Wednesday, July 29, 2009

Another chapter

Psalm 103:1-5 reads,
"Praise the Lord, O my soul, all my inmost being, praise His holy name. Praise the Lord, O my soul, and forget not all His benefits. Who forgives all your sins and heals all your diseases, who redeems your life from the pit, and crowns you with love and compassion, who satisfies your desires with good things so that your youth is renewed like the eagles."

That was my 'flip open the bible and start reading vs.' yesterday morning. The morning of my 27th birthday.
And today, right now, I can't stop crying about it. As I typed that just now the words settled a little deeper into my being. My heart cries out, my soul rejoices, my mind can't comprehend the full meaning.
My life reflects these words.
These tears rolling down my cheeks are caused by pure reverence and joy. The last three birthdays have marked some major milestones in my life, and unlike some girls who see the number 30 lurking around every birthday corner after turning 25, I celebrate because each one marks another year of a saved life.

Yesterday I got hugs from my favorite baby, one who wraps his arms around your neck and cuddles sweetly on your chest when you hold him. I sat, my arms linked with my patient whose tumor we couldn't remove, a disappointed child who still winked back with his only remaining eye at his nurse who could hardly hold back tears over the same disappointment. My heart is so perfectly content here, and a lot the appreciation has to do with where I came from, what my life used to be. My story with its many chapters.

So you may be asking how you celebrate you birthday when you live on a ship in Africa? Here is a pictorial of my day...

6:30 am. My roommate was psyched to come out bleary eyed in order for me to get a picture in front of our decorated hallway (that she stayed up late to help doing) Thanks roomies :)

This is my yearly salary. I'm not kidding! We get 'paid' 2 dollars a year in the form of a gift certificate for our snack bar.

So every year my mom makes our birthdays special by getting a balloon and various decorations together. She has always been so loving and thoughtful my whole life. When I listened to her message I cried along with her while she struggled through singing for me. She and my sister conspired with my roommate to have her set up everything they had sent, and the following three are my 'desk' as the day went on.

Even though Ali ran from the dining room when the bell was rung and the (dreaded) communal singing began, leaving me alone to face the crowd, I forgave her and we stood side by side during afternoon handover in front of our shared birthday cupcakes.

And then promptly stuffed our faces with them...literally.

Its hard when living in community to go out as a small group. In thinking up what to do, with a big party already planned for Saturday (4 of us are turning 20 something this week), the former 4341 girls (Anouchka left us for a bigger and better 3 berth) set out for a night of delicious Indian food. We even got dressed up which is even more rare than going out in small numbers.

Be impressed..I took this picture of us myself. I've clearly got skills.

The owner of this Indian restaurant is so sweet. We told him it was my birthday (as if all the decorations sent from home weren't evidence enough) and he brought us wine and a yummy (partially burn-your-tongue spicy) platter of food on the house. He also went around the corner and picked these flowers for me. You know you're in Africa when someone can just grab a handful of wild flowers and they look like this...

Balloons and ribbon from home-

Although there was no official cake (surprisingly birthday cake is not on the menu of an Indian place in Africa) I wanted to light the candles my mom sent anyways. This is my face while attempting to do so... with an overhead fan whipping around and a strong African breeze. I had to add it because of the laughs that ensued after Sandra realized what she had captured and shared with all of us. Besides, its funnier to put pictures of yourself looking like a goofball than it is to only publish the ones that you like. Lets change it up a bit.


Yesterday was so special, there isn't room to explain how much everyone means to me. My mom and her "momness" with sending everything was so sweet, the essence and evidence of what an incredible woman she is surrounded me all day. My dad sent the sweetest gift he has ever given me, the sentiment behind it being the driving force behind my absolute love for it. My sister, I can't even begin to describe, wrote a note that I will forever cherish (and brought me to tears over and over again throughout the day). My roommates, friends, coworkers, I honestly can't believe the love I felt yesterday.

The fact that I turned 27 in Africa seems so fitting. My story is of a girl whose life was redeemed from the pit. While my eyes were cast down at the ground in shame, I was crowned with love and compassion. My inner most desires have been met exceedingly over and over again.
Each birthday that passes reminds me of my renewed youth. I don't deserve it, yet I don't owe anything for it either. Its a gift.

I am forever grateful.

Friday, July 24, 2009

All you need...

Tonight is a night I have trouble finding words to describe. I'm determined somehow to do it though, it almost seems too important to let it go by without some recognition.
I walked in to B ward this afternoon excited to see my patients. I knew the majority of them from 2 nights before, yet somehow I wasn't expecting what I heard.
Which was quickly followed by a tap on my thigh and a scruffy voiced, "yovo" from the most recent maniac sibling on the ward.
The excited little boy who remembered my name is possibly one of the sweetest boys I have taken care of...ever.
Ok, I may have said that before, and will likely say it again sometime, but there is room in this girls heart for plenty of "cutest/sweetest kid ever" types.

He was born with club hands and feet. Although we have no ortho surgeons available to help him, we do have a general surgeon who was able to fix his hernia yesterday. I had him the day before went for the repair, and then again this afternoon.
Today he was clearly not feeling great, and had a few things going on that were of concern. I spent a lot of time organizing his care, making sure to give him a kiss on the forehead every time I passed his bed. He has a mischievous glint to his eye, and a smile that makes my heart melt. To say I felt bad about having to put a new IV in him was an understatement. With kids it can sometimes take a lot of time to gain trust, to get them to believe that you are on their side. Ask any pediatric nurse how much it hurts to lose that trust and they will tell you.

I grabbed my supplies, summoned a translator to assist, and went to my patient and his mom with the news.
"If you stay really still it will be ok. I can give you some stickers after if you stay still for me"
He didn't flinch. His small contracted body laid perfectly still as I drew his blood and finished hooking up a fresh bag of fluids. Afterwards I leaned in and kissed his forehead, watching him pucker his lips. After all was said and done, after I had to inflict pain on this little guy, he kissed my cheek. And simply smiled.

I felt the familiar warmth deep in my soul, its unmistakable. A feeling that used to be so fleeting, with instances few and far between, has now grown familiar since coming to Africa. True love, true glimpses of perfect love are so astounding, so breathtaking, I covet every single chance I get to experience them.
Perfectly 'imperfect' babies, children, and adults are around every corner, waiting to show me what love looks like. What love acts like. What love feels like.

Thank you God. Thank you for showing me.

Saturday, July 18, 2009

Night Shift

It comes with the job, even seems exciting at first.
"I'll just sleep until everyone gets home from work then get up and have a normal life like the rest of the world."
"Switching back and forth isn't so bad, I don't need that much sleep to function."
"It will be fun!"
I said it, plenty of new nurses say it. 5 years later I am not so sure I feel the same way. Actually, I know I don't.
A small few of my kind enjoy night shifts. They adjust well, sleep great during the day, and find the energy to be "normal" when they are not working.

Then theres me.

I'm on my fourth night shift, I can't pull off more than 5 consecutive hours of sleep (that's with benadryl) and by Monday, when its time to switch back to living in the real world, I liken the feeling I will have to a nasty hangover, times 2 days. I don't mind the shifts themselves, I really don't. After all, I signed up for it when I became a nurse and we all have to do it from time to time. Now that I'm here, I must say I have a special place in my heart for the dreaded shift.

The other night (another side effect of nights, I'm not sure which day is which) I got called over to help with a patient who was steadily declining. Following a move to our ICU, the patient took a turn and I found myself alongside 2 doctors, an anesthetist, an ER nurse, our nurse manager, and an ICU nurse (who we called in her cabin at 1am to wake up and come help). Despite our efforts for over 2 hours the patient continued to decline. On the ship, our 'blood bank' is the crew. At home you call the lab, fill out a slip, and the tube system delivers a nice bag of chilled blood 10 minutes later.

Here, you call the lab tech in his cabin at 2am who then finds the matches on the ship and begins waking them up, at times going door to door. The first one was our Captain. As he lay next to us and commented on how 'this is the best part of being on the ship', we continued to fight for our patients life. Within a half hour I was hanging a warm bag of B+ blood, and we were looking for the next donor, our patient was losing blood faster than we could replace it. The only other perfect match on the ship was one of the doctors running the emergency with us. He handed over the task of pushing the medication he was in the middle of and lay down to give his blood. When he was finished he came over, still holding the gauze to his arm, and continued to direct us all. In a situation like this, I find you remember small bits and pieces days later, some very vivid, some that will stay with you for the rest of your life. The first one I have was on one of the runs to the lab to retrieve the second unit of blood. My mind was focused, but my heart cried out to God.

Please, save this mans life. He is in your hands. Help us save him.

At one point after that we started seeing the worst case scenario unfold. The surgeon, calmly and gently, after checking for pulses and not finding them said, "come on guys, we're losing him, we're going to lose him"

Please God

"I need staple removers and scissors. The only chance this guy has is if this is compartment syndrome" (basically his organs, mainly his heart, was shutting down secondary to a major internal bleed, causing pressure to build)
Now I've heard of bedside surgeries but I can't say I have ever been a part of one, until the other night. In a split second decision, our surgeon saved a mans life. Once the cause was found, we watched a blood pressure register on the screen, found pulses, and collectively smiled with relief.

With the patient in surgery (finally made it to the actual operating room) a few of us set off with the task of cleaning up our mess. Standing in the ICU, I said "Thank you God" to which everyone replied "Amen"
Sweet and simple, yet all of us said it with absolute, heart felt conviction.

I've never been in this type of circumstance. I have never not had a button to press which sounds the alarms and calls all the surrounding experts to come running in. In this case when the question was raised to call a 'medical emergency', the equivalent to a code blue, the surgeon looked around and said "no point, we're it".

None of us knew exactly where every supply was, there were at least between 3 and 5 nationalities in the room, all with varying accents, (not to mention different names for all of the supplies). The patient was in a rare crisis which almost none in the room had ever seen, the surgeon himself commenting after that he had never seen it develop so quickly.

The odds, scientifically speaking, were slanted against us.

And that's the best part.

Call it what you will, but I promise you ever person that was in that room gives credit where credit is due.
God is real, He is present, and He comes when you call on Him. I said a while back in a newsletter that I feel blessed to have a front row seat to all God is doing here. That night was one of those instances (however, if I stay within the metaphor it would be most certainly be called an all-inclusive, backstage pass. but that's a bit over the top, wouldn't you say?)

The past few nights have been really good. I've had time to sit and hold little Abe on my lap, watching him try to bite my stethoscope in half, drooling buckets onto my sweatshirt . I shared popcorn with two VVF (fistula repair) ladies, one whose electric blue toenail polish I complimented. I quietly watched as my patients slept, my mind at ease seeing them with a comfortable mattress, a soft blanket, and clean water next to their bed. I almost had a heart attack when a caregiver grabbed my ankle (they sleep under the patients beds here) managing not to scream. The other night I walked onto the ward to see our patient, the one who nearly died, already out of the ICU. He is awake and stable. Not perfect, but my goodness, he looks good to me.

So here I am on my last night shift. I'm tired, my head feels like it might roll off any second, stuffed and heavy with a cold I am certain I am coming down with. Tomorrow will bring little sleep and overall lack of motivation to do anything. Yet, despite any of this, I have never felt more alive, more fulfilled, more satisfied, in my entire life. I soak in each moment, every hand held, every life that comes through these doors, and count myself ridiculously blessed. God doesn't need any of us, but He calls us by name, picks us to be a part of His plan. He has been very real and present these last few nights, and I wouldn't have missed it for the world.

"You could feed the whole world with the crumbs of old bread.
Spread the good news through dreams and stones.
With a breath of the wind You could raise up the dead, But You ask us to go.
Help us love mercy, help us do justly, Help us walk humbly with You God"
-Micah 6:8, Charlie Hall

Monday, July 13, 2009


hmmm. yeah, these titles seem cheesy to me at times too. I was actually quite excited about this one though, read on and you'll see why...

I have been working now for a full week on the wards. I still feel like I am in some surreal dream-job. Every time I feel an ounce of stress, within seconds I also feel a little hand on my leg, reaching up as far as he can saying 'mama' (I'm working on the ohh ohh ahh ahh, like a monkey with Abe, we're getting there). Kisses and songs, drums, rattles made from metal bowls, alarms ringing, toys crashing, all of it create a symphony of sound incomparable to anything I have ever heard. (do you like how I used the word 'symphony' there, some would beg to differ if they were to stumble upon 'B' ward in the morning).
While I have been in Africa, I have noticed something which has had a profound impact on my life, my walk with God, how I see myself, etc...(not going to get too mushy on ya').
When you look into a child's eyes here, you can see your reflection. Their eyes are so ink-black, it is quite easy to see yourself. I'm sure it would happen if you gazed longingly at an adult here too, but I much prefer children, thankyouverymuch.

I had just picked up a little baby when this line of thinking first occurred to me. While I looked into her eyes and saw myself, I thought of how we should reflect Christ. I've heard the example of a mirror, the 'who's looking back at you' spiel, but for me, the analogy only makes sense when I look at myself through the eyes of a child. Anytime before coming here, the scripture I paired with kids was "let the children come to me, and do not hinder them. For the kingdom of God belong to such as these..."
That day, and everyday since, when I look at a child I hear an almost audible,
"whatever you do for the least of these you do for me."
There is an honesty about children that is captivating. I jokingly talk about how I relate better to kids than I do adults, but its actually a fact. For as long as I can remember that's how its been. Its hard to put into words, but I admire children to an extent that I strive to be on their level, to understand their simplicity, fully embrace their sweet spirits.
In admiring them that much, I have found that I do a lot of self-reflection when I am with them, and just in general since being here too.
I'm here to say we need to look at our lives. We need a selfless, honest look into our souls, a look at who we really are, what we are doing in this life. Then, if you are like me, you need to repeatedly look in that mirror, gaining understanding each time you do.

Today I couldn't help but reflect on my life. I had 30 minutes where I was alone on the ward this afternoon. Besides the monitors and a toy with dying buttons, all was calm (I won't say the 'Q' word for fear of the evening nurses coming after me). As I sat and looked around, I recalled so many instances in my life where I would have picked the exact opposite for myself, yet God was steadily preparing me, watching me ever so patiently. Every single aspect of who I am, how I act, the fact that I am alive and breathing, every ounce of me was made to be there, to be here, at this very moment.
I am astounded at the privilege of being here. I am in awe that my lessons in faith these days are learned while staring into the eyes of a child in Africa, studying them, humbled by each encounter.
I can't get over it. I just can't. Its incredible.

My story, my life, my being here, couldn't be less about me. I think that's what I am starting to realize, and I think of a roller coaster (which seems kinda weird). That feeling in your chest of falling. Its thrilling, exciting, eye opening, and sometimes a little scary. My story has an author with a vivid, beautiful, unbelievable, undeniable love and desire for me to live.
That takes my breath away.

Last 2 things. While writing this I have been listening to a mix cd (I am admitting now that I originally wrote 'mix tape' here. Hey 1990's called...) from a new friend, Meg. It has songs I have never heard, and others I find comfort and familiarity in listening to. In the middle of writing this, I heard this verse...
"For we, we are not long here
Our time is but a breath, so we better breathe it
And I, I was made to live, I was made to love, I was made to know you"
-C.S Lewis Song, Brooke Fraser

And lastly, something that has been making me laugh, and now that you have been 'introduced' to Abraham, you can appreciate my perspective;

Thursday, July 9, 2009

Not even close

Three days ago I temporarily switched to working on the wards here on the ship. I had said yes a while back to the switch when a need for a pediatric nurse was brought up for the summer months. Little did I know what was in store. Its hard thinking about not seeing my other patients for the next several weeks.I cringe with the "what ifs" that accompany my line of work in palliative care, then I rest in Gods promise that everyday is His, all of this is part of His plan. He holds each and every patient gently in the palm of His hand, all will be well.

As I got ready for my first shift I felt excitement start creeping into my stomach. I smiled at the familiar feeling. I don't have a doubt in my mind that God made me to be a pediatric nurse. Every fiber of my being is made to love kids, and the fact that I get to be a nurse and work with them full time as a profession, well, that's pretty awesome in my book. I filled up my pockets, slipped my feet into a pair of clogs (a glorious feeling when you haven't done it in 6 months) and made the 1 minute walk to work one floor below my cabin (beats the Boston commute). The girl assigned to orient me was Ali. We both had mischievous looks in our eyes as though we somehow knew it was about to be a fun evening. Ali strives towards excellence in everything she does, her talent and ability evident in her daily life. I am proud to call her my friend. She is one of those 'heart friends' who instantly walks up next to you and remains posted by your side regardless of what you say, do, confess, you name it. Add to that the fact that she also goes bananas over kids and you have quite the duo.

At the change of every shift all of the nurses who are coming and going pray together.
Did you get that?
We pray for each other, for the patients, for the shift. Sorry, I still think that's amazing.
As we walked into 'B' ward I was greeted by Abraham. The drooling maniac of a toddler who belongs to one of the patients on the ward. He wrapped his little arms around my legs and cried out 'mama'. Those who know me reading can tell you this is the exact point when my heart started to swell.
Throughout the shift I found myself in amazement of the patients that surrounded me.
5 month old Maomi, the size of a newborn, steadily gaining ounces and grams after a tumor half her size was removed from her face. Her mama learning step by step the intricate ways of caring for her baby who has been given a new chance at life, but has a long way to go.
Antoinette, a beautiful little girl with a rare case that has eaten away at her face, leaving a disfigured mouth and nose. Her mama crying while removing the ointment and reapplying, a process that is painful physically for Antoinette and emotionally painful for both.
Brightly colored nail polish being applied to women who have had surgery to correct fistulas that left them incontinent and virtual outcasts of society.
Johnnies loosened from playing on all of the little ones, leaving me smiling at every brown bum that scooted past me.
The patter of Abraham's pink feet running around as he cooed and screamed gleefully with anyone willing to play with him.

As the night went on, and I slowly started realizing that I haven't forgotten everything I know in the last 6 months of being away from ward nursing, I settled into all of it.
The electric feel that surrounds me when I'm working, the comfort deep in my soul of holding a baby. The excitement of laughing with a child. The sense of absolute accomplishment when a kid smiles at you for the first time (even if you had to use a balloon as a bartering tool).

I kept kissing Antoinette with an exaggerated 'Muah" sound and after a few minutes had taught her to say "ciao bella" MUAH! Her mama, who had cried just an hour before, beamed when we told her we were saying "bonjour belle" or "hello beautiful" and squeezed my hips with a big 'MUAH'
When Abba came on the iPod mix, the fistula repair ladies started walking the 'catwalk', some holding their catheter bags as they turned and smiled, each one sassier than the last.
I loved every hug, kiss, squeeze (they do a lot of squeezing here, that one is a little harder than the others to get used to). When the mamas started taking out their cell phones and taking pictures of us, Ali and I instantly posed and whispered quickly how our hearts felt like they would explode with happiness. I can't formulate the next sentence in my head without it sounding cheesy, so I'll just come out with it. You could reach out and quite literally feel the love in the air, we were fully immersed in it. Yet, the people, the patients, were only being themselves (which really, I suppose, is the best part)

The next night was more of the same. The nursing felt altogether familiar again as my first patient started throwing up during report. These things always happens during report, ask any nurse you know. Its like patients have some sort of radar or instinctual gut level (no pun intended) reaction to nurses handing over report and all things hit the fan (or my fellow colleagues hands in this case). Things started feeling normal but at the same time so profoundly surreal to me. The wards here are wide open, the beds are all in one room. The kids play together, the parents chat, the translators sing and joke, occasionally picking up a drum or guitar. As I helped one patient, I laughed at a toddler freaking out about his balloon, totally psyched to have it. I charted with a baby on my lap or hip, got kisses every time I passed another one, and laughed out loud when I saw one of the toddlers who split his eye open on a toy wooden dog, still holding on tightly to the tail while his nurse iced his head. Afterall, whats a little blood between friends?
Last night, back on B ward, I had the following conversation with Abraham (obviously nicknamed 'Abe' by me) while he sat on my lap as I flipped through charts. Keep in mind he doesn't talk yet, and I don't speak his language even if he did.

[Abe is sitting, picking at his toes and feet. A little later he casually tries to hand me a little white 'blob' of something]

"Abe, is that a booger, or did that come from your foot?"

[Abe points to his foot, making sure I am seeing that he has a tiny fleck of skin peeling off the bottom.]

This is why I love my job. This is why I love Africa. This is why I love God and thank him for every single day I get to have the privilege of experiencing this life. I am in awe of how fulfilling these last months have been. I can't begin to imagine whats in store.

"The blood in my veins and my heart you invade...The way that I feel and the love in my soul, I thank you my God for letting me know. I am, I'm captivated by you"
-Captivated, Shawn McDonald.

So many things about nursing are the same here. The charts, the tasks, the pukey patients, the energy, the excitement. Simultaneously, its not even remotely close.