The Art of Walking

“Walking is an art; if we are always in a hurry we tire and cannot reach our destination…Yet if we stop and do not move, we also fail to reach our destination. Walking is precisely the art of looking to the horizon, thinking about where I want to go, and also coping with the weariness that comes from walking…the way is often hard-going. And this is beautiful: it is working every day, it is walking humanly. It is terrible to walk alone, terrible and tedious. Walking in community, with friends, with those who love us: this helps us, it helps us to arrive precisely at the destination where we must arrive.”

~ Pope Francis

The idiom “walk of life” traditionally refers to the distinct social class and background of a person, the unique circumstances and experiences by which one is formed. In this expression lies the significance of life as a pilgrimage, a journey actively traversed rather than passively observed. Though we all come from different “walks of life-” some with sturdy shoes and others with bare feet, some with a lengthy stride and others dependent on another for movement, some with a head start and others with numerous road blocks- a well-lit path is always on our horizon. When our distinct “walks of life” converge, this narrow path that is perceived uniquely, though incompletely, by each human heart, becomes all the more visible, all the more spacious, all the more accessible, and all the more traversable.

***

Our boat pulls up to the precarious cliffside lining a small indentation in the vast and winding Napo River. We have come to deliver wound care supplies and medications to a family whose daughter fell from a tree about one year ago. After sustaining permanent injury to her spine she is paralyzed, bed- and wheelchair-bound, rarely able to leave the confines of her stilted house which overlooks the passing river and seemingly never-ending rainforest on the horizon. Taking in the surrounding scenery as we near the top of the hill, we are greeted by a group of smiling, playful children and the girl’s father. The kids laugh uncontrollably at our meager attempts to communicate in Kichwa and our careful navigation of the trail of cow dung carpeting the jungle floor. And upon finishing our adventurous ascent to the family’s humble abode, we are graciously welcomed into their home.

Together with our hospital’s pediatrician, a group of visiting doctors enters the girl’s dark, wood-paneled room where her mother sits cleaning her daughter’s pressure wounds. She lies on a thin mattress on the floor, and noting the absence of a window, one of the doctors illuminates the scene with her phone’s flashlight. A brief look reveals a large wound on her backside, the result of hours spent lying in the same position. Despite the presence of the wound, however, she is clean and there is no evidence of infection- it is clear that she is well cared for. Across the room I see her father looking out the window- I recognize his face. Our team took care of him in the hospital a few months ago for complications from HIV infection. I ask him how he has been, what he is cultivating in his “chakra,” or farmland, and how he is responding to his treatment. We discuss the weighty process of the building of his home and the even heavier process of caring for his paralyzed daughter after her accident. Behind the strength and resilience of his sincere answers and unrelenting facial expression I sense the paradox of emotions: sorrow yet joy, worry yet peace, remorse yet gratitude, pain yet healing. Some moments later we work our way back to the boat. We depart with a generous gift- a large stalk of bananas, a testament to the gracious and humble family walking forward one day at a time even when paralysis attempts to hold them back.

***

He approaches the clinic with an unsteady gait. A constricting wrap around his knee and an expanding smile on his face, the young boy limps his way up to the health post as his mother guides him by the hand. In his carefree smile I recall the well-appearing child who visited us in Santa Clotilde a few months ago. In his unstable step, however, the boy appears noticeably different. Though a few months ago the X-rays of his knees provided orthopedic reassurance, this reassurance is soon dispelled by newly discovered exam findings and more advanced imaging tests. Later, I will feel grateful for the community health worker who encouraged the mother to bring her child to the health post and the pediatrician who evaluated this child as our health brigade passes through for the day.

After a consultation with our visiting pediatrician we learn that what began as a mild bout of knee pain has now progressed to something more concerning and serious. In addition to his physical suffering the child has also endured bullying and learning difficulties in school. When asked to stand on one leg he begins to cry- though his mind tells him he can, his body violently resists any potential threat to his balance. A thorough neurological exam reveals that the child has ataxia, an inability to control his movement especially while walking. There are a number of diseases and disorders that can cause ataxia- structural, infectious, inflammatory, nutritional, and cancerous. As we close clinic for the day, together we watch him sway down the hill. The possibilities race through our minds as we await his transfer to the city of Iquitos for a confirmatory diagnosis. En route to Iquitos the boy’s consciousness begins to wane and recurrent episodes of vomiting suggest a malignant process in his brain. A few days later, a CT scan reveals a brain tumor compressing the cerebellum of his brain. I recall this child’s outwardly regressive walk, a physical sign of the progressive cancerous process occurring within.

***

It is our last hot and muggy morning on our ten-day health brigade to the outlying communities along the vast Napo River. We set up our makeshift clinic in a large, empty building surrounded by a still, grassy field stippled with cows. The pace of the day picks up quickly- seventy patients later, the morning seems to have moved at a speed much faster than that of the unheeding cow pacing outside our window. As I look up and call the next patient over to our pop-up consultation “room,” the hastiness of the morning comes to a sudden halt. From the corner of my eye I see a group of physicians and students surrounding a patient lying on a table. Quickly it becomes clear that the woman is ill as I see the group accompany her to a private room in the back. One of the nurses mentions the woman’s name- a name so unique that I immediately match it to her face and the aggressive, rigid tumor that has been invading her submissive, compliant abdomen over the past year. I enter the room where the somber atmosphere penetrates the senses more intensely than the heat and humidity on our skin. I listen and watch as her direct, unwavering speech and indirect, vibrant gaze command a weak, emaciated, and increasingly featureless body. After a long conversation we encourage the patient to consider palliative care at our hospital since her symptoms of pain and vomiting are becoming unbearable at home. With an unclear pending decision, we part ways.

As I board our hospital boat to return to Santa Clotilde, I see the patient being carried in the arms of her loving brother as he trudges down a treacherous, mud-laden cliff that clings to the river’s edge. I see the beauty and concern in his taxing and selfless walk, his arms clinging to his dying sister’s body, their bond infinitely stronger than that of the wavering cliffside falling into the unperturbed river below. A few minutes later I learn that her arrival to the rural health post was an even more arduous journey. Unable to walk, she was carried by her brother for just under an hour to reach the river whose forward-moving current would facilitate the remainder of their hope-seeking trajectory.




“The people who walked in darkness have seen a great light; upon those who lived in a land of gloom a light has shone.”

~Isaiah 9:2

***

A few days later we begin our northbound trip to the “alto,” or upper, Napo. Recognizing the family’s need for a new, protective surface on which the paralyzed child can sleep, one of the volunteers on our brigade suggests gifting them one of our portable mattresses. Our boat makes a quick pit-stop to the same riverbank we approached only a few days earlier- only this time the precarious cliff looks much less formidable as the child’s mother quickly descends to receive the mattress. Though we know a new mattress is not the solution to all of their difficulties, we hope it will ease the child’s discomfort and provide some needed rest for the family’s continued journey ahead.

As we depart for the second time I see her mother walking steadily uphill, the visible mattress grasped tightly in her hands and the invisible burden and sacrifice carried humbly in her heart- I am reminded that it is only in descending that we will ascend again.

***

It’s been a long week of uncertainty, imaginably longer and more uncertain for the worried mother awaiting her child’s brain surgery. As the days drag on, the reasons for the delay become evident- the necessary supplies are unavailable, there is no anesthesiologist present to assist with the operation, etc. The realities of a resource-limited area and broken health system again turn their heavy heads in our direction. Despite the barriers and challenges, however, the child eventually and successfully undergoes surgical removal of the brain tumor some days later. After a medical-induced coma in the intensive care unit for three days we hear good news. The child is now in the normal pediatric ward- awake, talking, and eating again. We later learn from the pathology results that the tumor is benign, and the boy’s prognosis is very favorable. He will only require therapy to recuperate the neurologic function he has lost and develop those skills in which he has fallen behind.

There is no doubt their journey will be long and difficult. Equally without a doubt, God has been and will be with them every crooked step of the way- for this we are grateful, hopeful, and unafraid. I am reminded that when our impeded, wayward steps signal the expansive malignant process within, His blessings and our cooperation with His grace will make our collective steps unfaltering and our path straight.

***

From the hospital nurse’s desk I hear the moans of a patient in significant pain. A wheelchair bolts toward the emergency room entrance while the woman’s familiar face and the memory of our not-so-distant encounter slowly lingers in my mind. Only a couple of weeks ago her body deceptively told me her earthly journey was coming to an end. While the rest of her body conveys a sense of powerlessness, her voice and eyes convey her steadfast will. Without needing me to investigate she asks me for exactly what she needs- medication to alleviate her pain, relief from an extensive stool burden, and a blood transfusion to replace the life-sustaining substance consumed by the ruthless cancer within her abdomen. Her three school-aged children stand at the foot of her bed, and I wonder what they think about the physical changes taking place in their mother’s body- her sinking eyes and her protruding abdomen, her wasting arms and face and her swelling legs, her fading autonomy and her growing dependence, her new role as the one who needs cared for and theirs as her caregivers.

The rosary draped around her neck is an outward symbol of her faith and trust, and as the days go on I begin to see her sense of peace and acceptance- she tells me she is ready to go home and be with her family. And though her physical body can no longer walk, I can see that her soul moves forward. I am reminded that the human person is not defined by what he or she can do, what he or she has to offer, or who the world makes him or her out to be, but rather by who he or she is- a beloved child of God.

“When you walk, your step will not be impeded, and should you run, you will not stumble.” 

~Proverbs 4:12