Komlan RN...age 8?

We had just started our shift-change report when 8-year-old Komlan walked up to me and grabbed my left arm.  With a few well-timed swishing noises he pretended to wrap something around my bicep, and then started slapping the inside of my elbow hard.   He poked around thoughtfully for a moment with his index finger, then stuck a fingernail into the bulging antecubital vein, tapped my arm, and declared evo (It’s finished).

I, being a good pediatric nurse, egged him on after a good laugh, and he pantomimed several more IVs on our nursing staff before tiring of his new game.  Ironically enough, this started just a day or two before I was called down to B ward to start an IV on Komlan – restarting on IV antibiotics for a swollen ankle and leg after his skin graft surgery.   I showed him how to tie the tourniquet, and he put it back on me, happily poking through the equipment until he understood that I was actually going to put one in HIM.  He wouldn’t look me in the eyes then, and dropped silent tears onto his gown until we carried him to the next room.  The minute the tourniquet went back on he started to scream, and didn’t stop until I finished filling the syringe of blood for labwork, popped off the tourniquet to flush the IV, and declared evo, dodgi…bravo (It’s over now, brave boy…well done).

I tried bribery with stickers and a tourniquet of his own afterwards, but I wasn’t forgiven.  He was set to sulk, and sulk he did…through the next few doses of IV antibiotics, peeking over the bedrail at me when I came to visit.

Shortly after that I brought over a kidney dish, filled with all the usual IV start supplies, and a cannula minus the needle, to announce that it was his turn to put an IV in ME.  He happily tightened the tourniquet, nodded in understanding when I complained that it was too tight, and put a finger over his lips with a whispered shhhh.  He slapped until it looked like my inner elbow had developed some sort of a rash, rubbed thoroughly with alcohol, and chose a promising-looking freckle.    Out came the plastic cannula, and he jammed it into the freckle, then the vein I pointed out, with enough force to buckle the cannula into quarters.  After a few pokes he declared evo and taped on a bit of gauze before taking the tourniquet back off.

Komlan frequently starts IVs on his nurses now, complete with occasionally taking a fingertip off of his glove to feel for a vein. The last time I drew his blood for labwork, instead of screaming, he pointed out all of his veins and freckles and scars for me to choose from.  He nodded in understanding when I indicated my choice, and watched interestedly as the blood spurted into the tubes, pointing and commenting in wonder cesi est sang moi (this is my blood!).

Others of our pediatric patients frequently join in using medical equipment for a variety of things – from practicing with their designed function to other, more creative uses.  In the long run, we hope it makes their time on our big white ship much less of a scary experience and more of an interesting learning experience.  In Komlan’s case, he should be ready to join the IV team well before he starts high school…or maybe once we actually let him use needles.

If it beeps in the armpit, time to take it out and make an important call...

Our young patients-turned-nurses try out the sound quality of the stethoscopes.  Yes, they do make great microphones!

Where Joy and Sorrow meet

Look through the window of the pilot's entrance, and you will see a single hospital bed with the husk of a young woman so frail she could almost be blown away by the light breeze.  Just a few yards away, the sun is starting to fall over the waters and rocks and beaches beyond, streaming into the opened doors and onto the sheet.  The singing is soft in the sea air, Akpedada ye dze ne...He is worthy of thanks.

The pilot's entrance on deck 3 is designed to be opened during a sail, to let the port pilot on or off the ship, or to access the water for any other reason.  Usually we keep the doors closed, with eye patients going to and from surgery in the little room adjacent.  But Thursday was different, and with permission from the captain and help from a very accommodating eye team and deck crew, we wheeled Chanti and her big bed down the hall from ICU into the tiny room next door for some fresh air - a wistful request from earlier that morning.

Chanti has been here since the beginning, admitted shortly after screening day with badly infected wounds from a skin graft years ago.  Over the months she endured long dressing changes to keep her wounds clean and healing, surgeries, and - as it became evident that her body was not adequately fighting the infection – round after round of antibiotics.  Her nurses and physiotherapists, the patient life counselors, and the other patients on the ward became a family for her– there to pray with her, encourage her, and cheer her on in little successes like walking to the bathroom on her own.

I knew her mostly as emergency room nurses know their patients – in bits and pieces, hours and moments of fragmented care, while other nurses provide the steady and patient encouragement and monitoring over weeks and months of wound dressings and feeds and antibiotics and transfusions.  I was paged to start IVs and draw blood, to attempt EKG readings through and under the thick sterile dressings on her chest, and to make the blood transfusions run faster when they wouldn’t go quite fast enough.  It wasn’t until this week that I took care of Chanti for my first shift…and her last.  

Less than an hour after getting back to the ICU from the sunshine and sea and singing, after a last quiet talk in the language of her heart, Chanti passed away.  Her last words to a dayworker next to her bed were Jesus is here.  Because for Chanti it wasn't physical healing that she found on our hospital ship, but spiritual.  A few weeks ago, she met Jesus, and in him she has found life and hope and love.  We as her family grieve her loss and our limitations of care, but in her life and passing I've also found a true challenge to trust.  We may not always see the reasoning behind God's purposes, but He is good, and He is enough.  If the only reason Chanti was on ship for almost 3 months was to see Jesus, then this too is enough.

I'm in the place tonight where joy and sorrow meet.  But for Chanti, there is only joy now...Jesus is here.

Easter adventures in Benin, part 2

In which we meet the horse and his boy, witness a shark on a motorcycle, dance wildly at church with the Christian Man, and narrowly escape several car crashes in the taxi of impending doom.

The next morning I woke briefly to a warm sunrise, a small inquisitive brown child who peeked into my hammock and whinnied at me ("He whinnied?" I thought, confused), and a mosquito net that had partly come off during the night.  I woke again, several hours later, to a humid and sunny day, and a quiet time rocking in the hammock, reading my Bible and enjoying the ocean view.

It was a leisurely and unplanned day, and altogether wonderful.  We spent a few hours attempting to body surf - a rather entertaining sport in the violent waves, which ended my surfing several times with a hard body-slam on the beach.  Despite a bucket rinse later, I still found sand in my hair and permanently ground into my skin for days after that.  The mangos we had purchased the day before were irresistibly ripe - oozing juice until I squished one up in my hands and drank it African-style out of a hole in the skin.  Our belongings, meanwhile, were guarded by a friendly pack of dogs who insisted on sleeping everywhere on the hostel grounds (including under the tables and in the bathroom stalls).

Later, walking along the beach road, the four of us saw a motorcycle coming towards us with what looked like a huge fish draped over the back.  With every bounce on the rocks and ruts, a tail slapped the dust in the road, and something that looked like a head came close on the other side.  It wasn't until the motorcycle passed and we all turned around to get a better look that we saw the gill slits along the head and realized our "big fish" was actually a shark over 6 feet long.  Sadly, by the time we realized there was a shark on the motorcycle, it had already passed with no chance of pictures.  Shortly after that we decided we were done swimming in the ocean for the day.

S'mores are an American thing, a campfire treat usually involving marshmallows, graham crackers, and chocolate.  Noel had brought along s'mores supplies with us, thinking that we could build a campfire on the beach to roast marshmallows.  By the time we reached Benin our chocolate bars were liquid and the marshmallows had fused into one large blob.  With a few hours in the hostel fridge, however, the supplies were solid enough to attempt some s'mores creation.  

In our search for firewood, Noel and Melisa were met by a small boy galloping along and neighing to himself.  Earlier in the day we had seen him around the hostel, mostly in the company of a rather bony horse tied to one of the trees.  In an urge to be helpful in collecting trash, the boy took all their firewood and threw it over the fence. Once he realized we were collecting things to burn, however, he started bringing in piles of palm fronds and pieces of furniture to throw onto the fire.  We tried to discourage burning furniture, and really were trying to wind down the campfire by that point.  Since no other languages were working we tried neighing at him...he neighed back happily, slapped himself, and galloped off into the darkness.

The whole evening we'd been a bit confused, as a friend of Justin's was supposed to join us for the evening and then church in the morning but hadn't ever come.  Early the next morning, however, Justin came back into camp and announced that a taxi driver had come, claiming that he was sent by "a Christian Man" to pick us up for church.  Of course, we packed up camp and hopped in the taxi!

We joined Emmanuel at the Apostolic Church of Benin for a service packed with prophecy and solidly enthusiastic worship. I felt slightly out of place, not because I was a different skin color than everyone else, but manly because I lacked the colorful headwrap, the apparently mandatory baby to tie on my back, and a set of hips and feet that could keep up with the wild double-clap rhythms of worship.  It was good to celebrate the resurrection of Christ with brothers and sisters of a different background and language, with all the color and exuberance and enthusiasm of West Africa - a celebration indeed.  After church we visited Ema and his family at his home in Cotinou, and enjoyed an amazing home-cooked meal of African food.

It was in the ride from Cotinou to the border with Togo that we all learned the word doucement. Ema had mentioned to us just before we left that if we needed the driver to go more slowly or carefully that was the word to use.  I repeated the instructions, then promptly forgot the word.  Our driver grinned and announced in extremely broken English that he would be taking us to the "frontier."  We started out slowly, but with a quick and reckless acceleration through the car traffic and swarms of motorcycles.  The man would have put a New York City cabbie to shame, as his driving commentary was not only complete with fist shaking and threats, but he also occasionally grabbed motorcycle drivers through the window.  As it started to grow dark and we continued careening around pedestrians and potholes and speed bumps, with frequent "chicken" matches with oncoming cars, we started praying fervently and trying to remember what exactly Ema had said to say.  Unfortunately, we remembered the word just as we hit a long stretch of speed bumps, so our driver then thought we wanted to go slowly just over the speed bumps.  We continued our mad rush down the road, but with each speed bump our driver would slow to the point of stalling the taxi, grin rather maniacally at us, and reassure us regarding his excellent driving skills, "doucement, doucement, doucement!"

On reaching the Benin-Togo border we offered up thanks to God for all the overtime our guardian angels had been putting in, and sincere prayers for the driver and his safety returning to Cotinou that night.

Our unpredictable, entertaining and somewhat dangerous Beninoise adventure concluded with a safe return to our ship home and quite a lot of plantain chip consumption while sitting on top of each other in the back seat of the last taxi.  Occasionally I start to wonder how my friends and I encounter such interesting occurrences with all our trips traveling through Africa, while others seem to go out and enjoy perfectly normal and boring trips to the beach or the mountains or the market...

I much prefer life lived every moment to the fullest; a life tiptoeing on the edge of the cliff, with my own safety carefully sheltered in cupped hands and then flung, open-armed with exuberant trust, into the wind.  

Easter adventures in Benin, part 1

I learned a new word in French this weekend: doucement.  It means "softly," or, if spoken in a desperate tone with explanatory hand motions, "please slow down this taxi  before you kill us all."  I was hoping to expand my vocabulary a little further, and include things like, "if you stop clapping with the loud rap music and put your hands on the steering wheel, we won't drift into the opposite lane" and "why is there a shark on the back of your motorbike?"  These are things you can't find in your average French phrasebook, unfortunately.

The four of us started out from ship on Friday, walking with our packs to the nearest gas station, where we found a car driver who agreed to take us to the Togo-Benin border. His previous passenger (who thankfully spoke quite good English) thoughtfully bartered for us, and so we all piled into the backseat with our camping gear.  It was a tight fit, but we did manage to get the door closed.

We breezed through immigration on both sides with few problems, enthusiastically welcomed by the Beninoise immigration officials...Barack Obama?  Welcome, welcome!!   Melisa and I bought our dinner for later on the street - avocados and bread and Laughing Cow cheese and little mangoes - while Noel and Justin bartered for the taxi to Cotonou.  A few hours later found us bartering for a taxi yet again in downtown Cotonou, with about 20 zemi (motorcycle taxi) drivers looking on and offering helpful commentary and directions.  A young man named Alley helped us negotiate the system as we refused zemis again and again, and finally found a small motorized 3-wheeled vehicle with a driver that agreed to take us out to the hostel grounds where we would be camping on the beach.

We later learned that the beach was out well past civilization, 11 kilometers down a a sandy dirt road lined with occasional palm-leaf shacks.  We had made it about 7 km down the road and just past a police checkpoint, when our driver decided he had gone far enough.  We stopped at a small concrete building with a sign that announced the International Theater School of Benin.  The hostel was too far to go tonight, the driver said, so we would need to pay him more money.  Almost twice as much as we had discussed previously, in fact, and he also announced that he didn't actually know where the hostel was.  After some negotiation, a bit of walking back towards the police checkpoint for directions (on our part) and some sitting in the sand and refusing to discuss anything (on his), along with attempted directions in French and Fon from a rather drunk villager, we found ourselves on the side of the beach road with our backpacks...and no tricycle taxi.  As we started to walk down the road the rest of the way to the campsite, our thoughtful drunk friend woke up the Theater school staff and requested a ride for us.

We finally made it to the hostel, set up our campsite by headlamp and flashlight, and sat down to our avocado and cheese sandwiches, thankful that we had actually made it all the way.  Melisa tucked me into my mosquito net cocoon, and we fell asleep to a full moon and the rhythmic crashing of waves on the beach.

To be continued!

Isaac

Meet Isaac. He's six, with an infectious giggle and patience beyond any six year old I've ever known. Confined to their beds for a week to allow tender surgical sites to heal, Issac and his buddies Gideon  (below) and Arnold became the life of A ward for the small time they were there. Every nurse coming in for shift was greeted by a shout of Tata Yovo!! (Auntie white person) and enthusiastically blown kisses. We blew back kisses, made faces at them through the doors, kissed them goodnight, and changed scrubs again and again after the catheters came out and we got accidentally peed on a few times.  Our other patients enjoyed their antics, and instigated several games of balloon volleyball (often involving crutches) between the beds.

Once allowed out of bed, Isaac joined us for shift changes, excitedly hugging one nurse, then reaching for two at once, then beckoning everyone within reach...until there was a laughing huddle of white and brown arms and heads encircling Isaac, with Gideon and friends all climbing through the sea of legs. And as we sang in worship, Isaac joined in wholeheartedly, a half-key off and several steps behind, proud that he knew the words.

 

Although our patients often come and go quickly, sometimes a few find their way to snuggle deeply into our hearts and leave an imprint of themselves.   Isaac, with his unconditional love for everyone he met, has found his way into mine.

 

 

A few of the others in my heart - this snapshot of the A ward crowd was taken a few weeks ago...patients, nurses, and translators all gathered for a bit of fun :-)