Old enough for a nose

November 2011...
We sat together in the back of the church service, listening intently to a three-language sermon.  I was trying to understand the Krio that sounded so familiar, and Kadi was trying out her own bits of Krio.
AAmen, she murmured at the end of the pastor's every sentence, every pause, and every exclamation.  Aaaahhhh-men.  A-MEN-a.   EhyMEN.  Each time she got a little louder, we were starting to get a few looks from the curious patients next to us, and I started to wonder what point is appropriate to shush a 5-year-old's mid-sermon enthusiasm.  Granted we didn't look much like your usual church-goers.  I was in scrubs with my hair pinned up, perched on a high stool next to the crash cart.  Kadi's NG tube was pinned to her intricate braids, out of reach for small hands to pull on.  The center of her face was covered in steri-strips...only smooth skin and suture lines where a nose should have been.  But we were both pretty excited about the sermon and the worship-dance party that inevitably followed.

As our ship sailed from Sierra Leone a few weeks after that last ward service, I often wondered what happened to Kadi.  Would she ever have the chance for a nose?

I asked once why we hadn't made a nose yet for Kadi.  Our doctors have creatively pieced together faces for so many.  The reason was simple, our surgeon told me.  Kadi was too young for a nose.  If she got a new nose then, it would be too small as she grew older.

I reached up a little self-consciously to touch my own nose.  What would I have thought, at 5 years old, if someone had told me I was too little for a nose.  Didn't everybody else have noses at that age, usually?

Fast forward a year and a half, to one morning in March when a tall gentleman came from D9 to greet me enthusiastically in Krio.  I recognized him immediately, but it took a little while longer to recognize the Midazolam-doped girl in the bed as my Kadi, headed to the OR in 5 minutes to finally claim her nose.  She's joined the crowd of Noma survivors and war mutilation victims here on D ward and B ward, with scalps pulled down over faces and bits of face flipped and sutured in a myriad of creative flaps, grafts, and miracle-working.

I was her nurse the next day - one of my treasured pediatric nursing shifts.  Kadi was not even 24 hours post-op, terrified and exhausted from fighting and pretty miserable.  Along with a piece of scalp temporarily down over her face to make a new nose, Kadi also had her tongue sutured to the top of her mouth to close a hole there.  Two long arm splints and a patiently dedicated nursing staff had kept her from pulling out her nasal airway, IVs, and gastric tube.  Still a spunky fighter, Kadi was not a fan.  I used most of my small Krio that night - playing guessing games of what she needed (Yu wan piss?  Yu wan popo?) and making bargains, with a lot of pointing, strict instructions, and a wonderfully serious translator just to make sure (If I remove this, yu no pul am.  Yu sabi?).  By the end of the evening we successfully had both arm splints off with all tubes still intact.  Part of the bargain was me letting her popo (ride on my back) the rest of the shift, and so I finished my paperwork and gave report with her clinging limply to my back and the NG feed running slowly from the bag on a magnet hook over our heads.

We're fast friends again now, and last week she spent the beginnings of each of my night shifts popo as I took report.  I started the shifts off with gigantic drool spots soaking the back of my scrubs, but the cuddles were well worth it.  She's full of fun, inquisitive energy, and great at the pantomime communication so common on the ward now.  We're training her as a nurse as well (7 years old is certainly not too early), and she can turn on and administer her own nebulizers, connect and flush her NG feeds, and do a pretty good oral assessment by flashlight.

Less than a week now, and it will be time for another surgery.  I am excited to hear her Krio-Temne chatter and sweet singing again, and I can't wait to see her new face.  No more waiting; she is finally old enough to have a nose.