smelly cast

I'm sitting here in the wee hours of a new week, waiting for my pager to go off and summon me back down to the ward, wondering if I'll ever be able to go back to The Real World.

We talk about it all the time around here, usually with some measure of disbelief, sometimes even disdain. I can't believe I'm going back to The Real World next week. I forget; is that the way they do things in The Real World? Who really wants to live in The Real World? I'm not saying that life here isn't real; sometimes the reality of it is more than I can bear. It's just, well, it's different here. I live my life in a dimension that no one who hasn't experienced it could never understand, and most days I'm okay with that. I'm okay with the fact that I'll never be able to really explain this place to someone who's never spent a week or a month or a year on board a floating city in West Africa.

To explain what it feels like to go to work and be the charge nurse in a place where in charge means so much more than it ever did on land. Sometimes, on top of all the rest of my duties, it means hiking up and down a few flights of stairs, bringing bottles of medications to an illiterate mama, so she can identify by color which one she'd been giving her baby. Sometimes it means trying to explain to another mama that, even though she has twins, I will not let her be admitted with an entire posse: herself, the two babies, her husband and another caregiver. We just don't have the space. Sometimes it means volunteering to keep the pager overnight after I've finished my shift, ready to get out of bed and throw on scrubs any time during the night that the ICU nurse has to pee, because there isn't anyone else who can cover her patient while she takes a break.

And sometimes it means stepping out into the damp, hot evening air to find a little boy on the dock, the cast on his leg giving off a sharp, sour smell, his mama next to him gesturing wildly in the dark. Sometimes you have to get that boy down the the ward to asses the leg, which would mean first getting up the gangway and then back down two decks to the hospital. And sometimes there's really no good way to do that other than to bend down and let the little boy climb on your back, to make your way carefully up the gently moving stairway and then down to the ward.

As I pushed past the people in the reception area, the boy's cast sticking straight out from my side, his little hands threaded under my arms to clutch my shoulders, (standard piggy-back style here in West Africa) I started laughing. I laughed all the way down to D Ward, where I gently deposited him on a bed and went to copy his name down onto my charge sheet. (Incidentally, I can't remember his name, just the fact that it started with a D.) As I stood by the desk, I realized that the sour smell had followed me across the room, and when I touched my back I realized that it was damp. Par for the course really, so I thought no more of it until I went to pad the sharp spot on his cast, and saw that D's clothes were dirty and wet, that he probably hadn't been washed in days, that he didn't have a shoe on his uncasted foot. D's mama watched me stuff gauze into the top of his cast and secure it with tape, and when I finished, she fired an angry question at me. My translator shook his head as he relayed the message. She wants to know why the cast smells so bad.

I thought about being sad for D, for letting myself enter into the pain of his situation. Trying to grasp what it must be like to live for days in the same clothes and have no one care if I was clean or not. But right then, after everything else that had happened during the shift, I didn't have the energy. So instead I just laughed. I laughed at the fact that none of this would ever have happened in my old life, the one I used to live in The Real World. I laughed at the fact that this is all normal to me, that I think nothing of carrying my patients into the hospital on my back. I laughed at the fact that I used to get stressed out in a job that never required me to give the following explanation:

It's not his cast that smells bad. It's his clothes. You need to wash them. I don't care if they're his only clothes; he can go naked while you're working. But you need to wash them.

Now if you'll excuse me, there's an ICU nurse downstairs who really needs to pee.