Angels amongst the Sons of Men...

I wanted to share a poem with you, written by a patient aboard the Africa Mercy last year...a tribute to my co-workers. It's also a challenge to you and to myself, to stop and think about how others see you in your life and work. Are YOU the light of Christ, am I the hands of Christ to a hurt and dying world? And if not, what needs to change?


Angels Amongst the Sons of Men

The day the Big White Whale landed on the black shores of Africa
was a blessed day to the Sons of Men.
It came with Angels to walk amongst the Sons of Men.

Why do I call them Angels?
Let me tell you of my time with them.

I came on board the White Whale
with rooms filled with the lame
the maimed
the formed
the deformed
the wrong
and the rough.

And deep into the darkest part of the night,
I saw men and brethren,
maidens and ladies,
though flesh as us,
yet with hearts as Angels.

Sleeplessly and tirelessly they toiled through the night,
through the pains and aches of men;
they with hands to heal and mend,
bringing from above the Father's love to the Sons of Men.

Some they cut.
Some they tie.
Some they seal,
and yet others they fix with tools untold.

Like messengers of the Most High they came.
Not thinking of their own,
they risked their lives
and sailed the seas to lands beyond the endless world,
to shores of Men afflicted and in pain.
Their hearts and lives they came to share,]
as Angels walking amongst the Sons of Men.

Some in this life are born to pass,
and some are born in life to live,
yet these Angels are born to preserve humanity.

Though some may see lives as waste,
yet with speed they move to save.
With words of love and touch of peace,
they endlessly toil to make right the wrong.

You were born as Men to your lands,
and yet as Angels you served the earth.

Gold is digged from earth beneath.
Treasures are hunted on high seas.
But love so pure and true
can only in hearts like yours be found.
Your labor in the Lord shall not be in vain.
For every life you touch and every soul you save,
For every bone you mend and every face you straight,
The Lord of Life and Light will light your path
and guide your life.

For you are truly Angels amongst the Sons of Men.

noma

No, not Rob Bell's video productions. Noma is a disease that most of us in the western world have not even imagined, much less seen. Photos, inservices, and teaching times aside...up close and personal, noma is a pretty wacky illness. I had my first noma repair patient for the last few days, a full challenge and a half!

"an acute, necrotizing ulcerative process involving mucous membranes of the mouth. The condition is most commonly seen in severely malnourished, debilitated persons, especially children with poor nutrition and hygiene. There is rapid spreading and painless destruction of bone and soft tissue accompanied by a putrid odor...Treatment involves high-dose penicillin, debridement, and improved nutrition. Healing eventually occurs, but often with disfiguring defects."

That's cut-and-dried for, "sorry kid, you don't have a face any more." At 7 years old, that can be totally devastating.

Aimee arrived on the ward a few days ago. She is one of the survivors, the 10% that make it through acute noma to live an ostracized life, hiding the hole in her face with a rag, struggling to chew soft foods when they fall out as she chews...without even daring to hope for normalcy. Graft after graft have failed, leaving a scarred cheek and a scarred heart. One of the blessed ones - her infection was caught early, before it took an eye or nose. She's chunky now, her exhausted body on my back and soft cheek relaxed, tired from the last love-starved tantrum that we ignore, basking happily in the aftermath of love. We talk in pantomime, waiting for the one staffmember that speaks a little of her tribal language to come down so we can explain surgeries and dressings and drains and tubes. Our plastic surgeon had been held up in Europe, airplane grounded by a volcano a million miles away.

As of yesterday, Aimee has a face again. The physicians assistant that brought her from Cameroon came down to excitedly show photos of surgery - of sutures and skin where there was no skin. My night was filled with IVs and antibiotics, NG tube feeds and codeine and JP drains...and mainly just praying hard that our irrepressible little girl with discipline issues wouldn't pull any tubes out or sensitive plastic surgery dressings off. Her bandages won't come off for a few days yet (we hope!), but we know that underneath there's a new face just waiting to smile!

I am not forgotten

Chantalle's face lit up as she danced her whole heart out in praise to the Lord. Arms lifted high in praise, her feet pounded out the rhythm along with other mama and patients, a worship service like no other. Because this congregation is still bandaged, still bleeding, still casted, still disfigured. Nurses mixed in with the patients - a fussing child tied on a yovo back here and there to give a mama some relief.

Jasmine sat on my lap, still drooling a bit after her palate surgery almost a week ago. I remember just the day after I had taken care of her in the ICU mama called me over on deck to rejoice with her that the nasal airway was taken out and she was breathing well on her own. The little nose is clear now of airways and feeding tubes, the small fingers twined around mine as we sing, "I can't do without you in my life, oh Lord..."

Baby Brian lay in mama's arms in a corner bed, body bouncing a bit as she clapped in time. He is still on a bit of oxygen, our miracle baby is still a sick little boy, still has his moments where he struggles to breathe and then stops, to start again.

Like everything else in our floating world, the songs and sermons and sharing are a mix of English translated to French to Ewe and Fon, or vice versa. The maracas and small drums played by patients and staff, a whiskered cleft lip baby dancing on his mother's lap. A little girl with her face melted away by Noma banging legos together and singing in a language no one else understands.

It puts my heart to shame, witnessing this unabandoned joy in worship. How often do we refuse to rejoice, refuse to be thankful, thinking of all that we could have. And these who have nothing, worshipping with everything they have. Those who have been cast out and forgotten, the broken and hurting, with maybe just enough to survive.

I haven't told you about Chantalle. She came early with her little boy Mark, a skeletal 4-month-old with a smile for everyone. Bit by bit he gained weight, tucked away in a corner of the ward or at the hospitality center until his lip and palate could be fixed. I didn't recognize him when I saw him again, with dimples in his knees and a chubby fist tucked in around the cleft.

Like so many of our babies with holes in their mouths, he inhaled his milk one day and surgery had to be postponed until the pneumonia was treated. Finally the surgery day arrived, only to have his throat close down in reaction to the anesthetic gas. Emergently intubated, then trached, Mark is still in the ICU with a hole in his throat allowing him to breathe, connected to oxygen and tube feeds and central IV lines. "What about this one," I asked God. "Ana you took home, Brian you kept here. Have you forgotten this one?" And yet in all of this Chantalle continues to praise her Lord with her whole heart, with total abandon.

What makes us think that we can demand things of God, that we are entitled to privelege, health, and wholeness? When is it that we will finally be able to say with Job, "The Lord gave, and the Lord has taken away; may the name of the Lord be praised!" When will we be able to rejoice in the presence of God, knowing with certainty that they, and we, are NOT forgotten.

A home for the healing

There is a place we send our patients after surgery, after discharge, just a few kilometers into the city. We call it the hospitality center. For those who have traveled far, will need cast changes or follow-up care, and need to stay in Lome. It's a place of song and dance, of happiness and healing.

I went to visit a few weeks ago for the first time...just hopped in the back of a land rover, along for the ride with a few discharged patients. As we walked into the center I wondered just how many patients I would know, how many would still be here and healing. Just a few steps into the hallway I realized it would be quite a few. Smiling fit to burst and hobbling towards us as fast as they could on crutches were three of our discharged patients. Liberty climbed up and patted my cheek as I exclaimed over her walking progress. Bo, who spent 4 days on the ward crying because he thought we had taken away his nice brown legs and given him yovo (white) legs, lost his crutches in the rush over to say hi and just hung on to my legs. Eram, who spent almost a month with us and knew every nurse by name.

We hugged and grinned and chatted - our bits of French and Ewe and their bits of English, and a lot of hand motions all mixed in. And then we headed out to the courtyard. I didn't know it could get even better.

"Tata LAURA (Auntie Laura)," 4 year old Komla started hollering as soon as he saw me. "Bonsoir tata LAURA!!" Mom smiled and waved, and I headed over right away to pick him up and twirl him around in a crazy hug. This was my buddy who sang in the shower in the early morning of his surgery, who was always ready for a high-five and a hug, who looked forward to his Q4hour neuro checks because it meant that I tickled his toes. My token pediatric patient for the high school student shadowing me...as I taught her assessment and nursing skills Komla decided to learn too, and fell in love with my stethoscope. It never ceased to amaze him as I put the rubber tips in his ears and diaphragm on his chest, his whole face lit up and he would shout, "boom boom boom boom" in time with his heartbeat.

He wiggled his toes for me and showed off new candy-cane striped casts with a protective piece of rubber tire on the bottoms. "He walking now," mama informed me. He put his fingers in his ears and asked me, "boom boom?" "Next week," I promised, I would bring the stethoscope.

11-year old Abe waved and politely asked in pantomime if he could borrow my camera. I went over for a hug with him and handshake with dad. Abe had been our star patient for several weeks. He came in with chicken legs - kneecaps far behind his legs and feet jutting forward - a result of antimalarial injections in childhood. He stayed incredibly cheerful through several difficult surgeries, blood transfusions, cobbled-together wound vacs, and a multitude of confusing hospital procedures. Now his legs stick out straight as he proudly hugs his very own water bottle, joining in the balloon fight.

Anna, one of the other ward nurses, pulled out her djambai and we had an impromptu dance/praise party. The dirt pounded up between my flip-flops as I hugged Komla and danced, with him clapping energetically and singing off-key in his little boy voice. The mamas smiled and sang and danced, and asked us how we were. The kids hobbled around crazily on their crutches, showed off whole lips and palates, proudly sported name tags from all the visiting nurses. It was a wild and beautiful afternoon.

These are the kids who had cried, who weren't sure of the yovo nurses that smiled and gave them balloons and promised that they would play soccer again, who we had soothed through nights of pain with a gentle hand, a morphine injection, a quiet evo, evo, babade, baba (it's OK, it's all OK, it's over now). Here they were smiling and running just as fast as the crutches would go. I can just see Jesus sitting here with a few cast-footed kids on his lap, pounding away on the djambai and singing praises to God along with the rest of us, telling the mamas and the babies "see, I am here. I have not forgotten you."

One drop of blood

...or a pint, if we're being literal, filled the bag resting on a scale beneath the hospital bed. I've done this before. It's not the first time...but this time I know who needs it, and that makes all the difference.

I met Mariam* just a few weeks ago - barely responsive and wilted into the hospital bed a few hours after her arrival on the ship, unable to swallow for a week before that because of a painful growth on her jaw. "We need an ER nurse," my charge nurse said, and so I followed her over from the B ward dance party to a sobering A ward, to the young woman in bed 20. "How are you feeling about your IV skills? She's got just about nothing for veins." I untied the baby from my back, we had a small IV line infusing a few minutes later and I returned to a wild and cheerful B ward praying for the lives in A ward, for the dying cancer patient Vince who was slowly slipping away after a traumatically bloody episode a few nights before, for the skin-and-bones infant a few beds down, little Ana, and for the little mother just a few years older than me who could no longer eat or drink.

Rushed to the ICU a day or two later, Mariam has been with us since then. Despite tests and retests, we're still not entirely sure what's wrong. Why can't she breathe properly, we ask. Where is the fever from? What happened to her electrolytes...and most recently, where did all the blood go?

Out of 400 crew members, there are five of us with Mariam's blood type registered as donors. Two of us donated this morning. The crew is a living blood bank available for patients in need. I put in her new IV in the quiet hours of early morning, knowing it would be my blood infusing through it come sunrise, thanking God for letting me find a good vein on the battered and bruised arms, for the one IV catheter from home that slid in so easily.

They walked it down the hallway after the tubing was clamped and cut, a double handful of life to infuse, still warm, into Mariam's veins. A few hours later another nurse donated another unit, allowing Mariam's body to find some relief and rest now that it has a bit of blood again.

It is a privilege to donate for someone that I know. To share my life and heart with hers, to know that I am truly making a tangible difference in her life. To feel the sore prick in my inner elbow and be reminded to pray for her and her family, for her attentive husband who held his own prayer service at the bedside day by day, for her small son that needs her home again. Because I know that even more important for Mairam's life is a need for realization that what she needs to accept is not a gift of human blood for transfusion, but the free gift of Christ's blood for sacrifice. In the end, that is what will be the difference between life and death, both in her life and in mine.

"For you know that it was not with perishable things such as gold or silver that you were redeemed from the empty way of life handed down to you from your forefathers, but with the precious blood of Christ, a lamb without blemish or defect." 1 Peter 1: 18-19

*Patient names in all my posts may be changed to protect patient privacy.

For the least of these

She smiled up at me as I rocked her and sang, an empty smile. The weight in my arms was all cloth and casts, and almost no baby. Little Abbie had been born a premature twin, the cord wrapped around her neck. "She wasn't breathing for a long time, maybe 5 minutes"mama told us, stolidly accepting that her baby might never be normal. Both little feet turned in, clubfeet slowly but steadily being corrected by progressive casting. Both she and her twin weighed in at a whopping 1.8 kilos that morning, all of 10 days old.

"The King will reply, 'I tell you the truth, whatever you did for one of the least of these my brothers of mine, you did for me." Matthew 25:40

The infant feeding program aboard is full of these stories - tiny children with cleft lip or palate who fail to gain weight, who cannot suck on a bottle, who inhale their milk like little Ana and die, or who stay alive through only sheer force of a mama's love and persistent prayer. We've sent one home now, dimples in the rolls on his knees, and sutures through the broken lip once he had gained enough weight for surgery. Two others on the ward this week are in stark contrast to each other, one now a chubby baby cheerfully waiting for a lip repair, the other on all of our hearts as he deteriorated slowly before our eyes...

Every muscle in his little chest and face pulled in, then out, working harder and harder to supply the tiny body with enough oxygen. Breathing 50, 60, 70, 80 times a minute, I wondered how long it would take before he suddenly...stopped. We prayed as we cobbled together an infant CPAP mask from anything we found in the pediatric drawer of the code cart, prayed as we held it to his face, thanked God as he started to kick and fight and struggle again. At 4 months old, Brian (not his real name) weighs barely over 6 pounds. Mama lovingly feeds him every two hours, a small syringe of milk down the feeding tube in his nose, somehow curled around and through the split lip and palate, down into the stomach. I was told he had been having some trouble over the last few days; now, only an hour into my shift, I had the sinking feeling that we were losing this little boy, losing another baby during the already heartrending Easter week.

We transferred Brian a half hour later to the Intensive Care Unit - to a ventilator that had miraculously arrived a week before and could provide continuous mask ventilation support to the tired lungs. I went with him, now suddenly turned into a pediatric ICU nurse, praying for all I was worth. He was an island in the huge ICU bed, tubes and monitoring wires in every direction. Only an hour later he peeked out around the coban that held the mask to his face, interacting with mom, breathing slowed to only 40 times per minute.

We call him the miracle baby. Not because of that long afternoon shift, and not because of anything that we have done. They told me that later in the night he again started having breathing difficulty despite the machine support. As the nurses prepared for intubation and the doctors discussed whether he would ever come off of machine support, the surgeon simply laid on hands and prayed. And seconds from intubation, suddenly Brian was fine. Breathing slowed, eased; oxygen saturation came back up to 100% with only a little blown by his face. No breathing tube, no mask, no problem. Things like that don't just happen. Babies don't go from acute respiratory distress to a sudden...calm.

I started this post a few days ago, planning to ask for prayer for little Brian, for our tiny feeding program babies. I am still asking for, pleading for prayer for this little one and a thousand others. But I do so with a full heart, knowing that our prayers are already being answered in incredible ways. He still cares, even for the least of these his children.

To save a life

A life saved…
There are the moments of adrenaline ... of holding a bleeding artery under gloved hands to stop the wild spurting, of chest compressions riding down the hallway on a stretcher. Of squeezing a bag to watch a chest rise and fall, of giving a drug and watching a heart slow, slow again back to normal...another life saved.
Here there is another, a quieter lifesaving that goes on day by day, moment by quick moment in the sterile rooms of the OR. Tumors that would take a life – by slow poison, by choking or starvation, by bleeding and bleeding until there is no blood left. It’s like watching an artist at work, I thought, watching our maxillofacial surgeon explain his repair as he sewed. The same hands that take out that tumor piece together a face again.

4-year old Esther showed up at the eye clinic with a cancerous tumor growing inside of her eye. That afternoon the opthamology team took out her eye and the tumor, giving her a chance to live past 5...another life saved.

Afi was starving. The tumor that had been growing for eight years now left her only a small mouth hole to spoon in porridge, to squirt in water by the syringe-full. Down to the size of a child, she was slowly starving to death. When she came in she had little blood left – we heard another crewmember called overhead, and another…paged to donate pint by pint a replacement for the bucketfuls lost. As of this week she now has blood, she has a mouth, and she has hope.

And there is the renewal of hope - a soul hidden in bright layers of shame along with a disfigured body finally now daring to come out into the open. A blind woman, seeing the world for the first time. A baby gaining weight despite a broken face, with the possibility of life, marriage, children, community...another life saved.

A life lost…
She bleated pitifully as I looked for a vein, any vein, in the shriveled arm that waved at me from a nest of bright African cloth. Words like failure to thrive, cleft palate, possible metabolic problems…all these fade off into nothing in the stark reality of the here and now. At just over a year, Ana weighed about as much as a newborn child. A drastic comparison to the chubby baby pictures from her cleft lip repair last year.
Ana went home two days later. A home where she is fat and happy and crawling. Where no one looks at her and calls her cursed. Where she thrives! Here we grieve for her and her family…knowing that our best was not enough. But was it? Was it enough to know that she is loved, that she is wanted, that now her broken face and body are whole? In the end, each life is in God’s hands.
We came to Africa to bring God’s hope and healing, they tell us. Nurses save lives, we say. Only God can save lives; sometimes he chooses to take them home.

What is life but a gift? Years, months, days…they are each one in God’s hand.