patient stories

Oh, today. Today was perfect in such a typically African way. From start to finish, it was everything that I miss when the place is packed up and tied down to bolts in the floor. I could tell you so many stories, but I'll stick with two, both awesome for different reasons.

First the funny. The patient in Bed Fifteen has her sister staying with her to help care for her and her little baby. Sister is slightly demanding, albeit in a rather endearing way; she's definitely the bossier of the two. Yesterday in the evening Sister came to me and asked if she could leave for a little while this morning to buy shoes for the pikin. Despite the fact that said pikin is no more than three months old and nowhere near walking, I told her she could definitely be released for a while.

This morning she came to me when she was ready to leave, and asked for one of the many little pieces of scrap paper that live in the top desk drawer. I handed her one, not sure what she might need it for, and sent her up to the gangway with one of the translators.

I thought no more of it for another couple hours until I got a call from the gurkha guarding the entrance. Atypically, he was laughing pretty hard, and it took me a minute to realize he wanted me to send someone up for Sister. She arrived down to the ward a minute or so later, a bundle the size of a wadded-up king-size duvet wrapped in plastic balanced on her head, (definitely more than one pikin-sized pair of shoes in there, I'm pretty sure) and immediately started waving the scrap of paper at me and yelling in her tribal language.

If you've never been yelled at by a tiny little African lady with a huge bundle wobbling on her head with every shake of her little fist, you've never really lived.

She eventually surrendered the paper, which I unfolded to find just as blank as when I gave it to her. Dis papah no good! No good! It turned out, after a good bit of translation, that she thought she was asking me for a signed permission slip to leave and come back. She had presented the blank scrap to the gurkha, intently demanding to be let in as a result, which caused the normally serious guy to laugh nearly as hard as I was right at that moment. Regardless of the fact that she can neither read nor write, I would have expected the utter blankness of the paper to clue her in to the fact that it wasn't going to give her permission for much.

I think I expect too much.

Or, as it turns out, maybe I don't expect enough.

We stood together at handover, and Natalie (the current Team Leader who's been training me to step into her shoes next year) brought us a challenge. What if these wounds haven't healed because we haven't asked? What if God is waiting for us to speak out our requests, to rest in expectation on His power?

And so we did a different kind of rounds today at two o'clock. Instead of discussing drainage and fevers and what the inside of mouths looked like, we gathered at each bedside and prayed our way around D Ward.

I've been present for a lot of handovers here on the ship; I don't know if I've never been at one this powerful.

I don't know what it was, but taking that time to lay hands on these precious people and pray in faith for their healing, one at a time, leaving no one out, filled me with a sense of awe I don't normally have amidst the busyness of my shifts here.

One by one the patients bowed their heads. Some held out their hands to receive blessing, some snuggled further into the arms of the nurse holding them, some wrapped their arms around our waists as we stood at their bedsides and we prayed. We prayed for our sisters and brothers and grandmas and the pikins whose presence in our lives has become the standard by which we mark our days.

Tomorrow most of them will go in the wee hours of the morning. Just a few will stay one more night and then we'll close down for the year and somehow we'll go back to sleeping at night without lying awake wondering how they're doing downstairs.

These ones will go buoyed by prayer, surrounded by the angels we called down for them, filled with the comfort of the Spirit.

We should round like this more often.

Mondays are generally busy around here, at least for me. Since I don't work on the weekends, it always feels like I'm playing catch-up. Rounds are spent rifling through the charts to answer the questions I don't know the answers to offhand, and it takes most of the morning at least until I feel like I've got a good handle on the place again.

Today wasn't just any old Monday. Today was The Last Monday, the first in a long series of lasts until this place will be packed up and tied down to bolts screwed into the floor and we'll sail away from Freetown some muggy day in December. The wards close for good on Friday morning, and so this week is going to be spent sending the remaining patients home.

It's always a bittersweet time. There are a few patients on B and D Ward right now who I don't know very well, simply because they just had surgery last week, but the vast majority of them are long-term residents of Deck Three. They're the ones with wounds that won't heal, the ones who have been back for second, third, and fourth surgeries. And because they've been here the longest, they're the ones I love the best.

I know; I'm not supposed to have favourites, and I'm certainly not supposed to admit it out loud to the whole internet. But if you could see that place right now you'd understand why my heart aches to think that their beds will be empty soon.

However, regardless of how much I've come to love my pikins and my Grandma Groundnut, go they must. The going is complicated, more so than almost anything else; this is not an easy place to live with a health problem.

If there are any nurses who read this blog, I'm sure you can sympathize. It's hard enough, sometimes, to get a patient discharged home with everything in place so that they can continue to be cared for. Add in hundreds of miles of dirt roads, mud huts, malaria-carrying mosquitoes, heat and humidity, and a complete lack of resources and it's a recipe for disaster.

This is the time of the year when we start to pray for miracles. We know that some of the wounds that still remain aren't going to heal by any other means, and so Doctor Gary isn't really kidding on morning rounds when he orders prayer, every two hours and more as necessary. This is the time of year when we see those miracles. We've already taken Abu's name off the list of patients who will need follow-up care when his neck healed overnight, but there are many more, and the situations are complicated.

Pinky needs to get back to Liberia. I haven't written about her yet, but she sleeps next to Sia and the two of them are good friends by now. The surgery to remove a tumor from her jaw and replace the bone with a rib went well, but the money for their return journey was stolen from her mama on the way here. Please pray that the money we raised to send them back will be safely guarded and that they will find their way to their uncle in Duala Market. (I smile as I type that, because I can picture that dusty road in Monrovia so clearly in my mind.)



Sia is going to leave early tomorrow morning to make the long trip to Guinea with her mama and baby sister. They'll have all the money and all the medications needed for the rest of her treatment for Burkitt's with them. Her blood tests were good this morning, everything is in place for her at the hospital in Guinea, and all that remains is for her to get there safely. Please pray for protection to go with them as they travel.

Litte Kadiatu, whose face we've started to rebuild, finally had her feeding tube removed today. She flies at me the minute I step through the door, hands up until I lift her into my arms. She chatters away, just like a little bird, and I chatter back, wondering what on earth I might be saying. The skin graft inside her mouth didn't heal fully, so she's on the list for more surgery when the ship comes to Guinea next year. The place on her leg where we took that skin is taking far too long to heal, though, and we're working on teaching her dad how to care for it before they head back up north early on Thursday morning. She's another one who needs a miracle.

It's more than just these three girlies. Pray for Baindu, too, whose mouth is healing slowly. She'll need more surgery in the future, too. Pray for Isatu (Grandma Groundnut), whose future is uncertain and whose wound is also slow to heal. For Aminata, whose tumor is already starting to grow back and who will need to go home on medications that her mama might not be able to afford for a whole year until she comes to see us again. Pray for Bockarie. We built a nose to replace the one he lost when his house burned down around him when he was six days old, but the place on his leg where we took the skin to cover the place on his forehead where we took the nose (I know, it's confusing) is also stubbornly refusing to heal, and he'll be heading home on Thursday morning, too.

There are more, but I don't know their names, patients who have been here for months since plastic and general surgery rotations finished, each battling stubborn wounds as the clock moves inexorably forward.

We are almost out of time. Please pray with us.

I've waited a little to blog again, because I wanted to tell you about Sia but I wanted to have photos to share with you. Today our ward photographer came down to take some 'snaps' while we were working, and I think it will be fairly evident that my little Sia is feeling much better these days.

She had her second chemo treatment on Monday, and has bounced back much more quickly this time around. It's obvious why; when we gave her the first treatment, her tumors were huge and she was a very sick girlie. Today, though, she's a completely different person, and boy is her personality amazing.

She's still scared to death of having her blood drawn, though, something that unfortunately happens fairly often when you're being treated for cancer, and this morning I was the lucky one who got to hold her down for the proceedings. We use a cream that numbs the area so she's not feeling as much pain as you'd expect, but just the sight of us coming with the tourniquet is enough to start her crying. By the time we finished this morning (despite a fabulous nurse getting the blood easily on the first try), she was limp in my lap, a puddle of tears staining my scrub pants.

I wanted to be more than just the one who holds her down while we hurt her, so I did what comes naturally to me: I made a face at her. And then I made another one, and another until she was finally making them back. We kept going until she was laughing and reaching up to kiss my cheeks.



And now, it seems, I have broken dear Sia. She doesn't appear to be able to make a normal face in photos any more. I love it.



This kid is spunky like you wouldn't believe, and it's what's going to get her through the next few months. Everything is in place for her to go to the Hope Clinic in Guinea, and we're just waiting for her uncle to arrive so we can send her on her way with all the supplies she needs for the rest of her chemo treatments.

There's one every outreach. (Jenn wrote about hers here, and I love how she explains it, how there can be so many who mean so much but just one who really gets into your soul.) Sia is definitely my one, and as short as this time here in Sierra Leone has been, she's got just as much of a hold on my heart as any of the others have.

(Have I mentioned how much I love this place?)

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.

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.

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.

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.

This evening, we had a little excitement, Africa Mercy-style. I was eating dinner with some friends in the cafe on Deck Five when one of them casually mentioned that the retrieval efforts were still going on outside.

Retreive what? I asked, naively.

It turns out that one of the forklifts we use to unload containers had fallen into the sea between the ship and the dock and was buried in five feet of mud at the bottom of the port. The divers (my boss' boss Dan, and dear Aussie friend Tim) were suited up and getting ready to head into the murky water to see if they could attach cables so that the Terex (a huge container-moving machine found in ports, and yes, it's pronounced like the dinosaur) could haul it up.

What followed was easily the most entertaining night in AFM history. The rescue efforts went on until after dark while those of us watching were also treated to a beautiful sunset and a lightning storm off the port side. There were enough people on deck that it looked like we were getting ready to raise anchor and sail away, but really, it was just curiosity and lack of anything better to do. (We're easily amused over here.)

I stayed until the divers resurfaced and it became apparent that the Terex wasn't the man (pardon me, machine) for the job and then watched the lightning storm for a while before work. I headed down to B Ward for my second night shift in a row fully convinced that I had seen the most exciting thing that would happen for a while.

Until I picked up the chart for my little four-month old patient in bed twenty. Taslim was all tucked in and sleeping soundly, making little whiffling, sleepy noises through her cleft lip and palate and when I got to the part about family history I stopped cold.

Adopted. (Child was abandoned.)

Just that. Nothing more. When Taslim was born with a face split wide, her mama couldn't bear it. I dont know why. I don't know what kind of fear or anger or feelings of inadequacy were going through her head when she bundled up her baby in the middle of the night and left her on the doorstep of a woman she knew was a nurse. All I know is that she couldn't see her way clear with a baby born so broken. They found her there the next morning, crying for hunger, and they took her in, fed her, loved her. When the rest of the world ran away, this family ran straight for Taslim, scooped her up and poured life into her.

She'll have surgery to correct her cleft lip in the morning. Tonight she sleeps in the care of her new family.

That's the most exciting thing.

I was sitting at my desk in the office today, working on some mind-numbingly boring paperwork revisions when I felt a tap on my shoulder. I pulled the headphones out of my ears and turned around, expecting to be answering a question about where some box of supplies should be stored for the sail. Instead, a little girl clad in matching fabric from head to toe threw herself into my lap, shrieking my name.

Balkissa's tongue looks incredible. This second surgery has been a success by any standards, but it turns out God had bigger plans for little Balkissa than just the reshaping of her mouth.

The first time we met her, the doctor examining her heard something worrying through her stethoscope; the whoosh-whoosh of blood coursing through a heart formed wrong. And although the medicine we practice here is, by most standards, first-world, there are things we can't do. Diagnosing and treating congenital heart problems are definitely on that list.

Balkissa's not the first little one we've met with a faulty heart, and so we made sure she was strong enough for surgery and went ahead, leaving the murmur filed under the category of Things We Can't do Anything About. Her surgery, as you know, went well, but when she got home her tongue split apart again. A failure.

And this is where God's planning becomes beautifully clear.

When Balkissa came back to the ship for her second surgery, nothing had changed. Nothing except one of the anesthetists, a doctor named Paul. Paul wasn't here when we first met Balkissa, first heard her broken heart, but because she had to come back to us, he met her too and heard for himself.

Here's where it gets good, because Paul knows of a charity that does work here in Togo, a charity that takes kids to hospitals in the first world where they can get the treatment and surgery that they need for their heart defects. Today, one of our outpatient nurses took Balkissa to the clinic where they'd do an echocardiogram of her heart and decide whether or not the defect was something that could be treated. If it is, they'll make arrangements for her to fly off to another world, to another hospital (this one on land) where she'll be given yet another second chance.

There have been so many times that I've wondered whether any of the complications we see are for some sort of other purpose, whether God has plans for their coming back to us that go beyond just an infected wound or a broken-open suture line.

Today, I have proof. Proof that the hands weaving this story are so much more skilled than our own, that the heart loving through us is so much deeper than any I could dream up.

And speaking of hearts, I'll let you know what they find out about Balkissa's as soon as I know.

I mentioned a patient yesterday, a man who was willing to live his life with a tumor on his face if only he could have his hernia repaired and how we didn't think it was going to happen with time so short.

Today, I got to be the one to dance to his bedside, pen in hand, to add to his consent form. Next to excision of submandibular tumor, I printed in my neatest writing, repair of bilateral inguinal hernia.

I thought my eyes alone would betray the good news, but, like so much else here, there was a breakdown in communication. It's happened innumerable times now over the past two-and-a-half years, so often that I barely flinch anymore. It's always the same; I speak my piece, the translator relays what I think is my piece, the patient responds, and the translator comes back at me with an answer as unrelated to the question as chalk is to cheese.

Today, when I told the man that a place had opened up in the schedule, that he would be having both surgeries instead of just one, his face actually fell, his eyes downcast as he shook his head. Puzzled, I asked the translator to ask him if he was happy. The answer came swift, a word even I can understand in Mina. Ah-oh, he said. No.

Still rather confused, I asked the translator to ask him why he was so upset. The answer made perfect sense. If I hadn't just finished explaining about the second surgery. He is feeling sad because we wishes you would leave the thing on his face and take the other trouble instead. He will not be happy when he still has that one.

At this point in the conversation (and remember, this is something that happens to me literally every single day at work here), one's options are limited. You either get mad or you just laugh and repeat, using slightly different words, as many times at it takes until you get an answer to the right question.

So I explained again. A couple more times actually, until I realized that words just weren't cutting it. Thankfully, sign language is fairly universal, and one sharp motion directed towards his jaw and another at his more sensitive bits seemed to do the trick. I actually heard the English words chop it in the translation that time as both words and actions were relayed, and the patient's face broke out into a wide grin.

We shook hands on the deal and I signed my name as a witness to the new consent form.

It may have taken longer than it should have, but the message was finally clear; you will get your life back. Not only will you be able to go into public without people staring, but we will take away your hidden trouble, too. You are twenty-two years old and you will finally be able to work as fast as the other men on your farm.

Fixing a hernia might not seem like the biggest deal when we're normally dealing with things like tumors threatening airways, but for this one man, it's everything.

Sometimes, we can give everything, and it feels good.

Balkissa is back. When Sally, our speech therapist, saw her at a session recently, she found that Balkissa's tongue had split open again, making her look more like a snake than ever, since now the two halves were neatly delineated by what should have been a line of sutures. We spoke to the new surgeon, the one who's only got three more days of surgery for the outreach, and found her a place in his schedule.

She went to the OR today, but not before spending all morning hanging off my body and attempting to run loose down the hall. It appears that she has not lost her spirit, and her little voice rang out loud, if somewhat garbled, after we prayed at handover. Hallelujah! Amen, and her little hands swished underneath her headscarf as she twirled in a circle and came to rest against my chest.

Amen, she said again, quieter this time, and I echoed her.

Yes, God, let it be so. Let this child come to know You in all your Love and all your Beauty. Let her see herself as a reflection of You, no matter what happens in this second surgery, the last we'll be able to provide, successful or not.

And as we sat in our leadership meeting at ten in the morning, I flipped over my schedule to see that the back was empty. We had just assigned the last beds to the last patients we'll treat during this outreach, and my heart caught in my throat as I saw their faces in my mind. The man with a keloid scar hanging down below his shoulder. The woman recovering from yet another VVF surgery, her baby climbing all over her, a testament to her hope. The man with a tumor on his jaw that we're planning to remove and the hernia we might not be able to fix. Please, he begged. Leave the thing on my jaw. It does not look good, but it is okay. Please fix my hernia, because I work on a farm. I work slower than the others. Please.

And little Balkissa, recovering in her corner of B Ward tonight, wrapped in her blankets and the love of the nurses watching over her.

There are only three days left. I pray that we would use them wisely, that we would be faithful, that we would not grow weary.

Amen.

I forget that this is usually just after the halfway point in an outreach, that there are normally still four months still to work. We've gotten ourselves so fully immersed into the beginning of pack-up that I'm losing sight of the fact that there are still patients in the wards and lots more coming and going from our outpatient clinic.

Today, I was sitting in the nearly-empty C Ward making a spreadsheet for everyone in the hospital to input the weight of every single thing that isn't bolted to the ceilings before we head off around the Cape. I'm not actually kidding about this; every monitor, mattress and mirror has to be weighed and charted. (Don't even get me started on the bed frames. It's awfully tricky to stand on a bathroom scale while holding one of those and still be able to see the numbers.) I heard a little chirp outside my door and looked over to see the jug-handle ears and huge smile of one of my favourite little boys from this outreach, Godwing.

He's six, and when he came to us, scar tissue on the back of his leg held his knee at a right angle. He would hop around the wards on miniature crutches like a little bird until the day we were finally able to do his surgery. Afterwards, his healing took a long time. He required a skin graft to cover the area where the scar was released, and he's been coming back to the outpatient clinic every few days to have his bandages changed, his leg now sticking straight out in his custom-made splint.

Today, when I looked up, Godwing wiggled his eyebrows and beckoned me over. Va, mi jo, he told me. Come on, let's go. I got up and peeked around the door to see his leg covered with just a little bandage instead of the big, bulky splint he was used to wearing. I threw him a questioning look, and he started to giggle as he showed me how he can bend and straighten his leg now.

I thought that was it; I thought he just wanted to show me that the leg that used to be frozen by scar tissue could now bend like a normal little boy's leg, but it turned out Godwing had saved the best surprise for last. With one last look and a kiss on my cheek, he took off down the hall. No crutches. No support. Walking proud and tall (as tall as you get at six years old) down the middle of the corridor, slowly but surely making his way towards the stairs that would take him home.

I forget that this is the time in the outreach that the patients are learning to walk. We've seen them come and go from the wards, but the outpatient nurses and physiotherapists have continued on, bandanging wounds and stretching muscles, and this is what it all means.

And Godwing wasn't the only one. Over the last two days I've seen so many of them. Little Ali, who was burned with boiling porridge when he was a baby, has finally taken the first steps on his own, on an foot that can now rest flat on the floor. Tossedi is using little sticks to help him, but his crooked legs are straight, free from their casts, and supporting his weight.

All around the hospital, little boys are learning to walk. With my head full of packing up, my heart is full of this.