patient stories

It's a strange time on the wards right now. I suppose it always slows down a bit during the summer, but it seems like it's more than usual this year. The wards are emptying out, the combination of only one type of surgery and women healing without any of the usual major complications making it impossible to keep beds full. Not that I'm complaining; it's incredible to see our ladies dancing so soon after surgery, going home to their new lives in their new dresses with their new hope held firmly in their hearts. It's just that, for me, the charge nurse who doesn't really work with the VVF ladies, things aren't so fun.

We kept it up for a while, with Tani and Gafar and Josee providing enough work that we could keep D Ward open and humming. But Tani left yesterday in the darkness just before dawn. Climbed into a bus with thirty other patients and headed north, back to her village where I don't know what will happen to her. She's spent fifty-six days with us, the recipient of almost exclusive attention and constant repetition of our favorite phrases: I love you! I'm beautiful! But now she's home, in a village full of people who might not see her the same way we do. Who might look at her face and still see the maimed little girl who left, the absence of a right eye, the scars snaking across her skin. They might not see her intelligence, her beautiful smile and the sparkle in her left eye. They might make fun of her, just like they used to.

It's so hard to let them go, sometimes.

And it's not just Tani. We sent Gafar to the Hospitality Centre yesterday, too. Away from our constant love and craft ideas, he's withdrawn back into his shell in just twenty-four hours. They called me to see him in the outpatient clinic today where he sat, head low, refusing to meet the nurse's eyes. His ear and eye were swollen, the obvious product of a bandage pushed aside, and when he finally looked up at me I could read the guilt in his good eye, mixed in with what could only be sadness. I think he misses us.

It's so hard to know how best to help them, these kids. Do we keep them in the hospital forever? Shelter them and love them and tell them over and over how precious they are? Or do we let them out, send them home and out of our sight and hope for the best. If Gafar is any indication, I probably don't want to know how Tani's doing.

And the thing is, it's not just them. It's so many of the kids we send home. It's Anicette, who left us and starved to death. It's Maomai, whose story I'll probably never fully know, but who also didn't survive living at home despite everything we did. It's Aissa, whose Uncle Jean missed planting season while he was watching over her in the hospital, and so now they have no food. It's probably a hundred more kids whose stories I haven't heard, and there's nothing I can do about it.

I think it's just a part of this life and this work, the not knowing, but it never really gets easier. It's going to be almost be a relief to see the general surgery patients next week, people who come and go in just a few days. Patients whose names I barely have time to learn. Certainly no time to fall in love and get my heart all tangled up in their stories.



(And knowing me, it'll be about three seconds before I'm wishing myself right back in the middle of all that tangling.)

We put up a curtain in the middle of D Ward today. Split it into two sections. One for the patients, all four of them. Tani and Gafar and Josee and a little boy having his crossed eyes straightened. On their side of the ward it was crayons and bubbles and brightly coloured paper cut into strips so we could each make a rainbow zebra.

On the other side of the curtain the lights were low as a group of nine women sat in a huddle of chairs and stools. They were silent, eyes fixed on the floor, the translator working with them failing in his feeble attempts to bring conversation to their side of the ward.

The only thing connecting the two groups was the smell. It seeped around the flimsy curtain, reaching its fingers into every corner. Stale urine creeps sharp into your nostrils, impossible to ignore. Today, it was everywhere in the hospital. Ladies in beds in A and B Wards, recovering from surgery. More in the Pilot's Entrance, waiting on plastic chairs for their turn to be called. And in C Ward, curtains set up to make little rooms where woman after woman was examined and then sent back to wait. All up and down the corridor they waited.

My little group in D Ward was quiet as the time wore on. Once I had settled my kids on the other side with their latest craft (something to do with styrofoam plates and cardstock feathers), I pulled back the curtain to see them all still sitting, silent.

I asked them through the translator if we could sing, expecting the usual brightening of faces and lifting of voices. Instead, one woman, clad in bright blue and green that belied her downcast face, spoke for them all.

We cannot sing until we know the result of our exams.

I don't know yet either whether or not they'll get surgery. There are two weeks left until the VVF surgeons leave, and there were so many women there today. And because I didn't know either, I did the only thing I could do.

I sang for them.

After what seemed like forever, with my poor wavering voice shouting out words in a language I don't speak, the lady in blue and green joined in, lifting her eyes to meet mine for the first time. One by one, they added their voices, until they were teaching me new songs and we were laughing and finally I couldn't smell the urine anymore.

Sometimes things are good, no matter which side of the curtain you're on.

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In other, completely unrelated news, we're all going to be on TV! Very soon! Wednesday, in fact! If you're in the Eastern time zone in Canada, the Mighty Ships episode featuring Mercy Ships will be airing at eight PM on Discovery Channel Canada. Program your VCRs kids, because none of us have seen it yet and I wouldn't mind hearing if it's any good.

(Granny and Jenn's mom, I'm talking to you.)

On closer inspection of the art supplies, it turned out that there were actually two canvasses! And because recent observation of Tani and Gafar has shown an ever-increasing sibling-like rivalry, I figured it wasn't necessarily going to work out for them to work together.

So they each got to work, and the resulting products are wildly different.

Gafar is ten. He had a large tumour removed from the right side of his face. He's been with us for several weeks already while his little body struggles to heal. Up until a few days ago, he was quiet and withdrawn, a bandage covering his right eye and his left eye swollen almost shut. Just recently, he's come out of himself, running around the ward, pestering us to go up to Deck Seven and waiting expectantly for the next craft idea to come out of the charge nurse desk.

Gafar started his painting out very precisely. One by one, he painted the things he knew. A bike, a TV, a car and a boat in every colour. An orange and a soccer ball and a map of Togo, and then he got the idea to start mixing colours. In a few minutes he had painted over all the lovely colours with a dull faintly-purple grey. I think he may have redeemed himself a little by writing the name of each thing very carefully on the back of the canvas in his scraggly little handwriting.

Tani is nine and lives way up in the north of Togo. When she was five, she fell face first into a cooking fire, and lost her right eye and ear. Her face is masked in scars, her nose and top lip burned away and the fingers of her right hand mangled and missing. She's been on the wards for forty-five days now, and we've rebuilt her nose and upper lip. We've taught her to say I love you, and we've taught her to say I'm beautiful! She dances around the ward every day, shrieking about her love and her beauty and it is a deeper truth than any I've known. (Jenn explains it all so much better than I can.)

Tani's painting shows her personality more than anything I can imagine. It's a swirl of colours and shapes, all thrown together with absolute abandon. She attacked the paints like she attacks life; nothing held back, her scarred face pulled into the biggest grin I've ever seen. The result was something like a masterpiece.




I want two of you to have these paintings, painted with love (and, in Gafar's case, a lot of gray) on the Africa Mercy in Togo. Leave me a comment and tell me which one you want. Also, since I absolutely loved hearing about your dangerous streaks last time, I'd love to hear about your creativity this time. Tani's and Gafar's skills are fairly obvious, but what about yours?

I'll go first. I'm a writer. I love to take my experience and somehow distill it enough that it fits into black and white, tiny strokes that contain a life's worth of love. I'm also a photographer. They go together, to me. Capturing moments and setting them down to were I can go back and live them again later. Also, I like Tani's painting best. If I could win, I'd want to win that one.

How about you?

(Comments will be open through the end of the weekend; speak up!)

I've had weeks here on the ship where I'm so overwhelmed with the work that I lie awake at night, worrying about the kids on the wards. I can't sleep, wondering if they will heal, grow, thrive or even live. They fill my mind, whether I'm on the wards or not.

This week, I've been losing sleep over something entirely different. This week, being an Assistant Ward Supervisor means some kind of cross between a Sunday School teacher, daycare supervisor and camp counselor. With just a tiny bit of nursing thrown in for good measure.

With the VVF ladies taking over B and A Wards at the other end of the hospital, D Ward has become the haven for pediatric eye patients and the three stragglers left over from plastics and maxillo-facial surgery.

Tani, Gafar and Josee, and between the three of them, they are enough to keep us busy.

The busyness isn't in nursing tasks. Josee gets the bandage on her foot changed twice a day, Tani needs some antibiotic cream to the tiny open area on her head at the same times, and Gafar has his bandage re-wrapped every other day. That's it, along with a couple of vitamin and iron pills thrown in for good measure.

Instead, our time is taken up in entertainment. Josee is eighteen and should be able to amuse herself, but she's confined to bed with her foot up on pillows to keep it from swelling. Gafar is ten, and Tani is nine, and they're stuck in a small windowless room for twenty-three hours every single day, and the bottom line is that it's a hospital. There's not much to do.

That's where the Sunday-School-teacher-daycare-supervisor-camp-counselor role comes into play. Instead of IVs and injections and NG feedings, we're focusing on Noah's Ark (complete with cotton balls for the clouds), crayon-coloured creation-story books, and glittery butterfly masks that don't quite fit over faces with eyes either missing or bandaged.

So these days, I lie awake at night and plan out crafts for the next day. It took me far longer to fall asleep last night than it should have, because I couldn't for the life of me think of anything that was going to take up more than half an hour's worth of time.

However, you'll be pleased to know that I've just had an epiphany. Back when Dina sent me that big box of craft supplies back in April, there was something in it I wasn't quite sure how to use on the wards. A little blank canvas and a set of paints and brushes. I took one look at it and pushed to the bottom of the pile, seeing all to clearly in my mind's eye the fights that would break out over such limited resources.

But there are just three of them left. Two, if you count that fact that Josee can't leave her bed and is far more interested in watching the World Cup than the current craft.

Tomorrow, I'm going to head down to the wards and get Tani and Gafar to paint something beautiful for one of you. The two of them have hit it off, and alternate between playing together and fighting like brother and sister, and I think it's only fair that they work together to create a masterpiece. Once it's finished, whatever it is, we're going to have another giveaway on this here blog, and one of you will get to have an authentic piece of African art by two of the continent's premiere up-and-coming artists.

(Please note: I am basing my assessment of their skill solely on how their glittery butterfly masks turned out. This has the potential to either go very, very badly or be totally spectacular. It's going to depend, in large part, how much Gafar is able to control Tani's boundless exuberance for everything craft-related.)

I'll post a photo of the finished product and let you know when it's time to start commenting!

Finally, all those years at camp are paying off.

In an interesting turn of events, it would appear that Akou is not actually forty years old, despite what her records in our database indicate.

I sat with her this morning and chatted while she did her arm exercises. She wanted company, so together we touched our fingers to our thumbs and flexed our wrists up and down and up and down, and all the while we passed the time talking about our families.

She has four children. Her oldest is a girl, and when I asked that girl's age, Akou hesitated a moment before answering. When Anani, the translator, relayed her words back to me, I understood why. Her oldest child is thirty-five. I pressed her a little further and found out that she was twenty-four when that child was born.

I burst out laughing as I did the math. I’m not sure if she ever learned how to add, but when I spelled it out the sum to her, her smile was more than a little guilty.

She paused for a long moment, visibly debating with herself whether she could tell me the truth, but in the end decided that I could be trusted. Through Anani, her plan came out.

I didn't know if you did surgery for old people. Maybe I would be too old and you would say no to me. I thought forty would be a good age for surgery.

I don't know what it's like to live in a system where medical care is so difficult to access that the choice to lie becomes an easy one. I don't know what it's like to live for three years with a tumor growing across my back and no real chance of it being removed. I don't know how it feels to pin all my hopes on a ship full of foreigners who are only in port for a few months every few years.

All I know how to do is smile back in the face of all this, to make jokes and hug a fifty-nine year-old lady who reaches back with her one good arm to fling it around my neck and whisper sweet words into my ear.

I wish you were my baby, too. Then you could stay with me forever and make me laugh all the time.

We found Akou at one of the very first screening days, back in February of this year. She's a sweet, forty year-old woman who had a large tumor growing on the right side of her neck, extending down her back over her shoulder. Her pure joy in this photo as she holds up the card that will allow her through the gate to be admitted for surgery has become the symbol to so many of us of what we are doing here in Togo.

On Thursday, in a marathon nine-hour operation, Dr. Mark removed the tumor. It had grown insidiously over the last three years, wrapping its way around nerves and blood vessels, until it had pushed almost into the space surrounding her lungs.

When Akou returned to the wards, she was scarred from battle. Long lines of staples wound their way across her shoulder and down her back. Tubing from drains stuck out from underneath her skin. Worst of all, her right arm hung limp. You see, in order to remove the tumor, the surgeon had to cut the nerves that ran through it; there was no other way. And even though he performed the minutely complex task of stitching those nerves back together once the offending growth had been removed, the healing will only take place at the rate of about one millimeter every day. There are many millimeters to grow.

Yesterday, we stood around her bed during rounds while Dr. Gary asked her if she was happy with the surgery. She shook her head, gingerly, and explained to the translator who relayed her message to the waiting circle. She says she is not ready to see the absence of the tumor. With her arm like this, she is not ready. And it was true. Akou wasn't the smiling, happy woman from that screening day photo. She was quiet and withdrawn, her brow furrowed more often than not as she used her strong left arm to lift the right and let it fall limp again onto the pillows.

Today, I spoke out in faith at rounds. She is feeling better, and she is dancing again. When Akou heard what I had said, she shook an accusatory finger at me, calling me a liar, even though her eyes held a hint of their former shine. I told her that I was a prophet, that by the end of the day I would see her dance, and her grin was wide as she shook her head at my foolishness.

This hospital is a funny place. It's got none of the conveniences of modern facilities in the first world. No windows opening onto spacious lawns; on deck three, there are no windows at all. No privacy; each bed is two feet from the next and ten patients share one tiny bathroom. And yet every day we see patients healing in ways that would seem incredible to doctors in nurses in those first-world hospitals.

Today was that day for Akou.

I don't know what it was that changed. Maybe it was watching the VVF ladies, seven of them, as they danced into their new lives. Maybe it was the joy on little Joseph's face as he played volleyball with his nurse, a string hanging from the ceiling and a blue balloon sufficing for a net and ball. Maybe it was the constant singing and guitar playing by the translators. Whatever it was, Akou decided that she was ready.

I brought a mirror to her bed, tucked another in my pocket, and watched while she examined the scar forming under the staples on her neck. When she twisted to try and see her back, I used the second mirror to give her a better view. She spent a long while just looking at herself, examining the wounds, flexing the fingers on her weak hand.

And when she was done, she looked at me with her old grin and used her good hand to signal to me that it was good.

Later, at change of shift, we gathered with the translators and started to sing. Over and over we repeated the words until Cael, our resident guitar-player, stepped close to Akou's bed and told her she was going to be singing a solo. She nodded her agreement, and our clapping turned to quiet snaps as she raised her voice, still hoarse from the breathing tube that was down her throat during surgery, to sing.

Akpe madana Mawu.
Akpe madana Mawu.
Akpe madana Mawu, madana Mawu, madana Jesu.
Akpe madana Mawu, madana Mawu,
madana Jehovah

Her good hand was raised high in the air, the fingers on the other curling and uncurling to the rhythm of our song as we echoed her simple words together.

Thanks be to God.
Thanks be to God.
Thanks be to God, to God, to Jesus.
Thanks be to God, to God,
to Jehovah.

Having my parents here means I'm doing a lot of things I don't normally sign up for. By the time the weekend rolls around, I'm generally exhausted enough that I spend the entire time relaxing in my room, sleeping in and doing very little that could be considered strenuous.

But now my parents are here, and they haven't been living in Africa for the past two years. They haven't grown inured to the sights and sounds and smells of this place; they want to see and hear and smell it all, and being alongside them as they take their first steps on this continent is like starting all over again.

So on Friday, I donned booties and a cap and headed into the OR after work. It was the end of a long week for me, one marked by the constant shuffle of patients from one ward to the next. When Monday had dawned, the list of patients was far longer than the number of beds that were going to be available. Hannah and I put our heads together, scrutinized the nursing schedule, and came up with a crazy scheme to open an empty ward, just for the week, just for the cleft lip babies. It would work, as long as the nurses and patients all stayed relatively healthy. At the bed assignment meeting that morning, we proudly called out the numbers. C1. C3. C7. Twenty minutes later, we had two nurses call out sick and it looked like everything was going to fall apart. I started to count the numbers, mechanically working through the list to see who was actually going to be admitted without C Ward opening, until I realized that each number was a child, a baby who was going to grow up with a face split wide open, battling demons I know nothing about, unless we could come up with a plan.

And so we made it work. It involved a lot of transferring and updating and list-making and admitting on faith, but the the time Friday rolled around, every patient on the list who had arrived had had his or her cleft lip repaired. That afternoon, we were watching the last few, along with three who had showed up on the dock and had their hopes answered. When I arrived, my parents were already there with eyes wide, almost as wide as their grins as they watched lips being sewn back together right in front of them. I watched as Amavi was put to sleep, her lip marked, and the first cuts made that would allow this last girl to present an unbroken face to the world. Together, we watched little boys saved with little tiny stitches from the ridicule that would have followed them to school every day.

On Sunday we crowded into A Ward with a press of patients and crew. I held Tani on my lap, a little one who's had her lip and nose rebuilt after falling into a fire. (The photo of her here is before surgery; I can't wait to show you her afters.) We sang and clapped together, standing to dance in the line of translators and nurses that snaked through the throng with the beat of the drum. Across the ward, my mum sat next to Amavi whose swollen lip showed the telltale signs of surgery. Amavi's papa was a few seats down, clutching his new Bible, her mama next to him with little sister fast asleep on mama's back. Together we raised our voices to God, and when I stretched out my upturned hands, Tani curled her maimed fingers through mine.

She leaned back to rest on my chest and whispered into my ear the phrase she learned along with Aissa. I love you, she told me, while the man in the middle of the room spoke words of healing over us all. After today you will leave this place with a new name. Forget the past. Forget anything they said to you, and go from here with a new name.

All around me sat the congregation of the broken, clutching rags to drooling lips, carrying drains and cradling bandaged limbs. They had limped into the ward for church, some barely making it out of bed. Staples shone silver against brown skin and catheter tubing hung beneath gowns, and as the preacher's words were translated they understood in a way I never will.

You will have a new name. Forget the past. These are people with a past to forget, children who have endured shame like I will never know, women torn apart with no one to put them back together. For maybe the first time they were being told that their future was more than just their pain, that the promise of hope was a sure one.

Together we sat, the broken body of Christ in a tiny hospital ward on a ship off the coast of West Africa. All of us worshiping together with outstretched hands, and I have maybe never understood so clearly why I'm here.

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And in case you're a visual person like me, here are a few photos of my parents and I at the orphanage we visited on Saturday. I won't write about these precious kids yet, because I hope to go back and learn their stories off by heart before I share them with you.

I sat at my desk this morning, running through the list of admissions for surgery tomorrow. Far too many for far too few beds, and I was reading without thinking until his name stopped me short and my heart fell out of my chest again.

KETOYE, O'Brien, the entry read. Repair of cleft lip.

We entered him into the database weeks ago, while he still had a chance. While we still thought the miracles were going to win out. We scheduled him for the very last week that Dr. Gary would be operating during this outreach, gave him every chance to grow and get fat, every chance to be ready.

Instead, the sight of his name brought me to tears, while all around me moved nurses who had never met him except through our words on virtual pages, and no one could really understand why it hurt so much to look across the room at the corner where I knelt next to his mama and pulled the tape from his tiny, still face.

This place changes around me too quickly, and I am left at my desk, my heart around my feet, wondering how it all went so wrong. How we could have lost him after all that love poured in. How his name in black and white in front of me this morning was enough to knock me off balance for the better part of the day.

How it's close to eleven at night and I'm not sure my footing has steadied yet.