Cara.

I don’t know what happened inside of me, but when those words left her mouth to answer my question, something in me broke. Something deep inside of me which wanted to hold her close and tell her it was going to be okay shattered like crystal.

With our final examinations looming ahead and the stress of work piling up, medical students like ourselves spend much of our time in the wards of the hospital, interviewing and examining patients whenever we can.

“Hey Wai Jia, can you go talk to her? You’re good with kids.”

She was sitting on the bed, with a colorful bright rainbow-coloured painting of her name stuck behind her. Her back was connected to a tube, which in turn was connected to a huge machine. But nothing in her smiley face and chirpy voice gave away the fact that she was in the children’s specialty ward, where many ill kidney patients were being treated.

“Hello, my dear. Are you *Cara?”

She looked up, bright-eyed and cheery, with a copy of The Little Prince placed on the portable table before her. It was almost jarring, to see a book of such deep poetic meaning in the hands of a child who didn’t look more than seven.

“Hello! Yes! I am!”

“How old are you, my dear?”

“Thirteen!”

Her straight bob hairstyle graced her beautiful porcelain face, a stark contrast to the other kidney patients we were used to seeing, who all had that characteristic sallow, yellow and sickly appearance. I introduced myself and my friends to her, and asked if she could answer some of our questions so we could learn more about her condition.

“Why are you here, Cara?”

Sometimes, children, and even adults have difficulty answering this question, especially if they’ve just been feeling generally unwell without specific symptoms. Nothing prepared me for the kind answer she gave me, which pierced my heart and wrung it out, and I had to disguise my shock with a placid “Oh”.

“My PTH level is too high.”

“What?”

It shocked me. I looked at my friends. Did I hear you wrong?

Because she looked so young, so cherubic and naive and guileless that it made me grieved and anguished and shocked and overwhelmed to know that she had been through so much in life at such a young age, and understood so much about her congenital kidney disease for her to actually tell me the specific name of a particular hormone in her body which was elevated.

“I have a kidney disease from birth. So the doctors say I have to learn PD during this admission.”

PTH. PD. Why are you using words like these? They are meant for us, medical people who give mechanical abbreviations and euphemisms to conditions and procedures and things which we do not dare face head-on because of the whirlpool of emotions we fear to face should we come to realise how much of your life and the lives of your loved ones has been taken away by what we can barely begin to understand, and much less, treat.

PTH is parathyroid hormone. It is elevated in you because of your failing kidneys. Your kidneys do not convert enough Vitamin D from the sunshine into an active form, and so, the lack of calcium in your body stimulates this hormone, and results in bone and joint pains, and other further complications.

PD. Peritoneal dialysis. It is a painfully awful procedure where a tube is connected to your kidneys to wash them and re-equilibrate the different ions in your body.

“I’ll show you,” you said in a sprightly voice, “This is the green button- that means Start. This is the red button- that means Stop.”

The junior doctor breezed in to check in on her, and asked cheekily, “So Cara, why don’t you tell these medical students what the 4 functions of your kidneys are?”

“ To clean toxins from my blood, to make my bones strong, to make pee and… er… “

“To make red blood cells, right?” said the junior doctor.

“Right!” You laughed.

I stood there, rooted to the ground as the scene unfolded before me. It did not help that she looked all but seven years old.

I did not want to ask if she knew she had DD. Developmental Delay, that is.

As part of taking a full history of a paediatric patient, I had to ask how she was affected by her illness.

“Cara,” I said very dearly and carefully, “Is there anything you can’t do because of your illness?”
“Yea, the doctor says I can’t skip or jump. Or do too much of sports. Because I might break my bones.”

Yea. You would know. That’s why your body is making so much PTH. Your kidneys can’t make enough active Vitamin D for the calcium needed for strong bones.

My classmates, charmed by your endearing smile and sunny disposition, started asking you about school, to which you cheerfully replied that you were home-schooled and that the release of the Primary School Leaving Examinations would be announced today. I keep forgetting you are 13, and not 7. Still, why should you know how to operate a PD machine by yourself?

One of my classmates asked if you knew what a transplant was, to which you told us that you were going to get one soon- they found a match from your mother.

A transplant. But was it truly the miracle you all were hoping for? I recalled a video I had watched before, of a young girl who had donated her kidney to her father and then living with bitterness because she could no longer engage in sporting activities. I recalled that even after transplants, some patients don’t do well.

“Cara, ” I interuppted, “Can I ask you a special question?”

She cocked her head inquisitively.

“You know, when you know that you can’t do certain things because of your kidneys which you were born with, how do you feel? What do you tell yourself to make yourself strong? Because I can tell, you are a very brave and very strong little girl.”

There was split second of an awkward moment, and I think my classmates were a little taken aback as well.

But she giggled and smiled.

“I know,” she beamed innocently, to which we were all tickled with laughter. There was a certain purity, humility and candidness about her which was beautifully disarming.

“And I also tell myself, that someday, all this will be over.”

I had goosebumps. “All of what will be over, dear?”

“All of this, all of this will be over,” she said in a matter-of-fact, child-like manner which suddenly brought tears to the back of my eyes.

Was this what kept you going, my dear? This hope in a future that lay ahead of you that you knew with such certainty was filled with rainbows and candy-coloured clouds? Because the way you said it, made it sound mighty like what life would be in heaven.

Weren’t you angry at God, my dear? What had you done to deserve this? To be born with kidney disease, and a whole host of other illnesses related to it. Don’t you know you could have skipped and jumped like all the other kids and how come you’re not the least bit mad at God? And here I am complaining about medicine and how much there is to study and the 100-hour work weeks…

Later on, I learnt that both your hip joints were dead and you walked with a limp. How come you still live and talk with such joy and maturity and gratitude? Cara, don’t you know what little you have?

But darling, you have much.

Because when my friends left, I stayed back to whisper to you that you were a very special girl indeed. And a stack of coloured cards with the heading God’s Promises on your table caught my eye. Next to it, was a piece of paper with your neat handwriting on it, saying,

“I have come that you may have life, and have it to the full.”- John 10:10

You have much.

Thank you Cara, for showing me what it means to have little, and yet, to live life to the full.
Thank you for reminding me of what a difference we can make to our lives and the lives of others, simply by living with the certainty of a hope of a certain place we can call Home.

Yes, someday, all this will be over, and we will live in a world filled with golden daffodils and songs.

I left you saying, “The Little Prince is one of my favorite books too. And by the way, God loves you very much.”

“I know,” you said, and beamed again.

I love you.

“The thief comes only to steal and kill and destroy;

*name changed to protect identity