It's Not Fair

The following stories are true. Please be aware that they’re emotionally heavy. If you’re looking for a feel-good human interest story, you’d better read something else. Sometimes life is hard for no apparent reason, but that doesn’t mean we shouldn’t dwell on it.

The heart of the wise is in the house of mourning. (Ecc 7:4, ESV)

So, if this is a good time for some soul-searching and maybe a cry, find a quiet place and listen to the stories of two near-identical women whose paths couldn’t have been more different.

*   *   *

I first met Melanie for a routine colonoscopy, or at least I thought it was routine. My job as her anesthetist was to administer sedation so her surgeon, Dr Vanderberg, could scope her colon. However, before the patient was even in the room, her nurse informed me that her oxygen was low. Sats of 88% on room air isn’t nearly what it should be for an otherwise healthy female. Overhearing us, the surgeon chimed in, “Yeah, she has cancer everywhere.” Concerned, I went to see the patient for myself. 

Walking in, I found Melanie and her husband waiting anxiously. Her sister Deborah, also a nurse, was there to help navigate the healthcare system. I introduced myself and briefly explained the procedure to the wide-eyed family. The medical history on her chart was scant, so I still wasn’t fully aware of the severity of her case. Before long, the nurse wheeled her away to the Endoscopy Suite.

Melanie was 40 years old and the mother of four children, the youngest being 11 years old. She had been getting progressively weaker over the last few months. Upon arriving at the hospital for investigations, scans showed a tumor in her large intestine and evidence of metastasis throughout her body. Lymph nodes in her neck and retroperitoneum were enlarged. Her lungs had spots everywhere (thus the low oxygen). Melanie’s liver was full of it too. In short, she had cancer all over. However, there was no tissue sample to make a definitive diagnosis, which is where we came in - the urgent colonoscopy was needed to find the primary tumor and take a sample of it.

Melanie didn’t look particularly unwell as she was wheeled into the room. Her oxygen level improved to the mid-90s on nasal prongs. I cheerfully greeted her again, hooked her up to the monitors, and administered sedation through her IV. Away we went. Hers was one of thirteen scopes that day, but this one wasn’t like the rest. The room was somber. I sat beside Melanie, watching the monitor as the scope advanced up her colon, apprehensive of what we’d find around the next bend. Watching her sleep peacefully, I noticed her hair looked just like my wife’s - long and brown, with streaks of silver. I held her hand, more for my own comfort than hers. Finally, in the cecum, there it was: an ugly mass of cancer, blocking 50% of the passage. Dr Vanderberg took samples and out we went. Soon she was wheeled back to her room.

We still had other cases to go, but I checked on Melanie regularly. First, to make sure her vitals were okay, and second, to explain what was going on inside her. I got the sense she and her family were still in the dark. 

I was right.

Walking into her room for the second time, I found Melanie awake and sitting up in bed. Her husband was next to her. Her sister Deborah was on the other side.

“How are you feeling?” I asked.

“Fine,” Melanie replied. 

I continued, “I was chatting with Dr Vanderberg about whether you’re well enough to go home. We don’t usually admit colonoscopy patients to the hospital, but your oxygen sats are still low. I expect they’ve been like this for a while. So, your two options are: (1) keep you in hospital, run a bunch of tests, and try to see if we can improve things, which I don’t think is going to make a difference in the long run, or (2) send you home as you are.”

Melanie’s husband spoke up, “Do what you need to do to get this sorted out. We need to figure out what’s going on with her.”

There was an awkward pause. Nobody wanted to address the elephant in the room. 

I spoke: “What have you been told?” 

Melanie responded flatly, “Dr Vanderberg said it looks like cancer.”

At these words, her husband broke down. A floodgate of tears opened as he heard the word they’d been dreading. Cancer. Turns out nobody had fully explained what was going on. She’d been told “there’s a mass” and “your lymph nodes are big”, which was entirely appropriate without a tissue sample to confirm the suspected diagnosis. As a result, none of them knew what I did, that Melanie was dying of cancer.

At 40 years old.

Her husband was beside himself with grief, sobbing and pacing the floor before collapsing in the corner. He cycled through covering his face with his hands, then looking at his dying wife, then burying his head again. He was living a nightmare, with no way of waking up from it. Meanwhile, Melanie and her sister sat quietly beside each other. The family clearly needed a moment to themselves, so I excused myself and promised to return soon to discuss things further.

Two scopes later and the slate was finally done. I scoured Melanie’s medical records to confirm what I had told them. Returning to the room, the three shell-shocked people were calm. I pulled up a chair and began a lengthy explanation. Melanie’s body had evidence of widespread metastatic disease. We couldn’t officially call it cancer until the pathologist reported on the tissue sample, but there was virtually no way it could be anything else. Dr Vanderberg had ruled out surgery as an option to treat her - it wouldn’t make a difference to take out the primary tumor because it had already spread so extensively. Radiation therapy could only zap isolated lesions, not her whole body - again, no chance of a cure. Chemo was similarly out of the question, but that was for oncologists to determine at an upcoming appointment. I told them that Melanie had months to live, if that. Her husband broke down once more. I talked about the next steps: go home, wait for the pathologist report, and the oncologist appointment. A palliative care referral was already in the works. I discussed symptom control - pain killers, stool softeners, anti-nauseants - but I’m not sure they heard any of it. 

When I finally finished, everyone was speechless. They had come to the hospital with questions about why she was tired and subsequently received the worst possible news, that Melanie was dying.

After leaving them for the second time, Melanie’s sister Deborah caught up to me in the hall. At first, she started asking questions about the plan, but soon she broke down too. “It’s not fair… my baby sister.” I don’t usually hug patients, but this time there was nothing I could do except put my arms around her as she sobbed on my shoulder. I had to wipe my eyes too. 

*   *   *

Fast forward a week. My wife and I were out on horseback. Trista has always been a better rider than me, so she was on the younger horse while I trotted along (awkwardly) on the old mare. Our two dogs happily patrolled the path ahead while our four kids followed behind on the quad. It was a perfect family outing, or at least it started out as such.

We rode around the pond, past the old dead tree, then circled the slash pile. On the return trip, our three-year-old girl wanted to ride on Trista’s lap, up in the saddle, but I shut it down. “Not a chance, it’s not safe. And neither of you have helmets.” Reluctantly, our little girl got back on the quad with the rest of the kids and they motored back home. Who could have predicted the potential disaster we had just averted?

As we started back, the dogs suddenly started barking. A groundhog? A bird? Who knows what set them off, but the excitement caused the horses to start bucking. My old mare kicked and jumped but somehow I managed to hold on long enough for her to sufficiently calm down. My wife, however, wasn’t so lucky. Her spirited horse bucked like a bronco. She held on skillfully for the first few kicks, but couldn’t help herself as she tipped sideways and started falling. More bucks sent her flying out of the saddle. 

I watched helplessly as all this unfolded, barely able to control the massive animal beneath me. Trista hit the turf, landing hard on her side. She immediately cried out in pain as her horse (now free of her rider) darted away with the dogs barking after her. I carefully dismounted and found my wife grimacing as she held her elbow. She was pale and lightheaded. “I think I’m gonna pass out,” she managed to say. I laid her down right there in the pasture. She was oblivious to the mosquitos landing on her bare legs or the pile of cow dung near her head. There was no way she could ride or walk back home - she could barely sit up. Assured she would be alright for a few minutes, I gathered the horses and quickly led them back to the barn. Flagging down my oldest son, I gave him urgent instructions: “Mom got bucked off her horse. She’s hurt in the field. I need the quad to collect her, and you need to get all the kids back to the house right now. Wait for us there.”

Rory took the news like a champ and herded his siblings back to the house. Returning to the pasture on the quad, I found my wife still laying down, conscious, but barely able to move. She couldn’t sit or stand without feeling faint. Thankfully our quad had a trailer hitched up, so I flopped her into it - still muddy from the weeds and manure we’d been hauling - and gently drove her back home. Fifteen minutes later we were in the truck and on the road to the hospital.

There are some perks to working at a hospital - Trista got into the ER right away. An X-ray showed a possible nondisplaced fracture of her elbow. Or perhaps it was just a bad ligament tear. Either way, no surgery was needed, just a sling for a few weeks. We were soon on our way home.

*   *   *

Life and death are rarely “fair”. Melanie and Trista were both relatively healthy. Neither smoked or drank excessively. They had no family history of cancer or any other disease. They were about the same height and weight, same age, and had the same brunette hair streaked with silver. Both were mothers of four young children. Each of them was brought by their husband to St Mary’s Hospital for an urgent medical issue, but that’s where their paths diverged. One left with a death sentence, while the other left with her arm in a sling to make a full recovery. As Deborah said as she wept on my shoulder, it’s just not fair. 

The race is not to the swift, nor the battle to the strong, nor bread to the wise, nor riches to the intelligent, nor favor to those with knowledge, but time and chance happen to them all. For man does not know his time. Like fish that are taken in an evil net, and like birds that are caught in a snare, so the children of man are snared at an evil time, when it suddenly falls upon them. (Ecc 9:11-12, ESV)

Time and chance overtake us all. Tragedy strikes the righteous and the wicked alike. Just look in the Bible at the story of Job: he lost everything he cherished in the blink of an eye. His wealth, children, and health all vanished like the morning mist. Job did nothing to deserve such catastrophe, but it all happened just the same. His pain, like that of Melanie and her family, was unbearable. 

Surely now God has worn me out… I was at ease, and he broke me apart; he seized me by the neck and dashed me to pieces; he set me up as his target; his archers surround me. He slashes open my kidneys and does not spare; … My face is red with weeping, and on my eyelids is deep darkness, although there is no violence in my hands, and my prayer is pure. (Job 16:7,12-13,16-17, ESV)

David similarly cried out to God when his best friend Jonathan died. The royal son of King Saul, Jonathan was intent on serving David - even giving up his throne to do so! - until his untimely death in battle. Despite his bravery and skill as a warrior (see 1 Sam 14), he died alongside his father and brothers. His dearest friend was crushed. 

Then David took hold of his clothes and tore them, and so did all the men who were with him. And they mourned and wept and fasted until evening for Saul and for Jonathan his son and for the people of the Lord and for the house of Israel, because they had fallen by the sword. (2 Sam 1:11-12, ESV)

In the military, survival guilt can weigh heavily on veterans. Sometimes the best soldiers die, while others walk away unscathed. David had been in many more battles than his friend, against far greater odds, but he walked away from each of them while Jonathan fell. Sometimes there’s no rhyme or reason as to who lives and who dies. And for those who narrowly miss disaster, we’re often unaware of the implications of the seemingly inconsequential decisions we make. I didn’t let our daughter ride back with Trista, so she was at a safe distance when the horses started bucking. And by the grace of God Trista didn’t land anywhere near a rock or tree. Her vital organs, spine, and head were all uninjured. But it could have just as easily gone the other way.

We live in a broken world. Calamity strikes without warning, sweeping away the good and the evil alike. Tsunamis, volcanoes, wildfire, disease, cancer, violence against the innocent, and pregnancy loss - tragedy is often unexpected. As humans, we strive to understand the reasons behind it, with varying degrees of success. Sometimes we see why bad stuff happens, like the heavenly debate that led to Job’s tragedy (Job 1). Other times, like Jonathan’s death, we don’t. And even when we can’t, our broken hearts often try to find the good in it all - the silver lining - when the most appropriate response may simply be to cry. Often the only comfort is that Jesus is right beside us in our agony, experiencing our pain with us, sobbing, “My God, my God, why have you forsaken me?” (Ps 22:1, ESV). It wasn’t fair for him either.

Within two weeks of the horse incident, Trista was out of her sling, while Melanie had passed away. I thought she’d have months to live, but I should’ve recognized that the extensive cancer in her lungs (remember how bad her oxygen levels were?) was an ominous sign that her death was fast approaching. 

I’ll never forget her - brunette and silver hair so much like Trista’s; the ugly tumor half-blocking her colon; her husband collapsing on the floor; and her sister crying on my shoulder in the hallway. There was no explaining why life ended so suddenly for her, or why Trista is still alive and well to this day. It haunts me that it could have been me burying my wife. And yet, tonight, I’ll see her for dinner like I always do. Only God knows why things happen the way they do. Sometimes there’s no silver lining. Jesus is there with us through thick and thin, weeping beside us through the hurt, but it still hurts. A lot. And life, for those who have experienced unexpected tragedy and loss, isn’t fair. 

Rest in peace, Melanie. 

© D. B. Ryen Incorporated, September 2023.  

A version of this article appeared online in Christian Women Living.