ali's african adventures

Note to Self:

If you have a tough shift and your misery and weariness are compounded by a raging sinus headache, taking NyQuil might not actually be a great idea. There's a slight possibility that your body will react in strange ways to that particular drug, possibly made exponentially worse by the fact that you live on a ship that is constantly trying to rock you off your feet.

Just be forewarned, dear self, that if you take those little blue pills, you might not wake up until noon the next day. You most definitely won't be able to go to work, since the ability to formulate a coherent sentence is the very least of the requirements on the list for taking care of a ventilated ICU patient. While someone steps in to fill your woozy little shoes, you'll probably end up passing out again until your husband wakes you up for dinner.

In addition, the fact that you slept for seventeen of the last twenty-four hours really isn't going to make it easy to head back to bed when the sun goes down again. You might just end up curled up on your couch in the waning hours of the month, writing dire warnings to yourself on your blog.


(Hypothetically speaking, of course.)

Yesterday was the second time I celebrated my birthday on a ship. In West Africa. In the company of hundreds of crazy people who have come to be my family. Naturally, when I opened my door, I was greeted by a blatant reference to The Office, complete with half-blown-up balloons and a matter-of-fact banner.

I was scheduled to work the evening shift, in charge in D Ward, and I figured it would be a piece of cake (birthday reference entirely intentional). Not much has been happening down in that end of the world, so I had my plans set accordingly; go to work, look busy for as long as possible, and then pull the birthday card and leave early to hang out with my husband. He's a lot less nocturnal than I am, so when I work a lot of evening shifts I'll go entire days where I barely see him.

It's worth mentioning that I have a birthday buddy this year, none other than Suey, a sister from my Gateway family and a peds nurse who makes me happy because we share the same, crazy love for small brown people. We're not huge fans of the birthday hype, so the mini-celebration on B Ward during handover, complete with cupcakes and golden oreos, was just about the right amount of party for the two of us.

When the cupcakes were eaten, I headed back down the D Ward, took report and settled in to do my tasks. The phone rang, and the operating room nurse put an abrupt end to my plans.

The dental abscess patient? He's sick; he's going to need to come back to the ICU.

I scanned the roster for the evening and realized that I was the only experienced ICU nurse on, so I handed off my charge board, grabbed my stethoscope and went to set up the ventilator. While I was busy drawing up medications, another of the nurses wandered past, giving a tour to a third nurse, one who just arrived. Her name is Wendy, and she was my birthday present yesterday. Wendy is what I call a triple threat here on the ship; she has experience in adult, pediatric and ICU nursing. Not only that, but her ICU experience is is both adult and peds ICUs! Which, in layman's terms, means that I had a very happy birthday.

I was just going to keep her by my side to give her a quick orientation to our ICU here, but Wendy and I ended up working together for the rest of the shift. As far as I know, she's down there again today, taking care of that patient on her very first shift off orientation, much like what I ended up doing last year when Benjamin and Sadie were with us.

We made a good team, and it was a good thing there were two of us, because we ended up doing things I'd never done before. Things like getting a CT scan to see just how far Oumar's Ludwig's angina had spread. Back in North America, that was a complicated enough procedure. Here on the ship, it takes on a whole new dimension. The trip involved gathering up a couple of anesthetists, unhooking our patient from the ventilator and all the medications keeping him asleep, loading him onto a stretcher and wheeling him the length of the ship to the CT scanner, giving breaths through a bag and medications through his IVs all the while. Only the hallways weren't wide enough, the ship was rocking, and the stretcher therefore had a mind of its own; I'm not too proud to admit that we let the men drive. There was also the small matter of his blood pressure, which bottomed out while his head was in the scanner, but a quick squeeze of the IV fluid bag was enough to take care of that for the time being.

Back to the ICU we rocked and rolled, and another surgeon lent his expertise to the case, performing another minor surgery on poor Oumar right there in the bed. We put in some more tubes and an IV to monitor blood pressure and finally, around eight thirty, he was stable enough that we let his Aunty come in to see him. She was stoic, sitting in the chair by the side of the bed, explaining that his mama was on a trip somewhere and so she would be holding vigil over her nephew until he got well. I outlined the plan, showed her the tubes and wires invading Oumar's body, keeping him alive, and she held out her hand to me.

In her palm was a string of small, white beads. Je vais prier, she told me when I asked if she wanted to stay by Oumar's side. I am going to pray. I will pray for Oumar and I will pray for you, Alice, and I will pray for Wendy. I will pray that you all sleep well tonight.

And I couldn't help remembering just a few hours earlier when Oumar had rolled into the room, fresh from the OR. Before the door closed, five men and women had also slipped in, their mouths moving in silent prayer. They were our ward disciplers, and they had left their other tasks to come and cover the room in prayer, believing, just like Oumar's Aunty, that God was listening.

So if it seems strange to you that caring for an ICU patient on my birthday was just about the best present I could have asked for, please realize what it means. I turned twenty-six yesterday; Oumar is twenty-five. If not for this ship, for the surgeons and disciplers and anesthetists and brave nurses like Wendy, Oumar would never have gotten even the chance to see his twenty-sixth birthday; he would have died yesterday.

And on the day that I celebrate my own life, it's only fitting that I got to be a part of saving someone else's.

D Ward is overrun with children, all of them in various stages of disease and disrepair. Antoinette is missing part of her nose, her face having fallen victim to a terribly rare parasite passed to her nine-year old body by the bite of a sand fly. Geraldo just had an operation to cover over the hole left in his forehead when his skin didn't heal properly after his other surgery, the one that pushed his brain back inside his skull where it belonged. Louisiano is seven and silent, his top lip swollen into a peak by the tumor there; he's first on the list for OR Four in the morning. In the corner of this band of outcasts is Anicette. She's all skin and bones and feathery curls and impossibly big eyes. Her toes are outrageously long, but maybe it just looks that way because there's not an ounce of fat on her body. It's hard to eat, you see, when your face is split wide open, the gash extending back through the lip to devour nose and palate.

To anyone standing at the door of that room, looking in without knowing what this place is, it would have been no more than a freak show. A collection of some of the most disturbing deformities we could have gathered under one roof.

To the babies and to us and to the mamas who sleep under the beds, it's a sanctuary.

D Ward is the one place where anyone who looks at Anicette is guaranteed to call her beautiful, to tickle her tiny belly and wait for the reward of a broken smile. It's the only place where Antoinette can be silly and sassy and strut her stuff in pipe-cleaner glasses without anyone staring at the sores on her face. It's a place where Louisiano is plied with stickers and toys and hugs until he finally lifts his eyes from the floor for the first time. A place where a sisterhood of mamas can sit with their bandaged babies in their laps while they play cards and sing songs and plait each others' hair.

There are times when I almost feel like taking off my shoes when I walk onto the wards. Because a sanctuary isn't just a safe haven, it's a holy place. All those children and mamas who have surrendered their fears, poured their hope out into our hands, trusted us to love them despite the horror of their wounds? They have made this place into hallowed ground.

Their sanctuary.

It's always encouraging to know that people are reading what I'm writing, that my words aren't just spinning through the trackless void of the internet. Today is one of those encouraging days; a post I wrote while I was doing my Gateway course was picked up by an online magazine, Blog Nosh. It's a blog in its own right, composed of hand-picked entries from blogs across the spectrum, topics ranging from politics to parenting to poetry.

And while it's nice to see that someone out there likes what I wrote, I feel a bit of a disclaimer on that particular post is necessary. Because I'm not really sure I wrote it. It was an assignment for class, during the week we were learning about poverty and theories of development. We were supposed to write about a new perspective we'd gained on the poor, and my first, awful thought was, What on earth did they teach me that was new? I've been with the poor, I've seen how they live. I know all about it.

Which is when I sat down at my computer and God quietly used my hands to type out that post, and I sat in tears in front of the screen.

Because I had been so blind.

I was in the clinic at the far end of the hospital this morning when I heard the drums begin to call. Voices raised in ululation beckoned me back to my ward, and I followed the sound of the singing.

As I walked the length of the ship, the hall was deserted save for a woman clad in a hospital gown, a faded lappa tied tightly around her waist. She moved slowly away from D Ward, her eyes on the floor, hands clasped tightly behind her back. I passed by, drawn by the tumult spilling from the open door.

Inside, the room was alive with the kind of vibrance I've only ever found here in Africa. Translators and patients clapped and stomped and played any instrument they could get their hands on, from bongos to cowbells to rattles pieced together from bowls and scraps of metal. At the head of the room sat Sietou, resplendent in a bright yellow dress, her headdress piled impossibly high above a beaming face. The swirl of noise and music pulled passersby off their courses while nurses from the operating rooms and the other wards paused in their work to stand at the door. Everyone was gathered to celebrate her, to watch her dance.

Sietou's story is familiar in its heartbreak. Her parents died when she was young. She got pregnant, and the baby died inside her, tearing her apart and condemning her to the life of an outcast. She had another baby, but when she went to his father for money, he turned her away, threatened her with a cutlass, told her he'd cut off her head if she ever came to him again. So she's been alone, and she's been wet. For eleven years she's been living on the fringes of society, leaking urine from a body that betrayed her in her moment of greatest need.

Today, Sietou danced. She laughed and she sang and she hugged and she danced. And her chair, when she left it again and again to take her place in the whirling crowd, was dry.

And out in the hall, the old woman walked slowly back and forth, back and forth, the lappa around her waist slowly growing wet again as she shut her ears to the sound of a celebration she had no part in.

There's an incredibly scientific term that some of us peds nurses here on the ship use, and I wanted to share it with you.

nooking: verb; the process of nestling a small baby snugly under your chin, their head tucked into the corner where your throat is the softest.

example: Remember that time I was nooking Maomai? I pretty much loved that.

I've been mulling this story over in my mind for the past few days. a little unsure of how to share it with you. A lot of what goes on in the wards is incredibly difficult to put into words, to convey to someone who's never been here. I know that sounds kind of patronizing, like I'm doubting your powers of imagination or something, but it's so true. When I think back to my old job, I almost want to laugh at just how easy it was. Not the technical nursing; that was so much more difficult and intense than a typical shift on the ship. Here, it's little things that add up and become so overwhelming sometimes.

Like the way our medications are all donated. Which means that we don't always have what we need, and we find ourselves improvising with the next best thing. Same with our supplies; sometimes the IV needles are blunt, the tubing is the wrong type, or the tape runs out in the middle of a dressing change. And then there's the world outside the steel hull of our ship. Garbage floats in the water of the port and collects on street corners. Houses in the villages are made of sticks and clay, dirty wells the only source of water for the families there. Corruption runs rampant, with bribes and extortion an accepted part of everyday life.

And through all this came Fatou.

Shes four, a gorgeous little girl from Nigeria. Her skin is creamy brown, her teeth tiny, even pearls. Her father is an older man, maybe in his fifties, and he quietly goes about the business of caring for his daughter. He speaks English, his accent a close enough approximation to Liberian English that we were able to spend plenty of time chatting while Fatou nestled into the crook of my arm. Her story is confusing.

According to her papa, her life changed on the second of March. He's insistent about this date, knows it marks the beginning of a new chapter, one whose close is so uncertain. Two March, he repeats over and over. It was two March. Fatou cry, Mama! Mama! Then she fall down. That how she get sick.

This, even to a non-medical person, is obviously a poor history. Given the fact that it's now July, that Fatou doesn't move her left side purposefully, that her once-clear speech has been reduced to unintelligible shrieks, we're pretty sure something more drastic than a fall to the ground happened.

We dug deeper. Fatou had been at a local hospital since that day in March, so we called over to get her records. A doctor arrived to the ship, a sheaf of dog-eared papers clutched to her chest. We asked questions through a translator while she thumbed through the papers, throwing out pieces of information like so many breadcrumbs, the trail leading us anywhere but home.

Last blood draw, end of March. Hemoglobin: 4.8 That number is insanely low, but it had never been treated, never checked again. She was in a coma for two months. But no one could tell us when she woke up; it wasn't written anywhere. She has seizures, so she's on medication. The doses weren't written down on her chart, but it didn't matter, because we didn't have the medications in our pharmacy anyway. Sometimes all the technology and first-world medical care we offer on this ship falls apart in the face of the surrounding darkness. and here was small Fatou, slipping away from us into that night.

We gave her some medicine and prayed she wouldn't have a seizure. When she fell asleep, we brought her carefully to the CT scanner to peer inside her head, and what we found confirmed our worst suspicions. I spent another long hour or so sitting on their little bed in the corner, Fatou's feet in my lap, her poor damaged head resting on her papa's chest.

In medical terms, it's called hydrocephalus. Inside Fatou's skull, her brain is being pushed inexorably back, fluid creeping into places it shouldn't, taking over space that doesn't belong to it. As her brain shrinks, so does her future. Unless she can get specialized neurosurgery, this will eventually kill her. It'll probably be sooner rather than later, and that breaks my heart.

Because it shouldn't be this way. Not for the little girl whose papa loves her the way he does. A papa who carefully bathes her and crushes up her food so she can swallow it and uses the mattress he should be sleeping on to pad the wall beside the bed in case she has a seizure in the night. A papa who prays to Allah and can't understand why the God I say loves him would do something like this to his baby.

Fatou left the next morning; she and her papa went back to the local hospital with a copy of her CT scan and the despair that's all too common here when we explain that there's nothing we can do. And I stayed behind, knowing that these patients and stories and experiences are changing my heart forever, in ways I haven't started to understand yet.

I love being in charge when the tasks I delegate turn into conversations like this one:

Hey Bonnie, you can go ahead and take out Bed Seventeen's drains. The one in his neck and the one in his manly parts. [Yes, I edited that particular piece of anatomy, for the sake of you non-nurses out there.]

(Several minutes pass while Bonnie works behind a curtain. She finally reappears and sits down next to me at the desk.)

So. Yeah. I took out the drains. After I took out the manly-bit one, he asked me to be his wife.

.
.
.

Repeatedly.

(Which is when we both lost it and laughed until we were teary-eyed.)

I know I've mentioned it before, but being here in West Africa has got to be the best thing ever for a woman's body image.

This photo was taken a few day ago by my friend Tracy. Maomai is the little bundle between us, and you can see her sassy mama there on the right. Today, I was going about my business on the wards, happily sorting out the myriad of tiny issues that inevitably end up on my plate when I'm in charge. Pelagie, Maomai's mama, was chatting with one of the VVF ladies, Veronique, who had stopped by the ward to say goodbye to the friends she made while she was here. My friend and former coworker, Meg, was there too, collecting info for a story she's writing. What happened next was inevitable, I suppose.

I'm not sure what set them off, but all of a sudden, Veronique and Pelagie were strutting down the middle of the ward, rear ends wiggling in a fashion completely unreproducible by anyone with white skin. They motioned for Meg and I to join in, which we did with significantly less success than expected. Pelagie couldn't figure out why I was having such a hard time with it, and grabbed my backside encouragingly.

C'est beaucoup, she assured me. It's plenty.

And then she danced off across the ward, leaving me and my plenty-big rear end there in hysterical laughter.

It's been a few days since I've posted, but there is an explanation for my silence, partly because Saturday was the ship-wide blackout where the engines were shut down while the cooling systems were cleaned. I spent most of the day relaxing poolside at a vaguely seventies-era hotel, the Benin-Marina, lounging on a padded chaise and downing fresh crepes with mango ice cream while my poor husband sweated in the engine room back on the ship. At one point, I fell asleep, and when I opened my eyes again, I had no idea where I was. I couldn't reconcile the palm trees and pristine pool with the image of Africa that fills my mind. The rift between rich and poor is so much starker here in Benin.

There are pockets of Cotonou where I can see my much-loved Liberia. In the winding alleyways lined with wooden shacks advertising their wares in chalk scrawlings on slabs of wood out front. In the bare-bottomed babies squatting in the dirt, playing with scraps of rubber and metal while their mamas hawk mangoes by the side of the road. In the sharp, earthy smell of the patients who are admitted from up country, explanations flowing through several translators before they press their thumbs to the pad of ink in lieu of signing their names because they have never held a pen.

But so much of this place is so much more modern than I ever expected. The rich really are wealthy, and the dichotomy robs me of my ease. Standing in the lobby of the Marina on Saturday, I couldn't stop thinking about the Ducor Palace in Liberia. It sits perched on top of the hill, overlooking the city of Monrovia, and it was once a five-star hotel. In fact, back then, all of Liberia could be considered five-star; it was the country against which all the other countries in Africa measured themselves, the so-called Gold Standard. Liberia was peaceful and prosperous, and hotels like the Ducor bore witness to her success in its shining opulence.

And then the war came.

And like everything else in Liberia, the Ducor Palace was soon nothing more than a gutted shell, inhabited by thousands of refugees made homeless by that war. Just before I got to Liberia, the squatters were thrown out and the Ducor was truly abandoned, nothing to show for the years of wealth but the scattered remnants of humanity left behind in the scuffle. Old shoes, some cast-off rags and various epithets scrawled across the bare walls the only echoes of former glory.

I stood in that lobby on Saturday, the marble floor cool under my feet, and I couldn't stop myself from imagining what it would look like without the expensive furnishings, the stained wood paneling, the carefully polished glass. I stared past the luxury, tracing the shape of the room, seeing it lined in nothing but concrete and empty space, grass growing in the cracks in the floor.

It's strange; in Liberia, I wanted nothing more than to rebuild, to gather the shattered pieces of a country and forge something new and beautiful. But here, when I'm faced with something that's actually close to that imaginary end product, I can't accept it. It's too good to be true, somehow. Maybe it's because, here in West Africa, this kind of progress seems just too breakable, too fragile.

If Liberia could fall, so could Benin.

So I don't know where that leaves me. I'm constantly torn, trapped between two worlds, a white girl awash in a sea of brown skin. Unable to enjoy the beauty of where I am because of the squalor I know lurks just around the corner. Yearning for the best but fearing the worst.

I have no answers.

I am torn.

I wasn't scheduled to work today, but the evening charge nurse called out sick just before two. The ward supervisor asked me to cover the shift, but I had plans to go out for dinner with a friend who's leaving tomorrow. I explained my dilemma and we struck a compromise; since there aren't too many patients right now, I just needed to come in for the first few hours and take care of some administrative stuff, at which point I was free to leave. I had been looking forward to a relaxing afternoon baking cookies, but I donned my scrubs and headed downstairs.

I'm so glad I did.

The ship is preparing for a day-long blackout tomorrow. The technical crew needs to shut down all the engines in order to clean some stuff, and that means there will be no power. No lights (except for the emergency ones), no air conditioning, no flushing toilets. It's going to be hot and smelly, and it's not exactly going to be a nice environment for the patients to be in. Because of this, we've been doing "simple" surgeries all week; hernias and the like, people who don't need a lot of looking after and get to go home the morning following their operations. We had a mass exodus over the past couple of days, and right now there's a grand total of eight patients in the entire hospital, all cozily ensconced in B Ward.

I can't figure out what was so special about the time tonight. Maybe it was because there really wasn't anything to do other than sit around and chat. I spent the five hours I was on the ward playing with a rogue baby, learning how to say it takes time in French and showing the translators my wedding photos online as they crowded close around my chair at the desk. (Their reactions to things like our ice cream bar and the hilarious look on my husband's face when I stole a kiss could fill their own blog post.)

When dinner time rolled around, I was sitting next to the bed of one of the VVF ladies. Mange, she told me, holding out her plate. Eat. So I did. I grabbed a bowl and asked the servers for some chicken and maize paste. Yovo, you sure? It's spicy! I just grinned and went back to sit with my friend. We ate together, and then she peeled an orange and gave me a few sections.

As a little baby climbed up into my lap for a snuggle, I savored the tangy juice on my tongue, the words of Jesus echoing in my mind. If you give a crust of bread to someone hungry, you're doing it for me, you know. I was confused; I wasn't the one giving out food tonight. I was just sitting there, having it scooped into my bowl and handed to me, fresh-peeled.

Oh. I get it. For once, I see.

I'm not always the one who gets to give. Sometimes I'm the one sitting there, bread in my outstretched hands. Or chicken. Or three pieces of a Beninoise orange.

Since today was my first day as the ICU coordinator, I don't have any fun patient stories for you. I spent the eight hours cleaning and checking and organizing and brainstorming, and somewhere in the middle of it I got to run upstairs and take care of the 'victims' that my husband pulled out of the fire during a drill. It was a good day, but nothing exciting to write about.

What is exciting, however, is a link I want to share with you.

In the process of planning my own nuptials at the beginning of this year, I stumbled across a website that celebrates all things unconventional in weddings. Since I knew the wedding we were planning was a little less than traditional in many ways, I took heart reading all the other stories of crazy brides who didn't feel like tossing a bouquet.

Once our wedding was over, in all it's laid-back glory, I found myself still loving the stories on the website, and on a whim, I filled out a profile on our wedding.

Imagine my surprise when I opened up my reader this morning and found this post!

If you ever felt the need to know more about my wedding, head on over there and check it out. I feel so fancy, being on the internet like that.

Yesterday I had one of those shifts that remind me so undeniably that nursing is my vocation.

To start with, I was orienting a new nurse. On any given day, I'm a big fan of orienting; I love being the one to introduce someone to this crazy floating hospital that feels so much like the only thing I've ever done. Yesterday is was even more of a bonus, because the name next to mine on the assignment sheet was none other than Suey. She's been working out in the communities as a palliative care nurse for the past months, but with a summer shortage of nurses, she was called in to the wards to help out. She's also hands-down one of my best friends here. Throw in the fact that she's a pediatric nurse from one of the top two children's hospitals in the country, and you had the two of us in precepting heaven for eight hours.

We only had four patients to worry about, two of whom were getting ready to go home this morning, so task-wise it wasn't a terribly demanding shift. We had plenty of time to go over paperwork and find things in cupboards and practice putting IVs in brown arms. I've always said that I must have been a teacher in a former life, because I love educating. There's something so satisfying about taking someone who's in the dark and being the one to turn on that little light, opening their eyes to something new. It was fun enough teaching Suey, but we quickly realized that there were some teaching needs far more profound on the ward.

One of our patients was a little old lady who just had surgery to repair an obstetric fistula. The card above her bed proclaimed her age to be thirty-five, but the lines on her face told a different story. I had to teach her how to train her bladder, to learn to control the urine that's been flowing freely for so many years. The instructions are actually fairly simple. For the first thirty days, go to the bathroom every hour. Increase that time by half an hour over the next two months, fifteen days at a time, until you can hold your urine for three hours. But this particular old lady has no concept of time. When we say measure your time in hours, we might as well be telling her to perform backflips and cartwheels. She was born in a small house in a village way up country, and that birth was never registered so she never went to school. She's spent her life ruled by the rhythm of the sunrise and sunset, pounding cassava and washing clothes in the river. How on earth were we supposed to teach her? Through two translators, from English to French to Yoruba and back again, we had the following conversation.

Each box on this paper is one day. Here is a pencil; each time she sleeps, she should mark one box.
So, she should mark each time she goes pepe?
No, each time she sleeps. One mark for one sleep. Is there anyone in the village who has a watch?
Yes, she thinks there is one man who has a watch.
Can he read?
She's not sure.
Can anyone read in her village?
She thinks there is someone who can read.
Okay, these directions are in English. We will translate them to French. She should have the person who can read and the person with the watch help her. There are directions for when to increase the time. See? The boxes are different colors.
She doesn't understand. The person who can read will have to explain it to her. She won't remember.
All she needs to do is make one mark every time she sleeps. The man with the watch and the man who can read will tell her the rest.

And if we thought that was difficult, our next task was to teach yet another illiterate woman (Maomai's mama, Pelagie), how to manage her baby's new g-tube when they go back to their village. It's hard enough for someone who can read the numbers on the syringes she uses to measure milk, who can run to the hospital at the first sign of trouble, who can jump on the internet and Google solutions to problems. Pelagie has none of those luxuries. All she has is an incredible love for her baby, a baby we've all fallen just a little bit in love with too.

So Suey and I kicked our teaching mode into high gear. Armed with the supplies we could muster (gauze, cardboard, some gloves and tape) we constructed a little "practice tummy" so Pelagie could start to get comfortable with the procedure for replacing the tube. She looked absolutely terrified, so we made sure she knew that she had as much time as she needed to learn. We gave her visual cues on the bottle so she knows how much milk to measure up for each feeding, and we cheered enthusiastically every time she did even the smallest thing right. We stopped short of teaching her how to use the alarm clock that someone gave her; that's a lesson for another day, and my Beninoise sister looked slightly overwhelmed.

Nursing isn't just handing out medicines and checking off boxes in a chart. So much of what I do is connecting with people, finding ways to help them learn how to take care of themselves, concocting mad schemes for getting a skill to become second nature. It's a job that can so often be incredibly hectic, but yesterday my heart was singing because I actually had the time to teach.

There's a little girl across the world who has stolen so many hearts. Her name is Kate, and she's very, very sick. I first heard about her story when my best friend, Audrey, told me that she had written a song for little Kate.

It hurts to know that, no matter where we live, pain is just around the corner. I've started thinking that it's only here, in the middle of this poverty and desperation, that real pain can be found. Kate's parents beg to differ.

Please pray.

An old friend arrived back on the ship last night, and I was greeted by her smiling face this morning at breakfast. Meg is another former-PICU nurse like myself, and we worked together last year in Liberia. When I say together, I really mean completely opposite shifts so the only time we saw each other was when we were handing off patients. (Except for that one time, the time an old pastor watched us while we shook what our mama gave us in the darkened ward, late at night. He regarded us stoically before proclaiming, Megee, you dance like Michael Jackson. It was a proud moment.)

At any rate, Meg is back, and with her return comes yet another memory, one of a song we used to sing back and forth to each other. Switchfoot sings, This is your life; are you who you want to be? This is your life, is it everything you dreamed that it would be when the world was younger, and you had everything to lose? We used to grin at the oddest moments, the times when the strangest things were happening, clutch our imaginary microphones and serenade each other. It's been stuck in my head all day.

This is your life.

I dashed across the ward while Maomai was getting a bath, planted kisses on her fuzzy little head, and patted her slowly-getting-plump rump. Pelagi, Maomai's mama, threw me a smile warmer than the summer sunshine and spoke her only two words of English. Thank you. Thank you.

This is your life.

I triaged the steady stream of patients who showed up at the dock. Some had old wounds that had gotten infected. Some just wanted a little attention. Some had come from a far place and shouldn't be admitted until tomorrow, but please could we have a bed to sleep in tonight? We have no friends in Cotonou.

This is your life.

I wove my way through the fabric market after work, the sun burning away the clouds and turning the sky to cobalt. The street was lined with shops, yards and yards of fabric in every colour in stacks that reached the ceilings. In every doorway, a man or a woman, calling out in French or English. Come. Come look. Venez, s'il vous plait, venez. Designs swirled and mixed and I bargained in English and French until I got the one I wanted for a price that didn't completely reflect how white my skin is.

This is your life.

On the way home through the dusty streets, we stopped by a stand at the side of the road. Glass bottles lined the wooden shelves, each one filled with some delicious treat. Roasted peanuts. Candied almonds. Cashews and oyster crackers and trail mix. I chose a bottle off the shelf; the cap said Johnny Walker, but it was filled with sweet, crunchy toasted coconut. I handed over my two dollars and claimed my prize, savouring the sweetness on my tongue as we headed back to the ship.

This is your life.

Out to dinner with friends to sit under the moonlit sky and feast on pork and whole fish and relish that tasted like summer, all fresh tomatoes and onion. Walking back through the darkened streets, the wild single headlights of zemidjahns often a little too close for comfort, my hand tucked tightly inside my husband's. The cool breeze from the ocean as we reached the dock, the lights of the ship guiding us home.

This is my life. And I am absolutely, exactly and completely who I want to be. Because this is so much more than I could have dreamed it to be.