into the night

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.