Africa on the right, and straight on 'till morning

It’s a magic moment, hovering between light and darkness, as the sun sinks behind thick clouds, and the sea slowly fades into progressively subtle shades of grey and deep blue.  I can watch from my window, looking out on the hard white caps and the shallow swells on the haze through the glass.  It’s endless, the blue and the grey, stretching out for miles and miles to Africa somewhere to starboard.  In the morning I wake to sunlight reflected off the sea and shining in the window across my quilt.  The welcoming sun belies the cold air conditioning, and I'm looking forward to some time in the warmth out on deck.

By last night we’d been sailing for over 60 hours, with the hospital and all our cabins tied down tight.  Large piles of bedframes and chairs and trashcans in each ward saran-wrapped together and racheted to bolts in the floor.  My first few hospitals would never have dismantled so neatly.  

The staff is scattered through other departments, with just a few left in the hospital.  My first few sails I also had been loaned out - to housekeeping and hospitality, with a few-week stint as the ship seamstress and a sewing machine tied down to the table.  This time I've stayed in the hospital department, and in between writing final reports and preparing for Guinea my main job is compiling an appropriate sailing playlist of songs such as "For the moments i feel faint," "Stranded," "Rescue Me,"and "Let the waters rise."  My initial assignment was unstrapping the land rovers on deck and seeing how long they take to go overboard, but in the interest of not being thrown overboard myself I've decided to postpone that for after we dock.  Others of my co-workers have decided to try a wide variety of balancing skills such as yoga and juggling,  some are on flying fish and dolphin watch, and windsurfing along the deck with hammocks also looks quite fun. :-D Just kidding, Mom, of COURSE I would never try something like that.

I took the first afternoon to get used to the rocking, my head attached on a string and bouncing around in a fog somewhere above me.  Guardrails on my bed let me sleep soundly without fear of falling out, and after a few hours I could walk without looking completely drunk.  It's sunny now, out on the bow, and I'm looking forward to a good week of catching up with paperwork and reports, and taking time just to relax and enjoy spending time with God and enjoying the beauty of His creation and the vastness of His love.  I am blessed beyond anything I could ask or imagine!

pink sheets

Scorn has broken my heart and has left me helpless; I looked for sympathy, but there was none, for comforters, but I found none.  ~Psalm 69:20                              

20M - jaw osteomyelitis, non-surgical, referred to dental.  21F - breast cancer - nonsurgical.  56M - hypertension and inguinal hernia; referred to local doctor for hypertension, wait listed for hernia repair.  2M - inguinal hernia; wait list.  Lipomas, cancers, goiters and physical assaults, urinary incontinence and tumors and hernias and more hernias.

Names cut off the top of the pink pre-hospital paperwork, each page gives an age, a problem, a reason we couldn't help.  The opening few notes of a requiem, ended before the story is ever told.  There are hundreds of pages, each one a life.

These are the people that made it past the pre-screeners and into the stadium on screening day.  The ones who maybe came onto the ship for an Xray or scan, or who saw one of our surgeons for evaluation.  The ages and problems are varied but the conclusions are the same - we could not do surgery for them during this outreach.  The space on the surgery schedule is limited, and not everything can be cured simply by cutting it out.  

We come testifying hope in Jesus' name, regardless of physical appearance or medical diagnosis or community position.  Often our patients understand that hope as they begin to see something tangible change in themselves, as they see people willing to reach out to them despite their appearance, and as they realize that after surgery they can re-enter their village and community with dignity.

For this pile of life, the spark of hope they had for a possible change in their condition with surgery was not realized.  We in our limitations can only touch the few, and must trust God with the rest.

Please pray for healing for each of these patients represented by a pink screening sheet.  We claim  hope for them from a God who has promised to hear and save his people.

The poor will see and be glad - you who seek God, may your hearts live!  The Lord hears the needy and does not despise his captive people.  ~ Psalm 69: 32-33

when the whiskers come off...

Monday afternoon I set a stool next to the charge nurse desk and gathered some supplies - gauze, saline, a basin, gloves, and several pairs of small sterile scissors.  We were fresh out of mirrors on D ward, so I walked down to B to get the most important item for my small salon: a handheld mirror.

Bla before surgery

And I chose my first victim carefully.  I looked up from my preparations to find 8-year-old Bla watching me intently.  He grinned and came over for a hug.  Bla was one of my broken-lipped kids, with a smile so genuine and brilliant you would never realize he had a hole in his lip, and an enthusiastic snuggle-hug every time he catches a nurse with an arm free.  Bla and his mama are from way up north, so far that no one else on the ward speaks their language.  When our one translator fluent in Moba goes home for the day, we pantomime.


The "serious face" - shortly after the
visit to the cleft lip salon.

So I made faces at Bla, sat him on the stool, pretended to clean my lip with the gauze, and gave him the purple mirror to watch.  He nodded, and smiled, and then looked very serious.

As I cleaned Bla's lip with the saline and gauze, we gathered a small crowd of whisker-lipped kids all intently watching and commenting on the process, reaching half-way up to their own repaired lips before remembering not to touch.  I kept up a running commentary of who would be next and how beautiful their lips would be, while the two-year-old with his hand on my knee patted me and giggled along with the rest.  Bla stayed very still, intently watching my hand in the mirror as I snipped the extra spiky suture ends along the upper lip and up just into his nose.  When I finished I told him how handsome he looked, and he inspected himself in the mirror before breaking into an excited smile.

The reward was stickers, and he decorated himself enthusiastically while I cleaned up.  Then I took him by the hand and led him over to my next victim, 4-year-old Abla.

See how handsome Bla's lip is?  I would like to take your stickers off your lip and make it look pretty.  Abla hid shyly behind the translator, but she didn't particularly object, so I soaked off her steri strips and started snipping.  Abla's mama came over to inspect the repair job.  I didn't understand much of the words, but the big grin and thumbs-up are relatively universal.  Little sister watched, interested, from her place on mom's back.  Once I had finished four little lips, we gathered all the mamas and the kids for a group teaching session on wound care and lip exercises -  in four different languages.
This field service our surgeons have repaired 34 cleft lips and palates.  We had 8 on the ward that day in various stages of healing; some still with nasal bolsters and fresh steri-strips, and others already "discharged" and just waiting for a final would check before the long trip back north and home.  The next morning 5 newly-healed little lips were ready for a final photo and a discharge once all the transportation and follow-up details finished.  They're in varying degrees of acceptance still: Bla is quite proud of his new lip, flaunting a "see how handsome I look" at every one of his favorite nurses and visitors that walk in the door, while 6-year-old Assoum isn't used to the attention and mostly just hides his face in his chair and 5-year-old Yaovwi hasn't quite forgiven me for taking off his steri-strips.  They'll forget to be shy eventually and forget that maybe once they were called ugly and outcast.

Instead I hope they remember that first look in the mirror once the tape and crusts and dried blood have all come off, that first glimpse of a chance at normal life, and a voice telling them they are handsome or beautiful...

I pray they know they are wanted and loved, and that beyond just physical repair they find wholeness and new life in a God who loves them regardless of the brokenness on the inside or outside, and no matter where they once had holes or whiskers still waiting to come off.

An ode(r) to toilet juice

Oh M3 blackwater treatment, how I love thee
50 mL of enzyme twice a week.
Your faithful and constant breakdown of waste
Keeps the pipes from clogging with reek.

Quiet and modest, your presence is ignored
Gone once vacuumed down the pipe.
If it's yellow let it mellow, if it's brown flush it down
Why is our bathroom odor now so ripe?

For three days the smell is increasingly rank
Deck 4 starboard main vacuum line closed.
A row of cabins with toilets out of order
Even Febreze just disguises the waste decomposed.

Oh toilet juice, let me not forget you,
Keep our toilet pipes unclogged and free;
And our cabin will be sweetly scented,
No longer graced with the odor of pee.

Biggest man on D ward

Maurice - watching life.

Just back from the operating room and a lumbar puncture, Maurice lay snuggled in a brightly-colored nest of African fabric after ravenously drinking his fill from Mama.   His young mama came back out of the bathroom and announced she was going to ward church (down the hall) with an unspoken question in her eyes...watch him while I'm gone?  I nodded and smiled, and picked him up to cuddle, nest and all, as soon as she walked into the hallway.  Fuzzy head cupped in one of my hands, he gummed a grin up at me and stuck two miniature fingers into his mouth to suck on furiously.   Both knees curled up to his belly, as if he were still in the womb, and he kicked one bare foot into my elbow.  Even the steri-strips are gone now, and the row of stitches around his eye lay flat, with no other signs of where there was once a bulge of fluid.    He's not a fan of frequent vital signs after his sedation, but with lots of sweet talk and cuddling he finally gave me a toothless half-grin around the fingers.  Every four hours I shine a flashlight in the fascinated eyes, check for any signs of neurological problems as he kicks off the oxygen sat probe, and I am thankful there are no signs of clear fluid leaking from the suture line or his eye today.
At 3.83 kilos of tiny perfection,  Maurice is one of the smallest babies in the hospital right now.  But we don't tell him that.  Instead, Rudy's mama cooed down at him that he was "the biggest man on D ward."  With a startled laugh, one of the other nurses and I realized that it was true...Maurice was the biggest (and only) male patient on D ward at the time!

Rudy on deck with one of his "aunties"

It was good to be a ward nurse again for a weekend and let someone else be in charge.  To change a bandage as the patient watches in the mirror, grin just barely starting to peek out through suppressed hope.  To tie a baby on my back while his mama recovers from malaria - checking NG placement and giving medications as he supervises solemnly from behind, drooling down my back with one small hand exploring the pager on my hip.  To catch Rudy escaping from B ward down the hallway on a scooter and scoop him up for a hug; to see Rudy and Shara both back in the ward from ICU - in need of prayer for total healing, but doing well enough  to join the rest of the small and broken village.  To lay a naked and fussy Maurice on the scales and see that he weighs just a bit more than he did yesterday....right before he gleefully pees everywhere.

There is a rhythm and meaning to the day that maybe wasn't there yesterday.  It's not the rhythm of the djembe this time but something softer, quicker...the rhythm of a mama's heart filled with hope; the rhythm of a patient's heart, wrapped carefully and lovingly in mine.

I found a man who has stolen  my heart...and he's the biggest man on D ward.

Life lessons from the PICU

Only four hours into my shift, and already I was tired.  I only had three patients - one had been discharged by a thoughtful co-worker, one was sleeping soundly, and the third...well, this is his story.

The nurse giving me report started with "I'm so glad you're here!"  The first hour went well enough.  He was settled peacefully in the big ICU bed, mama at his side.  I introduced myself, and we peeled open one swollen eye long enough for Rudy* to see his new "auntie" and give me a high five.  With both eyes swollen shut there's little for a preschooler to do for entertainment, so I set up my Ipod and speakers with some wild African music, turned down the midazolam drip a bit, and we settled in for the evening.

For about 20 minutes.  Then the crying started, and the kicking, and the flailing.  Sometimes it was tea he wanted and sometimes bread, and sometimes to get out of bed, and sometimes because he didn't like the diaper, and sometimes just pure temper.  But mostly he just wanted to see.  Hands reached up again and again to pull open an eye just a crack, trying to claw through gauze mittens at steristrips and the row of sutures that marched from under the bandages down his forehead and nose. The next several hours Gina* (Rudy's patient mama) and I walked the fine line of discipline and rewards and strategic ignoring of outbursts when possible, with one eye on the IV lines and surgical site to make sure everything stayed intact.  The delicate balance of trying to decrease his sedatives while keeping him safe, because while I don't mind so much getting hit in the eye with a gauze-covered armboard, too much screaming isn't exactly ideal only two days after major craniofacial surgery.  

Over dinner I prayed for strength instead of just for the food, while the other ICU nurse watched Rudy and a still-ventilated baby just back from extensive surgery, and then it was my turn with baby girl and the ventilator, with one eye still on Rudy.  Gina and I discussed the fears and challenges of young children in hospitals, loving discipline, and the importance of choices.  It's a scary thing to have every choice taken away from you, to wake up and not be able to see, to have surgery after surgery almost every year of your life, especially when you can't understand why, and tomorrow seems like a million miles away.  Granted, it wasn't always much of a choice we could offer (oral versus rectal Tylenol, for example) but hey, we did what we could.  And he dropped into a peaceful sleep long enough for Mama to head back to her bed and get some much-needed rest.

I sat down to catch up on charting, and heard a sleepily murmured Auntie from the bundle of sheets, as a bandaged head popped up and Rudy stood up on the bed in only his diaper.  Auntie, I need a hug.   I pulled over a chair, untangled the IV lines, and settled him on my lap for a good half-hour of cuddling.  I lifted one of his eyelids so he could wave at "Auntie Lindsey" and give her a high-five, and we whispered so we wouldn't wake up the now-extubated baby.

The next day, apart from a few cranky moments, Rudy was an angel.  One eye had opened on its own, just a crack, and he turned his head to peer at me with a half-smile on his crooked little lip.  We set up the music again, and as I suctioned nasal trumpets (here it's known as hoovering) and re-wrapped mittens and re-started IV's for baby Shara*, Gina laughingly commented "yesterday you were busy with Rudy, but now Shara is keeping you busy!"

Yesterday I stopped by the ICU, and found all the beds empty!  Shara is sleeping comfortably next to the nurses's station in D ward; helmet of perpetually damp bandages now almost gone, and swollen eyelids looking more like prunes than balloons blown up to the limit.  And Rudy waved at me from his bed across the ward, gave me a high-five as I hugged his mama, and he proudly showed me how far he could open his eyes on his own.  When the nurses took the patients up to deck 7 he came too, and as the djembe players and dancers went wild, we danced too - first with Rudy in my arms, then as he got tired, tied securely to my back in Gina's lappa.

And as we danced I marveled at how far he's come in just a few short days - from fighting, terrified and blind, to dancing wrapped securely in my arms, knowing he is loved.

Why am I so surprised...how often have I done the same?

*As with many of my blog posts, names have been changed for privacy.

Another donation

I’ve written before about blood donation, how we match up patients on ship who might need blood transfusions to crewmembers with the same blood type.  I’ve written before about donation, the personal element present here that is often lacking when I donate in the West, the intimate knowledge that the intravenous cannula I put in one night would transfuse my own life for Mariam with the sunrise, the surreal moments of watching my own blood drip through the chamber whole and warm.  And there is nothing like spontaneous hugs from an energetic little boy, knowing that the bits of myself I gave away two months ago have made a difference.

Yesterday was the sixth day I’ve been crossmatched to a patient in just over a week…after waiting exactly the minimum time since my last donation of two pediatric units for Eddie.  B+ blood is a hot commodity here in West Africa, and not common among the rest of the crew.  And because our blood storage capability is limited, we prefer to store it uncollected, inside a crewmember.  The week progressed into a laughable pattern – crossmatch notice in the evening, solid meals with several liters of water each day – and by Friday morning my bladder was starting to object.  On Friday afternoon I came home to my room and just started to giggle…not only did I have another crossmatch notice, but above the line where my name was written in as the donor, I had “faithful, old” written in as well.

Apparently #6 was the winner, because I got paged to finally donate – the third of four units of blood for a patient (quite a lot of our current B-group blood!).  But this time after Claudia pulled out the needle I downed an extra pint of water and asked if this time, maybe I could take my own blood to the patient.

So I waited, chugging orange juice, while she cross-checked the blood type to be extra sure, then I signed the transfusion form in the “staff delivering blood” spot, and carried it carefully down the hallway. 

A scrub cap and set of booties later, I found myself offering a double handful of my own blood to the anaesthetist in OR#3, the cobaan elastic wrap around my elbow still smooth and white over the vein we finished taking blood from less than ten minutes ago.  Lina was stretched under a sterile blue sheet, breathing easily with the ventilator, a name and type and blood bank number on a page as we checked and crosschecked the details. 

I only gave 450 mL...an amount my body can easily spare and quickly replace.  I might be a little lightheaded, or more tired the next few days, but I probably won't miss it much.  But if we needed to give all of mine, to save these lives at the cost of my own...would I be willing?  Would I give my life?

Jesus willingly gave all His blood: as a covenant and payment, for freedom and holiness.  He watched it drip, whole and warm, knowing it would give life in abundance.  But at what cost?

In giving everything, He has given us everything.  What an incredible gift.

Whoever wants to become great among you must be your servant, and whoever wants to be first must be slave of all.  For even the Son of Man did not come to be served, but to serve, and to give His life as a ransom for many. ~ Mark 10: 43b-45