Author: Jon

A Jon Post

I’ve started and re-started this note several times. I knew, I knew I needed to write something and I felt the urge to get pieces of myself and my grief onto this page.

This seems as good a time as any to do it.

While the year is hurtling into March, the end of last year and the beginning of this one have seemed to freeze in place for me. Grief can be cold some times.

Like death.

DIES iræ, dies illa,
solvet saeculum in favilla,
teste David cum Sibylla.

THAT day of wrath, that dreadful day,
shall heaven and earth in ashes lay,
as David and the Sybil say.

Manuel was a hustler, a “get-what-I-can-because-life-won’t-give-me-anything-for-free” kind of attitude infused how he carried himself.

A few years ago, following dreams for a better future, he hopped the border into our neighboring country, South Africa, a nearly mystical land of opportunity and wealth to many Mozambicans born into poverty. All seemed well and he made a habit of sending the strong South African Rand back to his wife and sons to keep them sustained while he bounced from opportunity to opportunity. At the beginning of last year, a small lesion appeared on his shin but he blew it off, knowing that he had no time to slow down in his quest for a better life for his wife and two young sons. After only a few weeks it grew to be too painful to walk so he presented himself to one of the government hospitals in South Africa where they quickly diagnosed him with a bone-deep carcinoma and took his leg above the knee before he could even think through what it meant to have only one.

In pain, and learning to use elbow crutches on his own, he lost his job, his home, and his way of life and limped his way home to a small border town on the Mozambican side of the South African border called Ressano Garcia. There, he tried his luck at facilitating currency exchange at the border for only a month until a lump started growing in his groin above his amputation.

With no way to return across the border he came to the Maputo Central Hospital.

By the time of his arrival the metastatic lump had exploded into a full blown necrotic wound on his inguinal lymph nodes, pouring its cruelty across his leg, his groin, his clothes, and his soul. Manuel had always found a certain comfort in his strength and in the caricature of masculinity he tried to embody. Cancer’s claws often seem to pinch the places it knows will bring the most shame.

When I met Manuel he was a shell of his former self, and I only came to know bits of his story after I invited him to come to my home and began helping him with daily bandage changes. His drive to get home between oncology appointments and his drive to find something or someone that would cure him lent itself to tension between the two of us. But tension doesn’t seem to be able to snap the cable forged from the steel of bodily vulnerability and bodily fluids. Manuel made many mistakes. So did I.

Last week he died in pain while looking for ancestral power from ancestral medicine in the home of his ancestors.

O what shall I, so guilty plead?
and who for me will intercede?
when even Saints shall comfort need?

Selma came back to Maputo and I’m pretty sure she knew what it meant.

She had come here a year prior, done six rounds of chemotherapy, 30 days of radiation-therapy, and gone home to her young daughters with high hopes that her cervical cancer had been eradicated by the toxic combination of oncological regimens.

It was not.

Selma’s cancer did not wait long. Coupling her determination to her weariness, Selma repeated the 1000-mile journey back to Maputo to repeat medical imaging scans and be re-evaluated for a second line of treatment. Her scans confirmed what was already suspected. I remember well sitting in a dingy office with her and a young oncologist, doing our best to hold the space for her grief and to make clear what the limits of chemotherapy were. She smiled, affirmed she wanted to try chemo again, and came to my home.

Months went by and, even as her own body grew frail and thin, she smiled through the pain and drew upon her faith and her family tradition of serving those around her. Selma had a strong will, a ready smile, and nimble fingers. She passed hours of nausea and body-aches knitting special gifts for my daughters, the other patients at Casa Ahava, and even staff members at the hospital. For every other patient at Casa Ahava, her love and her service became a bulwark against the despair brought on by chronic illness.

Six months of chemotherapy could not hold back the malignancy in her bones and her body. She went home to her two young daughters to die. We ache at the missing of her smile.

Last week her right leg stopped working at the hip.

Recall, dear Jesus, for my sake
you did our suffering nature take
then do not now my soul forsake!

Elcina was one of my favorites.

In work like this, much like in parenting, I am sure I’m not supposed to have favorites but my I can’t seem to avoid it sometimes. Elcina found her way into Casa Ahava and into my heart about the middle of last year. Her home is only a two hour bus ride away (still far but much closer than most of the others who come to Casa Ahava) which is usually a reason to disqualify someone from coming to my house. When I initially began telling her oncologist this, he pulled out a mountain of papers, each with a detailed report of her health, each directed to a different service at the Maputo Central Hospital. Cardiology, gynecology, pulmonology, physical therapy, nephrology, neurology, radiation-oncology, my head spun. Elcina’s breast cancer had invaded nearly every system in her body.

Elcina’s mother, who had accompanied her to the hospital, had just returned home to attend to farm and family so she sat alone on her hospital bed when I first came to meet her. As I often do, I asked her what she understood of her disease. As patients often do, she told me the extended story of what brought her to that bed and the many hardships along the way. When she came to a conclusion, I re-emphasized the question, asking what she understood of her sickness today. I have often found it to be remarkable that, given the clearly late-stages of cancer and illness someone is experiencing, they rarely have a cognitive or expressible in words understanding of their illness. Some time ago, this led me to believe in an absence of that understanding in any capacity. After having many of these conversations over these years, however, I’ve come to realize that the cognitive is not the only, and perhaps not even the best, way of understanding and integrating the reality of one’s own dying time. This was true of Elcina.

Elcina came to Casa Ahava and had an amazing bodily bounce-back. Her chemotherapy pushed dark tendrils a little further back, the tube pushed between her ribs into her lungs found plenty of necrotic liquid to pump out and offer air to starving lungs again, her heart medications reduced blockages and lowered blood pressure, and she found her sass again.

I could hear her laugh from 100 meters away.

While weariness did occasionally slow her down, she took to long walks and bus rides around Maputo city, encouraging her roommate to play and laugh a little longer with her in the light breeze of the afternoon. Her two younger sisters came out to visit her and, their little smartphone’s volume pumping its little heart out, they all danced under the shade of our veranda and our mango tree.

Elcina was one of my favorites.

Chemo doesn’t work forever, particularly the handful of old generations of chemo we have here in Mozambique. Liquid secreted through lung tissue and Elcina’s chest heaved a bit heavier when she walked. It pushed through pericardium walls and her heart beat quicker and shallower in its labor to push her chemo-laden blood through her veins.

Her laugh endured. But her energy did not. My urgent visits to the hospital with her increased. Echocardiograms, vacuum tubes squeezed through ribs and lungs, more morphine… and more days spent laying in her bed.

In intimate and emotional conversations Elcina had made it clear that she wanted to die at home with her mother when her time came. “That time” can be reckless in its approach. Elcina’s blood pressure plummeted and we frantically organized for her older sister to come to our home so she could accompany Elcina to her mother. On Elcina’s last day here, a hot day in mid-January, her roommate Isarda, stood faithful witness to what was occurring. Similar to the conversation from 7 months prior, neither Elcina nor Isarda had made cognitive what was happening in the spiritual. Nor had I.

As Elcina slowly edged into the back of our van where we had made a wide space for her to rest as she prepared for her journey home she reached out to her roommate, her playmate, her partner in chronic illness, Isarda..

And yanked her tightly into a sisterly embrace.

“This is not what we agreed to” Isarda screamed through her tears and through Elcina’s silent grasp. “It’s not what we agreed to” Isarda cried out again and again.

Elcina’s hand stroked Isarda’s head through the tears we all let flow. She never said a word.

I took off my shoes.

Two weeks ago, Elcina died in her mother’s arms.  

Your gracious face, O Lord, I seek;
deep shame and grief are on my cheek;
in sighs and tears my sorrows speak.

Felicidade was sitting patiently in the treatment room on the floor below the rest of the oncology service.

Her painful IV port protruded from her arm and her drawn face marked the long road she had already traveled to be here, in the oncology ward, hoping for a miracle. She was quiet and hesitant when I first approached her. Her oncologist had recommended I speak with her about coming to Casa Ahava though he didn’t have the time to accompany me in the introduction so she had no idea who I was. Although her family had more resources than most here in Mozambique, they did not have what they needed to house and feed her so far from home so she had spent the previous three months living in the gynecology ward, coming once a month to the oncology ward to get her chemo, then walking back across the hospital to her space in a hospital room full of strangers.

Felicidade’s personality was not warm. She carried herself a bit distant and sad, and she rarely opened up about her own inner struggles. When she did make known what she was feeling, it was nearly always pain. Her trusted Layne with the intimate details of her cancer and her body. As is often the case with cancer, Felicidade was stripped of privacy and dignity by her illness. Felicidade invited Layne behind the curtain of her soul and she trusted Layne to create space between the anguish of late stage cancer and her nerve endings. It was difficult.

When she began a new line of chemo, one which required 5 days of continuous IV treatments, I drove her to the hospital with a heavy heart. It is never an easy week for our patients who need to be admitted and lately they have needed it more than not. Still, I did not think hard on the consequences of walking her to her bedside, carrying her small backpack full of clothes and toiletries and a few snacks, and giving her a smile and a shoulder squeeze as I left her there.

Four days later I got a call at about 5 AM from the nurse on staff. Felicidade had died early that morning in her bed, struggling to breathe.

How worthless are my prayers I know,
yet, Lord forbid that I should go
into the fires of endless woe.

Azarias came smiling to my car and my home in August last year.

His one good eye beamed and he expressed how happy he was to become a part of the Casa Ahava family upon his arrival. His home and family were remote and, though I did not know it at the time, he had been in neither for a matter of years. Azarais’s stoicism in the presence of pain struck me as paradoxically exceptional and, strangely common. While it is impossible to have a true sense of the pain someone else is going through, I have found myself consistently astounded at what I imagine the pain levels of many of my patients to be, given the extent of their illnesses, wounds, and treatments. I have caught myself several times falling into the expectation that chemotherapy and radiation therapy are just “not that bad” given the grace and patience with which many of my patients undergo their horrors. Azaraias was no exception to this and his flint-faced approach to the rigors of chemotherapy contributed to my unconscious downplaying of its effects.

The exceptionality of his patience in the face of pain showed itself when, as I would help him with his daily bandage changes, he would tell me that he did not sleep at all the previous night as a result of the intense pain in his head and eye (the location of his tumor). I found myself simply staggered at his ability to function given how deeply and consistently Azarias’s pain impacted his life. To my own shame I often looked for ways to discount the accuracy of his words, assuming they carried less severity of meaning than the plain understanding of them. I still have much to learn in this work.

The last morning I spoke with Azarias, I woke to find him sitting outside, his body sweaty and his eye bleary. I was preparing to take another patient to the hospital and he was sitting on one of our outdoor couches near the door to her room. Despite his clearly difficult night, he smiled at me and he used an uncommon word (for him) to describe his current state. “Estou aguentar, Jon” he told me. “I am holding on” or “I am enduring” he said. His smile was strained but faithful. His breath was shallow but consistent. And he told me he would see me when I got back from the hospital.

Three hours later Azarias went to his room to try to get some rest and fell asleep on his bed. He did not wake.

When the doomed can no more flee
from the fires of misery
with the chosen call me

Joana spoke poor Portuguese but even in her limited vocabulary she expressed how eager she was to escape the bowels of the hospital in which I found her.

Her large protruding tumor above her right breast was a constant ache, was constantly in the way, and was a constant reminder of the death she carried in her body.

We have had other patients in the past who spoke little or no Portuguese and I am always left with a distinct feeling of an impassable chasm that exists between us simply because we do not have the same words with which we spell out and describe the world. I often heard the fear behind the rudimentary Portuguese words Joana used to ask her questions about how bad it looked when I changed her bandage. I often saw the sadness in her face when she heard that her chemo would be delayed again because her blood levels were just not high enough to start.

But I so rarely heard it in her voice. She was gentle, she was kind, she was shy.

Her open necrotic wound continued to grow and she developed a chronic antibiotic resistant infection. Her chemo was just not helping. We have a small couch reserved for conversations surrounding topics like that and so when I called her to come sit on that couch with Pedro facilitating the language transfer, she knew what she was there to discuss. In her beautiful Xitshwa language, she explained that she had had a dream of her whole family singing the funeral songs over her and lamenting her death. When I asked her if that made her afraid she quickly said it did. At first glance it was easy to assume that she feared that dream heralded her death and that she was afraid of dying. When I pressed just a little bit, “What is it that you are afraid of, Joana?” her bold response was not that she was afraid of dying. It was that she was afraid of dying here. The family funeral songs being sung were for one who had not died at home. Joana belonged to Mabote, her family name and the name of her village. Joana belonged to her people and to her land and she was afraid her death would be among neither.

Last month Joana went home to die and to have the funeral songs sung over her for one safely where she belongs. Last week her wound was bigger, she was weak and afraid, but she was home.

Joana is where she belongs.

Before You, humbled, Lord, I lie,
my heart like ashes, crushed and dry,
assist me when I die.

There is a Gregorian chant called the Dies Iræ! Dies Illa. The music of that chant created by an unknown Franciscan monk 800 years ago and its trochaic meter intertwines ascent and descent before finally descending in a falling scale. For several hundred years, long before the formal study of death and death trajectories were created, this music has represented death and dying in theatre and the performing arts. Only later have we come to see the musical representation often approximates the energy and strength of the dying person waxing and waning then falling steadily in a morbid resolution of its fatalistic melody.

Since December the power of that chant has cast its spell over me as I have held the broken pieces of my soul in a tenuous grasp on sanity while death has walked the hallways of Casa Ahava.

Come murmur with me the final lines of this call, this chant, this spell. Come hope for rest for the restless, peace for the weary, and a bit of joy in dark places.

Lord, all-pitying, Jesus blest,
Grant them thine eternal rest. Amen.

A Jon Post

A song has been resting on a bed in my house for the last four weeks. It rests in the bed near to where a young woman lay panting in pain four weeks ago. Reaching out to me, reaching out to Layne, murmuring to her brother in Matswa.

Matswa, the language Flora sung with the mother who raised and spoiled her, the mother 500 kilometers away and unable to hold her dying daughter while Flora wrestled through the pain and the meaning of dying young.

A decade in the death trade has given me some small familiarity with the rhythms and notes of dying and grief, crafting songs woven from the threads of suffering. In my case, those threads are usually passed through and tied to the eye of the needle of cancer, but really, that needle is not so important a part in the tapestry grief and dying weave from their songs. Like the music of many composers historic and current, most people (and in this, I include myself) do not recognize nor even enjoy the songs grief and dying compose upon first listen. For most people, it is a strange song, an arrhythmic beat, punctuated by cries and gasps, remembered for its long periods of silence interspersed with wails and howls or soft moaning then culminating in a crescendo of turbulence, noise, confusion, and emotion. This is the introduction most of us have to the songs of grief and dying and I do not blame anyone for their distaste for them. This distaste is most often borne for many long years after first hearing the duet of grief and dying sung in the throes of cancer, heart disease, SIDS, after a car accident, or finding a note left next to an empty bottle of pills.

The first notes I heard of that duet for Flora was when I was inviting her hospital roommate to come to Casa Ahava.

Selma was from distant Quelimane, a town in Northern Mozambique more than 1500 kilometers from where she sat in her hospital bed. Selma had done chemotherapy and radiation therapy last year but the dark tendrils of her cervical cancer had not been killed by those poisons so she was back in our hospital, depending on desperate doctors to offer her a desperate attempt to control the growing disease. As I invited Selma to my home, Flora wondered aloud (clearly for my benefit) “who will care for me when Selma isn’t in the bed next to me?”

Ah, yes, there they are. The African drum beats of grief and dying, playing softly in the background of this young girl’s request to follow her friend to my home.

The first thing to notice about Flora was her smile. It lit her face and the room and she made eye contact through intense eyes (exaggerated by her emaciated body). The second thing to notice was her swollen abdomen. Flora’s cervical cancer had grown at a terrifying rate in her body and bullied its way through organs, intestine, and bone, displaying itself prominently in a macabre and mocking imitation of the joys of a young woman in late pregnancy by forcing Flora to cradle her belly and support it whenever she shifted or walked from bed to bathroom.

It took little time to coordinate with her oncologist to bring Flora AND Selma to my home the following day. Flora was from the province of Inhambane, closer than Selma but still inaccessibly far in Flora’s condition. Flora’s plan of care was simple; a couple rounds of chemo to see if the mass in her abdomen would reduce at all but, other than that, try to control her pain and give her as much time as possible. Despite that plan having been explained clearly to her by her oncologist, in a quiet setting just she and I, I asked her what she understood to be happening both in her body and in her treatment. She expressed abundant hope, even expectation, that she would be cured, that her trouble walking would go away, that she would return to her mother and her younger sister; strong, sassy, and ready to prove how wrong everyone else was that this was a serious problem.

There it is again, the music of grief and dying. I know this verse well. This lament for the way things may have been, the loss of potential, the loss of future project, the loss of reputation and identity… So often upbeat, so often belying the story behind the music, all true, all good, all beautiful.

Flora’s cancer was not kind.

I suppose cancer rarely is but it seemed to hold some special malice for Flora. Malignancy wrapped its icy fingers around her digestive system, her nervous system, and her spine. Opiates passing through the bloodstream can sooth the pain of some, but not all of those systems. Bones are particularly resilient to any attempts to palliate their pain. Agonizing hours, days, and weeks passed for Flora at Casa Ahava. I am convinced that Layne was every combination of medical and miracle for Flora because what shoreline could be found in Flora’s sea of pain was guided by the lighthouse of Layne’s presence, wisdom, and medication dispensation. But storms on that sea make the waves of bone pain crash in a different direction as those of nerve pain which crash in an altogether different direction as those of muscle pain. In the turbulence of that storm, morphine can only offer succor in one or two of those waves but not all. Flora was very familiar with storms and with pain.

During one of the calms in the storm, I sat with Flora and her smile and asked her again, “What do you think is happening with your illness and your treatment?” Again she assured me she was going to get better and that, in fact, she was already feeling better than when she arrived at my house. But this time, she followed those assurances up with a question of her own, “What do you think, Jon?”

There they are; the uncertain notes, the lilting, questioning notes, the music of grief and dying dancing this way and that, as if unsure if melody or harmony is the best way forward.

In that moment, I was faced with a decision of faithfulness. To whom must I be faithful in the time when someone asks what I can see on the horizon of illness? Am I faithful to her family, which asked that I spare honesty and openness and use words which, while not “untrue” per se, at least communicate a hope that I do not have? Am I faithful to my teammates who tell me I am in danger of glorifying suffering, of becoming so enamored with it that I may do little or nothing to alleviate it? Am I faithful to the person in front of me who has a chance, a chance, at hearing the music of grief and dying and joining in harmony?

In that moment I chose.

I chose Flora.

“I think you are dying, Flora.”

A sad smile crossed her face and she nodded in acknowledgement and what I took to be acceptance. But the following days put the lie to my interpretation of her response.

Like a branding iron on her hip, her thigh, her back, the pain ripped through Flora’s already weak body in fits and bursts and she railed against it and against the music I asked her to listen to.

“I don’t accept it!” She cried and pounded her fist against the wall in agony, “I DON’T ACCEPT IT!” rang through the corridors of Casa Ahava, again and again. She hated the pain, she hated the cancer, and she hated my words:

“I think you are dying, Flora.”

Now dying, grief and Flora sing back and forth in a tumultuous fugue; contrapuntal, violent, one part taking the melody of the other, imitating, repeating… devastating. Terrible and beautiful in its tone, this section of music can rarely be ignored or forgotten.

Days passed like this. Conflict and emotion ran high among all of us who cared for Flora. Was I right to say what I did? Was the only accomplishment of my pronouncement to increase the pain of a young girl already nearly indistinguishable from the pain that defined her existence?

Another chemo treatment. Another week. More pain. More titration of morphine, amitriptyline, gabapentin, bisacodyl, and other chemical compounds building piers into the sea of pain and symptoms to break the fury of the tide pushing against the shores of Flora’s body.

And somehow Flora found days to smile. Days to laugh. Days to help in the kitchen… Layne carried her through much of it.

Another calm day came. Again, I sat in her room listening to the music.

Reader, if you are ever unsure what to say or do in the room with a person like that, pause and listen for the music. Maybe you won’t hear it. Maybe it will just feel awkward for you and the other person as you sit in the silence, between the beats of the music. Maybe.

“What is happening, Flora?”

“I don’t know, Jon.”

“Tell me about home, Flora. What is your mother doing these days?”

“She is preparing our family farm. Tilling, planting, cultivating, tending, and sustaining. But she is the only one who does all the work and then our whole extended family comes and eats from her farm. She works her fingers to the bone and eats nothing from the produce that comes from the soil she has prepared. Everyone else eats but her. She is the most generous person I know.”

Generosity. Selflessness. Doing all the hard work just so others can be sustained. This is how Flora spoke of and conceived of her mother, of her hero. I was swallowed up in the love and admiration Flora had for her mother. Silence. Waiting.

There it is again.

“Do you think you could be as generous as your mother, Flora?” I asked.

“I don’t know, Jon.” Uncertainty in her voice.

“Sometimes, all the hard work is lain in front of only you. And if you do all that work, it is only others who will come behind you to be sustained by the fruit of your labor. One of my favorite stories, in fact, is that of a man who knew he was dying and told all his closest friends and family, ‘Take and eat, this is my body, broken for you.’ That man’s dying was given as sustenance to those he loved. That man did all the hard work of dying, and gave its fruit to those who came to his table looking for bread and wine. Maybe, your mother has the same generosity as that man. Maybe you can be generous too.”

The same wan smile. The same weariness in her face. But this time… her spirit took some small step… trying to dance to the music grief and dying were singing.

Now grief and dying sing like weeping violins, pouring lament into their duet while wringing beauty and ashes from every note, every measure, and every bar. For months they have prepared and now they introduce their final, terrible melody. They sing in a canon of descending chords, each note falling with the grace of a flower pedal, and the weight of a sledgehammer.

Flora’s body deteriorated rapidly. Quicker even than I expected. What vitality she eked from her muscles and bones took its toll on her and, no matter how urgent and insistent she was, her legs would not obey her heart.

Layne’s unhesitating presence was at her side the whole time. Into and out of bathrooms, showers, clothes, bedsheets, clean or soiled, Layne danced with Flora to the music we could all hear.

In a mysterious mix of body chemistry and spirit, dying people often see things the rest of us cannot. One afternoon, while Layne sat with Flora in the room of our house set aside for those for whom dying sings the loudest, Flora looked at the door and asked Layne, “Who are those people? Why do they have spoons and forks? What is it that they think is being served?”

What a strange vision to have three days before dying stops singing and grief carries the rest of the song.

Flora saw several people in the room with her and Layne, prepared for a meal, for sustenance.

Take and eat. This is my body, broken for you.

When I next sat alone with Flora listening to the music. She laughed and told me that this sickness was making her as dependent as a newborn child. Weeks or even days before, that confession would have been filled with a bubbling rage at the loss of her independence. This day, she laughed. This day, there was music in her voice. I asked her if maybe it was more like a grandmother who depends on the rest of us to carry her around than to an infant. She thought for a minute and then told me of her own grandmother who, when age took her ability to walk, would scoot around on her butt, taking hours to get halfway to her destination then just laugh when she didn’t make it. Flora took the better part of an hour telling me story after story of how she cared for her laughing, handicapped grandmother who died with a smile.  

Four days Flora stayed in a bedroom in my home whose walls had already been soaked in dying and grieving. Four nights in a bed for a young girl learning to till the earth of her dying so that others could be fed.

Saturday came and, though in great pain, Flora wanted to bathe. In her determination not to be a nuisance, alone she shuffled her weary and pained body to the close bathroom. Layne found her on the way and, with a knowing smile, put her arms under and around her and helped her the last few steps into the shower seat where she helped her disrobe and wash her fragile body.

Rupture, screams, pain.

Friable inner tissues and compromised organs lost their tenuous hold on themselves and on each other and Flora’s cancer betrayed her one final time. Layne helped her to her bed. Layne stayed by her side and held her through all the wails, all the tears, all the heart-stopping fear, and all the unknowns.

The final crescendo. Here, dying’s solo is center stage, unrelenting and unashamed, where sanctity and sacrilege vie for prominence between moans and keening cries. This music has no obvious distinction between melody and harmony, it is darkness and light, paradox upon paradox, wholly figure and wholly ground, rooted in the temporal and expanded into the eternal. Dying’s solo is known around the world and across history and it is the cause of nearly every great and terrible event of each.

Layne held Flora to her bosom for hours on end. When Layne’s arms shook for the strain of it all, I picked Flora up one more time and laid her on a layer of cushions arranged so as not to place pressure where pain’s interminable grip held Flora in its fingers.

Matswa words stumbled out of Flora’s lips and she trembled under the strain of tilling the farm of her dying. I do not know if she saw those same spirits standing in the room, waiting to be served a meal or if she already saw eternity through the veil. Her strength, inherited from a laughing grandmother who scooted her broken body through the dirt and bushes of her ancestral land, lent Flora what was needed to pull her way through the field of her own dying and plough one last furrow into the soil.

Surrounded by Christ’s love and Layne’s arms, Flora died.

Now grief’s coda fills the emptiness of dying’s sudden silence. Stunned, solitary notes. In those first moments, grief is muted, mournful brass instruments, and a slow, steady djembe to mark the beating of hearts and the breathing of lungs. Now our own chorus of griefsong responds to the call of Flora’s deathsong and the call/answer is most commonly recognized in African traditional music where a single voice calls and the host responds. Our griefsong sings faithful witness to the beauty of Flora’s deathsong.

One week later we performed our grief rituals here at Casa Ahava. Our family, our partners, and our patients, all joined together and let the ashes of our grief mingle with the weight of our memories and be cleansed by the pool of our tears. It was in this gathering of the living and the dying together that I saw most clearly that Flora had, indeed, learned generosity from her mother and strength in dying from her grandmother.

Our walls echo the songs of grief and dying here at Casa Ahava and the refrain sung for and by Flora has been rattling around my soul these last four weeks. I know you may not like their music very much. I know most don’t. But please find it in yourself to consider what Layne confessed at our grief rituals among our little community of the living and the dying; “I am better for having known Flora. She made me better.” may be true of that music for you too.

This is the hard truth Flora learned from her lineage of strong women: You can till the earth from which others will be sustained. This makes you generous. And you can laugh at your own weakness. This makes you strong.

And these truths are only sung in grief and in dying.

A Jon Post

It has been one full week since the last time I carried him.

One week since my arms held his small frame, heavy in spirit, slight in body.

Paulo first spoke to me as a jovial interruption to my conversation with his ward-mate, Orlando. Orlando had arrived from a distant town and his doctor had asked me to consider inviting him to Casa Ahava, as his journey with cancer and treatment still had many months, perhaps years, yet to be trod. Paulo’s happy voice butted into my chat with Orlando and I turned to see (not simply look) in his direction. He was a short man, a ready smile found his face as he told me about how hard it has been to live in Urology and how he hoped it would be an easier stay here in the oncology ward. Perhaps it was my laziness, or maybe my impatience but I did not immediately take to Paulo, despite his friendliness. His demeanor eschewed confidence and a right to be heard and I balked at his demands of my attention and respect.

When Orlando came to live at Casa Ahava one week later, I asked him if he liked Paulo and if he would like it if I invited Paulo to come stay here too. You see, though Paulo’s home was comparatively closer than was Orlando’s, the hostility of rural Mozambican roads meant that, for practical purposes, Paulo’s home was inaccessibly far. Orlando’s response, merrily acknowledging Paulo’s penchant for chatter, was to ask in earnest for the invitation to be extended.

So in November of 2021, Paulo came to Casa Ahava and to my family.

His quick wit, his total lack of decorum, and his unwillingness to feel ashamed made him an instant hit.

For those who carry it in their body, Cancer, as an insidious custom, tries to force the trade of dignity and humanity for shame and barbarism. Paulo utterly refused that trade. His insistence on his own dignity, his own worth, and his own voice was unshaken.

But Cancer lingers.

Full of optimism and pride, Paulo visited his herds of cattle and goats over the Christmas and New Year’s holidays. The brutality of the dirt and gravel roads to and from his land returned him to us sick, pained, and weary on his arrival at Casa Ahava in January.

What we knew in test tubes, blood results, and biopsies in November made itself clear in fevers, pain, and fatigue in January: Paulo was dying. In November and December, I had conversed with him about the test results and the abstract of his dying several times. In January, over the haze of opiates and the weariness of blood loss, our conversations were not abstract. In spite of Tramadol’s deleterious effects on the mind and the body, Paulo’s smile remained. When I asked him if he would consider going home to die, he affirmed that while he wanted to die and be buried there, he wanted to stay in Casa Ahava until the doctors at the hospital told him there was nothing left to do.

But dying lingers.

Paulo spiked a fever again but 5 days of IV antibiotics and 3 liters of blood served only to weaken his already weak body. We waited too long. Much like the first day I met him, I sat bedside with Paulo, but this time, his voice was shaky and raspy, not strong and confident.

“Where do you want to die, Paulo? Here in the hospital, or at my home?” I asked him, with tears in my eyes.

He re-affirmed he wanted to go home, if only he could gather the strength for the journey.

I looked him in the eye and said, “Paulo, today you have more strength than you will have tomorrow. Tomorrow, you will have more strength than the day after. Today is as strong as you will feel for the rest of your life. Could you travel the road home, today, now, as you are?”

He smiled…

He smiled at me in his dying.

Because you see…

Dying lingers.

“No, Jon.” He said, “I do not have the strength for that road.”

“Where do you want to die, Paulo? Here in the hospital, or at my home?” I repeated.

“Here, the food is no good, Jon. I want to come to your home and eat xima.” Paulo’s smile was unwavering.

So home he came. It took only 3 days for him to lose the strength to walk. That was the first time I carried him.

One day more for his tongue to forget Portuguese and revert to Shangaan. That was when he started looking for home.

“Ni mooka”, he stammered in Shangaan, “I am going home”. “Ni famba”, again “I am going”.

“Not yet, brother”, I replied in a broken mix of Portuguese and Shangaan, offering the xima and stewed greens he had asked for, not knowing it would turn out to be his last true meal.

But dying lingers.

In delirium and frustration with the loss of his strong body, Paulo tried several times to heave his broken body off the unfamiliar bed in which he found himself. Home, the call of his spirit and internal compass urged him to try again and again. Several times I acceded to his hallucinatory demand to look out the door to his room, around the corner, and try to find home. Into my arms and to my chest he would cling, as he anxiously peered out the door, then, in a confused and frustrated resignation, he would allow me to return him to his bed.

But dying lingers, still.

Seven days, Paulo lay dying on his bed. Death’s scent and weight both lay heavy on his sheets and my skin. Seven days, my wife and I kept watch and bore faithful witness to both the urgency and the latency with which Death lay siege on Paulo’s body and soul.

Ghosts danced in our room.

Saints and ancestors, clouds of witnesses, spirits holy and foul.

But dying lingers, still.

Layne’s gentle hand under his, fingers interlaced, assured him he was not alone nor need he be afraid.

The day he died his eyes returned from the haze of delirium and the liminal space where death and life both overlap, and they met mine; he smiled at me one more time.

That night, in spite of great expense in both time and money, and in an effort to honor his deep desire to die at home and to honor the traditions of their people, his brother and sisters arranged for a vehicle to drive his failing body and fading spirit to their family land. Paulo would go home after all.

So one week ago, I carried him one last time and lay him as gently as I could in that car to begin that journey home.

Dying ceased lingering and found Paulo on that road.

Today I am sitting in the room where Paulo lay dying one week ago. I still smell the death-smell, I still hear his voice, and I still feel his skin against my hands.

My children are playing Legos on the floor.

The window through which Paulo whistled in harmony with a visiting kingfisher is letting light dance across the bed where he lay dying last week. I think my grief is looking for a home in that dancing light; playing across the mattress where my friend lost his voice but not his smile, remembering the weight of him in my arms.

For you see… grief lingers too.

But I’ve come to believe that a man of sorrows, familiar with grief, may linger in places with which he is familiar.

Maybe the places most familiar are somehow akin to the places called home. And if He is at home in a place where we mourn… well, what’s more comforting than being at home with the ones we love?

In expanding into our 17 beds at Casa Ahava, we have encountered some growing pains. It turns out our septic system simply cannot handle 20 people using it at once and we need to add capacity. It will cost roughly $4,000 USD to do this. Would you consider helping us raise the finances we need to do this?

Casa Ahava’s daily vehicle upon which we’ve relied for the last several years has come to an inglorious halt. The engine in our 2003 van simply gave up. In order to meet the ever-present needs of the men and women living at Casa Ahava, we make daily trips to and from our partners in the Maputo Central Hospital (usually the oncology ward). Layne has graciously made her family van available as we’ve scrambled in the wake of having no project vehicle but that leaves her and the Heller children without transportation every day we use it at the hospital. We have identified a good replacement for our previous vehicle, a 2008 van, which we hope will faithfully transport Casa Ahava patients wherever they need to go for the next several years. We need $6000 for this new (to us) vehicle. Would you consider helping us with this important part of our home for the sick and the dying?

If you can help with either, please click on the donate button below

Currently Raised:

UPDATE!!! New Van – $6000 of $6000 FULLY COVERED

UPDATE!!! Septic System Expansion – $4000 of $4000 FULLY COVERED

A Jon Post

The more I think about and hope to become more skilled at reflecting Christ to the sick and the dying the clearer it becomes that, despite the simplicity of the gospel, there is no simplicity in the practice it demands.

What is the good news to the 17-year-old boy living in my home whose lymphoma protrudes from his chest, his arm pit, his neck, and his ribs? What is the good news to the 43-year-old widow who lives in the liminal space between living and dying, unable to know if her cancer is growing as she does radiation therapy or receding? There are 14 men and women living in my home. Nearly all of them are unsure if they inhabit the land of the living or the land of the dying.

Please imagine that with me.

They sincerely do not know if the cancer detected in their bodies is responding to the poison dripped into their veins. The do not know if the speed-of-light radioactive particles ripping cell membranes and dignity to shreds is doing the same to their cancer, giving way to more living or simply prolonging an already prolonged dying.

So we wait in the unrestful place of helplessness.

Social workers and developmental experts like to talk and write about something they call “learned helplessness”. This is the idea that, after prolonged experiences of shock, pain, and betrayal, people and animals learn that “nothing they do matters”; there is no act, real or imagined, that could provide an escape from that shock, pain, or betrayal. Surprisingly enough, only within the past few years have researchers discovered that the original theory of “learned helplessness” was precisely backwards; that is, passivity in response to shock is the default, and that we learn that we can escape from that shock or pain. We learn control, we learn that we have power, we learn that escape may depend on our own responses and actions (if you are interested in this, there is a very neat article here about it). I’ve realized that it has become important that I unlearn helpfulness in many of the ways I serve at Casa Ahavá.

I mention the above because it seems important to me to enter deeply the spiritual reality (my paragraph about Christ and the gospel), the soul/psychological reality (the above paragraph about learned helplessness), and now I’d like to enter with you into the corporeal reality (our bodies, our dust, our fingerprints).

So why helplessness? Well, as I mentioned above, our psyche seems to begin with the assumption that we are helpless. With all of our modern medical advances (at least in North America and in Europe), it turns out our bodies still die. No matter how much we internalize the idea that we are not helpless, no one has yet found a way not to die. We can try and try to learn that we are not helpless, yet there comes a door through which we all pass on our way into our dying.

That door is helplessness. No act, real or imagined, will keep us from the land of the dying.

In Casa Ahavá, in our world of the sick and the dying I ask you to please imagine with me the helplessness of not knowing whether you are living or you are dying. Perhaps you, dear reader, have had cancer or have walked alongside someone who has. Maybe it was Krohn’s disease. Maybe it was HIV/AIDS. Maybe it was Parkinson’s. Maybe it was Alzheimer’s. If you have walked the paths of those dark forests, you may have come across this painful realization: You were taught a lie. You were taught that helplessness is wrong and that there is always an escape. You learned helpfulness. In an age of power and control, someone has tried to convince us that they can be delivered into our own hands.  

Is this important to you, dear reader? Is this stuff ok? I truly don’t want to bore you with this but it has felt more and more urgent for me to know the fellowship of Christ’s sufferings (back to the spiritual reality, right?) and this seems like an important pathway through that dark and confusing forest.

So what connects helplessness to the fellowship of Christ’s sufferings? I’d like to quote just a few verses of Scripture here, if you will be so kind as to bear with me:

He was oppressed and afflicted,

    yet he did not open his mouth;

he was led like a lamb to the slaughter,

    and as a sheep before its shearers is silent,

    so he did not open his mouth.

By oppression and judgment he was taken away.

    Yet who of his generation protested?

For he was cut off from the land of the living;

    for the transgression of my people he was punished

He was assigned a grave with the wicked,

    and with the rich in his death,

though he had done no violence,

    nor was any deceit in his mouth.

Yet it was the Lord’s will to crush him and cause him to suffer

Isaiah 53:7-10

Does that sound like helplessness to you? It does to me. The man to whom this prophecy refers had all power and authority laid before his feet… and he chose helplessness. He chose to be led away, silent, without protest, crushed, and suffering.

Yesterday I had a long conversation with a 23-year-old boy dying with cancer with a large open wound which has taken away his ability to walk. The cancer has robbed him of his dignity, his privacy, and his strength. And I can give none of that back to him. No action of his or my own, real or imagined, can provide escape from his affliction.

Today I looked a 17-year-old in the eyes as he showed me another painful lump protruding from his flesh and I could not tell if the mass under his skin was greater or smaller than the fear in his face.

For you see, I have no power here. I am helpless.

A wise man recently told me that the whole arc of the Passion narrative bends toward helplessness. Who then am I to seek power and control (helpfulness) when Christ gave those up?

To those of you reading this who pray with us, partner with us, are participants in this broken-to-be-given project that is Casa Ahavá, I say this: The blessing of serving in Mozambique is to become more comfortable with the spiritual reality of helplessness. So: here we are; send us.