Extravagance

I love sailing.  The hectic pace of life slows into final reports and meetings and handover, a time to think over all that God has done the last few months, to mentally close a chapter in the adventure I call life and plot out the next - handwritten in ink and saltwater and sea breezes and stars.  It's a different challenge I face this time, because I'm not just closing the Guinea chapter and sailing on through West Africa.  This time I'm closing the Mercy Ships part of the story written in sweat and blood and tears and large amounts of drool, closing that to open something new, because I'm trusting God enough to let this go for now.  The extravagance of His grace and the touch of a mighty hand on my life mean a wild destiny I could never have dreamed up, a poem of life written especially for me.

I am surrounded by God's extravagance.  Every day the sea and sky are a different shade of blue, the foamy spray off the bow full of sparkles and rainbows and sunlight and exuberant dolphins racing and dancing alongside.  Every night the skies are shot through with color and the stars come to sing with us of God's goodness.

My small ship was passing through - here and gone again.  This beauty is here regardless of whether I witness it or not - a lavishly beautiful creation on display for the glory of the Creator...an extravagant art show I am blessed to be a part of!

 

 The whole earth is filled with awe at your wonders; where morning dawns, where evening fades, you call forth songs of joy. 

~ Psalm 65:8

These last days

Scars and struggles on the way
But with joy our hearts can say
Yes our hearts can say
Never once did we ever walk alone
Never once did you leave us on our own
You are faithful, God You are faithful.

I reflected on those words yesterday as the piano music faded and our nurses and dayworkers began to share stories of God's goodness and faithfulness throughout the outreach here in Guinea.

"They came hidden under shawls and wraps, eyes dropped in shame.  It has been amazing to see the patients blossom into confidence..."

"There was a certain man who was very difficult when he first came.  He would not eat the food because it had been prepared by Christians.  He would not even eat food from the market if it had been brought by Christians.  But before he left he chased after me and asked for a Bible..."

"We have had some patients who were close to death, but we have not lost even one in our hospital during this outreach.  There is one who almost died who is very happy now...she calls me often and sends her greetings to all the nurses and the doctors."

We've not walked alone these last months, and our patients have not either.  Patients and papas and brothers and cousins stood eagerly Sunday to share with us what God had done for them.  The testimonies went long past the planned close of the ward service and continued - testimonies of past shame and persistent search for help, stories of hope and promise for a future.

A, B, and C ward all stand empty and well-cleaned tonight, and D ward will soon follow.  My last few nursing shifts were a week ago: a busy set of evenings my friend Hannah (and many of my co-workers here) laughingly call "typical Laura Coles shifts." No quiet evenings for me...if I'm working it's pretty much a guarantee there will be excitement of some form or other, whether it's diagnoses of contagious illness, walk-ins, babies with difficulty breathing, pager calls, sending patients off to surgery, or taking restless kids out into the hallway to race each other until night shift arrives.  I soaked it in, savoring each minute of the controlled chaos and thankful for a distraction from the quickly approaching finish line: the end of the outreach, next tomorrow.  It's a bittersweet week, but not a week of goodbyes.

I don't want to say goodbye.

I'll say "see you later" instead, in any way and every language you choose...sampai nanti, au revior, auf wiedersehen, oohwuwo, a go se yu bak.

I've said it over the last few months, to the tiny cleft-whiskered babies with their heart-shaped nasal bolsters and their parents who love them so fiercely.  I whispered it to Kadi as she slept against my heart during ward church Sunday, and when she ran down the hallway her last night here with no pants, giggling hysterically at the nurse chasing her.  I hugged my au reviors to Halima as she shuffle-danced to the beat of her own drum and blew little sideways kisses on my cheek, and to Lamin with his pirate eyepatch and taped-on gloves and too-big surgical mask when he showed up to join in our cleaning shift yesterday.  I sang oohwuwo to Fodi and Nanfadema and Bala and Mariatou with their brand-new faces, their new confidence, and changed lives that lie ahead.

As our patients leave the ship and travel back to homes and villages across West Africa, they will not travel alone.  I pray they would see God's faithfulness and provision, and sing with joy despite their scars and struggles.  I pray their neighbors and families would notice a change and begin to wonder, to ask why the outcast devil baby no longer looks like a devil, and how the curse that caused a face to melt has been reversed.  I hope they ask why there is new life, new confidence, hope and a future...that they would ask and find the answers.

As our ship leaves Guinea and I fly home, I will not be walking alone either.  Never once will I ever walk alone...God is faithful to go before me and with me, so I can lift my hands in confident surrender to sing

Carried by Your constant grace
Held within Your perfect peace
Never once, no, I never walk alone...

Dalaba musings

The wind whispers to me, combing long fingers through the hair that falls free outside my hammock.

I have kicked off my shoes, let down the tight ponytail, and lifted my face with the morning glories to be kissed by the sunshine from a cloudless sky.  The trees are telling secrets, and I hear a contentment in their voice that echoes my own heart.  It is easy to worship God in such a place, to be still and listen, tucked away and hidden in this secret overlook far above the patchwork valleys and behind the blue mountains.

I first went to Dalaba in November - a brief stop with the team during our screening trip.  It was a peaceful evening and beautiful.  The boys killed chickens and built a fire, while Melodee and I made rice and sauce and chai.  Only one evening, but it allowed us to breathe and just enjoy God's creation, a needed break in the rhythm of hope and heartbreak that is patient screening.

I had a vague idea of where we were going in January, having been there once before.  Following the vision of mountains and cool forests that floated on woodsmoke through my heart, my roommate Heather and I set out on the beginnings of an adventure.

Five hours later, we were still in Conakry.  The popular method of transport here is public taxi, with 9 or more complete strangers packed into a small car and their belongings piled high under a fishnet on top, with stops only to add or let off passengers, for prayers, or the occasional food.  

With a foot planted on the door handle, our driver climbed past me onto the room and our taxi began rocking violently as chicken feathers and small pieces of poop flew through the window in a dusty cloud.  10 minutes later the last piece of fishnet was secure and we were on our way.

It was a long sunny weekend full of peace.  The monkeys chattered and swung overhead as we read and wrote in the hammock or took long quiet walks looking for waterfalls, and the crickets sang at night while the thick blankets of starts danced and we built fires to ward off the evening chill.  There was space to think and pray and listen.

A few months later I was back on the road to Dalaba again, held up at the police checkpoint while an officer frowned at our driver's dubious papers and asked us for advice on his gastroesophageal reflux.  We trekked through dusty villages and mountain forests, feasted on rice and sauce, or crusty street bread and avocados and sweet wild mangos, caught baby goats, and gloried in God's creation.  We may have also shared our beds with some local creatures, as the first night we were graced with mosquitos and bedbugs and and spiders and something dead in the wall (I don't know what), and the second night I industriously swept mouse poop off our bed by headlamp and hoped the culprit would not come nest in our hair as we slept.                                                                                      

 Dalaba and the surrounding mountains and villages have been a much needed adventure in simplicity.  A much needed time simply to rest and enjoy with friends, or trek from village to sand mine to forest in a relief of finally having somewhere to go and go and go for miles without running out of deck space and stairs and falling into the sea.

 I came home thankful - in our packed taxi with a wealth of mangos at my feet and avocados falling on my head, with the chickens scrabbling on the trunk behind and my face covered in dirt and sweat and truck exhaust.  Thankful for peace, for beauty, for space to hike and good friends to share it with... and thankful for a very large freezer to kill all the small things that might have tried to come home in our backpacks.

Retrospective thankfulness

Retrospective (adj): Looking back on or dealing with past events or situations.

We had gathered in our customary circle at shift change, taking turns sharing what we were thankful for that week.  "I'm thankful for the things we used to have," one of my fellow nurses confessed.  "I'm thankful for ensure, and 10cc syringes..."  I found myself nodding along, thinking of the intermittent supply challenges and all the things that won't be back in stock until the next field services.  I remembered, too, the other field services when we were short on saline, or tourniquets, or alcohol swabs, and reminded myself that it was good to be thankful for the things we still had, not just the ones we didn't anymore.

It's easy to be retrospectively thankful.  To think back on all the things that used to be an unappreciated and commonplace part of our lives and remember how great they were.  It's been especially easy to practice retrospective thankfulness at the end of this field service.  There are a lot of things I've been glad that we used to have.  In March I wrote about our Ensure shortage.  To be honest, for most of my nursing time here I hadn't thought much about our Ensure supply.  Once it was gone, though, I was thankful we had once been stocked with cans and cans of Ensure.  When the smooth peanut butter ran out, I was thankful we used to have some, and when the blender died two weeks ago I shook Nalgene bottles of milk and peanut butter, hoping to get the chunks small enough to fit down an NG tube, and was fiercely thankful for the blender too.

It extends over into my personal life sometimes, this thankfulness for past blessings.  I'm thankful we used to have hot water, even though we haven't had it much in our cabin since October.  Now that the acid bugs have returned with the rainy season, I'm thankful for the long months without them, and when the vacuum system breaks I remember that we once had a working toilet.

Living a life without can be a good reminder to appreciate what still is.  It can be easy to brush past the everyday, not realizing that sometimes the normalcy of everyday is a blessing, too.

I am thankful for the things of the past, but I am more thankful for the reminder of the present.  How often do I stop in gratitude for a simple meal, remembering those who have none?  I have clean clothes and my own (small) space to store them, a loving family, a safe home despite the riots that are scattered throughout the city.  Shoes that fit and the ability to read, a face that I can recognize in the mirror - not one I have to hide in the dark in shame.  Finding joy and blessings in life, choosing to rejoice in ALL circumstances...this is a choice.

I choose joy.

For each thing I no longer have and learn to creatively and cheerfully live without, I am reminded of all the amazing gifts I have been given that for me have become normal.  Retrospective and expectant, in all times and places and challenges of life, I choose thankfulness.

When the bandages come off

One of my favorite moments of a day shift is that first dressing change...when the bulky bandages finally come off and a new face is revealed for the first time.  What would it be like to see your face for the first time, after a tumor or deformity you had lived with for years was finally gone?

Abraham intently watched through the mirror as I gently peeled back the last of the tape and lifted a drainage-stained eyepatch to show the results of his surgery - a bone graft to the place where he had a maxilla previously removed.  He lifted his mirror to look more closely as I snipped the suture to pull out a drain, and cleaned the dried blood from around his eye.  "What do you think, Abraham," I asked.

He was very serious as his hand reached up to hold the mirror closer to his new cheek, the cheek that yesterday was flat, and he looked up at me with the beginnings of a shy smile.  "C'est bon, Laura," he said very seriously, and then lit up with a huge grin. "C'est tres, tres bon."

It is very, very good.

Rugi refused to watch her first dressing in the mirror, leaving it forgotten in her lap as she concentrated on holding still while I soaked off the places where gauze had stuck, and cleaned the staple line down her half-shaved scalp.  When the last of the gauze came off I encouraged her to look and look again, and she rather uncertainly held up the brand new mirror to examine the steristrips where her eye had once been.  She, too, broke into a smile and reached up a hand as if to touch the tumor she used to have.  As soon as my gloves came off she was shaking my hand over and over again..."merci, merci, merci, merci!"  I winked and called her beautiful, and left her admiring her new face in a small mirror.  There was one thing more that could complete her happiness, and she pointed hopefully at the urinary catheter and asked me a question in Pular.  "She say she can piss on her own," the caregiver from the bed next to her informed me, "if you can just remove this tube for her."

One catheter removal and mad bathroom dash later, Rugi was ecstatic.  She wiggled happily through her vitals check and IV flush, and hugged me over and over, then settled back in bed with her hand mirror to admire her new face once again.

C'est tres, tres bon.

It is very, very good.

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.

Dr. Seuss and the fizzy mango

Dr. Seuss and the Fizzy Mango: A bedtime story from Africa*

     by Heather Klassen, Laura Coles, and Trudi Attema

Travel to the beach and see

How fun my Africa can be!

Would you do what we have done?

Try it, try it, you’ll have fun!

Did you say no boats today?

No public boats today you say?

Are you sure you tell us true?

“Trust me, I no lie to you!”

800,000 we won’t pay,

These Fotay will just walk away!

Bargain, bargain, bargain more,

Check the price with three or four!

Would you could you stay afloat
 Maybe you should bail your boat?

Would you could you keep bread dry

When the waves are splashing high?

Would you stop along the way

With some local children play?

Would you could you go exploring,

Following the ocean’s roaring?

Would you down a cliff backpack-it,

Padded by an orange lifejacket

Camp out on a hidden beach,

Hotel comforts out of reach.

Would you could you in the dirt

Would you could you in a skirt?

Would you could you sleep in trees?

Swaying in the ocean breeze?

Would you hammock in a tree?

Disney princess you could be.

Would you climb in upside down

Eighteen inches off the ground?

Eighteen inches do you say?

No, we’ll hang them high today!

Chase a crab in rising tide,

From your headlamp he will hide.

Gaze at stars up in the sky, 

Rock to baboon lullaby!

Fizzy mango would you eat?

Or some donuts from the street?

Do not eat your street food bland!

Please add spices (and some sand)

Would you could you in the sun?

Coffee on the beach is fun!

Would you could you in a boat, 

Would you could you with a goat?

Would you could you wade through muck,

garbage, fish and not get stuck?

You would not could not, so you say, 

Try it, try it and you may!

Travel to the beach and see

How fun my Africa can be!

 *Based completely on a true story...I promise.