ali's african adventures

Yesterday was busy, much like every day around these parts. We still have more than our share of max-fax patients on the wards, and Natalie's been letting me hang out with the patients while she does the mundane office work.

I had finally started writing notes in charts when the Patient life team came onto D Ward to start morning worship. Content to sit and finish my tasks, I was listening to the singing and not paying much attention to what was going on around me.

Sometimes, though, there are things more important than note writing.

It wasn't long before I felt a little hand on my knee and looked up to see Kadiatu, her head cocked to one side, eyes asking me to come with her.

Kadiatu lost the middle of her face to noma, and we've started the process of rebuilding it. She's still small, so it's too soon for a new nose, but Dr. Gary has cut and pulled and moved and sewn until he's covered the hole next to what's left of hers. It's been a battle so far, and we're not out of the woods yet, but Kadiatu is a far cry from her former self.

No longer angry and frightened, she skips around the ward, feeding tube dangling off her cheek, chirping out goodness knows what in her tribal language. Yesterday, she wanted me to worship with her.

I was busy. It was late and a meeting was just around the corner, and I wasn't finished my work, so I tried to resist. She gave me a stern look, the likes of which only the very stubborn can really master, and pulled harder at my hand.

It's hard to resist a pikin with a feeding tube and a new face and a lifetime of struggle in front of her if we don't build her that nose one day. So I got up and I worshiped with little Kadi. I clapped and sang and shuffled my feet, and the words surrounded me like a prayer.

You are the pillar that holds my life.
You are the pillar that holds my life.
Daddy Jesus, You are the pillar that holds my life.

Whatever we do for these patients, whatever help we can offer, it's not us who holds their lives. There is one much stronger, much more capable of making sure each little chirping bird is sheltered.

There are some days that I would kill for a hidden camera on the wards, because there's just no way to properly describe this place in plain words. Today was another one for the books; half hilarious, half heart-wrenching.

The hilarity started when we got the doctor to come see the sister of a patient. The patient, eighteen years old, has a little baby, and the sister is here, too, to help take care of the pikin. The sister was complaining of pain, and we needed to send labs off to make sure she was okay. In order to send samples to the lab, we need to have an ID number so that the results can be entered in the hospital database, and in order to give out an ID number, we need to know the name and age of the patient. Simple enough.

I asked the sister her name, and she answered without hesitation. The trouble came when I asked her, how many years you get? Eyes narrowed, she sized me up before answering. Fifty. Since she's maybe twenty-two at the absolute max, I laughed and told her I needed another answer. It came quickly: Okay, fifty-four. At this point a crowd had gathered (as per usual here in Africa), and I told her that we, in fact, that number was still far too high. A question in her voice, she gave me her final answer. Twenty?

Sold to the lowest bidder.

A little later, I was writing a note in a patient's chart when I felt an inquisitive finger prodding the underside of my bum. (For those of you not blessed with curves, yes, a bum can have an underside.) It's a measure of the comfort I have with this place that I didn't even flinch. When I turned around I found the mama of the little one in Bed Eleven holding her hands a good three feet apart, an approving look on her face. Fine, she assured me, You have the African shape! From behind me came another mama's voice. Ali Tumba! 'Tumba' (TOOM-bah) is the word for rear end around here, and mine has garnered a good amount of attention in recent days. This morning, it ended up as the deciding factor in a debate.

The pikin in Bed Eleven is a little three-month-old baby who had his cleft lip fixed yesterday. His mama calls him Duck, and yesterday she promised Jenn that she could marry him. That was, however, before she caught sight of my tumba. There were hoots and hollers and a fair amount of elbowing, and I'm not sure, but I think I'm now engaged to Duck. Please don't tell the HoJ.

The last story is the heart-wrenching one, but for once it's not in a bad way. For once I have nothing but good to share with you, and it's good for Sia. Her story developed in the most amazing way today.

First, I want you to head over to Reka's blog and read the story of how Sia was found on the street. That's how Sia's story started, and you've heard a lot about what's been going on since she arrived on board. I want to tell you about what's going to happen when we leave.

We've found a hospital in Guinea where she can receive further treatment, and we've been working out the details as far as how she'll get to and from her home in the north of Sierra Leone and what sort of financial help they'll need to make this all happen. I worked on the wards today while Natalie, the current Team Leader, spent the day doing office work. She felt like she wanted to see the sun, so she took her work up to Deck Six to sit in the internet cafe. While there, one of the women who works with Patient Life came to talk over the whole thing and see where we were at.

Natalie and Yvonne moved to the comfortable chairs near the cafe and started working out the total cost for Sia to receive the four more months of treatment she'll need. Factoring in all the costs, it came to around $130. There's a woman who attend's my mum's Bible study back home who shares my blog with a friend of hers. That friend already donated thirty dollars towards that sum, and Natalie figured that the remaining hundred would be easily raised since we all love Sia.

Which is when God stepped in.

A woman sitting a few chairs over leaned towards Natalie and apologized for eavesdropping. It's just that, before I left, my neighbours gave me a hundred dollars, she explained. They wanted it to be used specifically for the care of a child, and I had no idea how to find a child or how to best use the money. Are you talking about a child?

Of course they were talking about a child. It's not a joke when it says that He does more than we can ask or imagine; before we could even come up with a plan to raise this money, God had already provided. He moved in Marie's heart to donate thirty dollars, and he moved in the hearts of an unknown couple to give the rest of the money, specifically to be used for a child. He arranged for Natalie to take her office day upstairs, for Yvonne to meet her there, for the woman to be sitting near enough to hear their conversation.

This God of ours, He does nothing by halves.

Here is my little Sia; this was on Friday just before she went back to the operating room to have the dead tissue that used to be her left eye removed. She looks even better now, and she's like a new kid these days. She smiles and laughs and plays and just hangs out like she owns the place in her own quiet way.



She's due for her next dose of chemo this Friday, if all is well with her bloodwork. We're still trying to figure out what will happen with her when we leave, so please be praying that the way will be shown clearly in front of us.

(Photo courtesy of the talented Deb Louden, ward nurse and photographer extraordinaire.)

Since I've been in bed all weekend nursing a nasty cold, I don't have any updates or stories from the wards. It would appear that I handle proper illness with much more grace than I do a simple cold. Whatever the case may be, I haven't left the comfort of my cabin for more than a few minutes at a time. Not even to head outside to the deck or the dock. Which, speaking of, I've never shown you.

Since I live on a home whose backyard changes at least once a year depending on where we drop anchor, I figure it's only fair to keep you updated on the changing view.



This composite was shot during the forklift incident a couple weeks ago. (At the bottom left is the Terex machine trying to fish that poor forklift out of the water) At any rate, the view from this particular dock is absolutely wonderful if you can get past the four-high row of containers hemming us in. We have a beautiful mountain view, little houses creeping up the side of it, topped with university buildings.

At the far left there's a little area fenced off for a basketball court; dinner last night was a barbecue out there with everyone sitting in beach chairs and balancing plates on knees. All along the containers we park our Landrovers, and on the far right is the narrow walkway where we come and go from the dock. Well, technically, on the far right is a sunset. Every night you can find people up on Deck Eight watching the sunset. The sun slips below the mountains on the other side of the harbour as smoke rises from the fishing villages and the call to prayer sounds from city mosques. On a quiet night you can hear two or three at a time.

There's not always much room to roam here in West Africa, and it's nice to have a berth with a view this year.

If you downloaded any of the November wallpapers, please accept my scatterbrained apology. I somehow managed to make all three of them with the month starting on Thursday, not Tuesday. I didn't notice until today when I started trying to make outpatient appointments on absolutely the wrong days.

Please accept my hearty apologies and these newly-uploaded backgrounds which have calendars that actually start on the correct day.







(However, if you just want them for the photos, then feel free to disregard all this!)

Little Sia is still on D Ward; I've been off for the last two days, and when I walked into the room this morning I thought I was seeing things. Where before she had a tumour the size of a small orange, now the contour of her face is nearly normal again. Burkitt's responds so quickly to treatment that it's almost unbelievable.

She still cries every time we come near her with a needle, something that unfortunately happens every day since she's had a few issues after getting her dose of chemotherapy, but she's eating again, which is a start. She and her little sister, Kumbah, sit facing each other on the bed at each meal, Kumbah more often than not offering her big sister a handful of beans or rice.

Today, for the first time, Sia was up and walking around the ward with Kumbah when one of the nurses for some reason decided to scoop Kumbah up in a pillowcase. Don't ask me why any of these sort of things happen; I'm supposedly in charge of the place, but my hold on the reigns is always just a little tenuous. Be that as it may, the effect of this move was something I really hadn't expected.

I looked down a Sia and she was laughing her head off. She's spent the last week curled up in bed, not speaking a word; I've never ever seen her smile. Today she laughed.

Sia's future is still uncertain. We're working on finding a way for her to get follow-up care when we leave, and with only three and a half weeks until the hospital closes for good this year, we don't have a lot of time. God is God of the details, though. He knows each curly hair in each of the braids on Sia's head. He's written each day of her life in his book, and although we don't know right now just how many days she has left, we've bought her this time at least.

There are so many things I love about this place. A few of us sat together after church tonight and just shared stories of D Ward, and I realized again that there's nothing else I'd rather do. It's a hundred things a day, and as I live through it all I tuck them into the back of my mind so I can tell you all later.

There's Nurse Shaka, a patient who had a huge tumour removed from the back of his neck and who may or may not actually be a nurse in real life. We've caught him adjusting the IV fluid rate on the patient in the next bed, and just today I found him, along with two other patients, in the isolation room where the lady with the fast-fast is staying, having a little chat. When I mentioned the reason for her isolation, I have never seen anyone move quite so fast as they all did when they realized that they could be catching the fast-fast too. (Have I said fast enough yet?) Given the fact that Nurse Shaka speaks her language, I kept him outside her door for a little while longer to translate for me. Community is alive and well on D Ward, folks.

Speaking of the lady in isolation, she tried to kick me in the head today, and I learned the value of therapeutic yelling. Now, I don't generally condone yelling at patients, but a needlestick way back in Liberia has made me a little jumpy around people who flail when sharp things and blood are involved. I was in there to restart her IV, and when the needle touched her skin, the leg closest to me came up in a decisive kicking motion, and it was at this point that I decided to employ the therapeutic yelling technique, regardless of the fact that she doesn't speak a word of English. It seemed to work, because when I moved to the other arm for a second try, she screwed up her face and glared at me, but kept perfectly still.

Fanta Man is doing better. He has a caregiver here with him now, a man who may or may not be his son. When I came back into the ward from the near-kicking episode, I had one of the funniest moments of the day when I found the caregiver helping Fanta Man drink tea in an incredibly unique way. There was a large syringe (the same size as the one he was drinking Fanta from the other day) filled with milky tea, and attached to the end of that was a piece of IV tubing about a foot long. Fanta Man had the other end of the tubing in his mouth and was sucking back tea, gesturing all the while at his son to speed up the process, please, and mumbling something about how the tea just wasn't coming fast enough. (There's that word again!) It's hard to picture, I know; just trust me when I tell you that it's one of the best moves dear Fanta Man has pulled since arriving.

Once I had finished laughing about Fanta Man, I headed to the recovery room to check on little Kadiatu, who had to go to the OR this morning because she basically removed everything possible during the night; feeding tube, IV, bandages. Everything. And because she needs to wait for surgery to build her a nose, inserting a feeding tube that goes through the nose and into the stomach isn't something that can be done just anyhow. I heard her yelling before I even got into the room, and she was already starting to reach for the new tube, so I did the most obvious thing. I ran to the ward for a safety pin and I pinned that tube to one of the braids in top of her head. Only in Africa.

Four moments out of a hundred, and I head to bed exhausted again but happier than ever that this is the place that God wants us to live out the love He's given us to share.

Today was another busy day. We really could have used another nurse, and we were all running from the moment we came in until long after the shift was over; it might be enough to mention that I just ate lunch. At four thirty in the afternoon.

There were problems to be solved and issues to be dealt with left and right. Sia got her chemotherapy last night, so her medication record has grown to span three pages as we work to keep her system running properly. Kadiatu, a little one who had surgery to basically create a face where noma had taken hers, screamed whenever anyone even touched the feeding tube that she needs until her new mouth heals. Baindu's tongue has a dead spot in it that needs to be dealt with, and one of our patients who has been staying in B Ward needed to be brought back down the hall and placed in isolation in the ICU for a raging case of what the Sierra Leoneans politely refer to as fast-fast. (Hint: it comes out of the backside at precisely the speed indicated.)

Add to this the fact that there's a massive jigsaw puzzle to be fit together every weekend in order to get the new admissions in for surgery on Monday, along with all the administrative tasks that our admin assistants take care of during the week and notes and orders to be written for thirty-five patients, and you can start to see why I might have been a little busy.

Handing over the reigns to Jenn at shift change was a good feeling, and included my favourite problem of the day. Abu in C Ten is ready to go when his brother comes to pick him up. We just have to find him a shirt. Abu is from Guinea, and I've been serving as his interpreter for the last few days since he only speaks French. My language skills were sorely stretched this morning when he explained that his shirt had disappeared and that he didn't really feel like going home topless. I assured him that we would make it our top priority.

Forget kids with cancer and dehydrated old ladies; getting this guy a new shirt is probably the most important thing to be done.

Jenn agreed with the urgency of the task and dutifully wrote it at the top of her list. It's comforting to know that the ward is in good hands for the evening.

Some things are just unfair. It's not the she got the green cup and I wanted the green cup kind of unfair, but something much more heartbreaking. It's Sia, downstairs in D Ward right now, her baby sister probably curled up with her, mama keeping vigil on a chair beside the bed.

Sia is eight, and where her left eye should be is an angry red tumour. Her belly is swollen with more cancer, and because she was born here in Sierra Leone, she might well die because of it. It's deeper than that, though. It's not just that Sia is West African; it's the fact that she came to us at the end of October. At any other time in the year, we would have entered her into the Burkitt's Program, and that would have been that. Our incredible palliative care nurse, Harriet, would have overseen her care at the local hospital, Sia would have received chemotherapy, and she most likely would have been cured.

Instead, we are faced with the reality that we have only three weeks of surgery left. The hospital will close a week after that, and then we will sail away and little Sia will still be here. How is it possible that a matter of months, weeks maybe, might be the difference between life and death for this little one?

She's getting her first dose of chemotherapy here on the ship as I type this, but all we're hoping is that it buys us a little time. Time to figure out what to do with her after. Time to find someone who will make sure she gets to the hospital, to find someone who will pay for the treatment. How can we be sure that she'll get what she needs when we're so far away?

I stood in the hall with Dr. Gary and Stacia, the oncology nurse who's giving the chemo, (yet another example of the right person being here at the right time) and he said something that makes the way forward just a little more obvious.

Eight years is too short.

Sia means firstborn girl; if it were me instead of her in that bed, I'd be named the same thing, and I don't know what to do with that. What I do know is that eight is not enough.

And the crazy days continue. This one wasn't so much because of Fanta Man or Bed Fourteen, although both are still here and both are still problematic behaviour-wise, but more because we had a rather prestigious visitor to the ship. Princess Anne came and spent some time on the Africa Mercy this morning.



The place has been buzzing with news of nothing else for the past few days. The hospital was a flurry of activity right up until the announcement of her arrival as day volunteers scrubbed away errant scuff marks on the walls and patients were tucked firmly into their beds. A few people (Brits, for the most part; my accent isn't nearly posh enough) were chosen as representatives of the hospital and donned crisp navy scrubs for the occasion. (This was a matter of much hilarity among the rest of us, who were somehow less classy in royal blue.)

We spent the morning practicing our curtseys, debating whether or not Americans should do so, and deciding which patients would be appropriate for the princess to meet. Unsurprisingly, Fanta Man was not on that list. In fact, we figured it would be best just to keep her off his side of the ward altogether, since his chats with the soap dispenser have now extended to include the water filter, too. It's just too hard to know how he would react to a real, live princess given his frustration with inanimate objects.

When she did arrive, Princess Anne was lovely. She met the two patients we had picked out for her, and then just kept right on going around that side of the ward and met all the rest of them, too. I got trapped in a corner, and so when she got around to the lady in Bed Twelve, I was the one the princess turned to when she asked about the patient's surgery.

I got to talk to the princess, bright blue scrubs and all. I've done come crazy things here on this ship, but explaining oro-nasal fistula surgery to the daughter of the Queen of England? That's right up there with the rest of them.

We herded her out before she had a chance to ask about beds one through five, and the visit can therefore be called a success. Fanta Man drank the rest of his purple Fanta in celebration, and Bed Fourteen (who is now in one of the smaller rooms off the ICU) slept through the entire thing.

The whole thing, having a royal visitor in our floating world, just seemed so surreal. Kirstie, the Ward Supervisor, put it really well at a nurse meeting this afternoon. I know we do this all the time, but as I was explaining to her that we just took a big tumor off this man's face, I realize how incredible it really is. All of this, Fanta Man and Bed Fourteen and changing bandages and taking temperatures, all of it is part of something so much bigger than ourselves, and we can't lose sight of this.

I heard a voice thunder from the Throne: "Look! Look! God has moved into the neighborhood, making his home with men and women! They're his people, he's their God. He'll wipe every tear from their eyes. Death is gone for good—tears gone, crying gone, pain gone—all the first order of things gone." The Enthroned continued, "Look! I'm making everything new. (Revelation 21:3-4, The Message)

He is making everything new, and we are a part of it every single day. Whether we're performing for princesses or sitting in the dark at the bedside of a confused old man, we are part of the making new of all things.

You didn't think yesterday's post was it, did you? That Fanta Man would just go to sleep and wake up clear-headed and bright-eyed this morning? Folks, if you were expecting that, then you have come to the wrong blog post, because this one is a straight-up continuation of yesterday's antics.

When we all came on shift at seven this morning, things seemed like they were set to run much more smoothly than yesterday. Fanta Man was tucked into bed, fully clothed, not a trace of orange on his dressing. My little man from yesterday was assigned to a different nurse, but he was off his morphine pump and feeling much better about life. Everything was quiet. Until breakfast.

Fanta Man produced not one but two Fantas from who knows where, purple this time, and proceeded to pour one of them into his bowl. He crumbled up his bread into it and then called over his nurse, Jess. I was upstairs getting my own breakfast when she showed up in the dining room in search of a spoon. Apparently Fanta Man wanted a spoon to eat his purple bread with, and when Jess didn't produce one right away, he pulled a huge wad of cash out of, well, somewhere. (There are no pockets in hospital gowns, so we're not sure where it really came from.) He had 92,000 Leones, and it was all hers if she could just find him a spoon.

Since we don't really take bribes, she offered instead to lock up the money in the safe where it belongs. That went well for about fifteen minutes until he decided that he did not trust us at all, and started yelling that he needed his money back. When it wasn't immediately forthcoming, he threatened to call the army on her, which only resulted in her bursting into laughter. Not terribly professional, I know, but it was really the only response given the situation.

Unfortunately, this didn't help Fanta Man's mood, and he headed over to the sink and started yelling unintelligibly at none other than the soap dispenser. He kept pointing over at Jess with a disturbed look on his face, and turning back to the soap dispenser for some sort of acknowledgement of his feelings.

The soap dispenser didn't have much to say.

So Fanta Man did what any confused old man would do; headed back to bed, donned a pair of bright pink pants under his gown, after which he rifled through his bag for a while and pulled out a book that he had been reading. He had apparently been marking his place with a piece of bread, at least a week old and as hard as a rock with a little hole eaten out of the center, which he pulled out and waved at Jess, who was pretty much unable to keep it together at this point.

It was shortly after Fanta Man pulled on the second pair of pants, bright blue over the pink ones, that confusion broke out on the other side of the ward. The patient in Bed Fourteen, the guy I used yesterday to translate for my patient in Bed Nine, was fully dressed and halfway down the hall, heading home before anyone noticed. One of the translators ran after him and returned with his bag, but not with him. At least now he will not go far, was her matter-of-fact explanation of why she chose luggage over patient.

Somehow, overnight, the tables turned, and now Bed Nine was able to speak more French than Bed Fourteen, and so I used Nine to talk to Fourteen as I tried in vain to convince him to stay. It was slow going, since both the men have recently had surgeries on their jaws that have left them mumbling and near-impossible to understand in any language. The three of us stood in the hall for a while, working on communication when a third patient showed up from B Ward on crutches. She also spoke no English, but her French was perfectly West African, and clear as day for me to understand.

Unfortunately, just understanding the language doesn't mean you can convince someone that they're at risk for infection if they leave the ship, especially not when Fanta Man is escaping D Ward through the back door to the ICU and needs to be caught. (Incidentally, the only way to get Fanta Man out of the ICU and back into bed was to convince him that not only the ICU but also his home and the entire country of Sierra Leone were, in fact, closed for business.)

At some point, we just kind of threw up our hands and yet again admitted that only the essentials were going to get done today. Keeping Fanta Man and Bed Fourteen in the ward were the only real priorities, and it seemed like it took all of us all day just to make it happen. When I went down just now to retrieve a water bottle that I forgot at the end of the day Bed Fourteen was still there, his bag hidden under another patient's bed, and Fanta Man was sitting with a translator next to his own bed, a classy coral jacket added to his ensemble over his gown.

I'm not going to lie when I say that I'm glad I have the day off tomorrow.

Tomorrow I'm going to see if I remember how to be a real nurse.

Famous last words, those.

Today was a shift unlike any I've had in recent memory. It wasn't that I had a bad assignment; a pharyngoplasty two days out and three grownups who could, for the most part, express their needs and didn't have a lot of care to give is a great set of patients. Except it's never that easy, is it? Of course one of my patients only spoke obscure tribal languages, and the only other person around who spoke those same languages was another patient (not mine) who also only spoke French. I didn't really hesitate, since the kid who had had a pharyngoplasty (a nasty surgery, by any account) was vomiting on the other side of the room, and pulled the French-speaking patient to the bedside of my old man so I could do a quick assessment. That other patient has apparently been here long enough that he started anticipating my questions, and was able to tell me not only that my old man had opened his bowels, but what the consistency of said action was.

That being sorted, I turned to Alpha, my poor little man in Bed Twelve. He was a sorry sight, with a soft plastic 'trumpet' in one nostril so he could breathe, a feeding tube in the other, an IV of morphine running into one little hand, and a pathetic look on his face. Although, to be fair, if you had a flap from the back of your throat cut off and sewn to the top of your mouth, you'd probably look a little pathetic, too. It was one thing after another with Alpha today; everything I put down his feeding tube came right back up, and since kids aren't really picky about where they vomit, he got numerous baths and two complete linen changes.

All of this would have been fine, honestly, if it hadn't been for Fanta Man in Bed One. He wasn't my patient, but it quickly became apparent that he was everyone's problem. He started the shift with a heartrate over 130 (not good) and breathing that sounded like a sick duck (very not good). He was becoming increasingly confused (also not good, although in my case it's fairly normal), and wouldn't keep the oxygen mask on his face. Just try, if you can, to picture the scene. An elderly gentleman with his gown around his waist and his head wrapped up in a huge white bandage sitting on the side of his bed. A wheelchair is waiting to take him to x-ray, and there are at least five nurses and doctors around the bed. Sheets in absolute disarray, monitor showing crazy numbers, egg smeared all over the floor (not sure how that happened), and a puddle of something best not mentioned on a family blog also all over that floor. And in the middle of all this sits Fanta Man, oxygen mask firmly pulled away from his face, pouring an orange Fanta in the general direction of his mouth, missing completely and soaking his bandage in the process.

Somehow, I don't think we'll be seeing him in the Fanta ads.

It was quickly apparent that Jenn (who, I must add, is a NICU nurse, and not really the first one you'd imagine taking care of a confused old man) had to focus completely on this guy, so we each took one of her other patients, giving me the barfing boy and four grownups with two dressings each to change.

Folks, I'm officially recovered from that arthritis, because I did not stop moving for eight hours straight. They were possibly the fastest eight hours of the past year, and only when it was over, Fanta Man tucked into bed with a clean gown and bandage, a new IV started on my little guy by Jenn (who is, honestly, a rockstar) and all of my tube feeds were given did I realize that I'm still a nurse.

I guess there are some things you don't forget, no matter how long it's been. Changing bandages and holding barf buckets and titrating morphine and juggling the needs of a whole row of people seems to be, at least for me, like riding a bike. I'm just hoping that tomorrow I can ride a little slower.

In the hospital here on the Africa Mercy, we have a policy that anyone fifteen years old and younger be admitted with someone to care for them. It's the reason we have a column on our computer census marked caregivers, where we keep track of those extra bodies on the ward. If a mama is admitted for her own surgery and she's still breastfeeding a baby, that baby gets entered on the caregiver list, too.

Today, in Bed Twenty, we had what must have been a record number of caregivers: three. A mama was admitted for surgery and she has twins who are breastfeeding. But because these twins aren't tiny babies but rather wild, crawling near-toddlers, she also brought along an Aunty (a female of undetermined relation) to watch over Hassan and Haja when she went to the operating room.

Let me tell you something here: there is not much that I like more than a good set of African twin babies. Especially when they're as beautiful as these two. This morning, while mama rested and Aunty took a bath, the Patient Life team came onto the ward for morning devotions. Patient Life is a team of crew members, both African and Western, and local Sierra Leonean day volunteers who take care of the spiritual and emotional health of our patients. While we change bandages and give pain medications, they're on call to counsel, pray and sing with our patients.

This is the first morning I've been on the wards, and when they started to sing, I couldn't help myself. Right away, I was clapping and dancing and singing along, and it was the most natural thing in the world to grab little Hassan and strap him to my back with a colourful lappa. (Here in Sierra Leone it's called po-po'ing, as in I po-po'ed Hassan.) I could feel him rustling around until he got his little thumb into his mouth, and then he relaxed and fell asleep as all around us voices raised in harmony, singing praise to Papa God.

Tell am tenki, tell am;
Tell Papa God tenki.
Wat He do foh me,
I go tell am tenki.
Na wat He do foh me,
I go tell am tenki.
Tell am tenki, tell am;
Tell Papa God tenki.

It was one of the first songs I learned back in Liberia; we sang it at the very first community meeting I was a part of. Now, more than three years later, I'm singing it again. Everything so much the same, and somehow so different. I didn't need help to get that baby on my back. My feet know instinctively how to move, my hands how to clap out the three-beat rhythm. It's the most natural thing in the world to stop dead in the middle of a day of work to have a dance party.

Who wouldn't want to live like this?!

And the icing on the cake, despite my love for my little twins, is the fact that today was my last official shift on B Ward. Tomorrow I head back down the hall to the land of maxillo-facial surgery and the patients who have the biggest place in my heart. Next year in Togo I'm going to be taking over the role as Team Leader, and Natalie, the current queen of the NG's, has a whole lot to teach me before she leaves.

Tomorrow I'm going to see if I remember how to be a real nurse.

If there’s one thing sure in an uncertain life, it’s that it will move on. James passed away yesterday morning, and the same afternoon a little almost-two-year-old with the same name was admitted to B Ward. Sporting curly hair and a miniature pair of sunglasses, he spent the evening laughing, stomping around the room and snuggling with me. (You can probably guess which was my favourite of his activities.) James had cataract surgery a while ago, and was back to have the sutures taken out of his eyes. It was clear from the way he grinned up at me that he could see perfectly, but he flat-out refused to let anyone touch those glasses, which earned him the nickname Baby Ray Charles. His mama approved.

By the time I came in this afternoon, Baby Ray had been to the OR to have the sutures taken out of his eyes and had already been sent home, so I had no one to play with. The shift turned out to be busier than I anticipated, though, so I didn’t have much time to miss him.

It was one of those shifts so full of both good and bad, one of the ones that has you reeling from the near-whiplash of emotions. For some patients, it was good news. Surgeries to be performed, stubborn wounds healing. For others, it meant heartbreak. We turned one guy away because of a tooth abscess that would make anesthesia too risky, told another that he’s HIV positive and watched his world crumble around him. It’s almost impossible to go from that to a particularly funny ward round where the surgeon tried his hardest to talk like a Sierra Leonean, and I was told in no uncertain terms that I speak Krio like a Liberian.

But that’s the way it is here. Life ebbs and flows and sometimes the only way to survive is to just let it wash over you, arms open wide to receive the joy along with the pain. The sweet and salty mix and it’s a drink that doesn’t always go down easily.

Kisses from freshly-repaired cleft lips help; I got a few of those today, along with a little three-year-old dance party in the now-empty ICU. I printed out the discharge papers for the boy with HIV, and as I headed home down the hall after handover, one of the day volunteers called out after me. Goodnight Liberian woman!

And so it goes on.

Thank you for your prayers for James; please pray for his family now. He passed away this morning, but he was not alone. That's all I think about, haunted by the memory of the others who have died downstairs. He didn't collapse in the street or die curled up in a corner somewhere. He was in the best hospital in the country, given every possible medical chance; there was nothing more we could have done. He was cared for until the very end and he died surrounded by love and prayer. I wasn't there, but I have been before, and I know how it is here.

And still it seems so wrong. I think I say this every single time, but this is not what we all sign up for when we come to Mercy Ships. We think we're coming to watch cleft lips be stitched back together, to see crooked feet straightened and blind eyes given sight. Nowhere in the orientation packet does it say anything about how, sometimes, they die.

It's jarring, the disconnect. Last night I went down to D Ward to get the keys for the pharmacy, and a little girl with an as-yet-unrepaired cleft lip lifted up her hands to me. She wound her skinny arms around my neck and planted a series of sloppy wet kisses on my cheeks, and right behind her was the door to the ICU where James was dying and it just seemed so unreal.

So please keep praying for his family. It rained all night, and it's still raining this morning, so I don't know how the roads will be when they try to take him home. Strange, to have to think about that, too. At home it's all so simple; you call the funeral home, and they take care of it. Things are messier here. We're more involved, more a part of our patients' lives than is considered really proper in the 'real world.'

I think it's how Jesus would have wanted it. I look into the Gospels and I see Him weeping outside the tomb of a man He was about to raise from the dead, fully present in the moment, sharing in the grief of his friends. And I think of the ones who stood vigil around James' bed this morning, present in his last moments, and I know that this is the way it should be.

We're not on this earth to live our own lives, untouched by what goes on around us. If that's the example we were to follow, Jesus would have lived his thirty-some years out in a monastery. He didn't. He lived in community with the world; He got dirty and He got hurt. Some days it felt like too much, but always compassion moved Him to give more. He loved the unlovable, had parties with sinners and wept with those who mourned.

This is the way it should be.