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Yesterday, a woman came to the clinic, thirty-seven years old, though the lines on her forehead told a much older story. Her voice, when she spoke, was like wind through broken glass. She has idiopathic pulmonary fibrosis, diagnosed four years ago, though she didn’t say that, only, “I can’t breathe at night.” And I understood. I placed the stethoscope on her back, and the sound -those dry, cruel crackles- rose like a death rattle from beneath her ribs. Bilateral basal crepitations. Her lungs are no longer organs of breath, but prisons of scar. Her oxygen saturation: 82% on room air. She coughs, always, yet nothing comes up, only fatigue. Only suffering. I gave her N-acetylcysteine, knowing it’s a weak offering. Bronchodilators- salbutamol, ipratropium- like water handed to a drowning man. No anti-fibrotics here. No pirfenidone, no nintedanib. No CT scanner to measure the damage, no pulmonologist to confirm what I already feel in my bones: her lungs are dying, layer by layer, like pages burning in a book no one gets to finish. She burns plastic to cook. There’s no gas, no electricity. So she gathers polyethylene bags, broken sandals, PVC pipe fragments, and sets them aflame. The smoke enters her alveoli and inscribes her death sentence line by line. I told her, “You have to stop inhaling the fumes.” She laughed. “Then I will die of hunger instead.” And I hated her for a moment, for the clarity of that response, for naming what I’ve tried not to accept. What is a doctor, in a place like this? I know the pathophysiology. Every biochemical mechanism by which her lungs are strangling her. But I cannot save her. The Hippocratic oath feels like a farce here. What do I say? “Die cleaner”? “Choke slower”? I returned to my bench and stared at the bare clinic wall. Outside, children play in rubble, laughing, coughing. The air smells of melted wires. And I, I who studied anatomy and pharmacology and protocols, sat with my head in my hands and asked God if this was medicine, or penance. There is no answer. Only silence. Only the slow, steady suffocation of a woman born into smoke. #GazaGenocide‌