patient stories

The past few days have been really busy on the wards. We're in the middle of a long weekend right now, but the beds are filled and we even had to do an emergency surgery on Friday, when the OR staff should have been enjoying a day off. We have several new nurses who are going through their "trial by fire" period, since, invariably during the last several shifts, nurses have come to work only to leave almost immediately, the latest victims of a particularly nasty stomach bug that's been going around. Since so many nurses are sick, there's no one to call in to cover, so everyone ends up taking more patients; with the myriad dressing changes on the plastics patients, it makes for some hectic shifts, and the new nurses have understandably been needing support.

All this translates into the fact that I've gotten to be a real nurse for a couple of days. I've gotten to change bandages and give injections and start IVs and even hold buckets for little old ladies to throw up into. (Sorry; did I go too far there?) I've thoroughly enjoyed getting my hands dirty, and it's been a welcome addition to all the time I spend sitting at the desk updating those statistics and figuring out how we're going to get enough nurses for the next shift when half of them are restricted to a very small radius around their bathrooms.

Even with all that, though, my favourite moment of this past week happened yesterday while I was sitting at my desk. I had finished with the bucket-holding and the old lady was sleeping quietly after her shot of anti-nausea meds, so I finally had a minute to do my charge-ly things. I was updating statistics (what else?) when I felt a little touch on my side. I immediately looked down to make sure Fagbohoun wasn't at it again on my toenails, which I had just finished stripping back to their natural state. It wasn't her, though; it was the little girl in the next bed over.

Gloria is two. She had surgery to release burns scars that had frozen her left elbow and wrist, and the entire left side of her body, it seems, is just one big bandage. Despite what had to have been a terribly painful operation, Gloria toddles around the ward in a delightful mood most of the time, barring the standard Terrible Two Tantrums, which only last a few minutes at most. She's got close-cropped, fuzzy hair and huge round eyes, and she was looking up at me hopefully. When Gloria gets that look on her face, she wants one of two things; a sticker, or a snuggle. I shot her an inquiring look, and she answered by holding up her good arm. She wanted the snuggle.

I gathered her into my lap and pulled her inquisitive hand off the keyboard, where she had somehow already managed to delete all the information about one patient and replace it with the much more helpful jklsllkjlkjlkjslshlkhsdg. She turned her body to nestle in to my chest, her unbandaged arm slipping around behind my back to hold on tight, and that little two-year old started humming. She looked up at me and smiled, and I recognized the tune and joined in while she tried to form the simple words on her little two-year old lips.

Mon Dieu est bon (mon Dieu est bon)
Mon Dieu est bon (mon Dieu est bon)
Mon Dieu est bon (mon Dieu est bon)
Il est bon pour moi.

My God is good (my God is good)
My God is good (my God is good)
My God is good (my God is good)
He is good for me.

We finished and she smiled up at me one last time and then wriggled down to go play with the other kids, apparently satisfied with our little snuggle and a song.

Because life really can be that simple. Sometimes all we need is a little snuggle and the reminder that our God is indeed Good, and suddenly everything is okay.

In all my excitement about my startling pink pedicure, I forgot to tell you that Baby Hubie's family came to visit yesterday.

Shortly after my polish had dried and it was safe for me to wander around the wards again without smearing pink everywhere, I headed over to the office to pick up some papers I had printed. I saw Suey and stopped to say hello when I noticed the small family clustered around her. Mama, Papa, Pauline and their oldest child, a serious boy of six. The mama's face lit up when she saw me, and I went to give her a hug. As soon as I was within range, Pauline reached for me. I gathered her into my arms and her little hands threaded around my neck while she nestled her head into the corner of my shoulder. We gathered up all the nurses we could find who knew them and had a little reunion right there in the hallway. Mama's eyes were still a little shattered, but she leaned into our hugs and threw her arms around us and held on tight.

As I was getting ready to head back into the ward to finish my work for the shift, Hubie's papa grabbed my hand one last time. Through a translator he told us thank you. You are blessed, you people. You are blessed because you took care of my son. We will not forget what you did for our family. Thank you. I smiled to myself, realizing that it was the first time I had heard him refer to Hubert that way. My son, he had said. My son. A child unmarked by the scars that carve mirrored gashes in the cheeks of his other two children, but his son nonetheless.

And then we unwound Pauline from around our necks and she went willingly back into her mama's arms, snuggling in there just as comfortably as she ever had with us, and I knew that we had won. For all the days that I wondered whether or not we were making a difference for that family, yesterday I saw the truth.

So if the only reason this ship came to Benin this year was so that Hubie could come to us and die with us, I think it's enough. It's enough because a papa speaks of his son, not the boy. It's enough because there's a little girl who can rest her head on her mama's shoulder and know that she's going to be okay, a little girl who can climb into those arms and trust that she will find love there.

And love is enough.

We've recently started collecting a lot of statistics about our patients here on the ship. Mostly, we're just trying to figure out how long patients are staying, how many people we can realistically book in for surgeries, and just how sick they really are. It's going to be useful once it's all gathered and sorted, but right now I find myself struggling to remember all the bits and pieces I'm meant to record and save each day.

This morning was no exception. I had finally muddled through rounds, chased down the not-usually-so-elusive Dr. Ian, who somehow forgot to come see his patients, and gotten all the discharges and admissions sorted out. When the dust settled, I sat down at the desk to update the nursing census, the master list that holds all the little details that the charge nurses need to make sure the wards are running smoothly. The last column on the sheet is one for acuity, a new measurement of how sick the patients is. We score from one to five, where one is You're Fine, Get Over It, and five is Oh Crap, You're in the ICU and You Might Die. Most of the patients in A and B Wards are ones and twos right now, so it's mostly the fact that every bed is full that's keeping us running these days.

I was about halfway through the list of forty patients, figuring out just how sick each one was, and I have to admit that I was concentrating pretty hard. I wanted to be a good charge nurse and get it all right and not cut corners, so I was basically oblivious to everything else going on in the ward. All of a sudden, I felt a tiny little touch on my foot, like a piece of paper had blown against my toe. I ignored it until it came again, a little harder this time, shattering my concentration.

I looked down to see the tightly-plaited head of Fagbohoun, a nine-year old girl who just had surgery to release the burn scars on her right arm. She was huddled half under the desk, her splinted and bandaged arm sticking out at a crazy angle, and how I hadn't noticed her earlier was beyond me. She was doing something on the floor, so intent on her work that she didn't look up when I tapped her on the head, trying to get her to move to a more out-of-the-way spot. I leaned over in my chair to get a better look at what she was doing, and almost fell right out.

Folks, she was on my third toe before I even noticed that that small child was giving me a bright pink pedicure. My laughter must have been shaking her canvas, because she looked up at me sternly, frowning as she mashed her good elbow onto the top of my foot to hold me in place. There was clearly no escaping my fate.

So I let her finish, despite the fact that I'm not so much a fan of painted toenails. Also despite the fact that I'm most definitely not a fan of pink ones. (I'm so sorry, Amy Beth!) Fagbohoun was just so proud of her work, I didn't have the heart to make her stop. (And let's face it; six or seven pink toes look a lot sillier than ten, even when those ten show a dubious mastery of the concept of colouring inside the lines.)

That, my friends, is why statistics are dangerous. Because if you're not careful, you might look down and find a small African child painting your toenails bright pink.


(Don't say I didn't warn you.)

One of my favourite faces around the ship is Dr. Ian's. And yes, I did just link to a Wikipedia article about one of our surgeons. We call him Dr. Ian, but his proper title is Baron Professor the Lord McColl of Dulwich, a name you'd hardly think fits the slight, 76-year old man who carries it.

Dr. Ian and I get along swimmingly. For starters, he's hilarious. I don't think I've ever done a ward round with him without hearing one of his jokes; today's dealt with sugarless tea, and I'm afraid, for the sake of you non-medical folk out there, that I can't go into any more detail than that. His longest-running gag, delivered in his dry British accent, invariably comes when I ask about a patient's diet and what they should be fed after surgery. There is a list of standard post-operative diets, and I used to expect him to choose one of these. Clear Liquids. Soft Diet. Regular. Dr. Ian rarely sticks to that list.

Today, we stood at the bedside of a man who just had surgery yesterday. If you're as good with the calendar as I am, you'll be quick to realize that yesterday was Sunday. We don't typically do surgeries on a Sunday. (Something about a day of rest and all that.) But this one was an emergency.

The patient was a middle-aged man who had had surgery on the ship a number of weeks ago to repair a hernia. He went home, thinking he was healed, and thought no more of his problem until the pain came back. It had been such a long time since his operation that he went first to a local hospital. They put in an IV and presented him with the bill, which he paid. They performed an assessment and presented him with another bill. I think he paid that one, too, but eventually his money ran out. At which point he was thrown out into the street.

So he came back to us, and we ran him into the operating room faster than anything gets done here in West Africa. It turns out his hernia had gotten strangulated, and he was in danger of losing a big piece of his intestines and possibly his life. Dr. Ian grinned wryly up at me while he explained what had happened in the OR. When we opened him up, the bowel looked ... well ... let's just say it was the wrong colour. We gave it some TLC and then all of a sudden it was pink again! (Pink, for you aforementioned non-medical folks, is a good colour.)

I paused a moment while I let those details sink in. Sitting up in the bed in front of me was a healthy-looking man, smiling and showing off his incision for our inspection. Just yesterday, his life was in danger, and today he looked like he didn't have a care in the world. I shook my head, laughing at the fact that I still find all this so incredible. The fact that we can take people and pull them back from the edge, open them up and fix what's wrong. That we can do it without charging them money, without threatening to throw them out in the streets. That here on a ship that's docked in the third world, our hospital is providing first-world care.

And speaking of care, the time had come for me to inquire about my patient's diet. Dr. Ian, I asked, biting back a smile in anticipation of his response, what would you like him to eat?

Without skipping a beat, Baron Professor the Lord Ian McColl of Dulwich looked up at me and delivered his standard response.

Well, haggis of course. If you've got it.


A new lease on life, yes. But I'm afraid, for all our first-world medical care, that haggis is the one thing we just can't offer.

The wards were busy today. I felt like a ping pong ball, bouncing around between the OR, offices, wards and treatment rooms, trying to keep my forty patients straight in a head made considerably foggier by the fact that I've fallen victim to the latest virus roaming the ship. By late morning, I was pretty sure I was going to die by lunchtime.

I needed to escape just for a minute, so I walked back to the hold (a big area at the back of the ship that doubles as a patient waiting area) to deliver a patient to the eye team. He had come in for a hernia repair, but in true two-for-one style, had made sure we knew about his eye problem too. On his way back down the gangway, we were able to get him assessed by the doctor, so everyone was happy.

As I moved to hand his chart to the eye nurse, a little brown blur detached itself from one of the waiting mamas and launched itself full-force into my legs. I realized that whoever it was was holding on for dear life, and when I looked down I realized that my little leech was none other than Perrin, a plastics patient I had taken care of a couple weeks ago. His hands were free of bandages, nothing but a stitch at the base of each thumb to show where his crooked fingers had been released, and he was obviously glad to see me.

When I knelt down, he melted into my arms, his little head resting on my shoulder. I felt a hand pull on the side of my shirt, and looked over to see the baby who had been in the bed across from Perrin, his foot wrapped in an admittedly dusty bandage. It wasn't long before that little boy's twin sister joined the crowd, and I had to sit down or else I would have toppled in an undignified heap all over the dirty floor. The babies crawled into my lap and Perrin hung from my neck and I wondered whether or not it could really get any better than that.

It did, actually. When I finally pulled myself up from the floor to go back to the mountain of work waiting for me, Perrin turned to his mama, gesturing for something that he wanted out of her bag. She smiled at me and shook her head before she gave him what he wanted.

Perrin whipped back around to face me, a piece of paper in his hand folded into the crude shape of a gun. Just like boys the world over, he squeezed one eye shut, got me in his sights, and pulled his imaginary trigger.

I paused long enough that he wasn't sure whether I was going to play along, so he shot me again a few more time for good measure. I took my time, made it dramatic and died right there on the floor of the hold with about thirty eye patients staring at me through cataract-clouded eyes. Perrin and the babies jumped back onto my prostrate body, we shared one last snuggle and then I really did go back to the wards.

Funny how my death was also the thing that made me feel just a little more alive today.

I was sitting at the desk inputting new patients into the computer this morning when a little brown hand snaked past my elbow and started hitting random letters on the keyboard. I looked down into the wide eyes of one of our sassier plastic surgery patients, Lotoufiath. She was burned by a pot of boiling oil, and as a result, her left armpit used to be a mass of scar tissue. Now her entire torso is a mass of bandages, a splint makes her arm stick out from her body at a ninety degree angle, and she runs around the ward without a care in the world. Apparently, she also likes computers. I used my limited supply of Fon to tell her that she wasn't allowed to mess with my charting, thankyouverymuch (which actually works out to me just saying no; eeyo.) She pouted for a minute and then pointed to the paper on my clipboard.

It's the list we get every week, the list of hospital admissions. Names, ages, problems and the solutions we've dreamed up. Lotoufiath pointed to one of the names and I read out the planned surgery. Temporalis muscle flap. Her eyes widened, and a look of intense concentration dropped over her face. Slowly, she copied my sounds. Tem....por...alis.....mu...scle....flap? I gave her a hug and told her gangi, good.

We spent the next ten minutes or so bent over the paper while she poked her little finger at the longest words. One after the other she mastered words like z-plasty and mandibulectomy and zygoma, parroting back to me the sounds of my language, just like I do to her when she teaches me to say hello.

When I put the paper away, she frowned, not quite ready to finish her quest for medical English. I lifted her chin with my finger, and used one of her own words. Konu, I told her. She looked quizzical and flipped her hand palm up, the universal sign for I want to know what that means here in West Africa.

Smile, I told her, konu means smile.

She darted away across the ward, placated by this offering, a word she could actually use. (Words like ameloblastoma, while they do have a nice ring, hardly get much play in everyday conversation.) I heard her from her spot near bed twelve, home to a little boy on crutches, passing on her new knowledge.

Smile, she told him, in English. He stared blankly back at her until she burst into laughter and grabbed the corners of his mouth. Konu!

They made their way back to the desk and stood on either side of my chair while I continued typing my information into the computer, the words a little less flat now that I had heard them rolling off the tongue of a fuzzy-headed Beninoise girl. And every so often, when I got too serious about my work, a little hand would pat my arm, a little hand would snake around my neck and pull my head down so a little tongue could whisper into my ear.

Smile Tante Alice! Konu!

Aime went to back to Jesus. In the taxi, on the way back to his house, he slipped away, just like all the other little boys we've cared for. Suey, our palliative care nurse, visited his mama today. I asked Suey how the mama was doing, and she answered by telling me what the mama had said. I feel like my heart has been removed. Which is kind of how it starts to feel when you stand by and watch this sort of thing too often.

But thankfully there was Sunday. Yes, I know today was Thursday; Sunday was the man in bed nine. He's from Nigeria and had surgery to remove a tumor on the side of his face. I had gotten report this morning and was just about to turn on my IPod when I heard the rustle of papers and the clearing of a throat on the other side of the ward. I looked over to where Sunday was perched on the side of his bed, glasses sliding down on his nose, a sheaf of music in front of him. He gathered everyone he could find and led an hour-long hymn sing, right there in D Ward, complete with Scripture recitation in between songs. When I got his discharge order and explained to him that he would be leaving us, he broke into a wide grin. I am leaving. This is true. But the song? The song will go on. You must never stop singing to our God.

But of course, there's really no way I can stop singing. Not when I walk back to the patient waiting area and see a woman in a bright yellow dress, her hair flowing in a sassy weave, an impossibly fat baby guzzling a bottle in her lap. Maomai and Pelagie came back for their last post-op visit the other day. Just as she always does, Pelagie grabbed me in an impossibly tight hug, laughing and telling me thank you, over and over. I took Maomai in my arms, touched her round cheek and sang her name. She looked at me, her brown eyes wide, and her chubby face broke into an enormous smile as she reached up her fat little fingers to touch my own cheek.

And this is why I won't stop singing.