Out of control

It was a warm spring day in Binghamton when I joined the other carefully picked students for a "meet and greet" and tour of the campus for prospective freshmen and their families.  One of the parents struck up a conversation, asking how I liked the school, what my major was, and if I had plans for after college.  He was enthusiastic about the fact that I was majoring in nursing ("good job security there") but not so much about my future plans.

"Don't you know those people get killed?" he asked, obviously concerned.  "It's not safe to go overseas.  There are cannibals.  You can't do that, especially not on your own.  It's not safe," he repeated, with a concerned glance at his daughter as if she might catch some sort of contagious illness from me.  I wanted to laugh, not really sure what to say.

I never told him that I grew up overseas, not always knowing from day to day whether it was safe to go to school, or if we would show up to church only to find it burning to the ground.  We rode motorcycles and climbed exploding volcanoes, hid behind cars during riots, kept our bags packed for months at a time in case of emergent evacuation, and walked by the training schools that sent Jihad warriors overseas to fight the Americans.  As childhoods go, it wasn't really a safe one.  My future plans were only in keeping with the same radical existence...a realization that safety isn't everything.

It is dangerous to work in emergency nursing, never knowing what contagious diseases you may be exposed to or which patients will become suddenly violent.  It isn't safe to sail to one of the poorest countries in the world, a country still recovering from 11 years of civil war and teeming with refugees and demobilized child soldiers, in hopes of reaching out to touch the hurting.  But I don't choose this life because of my background or a blatant disregard for my own safety.  It is in a realization that to live life one must encounter danger on some level.  Danger is not only in a life of wild adventure, it is also in driving a car, in trying new foods, in living, in loving.  Can we neglect our responsibility to reach out and touch lives because of a fear of failure?

We were never promised a comfortable long life as Christians - rather persecution and hardship.  We were not promised riches, but instructed to store up treasure in heaven.  It is an uncomfortable life and an uncomfortable gospel.  Our God is not a "safe" God...

"Then he isn't safe?" said Lucy.

"Safe?" said Mr. Beaver. "Don't you hear what Mrs. Beaver tells you? Who said anything about safe? 'Course he isn't safe. But he's good. He's the King, I tell you."                                             ~C.S. Lewis

"Hidup mulia atau mati syahid"...live gloriously or die a martyr.  My neighbors in Indonesia understood radical faith...how is it that my neighbors in America have missed the boat?  What is the point of hiding in a hole?  To  live a timid existence with minimum risk, only to die in a car crash or fade away with cancer?  You may pass through life with no ripples in the pond, never having lived at all.  Who is to know when your days are through and God will call you home?  You are not in control of your future.  It is God who is in control; God who holds you in the palm of his hand.  As my Dad so often liked to say, "The safest place for us is in the center of God's will."  A life of wild adventure in following Christ may not be overtly safe, but it is GOOD, and God is ultimately in control of what happens.

To others it may look like the terrifying adventures of someone with a blatant disregard for their own life.  Trust me, I don't have a death wish.  For me the safest place for me to be next month is aboard a converted ferry ship in the wide ocean, watching out for pirates, sailing towards a life of love amidst poverty, refugees, and ex-child soldiers.  If I die a martyr...so be it.  I will have lived gloriously in obedience to my King.

...I am out of control.

Prayer Letter

It’s a shock to realize that what you once dreamed is no longer the dream of your heart.  That where your heart once was is no longer your home.

It hits me hard when I look out on the beauty of small-town New England in the autumn and realize that, gorgeous as it is, there is so much more to life.  My past goals of living here, raising a family, saving lives at a local hospital – it’s a transient reality, lived for a moment and then ready to go on the back burner to simmer again. 

I thought that when I came home from Togo I could go back to normal, that the heartache would heal in time.  Instead I find myself still there, in the stark, bare reality of a life without resources and a soul joyfully reflecting the glory of God, regardless of the cost.  My skin may be white, but my heart still beats with the rhythm of the djembe.  My naiveté has been lost and instead I sing with Brooke Fraser, “Now that I have seen, I am responsible; faith without deeds is dead.  Now that I have held you in my own arms, I will not let go…”

I found myself debating the point with a doctor from work at 4 am this week.  Night shift can sometimes be good for substantial debate.  Dr. Duke is wrong…a life of service cannot and should not be separated from faith.  In reality, a life of service can only be lived by faith, a reflection of Christ at work in a soul…a heart surrendered in worship.    Otherwise it becomes dry and meaningless.

And so, friends, I am headed back to West Africa.  To be a part of the miracle of a child living only by the grace of a good God and the fervent prayers of a mama.  To love the outcast and touch the hurting.  I will be a pediatric nurse again with Mercy Ships, this time in Sierra Leone – a country already torn apart from years of war.  My commitment is from January - May, 2011, and I am very excited!

I plan to meet the Africa Mercy in South Africa for the sail to Freetown, Sierra Leone. Along with my responsibilities as a pediatric nurse I expect to participate again in surgical screenings, respond to the need for Pediatric ICU (PICU) and ICU nurses, and most likely joining the emergency team again as well. 

I covet your prayers and welcome your support.  Because all of our surgeries on Mercy Ships are provided free of charge, I will need to raise just over $5000 for my 4 months of crew fees and the plane tickets.  Regardless of whether or not God leads you to contribute financially or join me overseas, please pray for my co-workers, patients, and myself.  Please pray for volunteer medical staff to be raised up, for God to prepare our way in the hearts and lives of the West Africans, for safety and for opportunities to witness.  I have continued keeping up with my blog here at this address, and plan to continue to do so throughout my trip.

To learn more about Mercy Ships or make a donation, you can visit my page at https://connect.mercyships.org/page/outreach/view/crewmates/colesl.  Donations can also be mailed directly to Mercy Ships, P.O. Box 2020, Garden Valley, TX 75771, with a note attached that they are for Acct # 2699.

Aiming to reflect His love,

Laura

Reflection of Glory

Autumn in New England is a glorious thing; autumn in the Berkshires is no less beautiful.  Stretches on vast stretches of rolling green-and-gold hills.  A mountain view on the walk into work that makes me just stop, and stare, and sigh.  My heart sings with the brooks and creeks as they wander along the path God guides them in.

I stop for a moment and stare, lost in the reflection of fall colors so perfect it's hard to know which is reality and which is only the reflection in the smooth water.  A few hundred feet down the current swirls, speeds around rocks, and the perfect image is broken.

We were created to reflect the glory of God.  It's hard to remember that sometimes, living in a world that frowns on vulnerability, encourages us to trust in our own strength.  In a job where I need to present confidence and competence in the first few minutes of meeting a patient, twenty, fifty or a hundred times a day.  Where co-workers tell me that service overseas is a farce of proselytizing and coercion rather than a God-given calling and ministry.  Where genuine joy is the oddity and not the typical.

I love the Emergency Department.  It's not the adrenaline rush, not anymore.  It's reality.  Where facades are stripped away and people show who they truly are.  I miss the innocence of before, but now that I know the reality I can't stay away.  It's not just in Africa where there are the poor, the forgotten, the outcast and the needy.  They are here too, our neighbors and friends, the town drunk, the lady camped out under the bridge, the girl who intentionally overdosed, the young father with a new diagnosis of cancer.  It's just that here in America we try to hide our brokenness.  It may not be physical, not always.  We have to look a little harder to see beyond the mask.

Lord, to these the hurting let me be a reflection of Your glory, albeit still a little broken sometimes.

The limitations of Wong-Baker

I was getting patient report during an early orientation shift at an ED nursing travel job in New England. The nurse reporting off added as an afterthought..."oh, and you may have trouble communicating with "John". If a family member's not there you may need to call the translator."

I went and assessed my patients, had a nice conversation with "John", and came back out to touch base with my preceptor for the day. "Oh, and "John" is doing well, no nausea, vitals are great, and he needs a little more pain medicine."

"So, family was still there?" she asked.

"No, he stepped out, but he'll be back in a few minutes." And no, I don't know "John''s language. Within a few minutes I found myself explaining to a new staff how I came to be semi-fluent in medical pantomime.

It was difficult for them to wrap their American medical minds around a place where ATT translators are not readily available. Where we hire aides for their language skills rather than medical knowledge and background. Where conversations may go through multiple nurses, translators, and other patients or family members. Where a little girl and her uncle could spend a month on a ward with no one who spoke their language, and our one translator for them came

down a few times a day; where complex sterile dressing changes, NG feeds and assessments could take place with little or no verbal communication if necessary.

And so in an effort to convey the challenge and the reward of care in this environment, I found myself telling them about Sayeed.

Sayeed was born nine years ago into a society and culture where any physical disability could be fatal. Babies with any deformity could be thrown out on the belief that they were cursed; even if the family kept a child he became a liability because the family had to care for his needs. Until May, Sayeed lived life on his hands and knees.

I first took care of Sayeed just as he was coming out of the recovery room. His beautiful innocent grin lit up his face, a response to my welcoming smile as he rolled in the doors of B ward. One of the translators was next to me for this first crucial moment - an initial set of vitals and assessment, explanation of postop procedures, circulation checks and pain medicine. Reassurance that he would have his own legs back and they were indeed still there under the strange hard whiteness of the casts. He wiggled his toes, giggled and gave me a thumbs up when I pinched them, and pointed to the smiley face (0) on the Wong-Baker pediatric pain scale, then settled in happily coloring.

I opened his chart to look over the postop orders and stopped, half-stunned, at the medical history: cerebral palsy. Only the strong love of a mother and the grace of God could have brought him this far in the villages of West Africa. I glanced over at his bed and he gave me a brilliant smile and thumbs up, then went back to coloring.

He breezed through the first few hours after surgery with no complaints, no problems, no need for pain meds. Around dinnertime I went to check on him again, a routine becoming familiar to him by now. He turned on the pulse ox and put it on his finger, put the thermometer under his armpit and held it there until the beep. Vitals...WNL. I pinched his toes and wiggled my fingers. He grinned and wiggled his toes, gave me a thumbs up. CMS checks...good.

Finally I pulled the laminated Wong-Baker faces scale off the wall and ran my finger along it. Are you having pain, Sayeed? He pointed to 4, a slightly sad face, and gave me a happy smile. I pointed to the 4, shrugged and looked confused, and ran my finger along the scale again. Are you sure you are having 4/10 pain? Again the nod, beautiful smile, finger on the 4. Then he went back to coloring with his mother.

Confused, I called over one of the translators. "Yaovi, can you ask Sayeed if he is having pain?" I asked. He came back with the same answer, "A 4, Afua."

"But Yaovi, he looks very cheerful. Can you ask him again if his legs are paining him and if he would like some paracetamol?" He did. "Afua, he says his legs do not hurt, and he does not need medicine."

Now I was really confused. "Then why did he tell me it was a 4? Can you ask him what he thinks the faces mean? Yaovi did, and came back laughing uproariously. "I think he does not understand the faces, Afua. I have taught him again what it means."

I found out later that the faces meant something a little different to Sayeed than what Wong and Baker initially had in mind. The zero- I am having a lot of fun; a two - I am having fun. A four...I'm a little bit bored.  I love the pure, uncomplicated mind of this little boy who was completely unconcerned that he would be the object of horrified pity in my country, a symbol of family shame in his.  He didn't know that he had just had surgery and by any stroke of logic he should be thinking about his legs, crying, fighting the nurses....instead, in total innocent oblivion he trusted that we would fix his legs.  And in the meantime, he just wanted to play!

Sayeed hanging out with a few of his friends at the Hospitality Center, including Bo, Komla and Abe. Photos by the ever-talented Liz Cantu.

Mental preparation

As my next trip to West Africa with Mercy Ships is coming up soon (YAAAYYY!!) I've been planning ways to get back into the groove. After all, living on a ship and working in this unique hospital does take some creativity and adjustment. If you have been thinking about living or working on board a hospital ship in West Africa, feel free to try a few of these out and see how well you adjust. And of course, post and let me know how it works out for you!

*Disclaimer…”hospital life” suggestions are not meant to be tried in actual American hospitals, as some of these are by design not intended for western healthcare facilities.

Ship Life:

Invite five of your friends to stay with you for the next three months. You should all live in a partitioned one-room apartment, and take turns sleeping in the closet. Remove all the doors and hang curtains instead. All wall decorations should be magnetic.

Most of these new roommates will be medical professionals. At any given time, two should be working days, evenings, and nights respectively. Rotate shifts to keep things interesting.

At least half of your new roommates should speak another language. Learn medical terms in that language and try them out at work.

Set aside a small room for privacy and prayer, and spend time there regularly. Donate books in 10 different languages to the local library. Check them out in the middle of the night.

Line up for mealtimes at 0730, 1200 and 1700 each day. Eat together with 400 of your closest friends. Have fried plantains at least once a week.

When you go out into town, don’t wear shorts no matter how hot it is. Go with at least 5 other people for safety. At least 8-12 people should fit into each taxi...15-20 per van. Never pay the initial asking price. Sit on top of each other. Bring goats.

Move somewhere very sunny, and then take Doxycycline. Keep your apartment temperature above 90 degrees. Drink at least 4 liters of water daily. Eat the goats.

Fill plastic bags with water. Refuse to drink any water that comes out of the tap. Instead, drink out of the bags...or your nalgene.

Leave a lawnmower running in the living room for proper noise levels. Occasionally bang on pots. Turn on the vacuum every time you flush the toilet. Color water green and put it in the bathroom. Once a week measure some out and flush it down the toilet.

When you take showers, make sure you turn off the water while soaping down. Limit yourself to two total minutes of shower water per day and one load of laundry per week.

Have a birthday party at least once or twice a week. Invite 50 friends. Play baseball with an empty Pringles can as a bat. Cook plenty of sweets, using at least 5 mangoes. If you bake a cake, GoogleTranslate the instructions into Dutch, then ask your roommates to help you figure them out.

Stop wearing heels. Climb 50 flights of stairs per day. Watch the sunset over the ocean.

Ask famous national leaders to visit. Invite them to make a speech, or share their testimonies. Then give them a tour of your workplace. Introduce them to patients. Throw them a party.

Bring maracas and drums to church. Dance excitedly during worship. Encourage friends to dance with you. Sing in several different languages. Provide two translators for the pastor. Have a 100 person church service in your living room with all the patients from the hospital.

Announce emergency drills every other Thursday afternoon. Gather with a group of your friends in the dining room. Pretend to do CPR. Every few months change the drills to 3 times a week with life jackets. Take roll call.

Set up a rotating schedule to watch for pirates. Dress up like pirates. Watch Pirates of the Caribbean on a laptop. Then watch Titanic and the Guardian. Then hide for an hour in an undisclosed location.

Get up excited for work, knowing that God is in control and making a difference in hearts and lives!

Hospital Life:

Make individualized balloon animals for each patient. Hang them above their beds. Play volleyball with the balloons.

If family members want to stay, provide mattresses for them under the bed. Encourage family to stay for a few days...the more, the merrier!

Put all the patient beds two feet apart. Encourage your patients to get to know each other.

Pantomime all instructions and questions to patients. Insist on teaching each new admission how to use a toilet. Put up signs depicting improper toilet use.

Go to work in flip-flops. Bring your Ipod. Play music with a catchy beat to entertain the patients.

If the patient needing a transfusion is your blood type, offer to be the donor. Have your friend collect the unit while your bed is moving. Then start the IV and transfuse your own blood...by drip.

Refuse to use prefilled saline flushes. Draw up all of your own flushes instead. Wash the medicine cups and basins, and the Toomey syringes.

Start IVs with an emesis basin at the bedside. Don’t retract your needles; instead, put them in the basin. All IVs should be 18ga or larger.

Carry your pediatric patients up several flights of stairs, then take them outside in the sunshine and let them play on tricycles. Draw pictures on their casts with sharpie markers.

Refuse to use regular IV pumps. Instead use burettes, or syringe pumps, or calculate drip rates.

When the pain meds aren't working...blow bubbles, color, and put on fake tattoos!!

Dress your patients in surgical gowns and caps. Have tricycle races at 5 in the morning. Then wrap their IV sites in trash bags and encourage them all to shower.

Chart all of your temperatures in Celsius and weights in kilograms. If a temperature is above 37.5 consider malaria.

Hang privacy curtains from hooks in the ceiling. Move them around according to need.

CPAP? Take apart the crash cart and put together equipment that fits. Use Coban instead of elastic face straps.

Regularly have dance parties at work. Play the drums. Encourage your patients to play the drums. Provide crochet hooks in place of drumsticks.

Pray during shift change and ask your patients to join you. Wear matching scrubs with all your co-workers.

Play Jenga with your patients.

Scrub the wards on your hands and knees…on camera. Then watch when Discovery Channel airs the episode.

Pray during emergency codes. Ask for the resuscitation trolley. Who needs a crash cart??

Make sure to specify if a regular diet includes snake or not. This may be important.

Announce an emergency blood drive overhead. Draw blood from all your friends that are A+ or B+.

Need to do a stress test? Have your patient run up and down several flights of stairs, and then do an EKG.

Import medications from Europe. Ask other nurses to translate instructions for you. Refer to acetaminophen products as “paracetamol” and Versed as “midaz.” Double check with pharmacy before giving your IV medications orally, and optical preparations aurally.

Let your patients check their NG tube placement when you do, and ask if they would like to watch dressing changes with a mirror.

Crying baby? Tie them to your back with a sheet and keep doing your nursing work. They'll happily fall asleep soon.

Look at the drool spots on your scrubs...and smile fondly at the adorable brown baby who fell asleep while you were charting. Thank God that you get to be here.

Sierra Leone 2011!

I'm going back...and I can't wait!

Since I got back to the States in May things have been different. It's a good different, a challenging one. I love what I do here, but I found that I've left pieces of my American-Indonesian heart with the innocent little brown hearts I met aboard an ex-Dutch ferry boat. It's no longer a constant ache. I don't feel as guilty about showers longer than two minutes, I don't accidentally use Ewe or French in my sentences any more. But it hasn't totally gone.

There are reasons I'm in the US right now. But that doesn't stop my heart from asking when I can go back. There are so many triggers - the lyrics of a song, a call from a friend, an innocent co-worker's question about where I've traveled as a nurse....

All this brought me to my knees one afternoon at the lake, asking God for the privilege of being his hands once again aboard the white mercy box, for the opportunity to love on the unloved, that he would give me His heart and break it once again.

Questions like that should only be asked if you mean it. Because it's not a question of whether we are called to missions, but where. It's not if we are called to love, but how and who.

Isaiah 58 is a chapter that's spoken to me in the past, a set of Bible verses God has used to direct my choices of who and how to love. There is nowhere more than aboard Mercy Ships that I was truly able to say that verses 6-10 were truly being fulfilled in my life. But I hadn't really paid attention to verse 11 before: "The Lord will guide you always; he will satisfy your needs in a sun-scorched land and will strengthen your frame. You will be like a well-watered garden, like a spring whose waters never fail."

I think I can honestly say that God has a sense of humor. With this verse that afternoon I felt his clear call back to a sun-scorched West Africa, and with it direction and peace on a number of other questions I had been wrestling with. Friends, I can tell you with certainty that unless something drastically changes, I'll be headed back to Africa with Mercy Ships from January-May 2011!! I'll be a Pediatric Ward Nurse again, knowing that this will not be my only job. There will be ICU and PICU shifts again with my heart in my throat and a constant prayer on my lips, the difficult IV starts and lab draws saved for an ER-trained nurse, riding a stretcher down the narrow metal corridor doing compressions as a part of the Emergency team, the challenge of caring for a friend, crowded screenings in the hot sun and surrendering my own need for control when He chooses to take a child home forever.

My heart, still healing from my last trip there, is going to be irrevocably broken, again and again and again. While I'm not sure my heart can stand another medical missions trip to West Africa...I'm sure without a doubt that I can't afford not to go. Africa needs me, sure. But I need Africa more. The fog is gone, and I can see clearly again.

Isaiah 58: 5-11

⁵ Is this the kind of fast I have chosen,
only a day for a man to humble himself?
Is it only for bowing one's head like a reed
and for lying on sackcloth and ashes?
Is that what you call a fast,
a day acceptable to the LORD ?

⁶ "Is not this the kind of fasting I have chosen:
to loose the chains of injustice
and untie the cords of the yoke,
to set the oppressed free
and break every yoke?

⁷ Is it not to share your food with the hungry
and to provide the poor wanderer with shelter—
when you see the naked, to clothe him,
and not to turn away from your own flesh and blood?

⁸ Then your light will break forth like the dawn,
and your healing will quickly appear;
then your righteousness will go before you,
and the glory of the LORD will be your rear guard.

⁹ Then you will call, and the LORD will answer;
you will cry for help, and he will say: Here am I.
"If you do away with the yoke of oppression,
with the pointing finger and malicious talk,

¹⁰ and if you spend yourselves in behalf of the hungry
and satisfy the needs of the oppressed,
then your light will rise in the darkness,
and your night will become like the noonday.

¹¹ The LORD will guide you always;
he will satisfy your needs in a sun-scorched land
and will strengthen your frame.
You will be like a well-watered garden,
like a spring whose waters never fail.

moving on

The leaves are just starting to turn, green and red rustling softly together in the breeze. Blue skies and the mountains behind visible just outside my apartment window, it promises to be a beautiful autumn.

After a busy summer in NH, a relaxing week with family in Virginia and one with friends in Binghamton, I stopped off briefly in Potsdam and Saranac before hightailing it off on another adventure. I also got to go hiking in the Adirondacks with a Mercy Ships friend, enjoying the gorgeous view of mountains and lakes all around at sunset from the fire tower, topped off with a long and bumpy ride along narrow unpaved roads.

Travel nursing really can be described as nothing less than a crazy adventure into the unknown. 3 weeks on ice - with not-quite job offers from 3 hospitals in the Dallas area, I started wondering if there was a hiring freeze, or if perhaps Texas was plotting to secede from the union. Then after a brief and cheerful phone interview I found myself rather dazedly accepting an offer that seemed almost ideal in a state I was already licensed in...and an ASAP start date.

I've been here just over a week. After a brief and intensive orientation I found myself on my own, ED nurse once again. It came back to me quicker than I could have hoped...the first large bore IV slid in easily, the impersonal beep of the cardiac monitor registering "NSR, we're good" in my mind, a slightly quickening pulse as the sirens get closer, a calm smile for the anxious mother, a high-five from the 6-year old who "wants to be a doctor when I grow up". It's not the glamour and adrenaline rush of another life saved...not always. It's not the desperate creativity of a nursing staff without first-world resources. We don't dance at shift change or pray as a staff for the little ones that have filled our hearts. No, it's not quite the same.

But it's still a mission field...MY mission field for the next few months until I follow my heart back to the rolling blue waves that rock me to sleep and deep brown eyes that dare to hope despite the pain they have known. I still pray for eyes to see the wounded soul behind a cursing demand for narcotic pain relief, the drunken stupor, the anxious questions, the intentional drug overdose, the look of fear at the sound of a baby's wheeze. These are hurting and in need as well, just here it comes across a little differently. America has the needy too - people in need of hope, of reassurance and love, of a sense of purpose and an understanding that material wealth and drugs cannot solve all of their problems either. Lord, give me patience and love for these ones too...