Friday, May 29, 2009

Isn't it ironic?

Don't you think?

Sorry, sorry. I didn't mean to go all Alanis Morissette circa 1996 on you. I thought you may want to share in my I-have-an-annoying-song-in-my-head-for-days-dilemma. No?

At the beginning of this outreach a patient was referred to palliative care with what appeared to be terminal cancer. All signs pointed towards cancer, and as he progressively declined we went on believing his original diagnosis was correct. A few weeks ago he was admitted to the TB clinic in the city. You may remember me talking about it
Turns out he may only have TB, not necessarily lymphoma (can be commonly confused with limited tools to help diagnose), which quite honestly is fantastic news.
As we pulled in yesterday to see our patient who has steadily been improving I was planning on a quick visit to drop some things off as we were running a bit late.

Rewind for just a second (read: I don't know where to fit this part of the story in so I am going to randomly throw it in here)

On Wednesday afternoon after a couple of weeks of not feeling so great I went to the crew doctor to get checked out. Being a nurse I had delayed this for enough time that by Wednesday I could hardly keep my eyes open from being so tired and worn out. He ran the normal series of labs and planted a tuberculosis skin test, although both of us suspected my malaria meds were likely to blame seeing as though I had several symptoms associated with bad reactions to the medication.

On Thursday morning I woke up with a swollen red mark on my arm where the test had been done. For anyone who is not an American reading this you can go ahead and roll your eyes, but you Americans know this is NOT normal for us. I'm pretty sure if I went into work at the states they would run, scream, and throw on hazmat suits until everything I touched had been decontaminated. Ok, maybe not, but we don't ever see any reaction when we get tested once a year. We aren't exposed to it, and not immunized against it (which will show a reaction) in the states. I wasn't concerned. The test, if anything, at that point showed that I have been exposed to TB here (I'm no expert but I suppose the direct coughing of infected people on me may have something to do with that). It was not showing I have an active infection so all was good. I would however by lying if I didn't say I felt a little disconcerted every time I caught a glimpse of my arm through the corner of my eye.

back to the hospital. Me and my red arm were pulling into the grounds and to my right our patients son takes off in a sprint, chasing after the car. This once shy boy ran up and I was greeted with a big hug, (the kind where arms wildly arc out and then wrap tightly around your waist) and wide smile after our standard handshake. A lot of the kids here are absolutely beautiful. This boy in particular stands out. He has long scars on his cheekbones from voodoo practices over him as a baby where they strategically cut small slits on the face as a protection. They provide an incredible dimension to his complexion, add that to his liquid black eyes that shine when he smiles and you can't help but adore him.

We went into the room where our patient is staying. As we sat down on the bed across from him I was already grabbing some medication to restock his supply while telling him he looked strong and asking how things were going.

I watched his face fall as he hoarsely started speaking to my translator. Followed by an eerie silence my translator began telling me that the patient was just told he has AIDS by his doctor. The day before one of his wives (I know, long story) came in and told him she had tested positive. The same day his other wife, who is currently carrying their 4th child, also said she had tested positive.

My patient looked at me and although he spoke a foreign language to my ears I somehow understood.
"If this is true than why am I even on this earth?"

I felt like I had been punched in the stomach. I watched his mothers head lower, hanging heavy. I felt myself tense when I realized that there is a good chance the little boy who just excitedly greeted us was also likely infected. I felt a devastatingly gross sinking in my heart thinking about the other 2 kids and the baby still on the way, completely innocent to the fact its whole family is HIV positive and it too will be subjected to the disease.

More than anything, what do I say?

I apologized. Why? I don't know. I have no idea where the words I spoke came from. No, its not treatable. No we don't have medicine on the ship. No, no, no. How do you preach hope when you temporarily can't believe there is any? When you have forgotten for that sick moment that God is sovereign above all things.
"You are here for a reason. God wants you here. We will support you and love your family regardless. We will pray for and with you"
And now for a more honest look into what was going through my mind:
"Get me out of here. I am not equipped for this conversation. WHAT am I supposed to say? We are running late. Maybe we can talk about this later. Please change the subject"
I'm not proud of it. I hate that my mind immediately took off in a sprint to my own discomfort in the situation. But, as always, God's beauty and grace shines brightest when I am reduced to nothing, and the conversation went on despite myself.
I'm still coping a bit with how to wrap my head around all of this. For 2 months I prayed for a man we thought was dying only to find out his disease was different and curable. Within a week that extreme joy is replaced with nausea and a sick feeling in the pit of my stomach over a different death sentence, this time one that includes his whole family.

I titled this post "Isn't it ironic" not because I necessarily believe in irony, or think this is a case of it. I have been really thinking a lot about it over the last 24 hours. To say something is ironic would indicate to me that this guy got a crappy deal and that's all there is to it. Its pessimistic ideology, really. I don't worship a God who lets horrible things happen without reconciliation or redemption. I hope you don't either.
In all of this I learned some valuable lessons in faith, and gained perspective on the little red bump on my arm when I bowed my head to pray with my patient yesterday, holding his hand, fighting back tears, desperate to find solid ground for my thoughts to rest on.
I may never understand half of what I experience here, but I will not yield to any thought process that tries to seduce me into thinking anything besides the fact that my God will reign, and that He will be victorious.

A black fly in your Chardonnay isn't cool, but pick it out and get over it.

Romans 8:28
"And we know that in all things God works for the good of those who love him, who have been called according to his purpose."

Oh, and the advantage of writing this today is I can tell you I don't have TB, which is pretty cool. I was sick from my malaria meds which called for a simple switch and now after just two days I'm back to normal (whatever that means).

Tuesday, May 26, 2009

"What you don't have is much less than what you do"

Clocks that have been stopped for years. Or how about the type that ring every hour, certainly the rejects of people who couldn't stand the high-pitched tones. Laminated table cloths with plastic covered remote controls resting on top. Humidity that causes play dough to get stickier if left open rather than dry out. Silk flowers in an array of tacky colors. Cement floors with huge divots. Calendars left behind by anti-AIDS campaigns. 11x14 pictures of a parent or grandparent as the sole decoration, despite all of the nails littering the surrounding walls. An African with an Alaska hat on depicting the northern lights and a polar bear. Hand gestures and recognizing every 5th word as means of communication. Full chickens (thankfully minus their feathers) thrown in with the frozen hot dogs at the supermarche. A look of wonder from a boy using an ice and water machine for the first time.

Pencils worn dull from work in a much appreciated drawing book. Naked children without a parent in sight. Muffled singing from a mouth filled with cancer. Praise to God from the lips of a boy and his mom who were just told his deadly disease is untreatable. Hands held out, palms up in prayer from a dying woman who wants her children to pass their exams, their only chance at a life. Tears from a woman as she talks about being afraid of dying, the smell from her exposed breast cancer filling the air as we listen.

I started writing down these observations last week. At this point my mind won't comply with trying to sort it all out, therefore I can't help but present it as it stands here.

I'm reading a Max Lucado book titled "A Love Worth Giving". When I am reading a book I don't own, (and don't want to lose the flow of reading by taking notes) I fold the bottom of the pages I want to go back to and re-read. This is one of those books with quite a few dog-eared pages, and I am only halfway through it. Yesterday I was reading and came across something that really hit me. Lucado always seems to have a way of simply stating ridiculously profound thoughts and ideas. Without further introduction, here is the point of this entire post, a simply profound wrap up (not to mention a lesson in perspectives)

"Yet look at our faces [of believers] you'd think our circumstances had only made a "slight" improvement. "How's life?" someone asks. And we who've been resurrected from the dead say, "well, things could be better." Or "couldn't get a parking place." Or "My parents won't let me move to Hawaii."... (insert one of the complaints you have voiced recently and I'll do the same. Now I'll let you continue reading the rest of the text from the actual author)
Honestly. We worry about acid rain in silver linings. Do you think Paul may like to have a word with us? Are you so focused on what you don't have that you are blind to what you do? Have you recieved and encouragement? Any fellowship? Any consolation? Then don't you have reason for joy? Come. Come thirsty. Drink deeply from Gods goodness."

"...So be grateful, joyful-for isn't it true? What you don't have is much less than what you do."

Monday, May 18, 2009

Quick Update

Hey Everyone,

I thought I would give a quick update on Maurice and tell you how touched I am by people pouring out prayers for him! The morning after I wrote about him I went down to the ward first thing in the morning. He was awake, alert, and smiling from ear to ear. His mother was the same and I wrapped my arm around her shoulders and squeezed, watching Maurice light up while playing. When I left him the day before he was upset, crying, and struggling to breath, especially while sleeping. Between Thursday night and Friday we hadn't done anything medically besides give a little IV fluid and some medication to help with inflammation. This was not a product of work done by our hands.

My heart nearly jumped out of my chest every time I got a strong hug from Maurice throughout the day. It was only two days before this when he could barely lift his head from my shoulder. We brought him home with plans to visit him this week. In the car he chatted away with his mom, one arm resting on the window, the other holding tightly a roll of lifesavers. We will continue seeing him every week, you can bet I will be looking forward to each time (and will keep all of you updated).

Maurice still needs our prayers. We still don't have his biopsy results to know if this is a treatable cancer, and even then if we have caught it in time. He is a special boy, and I hope I can do his story justice while I try and relay to you his sweet nature and gentle spirit.

Phil. 4:6-7
" everything, through prayer and petition, with thanksgiving, present your requests to God."

"Now lose your grip. We'll not need our hands today. We'll build a city as we pray"
(Braddigan, City on a Hill)

Keep them coming!

Tuesday, May 12, 2009


I have been thinking lately about writing a post on love. I find it a constant struggle between loving freely and openly, yet guarding my heart and keeping myself protected. I compared my time here so far to walking a tightrope. It is a constant balancing act between extreme highs and devastating lows. It should go without saying that my balance is only maintained by a closeness with God, this would be an impossible, unbalanced experience without that relationship, that love.

Maurice is 5 years old. He has a sweet, simple smile and smooth velvety skin. He wears yellow flip flops that are several sizes too big which causes him to shuffle his feet rather than take deliberate steps. He warms up to you within moments after meeting, and then finds his way into your lap within minutes. He has delicate fingers that grasp the little rag which he uses to wipe his ever-running nose. When he falls off into deep sleep he snores like an old man, big, loud breaths.

I met this little man last Friday. He was referred to us because the chemo treatment we gave him doesn't appear to be working. His cancer is spreading quickly. We said goodbye on friday with plans to visit him this week. When I squatted next to him for a hug, he placed his small arm around my neck and pressed his warm cheek into mine. I closed my eyes and took in the moment, absorbing every detail, trying to ingrain the feel of his fingers on my shoulder and the softness of his cheek on mine.
His mother watches over him carefully, and called us at midnight on Sunday to report Maurice was not doing well. When he came in yesterday he could barely keep his head straight as he shuffled down the hall. I picked him up and carried him to our exam room, his head resting heavily on my shoulder. I held him as one of our doctors listened to his chest and belly and I listened as he explained that a biopsy should be done again, the first one being inconsistent with what we are seeing now. Maurice slept heavily on my lap, his disease evident as the odor from his open tumor crept into the air around us.
Maurice is constantly wiping his nose because the tumor has invaded his sinuses, spreading from his eye with rapid speed. That also is the reason for his snoring. His oxygen levels dip dangerously low, both evidence that his airway is compromised and the growth into his brain is extensive and now reeking havoc.

This morning I went straight to Maurice, anxious to see him. He was crying when I walked in and his mom is her broken English said "he cry for you". As I sat next to Maurice, holding up the weight of little body as he leaned into me, I connected in a way that is hard to explain. I felt the ease in his body while being held (not a normal quality of a 5 year old boy)I watched his hand as he squeezed playdough, marveling at the contrast between the purple playdough and his dark brown skin. At one point he grasped my finger one by one, forming my hand into a fist that he then put his hand over mine, holding it gently. I slowly realized I love this little boy. Its not a love that can be defined, or placed in a neat little box. I have started feeling this love towards my patients gradually as I get to know them. Its one thing to show love towards someone as opposed to actually loving them, I have that much figured out. This is real love, at least by my definition and standards.

I am currently sitting down after Maurice's biopsy. I asked the surgeon if it would be ok for me to stay with him through it which he kindly agreed to. Before the surgery, each time I walked over to the ward to see him I faced strong emotions, and balanced them ever so carefully with quick prayers for strength as I leaned in close to Maurice's ear to give him small kisses. We prayed over his small body before the surgery, and I just finished more prayers through countless tears. Things like this make me hurt everywhere, yet unseen strength rises up from beneath the tears and I continue putting one foot in front of the other.

Maurice needs a miracle, and I am balancing my hope for this with the very real chance he may not survive. I rest now knowing God is in control, and I am free to love this little boy as God loves him. In reality, that's all I can do, and I'm ok with that. Its freeing when I think about it. I have no control whatsoever, zip. All I can do is love him. I can do that.

I have to mention one thing that was incredible about today. Any of you close to your mom? Well, I am, and I missed being able to see her on mothers day. She told me a while back that she sent a card before the last one I received. She was bummed thinking it wouldn't get to me. Today, before I went into surgery with Maurice, one of my friends brought me an envelope from the mail room. The familiar handwriting told me what I hoped, her card had made it. The outside says "Just sending you a little hug" and then the inside just says "Did you feel it?"
At that very moment I had needed a "mom" hug. My mom is an incredible mom and amazing friend to me, my consistent comfort regardless of what life throws at me. Today God knew I would need this, some familiar comfort from the one person who can always deliver it. Believe what you may about that statement, I'm sticking with it. If you do believe, pray for Maurice. Pray he has a treatable cancer and its not too late. Pray he wakes up one day to a disease free life. Pray for comfort for this little boy who wants nothing else than to be cuddled and held close.

My mom has been in the habit of sending magnets along with each card while I've been away. Here is the scripture printed on the one from today (I think its quite fitting ;)

Psalm 91:11
"He shall give his angels charge over thee to keep thee in all thy ways"

Wednesday, May 6, 2009

Its hot in here

Last week I had one of those experiences I can't shake. I can say pretty confidently that not much rattles me. I can walk into most situations and take in what I see, regardless of how gruesome, and keep stride. As a nurse I have relied on this heavily,
until last Friday.
One of our patients made his way back to the city after futile attempts "up country" with tradition medicine. After getting to his house and realizing he wasn't home, our translator called to find out where he was. After hanging up the phone he said "He is at the coughing hospital".
This particular patient has lymphoma (a tumor) on his neck. As the tumor grows he struggles more to breath, and now has developed a cough. Thoroughly confused we started making our way over to the "coughing hospital". When we pulled in we found ourselves at a facility (notice I am not using the word hospital anymore) that treats tuberculosis and cholera. For those of you unfamiliar with these diseases, thy are nasty, highly contagious, and both life-threatening. Not to mention a fairly random couple of diseases to throw together in one room.

As we walked into the room we passed by two patients laying in their beds. The first was one I watched for an extra second, the delay caused only because I was making sure he was breathing. The second looked even worse, covered by flies with a dirty, blood stained cloth held next to his mouth by bone-thin fingers. I've been around dying people, I have seen enough poverty that I thought I had a grip on how things work here.

Apparently not.

At least not entirely.
My eyes found their way to my patient, something familiar, something to focus on besides the men nearing death laying on bare plastic mattresses. He appeared to have declined quite a bit since the last time we saw him. His quick shallow breaths were often interrupted by coughs that rippled through his body causing his face to show the pain he was feeling. His lips were pale, almost as pink as mine. His mouth was dry as he greeted us, but his kind eyes and sweet smile broke through it all, and I felt myself return the smile as I touched his feverish arm.
As we talked I swear I could feel the disease in the room start creeping in around me. The air was filled with this charge, a sickening feeling of claustrophobia.
At home a patient with tuberculosis (or one just suspected to have it) would be in a room with negative pressure air systems, respirator masks for everyone going in and out, signs posted everywhere and plenty of other precautions.
Here, well, the windows were open.
I don't know if it was because I was taking in tiny gasps or air in between the coughs of the man laying 3 feet away from me, or maybe it was the sight of the housekeeper using a dirty rag to wash, rather, wipe the germs from one side of the floor to the other. It could have been the actual heat too, the next day which was equally as hot registered close to 115 degrees F (something like 45 c for everyone else who reads this outside of America). Whatever the cause, all I heard come out of my mouth as I fought the urge to faint was;
"Its hot in here"
My body and mind were fully rejecting everything around me. As I tried to pick a fixed object to stare at and convince my mind to stay with me I moved towards the end of my patients bed, trying to find a spot in the room that didn't have air threatening to suffocate me. My eyes kept falling on the man whose thigh I could have wrapped my hand around. The coughing from the other bed didn't give up, it wouldn't stop.

I successfully managed to step back from the ledge that would have plunged me into unconsciousness. I tried to manage a conversation as we left but all I could focus on was a shower, please get me to a shower.
Once I was satisfied with how clean I was (read: scrubbed until my skin was red) I thought back to what I was feeling in that room, a mental debrief, if you will. My body started reacting the same way. I started pulling in breaths through my nose and forcing them out through my mouth. I used to tell my little patients at home "smell the roses and blow out the candles" haha, there I was, 26 years old telling myself the same thing while sitting alone on the floor in my room. Finally it dawned on me to pray. Novel idea, eh?
The feeling left immediately, I knew it was ok. I can tell now looking back I wasn't recognizing how overwhelming it was to see my patient in the condition he was in. Like I said, I'm ok with the process of dying and all, but this situation is just wrong. He shouldn't be there, this isn't how this is supposed to be.

I feel like this post will leave people wondering if I am discouraged by all of this, if this job is getting to me. Instead of pretending like I have found resolution or can reconcile all of what I see here, I will just tell you I am doing really well. I'm not seeking some philosophical answer to why this all happens, or why some people in this world are born into sub-standard living conditions. I am drawing close to God, some days clinging or praying through strained breaths, but feeling good overall.

Isaiah 40:28-31

Have you not known? Have you not heard?
The Lord is the everlasting God,
the Creator of the ends of the earth.
He does not faint or grow weary;
his understanding is unsearchable.
He gives power to the faint,
and to him who has no might he increases strength.
Even youths shall faint and be weary,
and young men shall fall exhausted;
but they who wait for the Lord shall renew their strength;
they shall mount up with wings like eagles;
they shall run and not be weary;
they shall walk and not faint.