay recommended that the specimen be sent to a private pathologist whom he trusted. Six days later the pathologist phoned Mark with her findings: ‘Lentigo Maligna Melanoma.’ She invited Mark to her office to discuss his report in detail, including the fact that the margins cut around the lesion were not sufficient to be considered safe. She advised that he would definitely need to have it re-excised, and that he needed further specialised tests not available in Nepal to determine the depth and degree of the cancer. The doctor had done her pathology training in Chicago and later at Johns Hopkins University, and was a U.S. board-certified pathologist. Her English was polished and her manner professional and caring. Together, she and Mark packed his microscope slides and biopsy specimens into a box for shipping overseas.
The next couple of weeks were a whirl of e-mails and arrangements. Dermatologists have long waiting-lists in the US and it seemed that health facilities in Thailand would not be sufficiently experienced with melanoma. Sending enquiries to U.S. medical colleagues, a long-time friend since college days connected Mark with his friend Dr. Linda Wang, an outstanding dermatologist in Baltimore and an authority on skin cancers. Dr. Wang immediately emailed Mark about his case and reviewed his pathology report, agreeing that he needed to send the specimens to her office as soon as possible and come to the US himself about a week later. A four-day visit to Kathmandu by Jim and Marilyn Simons gave us the chance to rush the box of biopsy specimens back to New York for mailing on to Baltimore. We researched air tickets and booked a flexible ticket for Mark to leave on the night of Easter Sunday, with free changes to his return date. The one silver lining to the cloud was that Mark would fly in and out of Philadelphia, and have the chance to visit his mother at the same time.
The increased numbers of doctors on the medical team meant that there was no difficulty for Mark to take the necessary leave. On the other hand, my work as the sole dietitian on a part-time basis was peaking towards a major presentation to senior doctors and nurses about the importance of developing nutritional services as part of patient care. More supervision was required on the home front too as the boys broke from school for Easter holidays. Benjamin spent a good amount of time working on basketball skills, while Zachary tucked into some serious study towards his international exams that take place in May.
The boys were briefly startled by Mark's diagnosis but understood that we were working to deal with it. We told close friends about the situation and many, including Benjamin's classmates, assured us of their daily prayers. A week later, our Nepali church was conducting a ‘Healing Program' to which we had invited a friend with lung cancer along with her husband. At the end of the service, folks lined up for prayers for healing and the church elders, including Mark, laid hands on them as the chorus sang softly. As the service was winding down, Mark shifted from pray-er to prayee and asked Krishna Kaji to lay hands on him, telling him he needed to travel to the U.S. for surgery on his arm without mentioning the cancer.
Spring did not sweep in as uniformly as we have grown to expect in this tropical climate. The weather was more reminiscent of an Irish spring, with strong winds bringing heavy showers and cooler days. With nothing planned for the Easter holidays, and Mark's impending departure, we organised a group of friends to hike up a favourite mountain ridge for a picnic lunch on Good Friday. Vehicle booked, bread rolls and hot cross buns ordered from a nearby bakery, and the fridge packed with sandwich fixings, we woke up that morning to the low rumble of thunder. The day was dark with clouds, and soon a rain shower was beating down. On the horizon we could see blue sky behind the mountain, but the weather seemed unreliable and we were still second-guessing ourselves as we made the one hour drive to our parking spot and the clouds drew in once more.
Up on the mountain however, the air was clear and the threat of rain receded. We even appreciated the cooler weather as the eleven of us pushed up the steep slopes of the ridge and climbed the final 1000 stone steps to the summit. Leaving the teenagers to wait for the rear-guard, four of us went over the top to our regular picnic spot to set out the lunch. Below us to the south was an undulating stretch of pine forest leading down to groups of village houses set in terraced fields; to the north, a more dense jungle of trees cascaded off the edge of the mountain into the surrounds of the city far below. As we waited around our picnic blanket with the food containers set out on it, we fretted about a scurry of approaching clouds. Suddenly, a squall of raindrops whipped across us, followed by a roaring wave of wind that thrashed all around us, bending the trees over and tearing at the surrounding vegetation. For a good ten minutes we crouched low, clutching our backpacks, our dog Bella and the picnic fixings as the wind persisted in its rage, whirling debris all around us. Then, as quickly as it had arrived, the wind dropped, and the air was still again. The clouds moved on without shedding their rain, and patches of blue sky appeared. Shaking the dirt off the picnic blanket, we gathered around to read the familiar Bible passages about Christ's crucifixion, including descriptions of the darkness and earthquake that occurred as He died. After a brief prayer, we set into our lunch before enjoying the more leisurely walk back down to the vehicle.
That evening, after the empty lunch boxes had been unpacked and the backpacks stowed away in the wardrobe, Mark opened his computer and an e-mail from Dr. Wang arrived with the subject line ‘Good News’. She wrote ‘preliminary wet read is that it is not a melanoma.’ We crowded around the computer screen in astonishment as she questioned the timing of Mark's flight in relation to when she could confirm the findings. With just 48 hours left before his planned departure, we wondered how quickly clarity could come. But within a couple of hours the full final pathology report from Boston arrived saying 'Lichenoid Keratosis (no sign of malignancy)'.
Just before bed Mark phoned the dermatopathologist in Boston. She was gracious about the Nepal report, saying this was a difficult call for someone not specializing in skin conditions. She herself was highly experienced, had applied stains specific for melanoma (which were all negative), and, just to be complete, had conferred with another pathologist. After his half-hour conversation, Mark was convinced that the matter was resolved for good.
Early on Sunday morning, Mark left the house and headed out into the dark, deserted streets of Patan. The tension of the previous weeks had taken their toll on me, and I continued in deep sleep without noticing his departure. The occasional truck hurtled past as he cycled under a buttery moon descending amidst the streetlamps. Reaching the church, he joined members arriving in ones and twos to take seats around the carpeted hall. Outside, grey light began to reflect off adjacent houses and a bird song through an open window mingled with the first hymn and prayers. It was time to celebrate our Risen Lord.
Sincerely, Deirdre, Mark, Zachary and Benjamin.