Marilyn Nishitani sizes up the little girl from Musoq Runa who settles shyly onto the exam table. Maribie’s curious brown eyes take in Marilyn’s crystal blue gaze and pale white face crowned with spiky gray hair. At twelve years of age, an orphan for most of those years, the little girl has never spoken to a gringo woman, let alone been poked and prodded—albeit with gentle concern.
As Marilyn kneels on one knee to take Maribie’s pulse, she patiently asks her questions in English while a translator passes them on in Spanish, relaying the answers or clues necessary for Marilyn’s meticulous detective work. T
he exam completed, Marilyn issues a prescription and spends a few moments talking softly with the tiny Quechua girl. This scene is repeated ninety-five times on that November Saturday in Macusani.
Ms. Nishitani is no ordinary nurse. As a Nurse Practitioner, licensed in New Mexico, she diagnoses disease and prescribes medicine just like a doctor. In fact Marilyn has a Doctorate of Nursing degree, which is unusual for her profession.
Laliang Aguilar Taipe takes a seat across from Marilyn. “I have a pain in my heart,” she says with deceptive simplicity. Out comes Marilyn’s stethoscope. The heart sounds loud, the pulse strong. “When does it hurt?” she asks. “All the time,” She says, a doctor told her that she has heart disease. The stooped, nut brown Quechua lady seems resigned to the diagnosis. At forty-three years of age, she believes her condition is hopeless.
“How many children do you have?” asks Marilyn. “Seven,” she answers, “but two died.” “How did they die?” asks Marilyn very softly. “Well, two years ago my nineteen-year-old boy got sick, and five days later he died,” the mother whispers, looking down at the floor. “They told me he had leukemia.” Another question reveals that only a few months ago another daughter died after three days of illness, and again the diagnosis was leukemia. Shortly after, another child became ill. He didn’t die, but the doctor said he had leukemia, as well. Marilyn begins to suspect that there is something else responsible for Laliang’s aching heart.
Marilyn draws in a deep breath and tells the woman that it is a statistical impossibility for leukemia to be the cause of all the illness in her family. She explains that leukemia would not have taken her children so quickly. She reassures Laliang, who fears that she has passed on the leukemia to her children, that she is not the cause. “Children do not inherit leukemia.” Marilyn suspects that the children suffered from undiagnosed infections with the accompanying elevated white cell counts. Leukemia was simply a convenient diagnosis.
Marilyn’s diagnosis of Laliang: depression and anxiety. She prescribes three months of anti-depressants. A mother of two children herself, Marilyn relays her diagnosis to Dr. Dwight Bailey the Quechua Benefit mission leader. Together they decide to increase the prescription to six months. But Marilyn’s kind words absolving the mother from responsibility for the death of her children seems a more likely cure for Laliang’s broken heart.
Still full of energy, Marilyn is upset when the clinic closes on Saturday evening. “I wanted to see at least 100 patients today!” she said, “Why close up now?” There are lots of reasons—eight straight days and a steady stream of patients, the late hour, and the need to tear down and pack for an early morning departure. But Marilyn’s energy is undimmed, and compassion still radiates from those pretty blue eyes.
