Entries by Ali C.

Well, it's Friday, and I'm sitting comfortably on the couch in my cabin on board the Africa Mercy, mulling over the events of the last few days, once again completely amazed by God.

For those of you with long memories (or at least memories longer than mine at the moment; everything they say about pregnancy in that area is true), you'll remember that I was meant to be leaving yesterday. In fact, if I'm doing the math right, I would be about halfway across the Atlantic right now if all had gone according to plan. My plan.

Not His.

Because apparently it's also true what they say about God's plans; they're way better than ours.

As of Tuesday morning, I was fully expecting to get on that plane last night. And then things changed, as things so often do around here. I'm not going to get into the whys and hows; suffice it to say that before I could really wrap my head around it, my ticket had been changed to Monday night. A glorious four-day reprieve, another long weekend to spend with the HoJ before we're separated for ten whole weeks at a time when we'd really much rather be together.

And here's where God come in. Because while I was selfishly celebrating the fact that I get to put off leaving a few days, He was pulling together so many threads in a much bigger story.

Tuesday afternoon, once it was clear that my departure date was changing, I got a call from D Ward. Dr. James is here and he'd like to see you. Dr. James is a Togolese maxillofacial surgeon who Dr. Gary works with every time we come to port here in Togo, and he and I have been trying unsuccessfully to set up a meeting with some other local healthcare professionals for the last several weeks. I ran down to the ward fully intending to make my apologies and tell him that there just wasn't time when I realized that, with my ticket changing, I had all the time in the world.

We don't have a speech therapist on board these days, and so all of the much-needed therapy for our cleft lip and palate patients comes through me. I was trained by the former Team Leader who was trained by our former speech therapist, and you can see where the system might not be quite perfect. Wednesday afternoon, when I was supposed to be packing my things, I met with a local speech therapist and his student advisee. We reviewed our program to ensure that we've been doing the right thing with our patients, and then sat together and worked out a plan for them to continue seeing our patients for therapy long after the ship sails away.

Thursday, when I was supposed to be heading down the gangway, I collected a list of all our patients from this year. The therapist is going to contact all of the old patients to see if they want follow-up, and we'll automatically refer all the new ones to him when they're discharged between now and the end of the year.

If I had been leaving last night, I would have said no to the meeting on Wednesday. I wouldn't have had time to set up the referral or collect information or do any of a hundred things I ended up doing yesterday.

God's plans are so much bigger than mine. I just wanted to hang out with my husband, but God used the extra time to work things together for the good of our patients.

And this morning, when I stopped by D Ward to make sure the charge nurse knew I was available if needed, Esther's nurse called me over. Esther was sitting up in a chair, a cover over the trach that she's been breathing through for the past couple of weeks.

Hello Ali, she said, her voice small and muffled around the tube that's going to be coming out later this afternoon. It's the first time she's been able to speak to me since we stood at the foot of her bed and got her permission to do the surgery that would change her life. And if I had gotten on that plane last night, I would never have heard her voice again.

My heart is full of these unexpected blessings. God, it seems, has opened His hand over me and is pouring out love in such an extravagant manner that it's all I can do to keep upright under the flood.

And now for something completely different.

My brother always e-mails me when we send out a newsletter. Something along the lines of, Nice to hear what you've been doing, but tell the HoJ I really liked his update. He loves hearing what's going on in more than just the hospital, and I figure he might not be the only one. So here, for the first time ever, is something that I hope might start to happen a little more regularly: a guest post by none other than the Husband of Joy! Because I agree with my brother; there's some pretty cool stuff going on on this ship, and not all of it happens on Deck Three.

-----

God knows. That's all I can think to say when I reflect on events of these past couple of weeks. As everyone knows, I work as an electrician in our engineering department. Most of the time we know what's happening on the deck above (in the ORs and wards and such), but sometimes we lose sight of that because we are very focused on the task at hand.

Usually the only times people realize that there is an engineering department on board is when the power goes off (along with the air conditioning) and the temperatures start to rise within the ship. Power outages are even more dangerous when a patient is on the OR table.

Well, this past week I was given a project to complete. I had to install a variable speed drive for our emergency diesel oil pump. Normally, we run two generators from the main fuel pumps. In an emergency, there are valves that switch over and there is only enough fuel pressure to run one generator, which doesn't provide enough power to run the whole ship. There's a certain amount of air pressure needed to hold these valves over to the 'normal' setting (where two generators will run), but this pressure is hard to come by because the lines get clogged. The variable speed drive would allow us to run two generators no matter what, whether on the 'normal' side or the 'emergency' side because it increases the flow.

[A note from Ali: There is a very good reason I work in the hospital and not the engine room. He's tried to explain all that to me more than once and I just can't wrap my head around it. I'm so glad there are people who can understand these kinds of things!]

So there I was that morning, going down to the engine room, when I noticed something different about the fuel control valves which are on each generator. At first I didn't think much of it; there must be something else going on, but I had this nagging feeling to go and get the third engineer and investigate. So we did that and found out the air pressure which keeps these valves turned in certain direction so that the generators get fuel from the main fuel pumps was dropping.

The third engineer said he would bring it up with the chief engineer, and that we might have to do a planned blackout to clean out the air lines, never something that's easy to accomplish when the hospital is up an running like it is right now. So I went about my work of installing this drive. The plan was for the drive to be installed before intentionally turning off the power so that we could be sure that even on that emergency setting, we'd still be able to run the two generators needed to power the ship.

It was nearly lunchtime so I went up and grabbed some lunch and went to the cabin to enjoy the air conditioning after spending most of the day sweating in the engine room. We normally get an hour for lunch, but I had this nagging feeling again to go and finish connecting the drive I was working on to the emergency diesel oil pump.

I pulled myself off the couch, went down and connected everything, and started up the drive just to make sure the pump was going in the right direction. As I was doing this, people were coming back after lunch and alarms started going off for our main fuel system. Just as I finished checking the rotation of the pump, the power went out.

Pitch black.

The emergency generator kicked in, and we had some lights and power to the systems that we needed in order to start up a generator and put power on the ship, so the engineers tried to start up one generator using the emergency diesel oil pump I just finished working on. It started up and restored limited power to the ship.

They then tried to switch back to the the normal fuel supply, but quickly realized that the air pressure had dropped to the valves and they were stuck on emergency fuel and not normal fuel supply, which meant that on any other day we would only be able to run one generator. There was starting to be a slight panic as to how we were going to get two generators going to power the ship, so I said, Well, I just finished installing this drive. Let's see if it can handle two generators. By the grace of God, the emergency diesel oil pump was able to run two generators and restore power to the whole ship, and eventually, after cleaning the lines and valves, we were able to rectify the underlying problem.

I know you hear a lot of stories about God leading people to other people to minster to them and things like that. This was one of the first times that I can think of where the Lord has clearly guided me not to a person, but to a piece of machinery to help further His kingdom.

Can you say God knows? God knows.

-----

[Me again: I was working that day, and had just sat down to a late lunch of my own when the power went out. There really is a feeling of panic that rises in your throat when you realize that the lights are taking too long to come back on and that there are patients on the operating tables in the dark, silent operating rooms. I didn't hear this whole story until a bit later, and I'm still blown away by how perfect God's timing is. He called an electrician down to the engine room in the middle of lunch and set him to work finishing the installation of the one piece of equipment that was going to solve a crisis that would begin just as the final tests were run.

God knows.]

Today was another one of the jumbled days, one of the ones where I live a thousand moments that I want to tell you about and then find myself sitting here in front of an empty screen, searching for the words to somehow make you understand what this place means to me.

It never gets old. I've been here for four years, and today I was explaining some of the surgeries we've been doing to a visiting media team and the wonder in their eyes looked exactly the way my heart feels every. single. day. I look around that room at the hope lying in each bed and I can't really imagine anywhere I'd rather be.

My disembarkation form, the one we all have to fill out when we're leaving the ship, was on my door today, Thursday's date printed neatly across the top. I burst into tears when I saw it because it means that my time left is measured in hours now, and hours don't feel like enough.

So instead I measure my time in those thousands of moments.

My mind snaps a photo of a mother and her still-so-sick baby, mama's hands covering her daughter's, protecting her even as she sleeps a sleep born of pure exhaustion. I store the image away to be referenced later on when I need to know how to be the right kind of mama.

Across the ward a teenager returns from surgery. What was meant to be a routine bandage removal turned into several hours on the operating table, but I can't help thinking that Someone planned for this, because the little piece of bone that had to be removed to make room for the muscle that would cover the hole they found was just the right size to give shape to a new nose, one we never thought she'd have.

A newly-minted thirteen year-old is admitted on his birthday, sitting shyly on a chair in the corner, a rag covering the tumor on the side of his face as we dance and clap and sing Happy Birthday in three different languages. His grandma sits by his side, her back ramrod-straight, eyes glittering with the promise that this year will bring for her grandson, for the day coming so soon when he won't have to hide anymore.

Just before shift change, a four year-old taps my leg and lifts up his hands, hope in his still-swollen eyes. I reach for him, settle him on my back, his feet wrapped around my belly, and he rests his head on my shoulder as we gather to pray. From behind me, I hear the amens echoed in his tiny voice.

Soon enough I'll have to open my hands and release this place. But for now I gather these moments like a farmer bringing in the harvest, stuffing my heart until it's ready to burst, tucking still frames and memories into each little corner.

It never gets old.

Tonight marks one week until I leave the ship for at least five months. I hate leaving. I know that it's for a good reason this time, but I'm already dreading the feeling of bumping a heavy suitcase down the gangway, climbing into a Land Rover, and driving away from the port.

One of my favourite parts about this season on the ship, one of the reasons I'm so torn about leaving, is the fact that I've had the chance to be a youth leader again. I love the youth on board here; they're a crazy bunch of kids from around the world, and I've been challenged by their perspectives over and over again. Carys Parker, Dr. Gary's daughter, recently wrote something that was exhibited at the Academy Arts Fair. I stood in the narrow hallway and felt my breath catch in my throat as I read because she's just got it so right.

Africa is my home. She is the sun-scorched deserts and the dripping rain forests, the mighty lion pouncing upon the zebra, the tribes that walk upon her rich, red soil, the palm trees growing strong and tall. The crowded, busy market places, where everything from oranges and mangos to jeans and microwaves are sold. This is Africa. Africa is the people sitting around the fire as the darkness of night closes in, She is the breaking of bones as the women carry their heavy loads high upon their heads, but not of spirit even though death steals so many. Africa is the bright colors and fabrics that blanket the land, she is the laughter of the scantily clothed children as they splash in the waves, She is family, and tradition, and a place of beauty, She is home. This is my Africa.

After years of living here, I have come to look past the poverty and corruption to see the beauty of this cultural land. Africa has forever left her mark on my heart.

Can't you just see it? This is why it's so hard to leave, even when I know I'm coming back. Because my life isn't what it used to be back before I ever set foot on the ship. There's some sort of fundamental change that's been worked deep inside me, some switch that's been flipped and now I don't know where home is anymore. I read Carys' words and I'm convinced it's here, and then I think of the family waiting for me in North America and I can't wait to get to the airport and I feel like I've lost all sense of equilibrium.

Compounding all this is the stark reality that in just a few days I will no longer be working full-time as a nurse. I know they say once a nurse, always a nurse, but I'm not starry-eyed enough to believe that nothing is going to be different. I'm stepping into a completely new reality, and while I love adventure, I'm not so great with change.

And then Lara, another one of the youth, got up at Community Gathering tonight, looked straight into my soul, and spoke to my secret questions. Your story has already begun. God is already doing something in your life. Don't wait for this time to be over. Your story has already begun.

I've been lying awake at night, wondering who on earth I'll be once the title on my badge is different, and all the time God's been writing His story around me and through me. I'm dreading the end of this season when God's already seen past it to the chapters ahead. Why do I doubt Him? This isn't the end of anything.

I'm sitting here laughing to myself as I read back over that last entry, the one where I said I had no idea how I was going to walk away from all of this. I really should stop saying things like that, because this time it resulted in a couple of twelve-hour work days, ever since I hit publish on that entry.

This week, we have a German cranio-facial surgeon on board, Dr. George. When I looked at the surgery schedule last Friday, the boxes marking out his days for yesterday, today and tomorrow were nearly empty, each one saying simply All Day Case. We were waiting to see if we'd be able to get the one neurosurgeon in Togo to come and operate alongside Dr. George and make those cases possible, and right up until Monday, we weren't sure we'd be able to say yes. But those boxes have names now. Rudolph and Maurice and two more waiting to find out whether they'll be able to go to the operating room tomorrow, and as a result our ICU is busier than it has been all year.

Rudolph is four and was born with extra space between his eyes and two holes in the front of his skull where his brain and spinal fluid poked out. Yesterday, Dr. George took apart Rudolph's head and put it back together again correctly, an admittedly meager explanation for an incredibly complex, a ten-hour operation. Rudolph spent the night breathing with the help of a ventilator, but as of this morning we've removed his breathing tube, and now we're just trying to walk the fine line between letting him wake up and keeping him calm enough that he doesn't hurt himself in his quest to get out of bed (something he'd very much like to do, apparently).

In the next bed, three month-old Maurice is snuggled up in his mama's lappa, all seven and a half pounds of him. He was also born with the hole in the front of his skull, but because of the placement, his surgery was much more straightforward. All Maurice has to show for his long morning in the operating room is a little incision curving around his nose, held together with steri-strips and a few IV lines giving him fluids and medications for pain, but he still needs to be monitored very closely to make sure his brain agrees with its new, smaller living space.

Tomorrow at least one of the babies who wait next door in D Ward will join Rudolph and Maurice in the ICU, having also had surgery to reshape their skulls. And I sit here and shake my head, because who would have ever thought that such a thing were possible here in Togo?

I used to work in an incredible PICU back in New Jersey where we had a neurosurgeon who would do cases like these on a fairly regular basis. In fact, when I saw the screening sheets for tomorrow's patients, I just had to smile because craniosynostosis isn't just a jumble of letters to me. But when I quit that job, when I got on a plane to come to West Africa for the first time, I had no idea that I'd be part of that type of surgery over here.

Just outside the ship are dirt roads and tin-roofed houses with no running water. There are six million people in Togo and one neurosurgeon. One, and even if our patients could have found their way to him, the cost alone of an operation like this would have put that dream to death.

Down in the ICU are two little boys who have been given the impossible blessing of having surgery that will give them a chance at life, a chance to look normal and to grow into young men who don't have to worry that their lives will be cut short because of the way they were born.

For once, we get to thumb our noses in the face of that often-repeated lament, that where you're born shouldn't determine the reason for your death. For once, we get to hold out the promise of life to the ones we'd normally have to turn away. I love that I get to be here for this, that in my last days on the wards I get to bear witness to transformations like these.

Esther went outside to Deck Seven for the first time since her surgery today. I can't wait for Rudolph and Maurice to join her out there.

When I opened up the nursing schedule this morning to check staffing for the upcoming week, I glanced up at the top line. It’s the one where my schedule is posted, and I never really look at it because my schedule is the same every week. Monday through Friday, day shift. It’s simple.

Today, though, I looked at my own schedule and it hit me like a fist in the gut. Five shifts left. After four years down in the wards, I have five shifts left until I pack up and fly home for maternity leave. And when I get back, my badge is going to read Primary Caregiver, not Pediatric Nurse or Team Leader.

I’m not saying it’s a bad thing. I’m more than excited about this new chapter in our lives, about the little one growing inside me, about finally getting to be a mama after dreaming of it since I was a teenager babysitting the neighbours. But this morning, looking around D Ward, the thought of leaving it all was a bitter pill to swallow. I’ll still be involved in little ways down in the hospital once we’re back on board with Poppy, but it’ll be nothing like it is now. I get to be there every day, now. I get to work with every patient that comes on board for maxillo-facial surgery. I get to hear every story.

Stories like Esther’s, who, at sixteen years old, came to us from Nigeria with tumors that Dr. Gary ranked in the top five that he’s ever seen. It wasn’t the size of them, although they were impressive by any standards, but the fact that they invaded almost her entire face. Usually we see this type of thing in either the lower or upper jaw, but not both. Esther’s disease had taken over both her jaws almost entirely, and in a marathon, nearly twelve-hour surgery last Thursday, Dr. Gary and two local surgeons took apart Esther’s face and put it back together with metal plates and screws and hundreds and hundreds of sutures.

Esther has been slowly recovering, first in the ICU and now back on the ward, and today I went to stand at the foot of her bed while her nurse changed her bandages and removed the drains from her incision lines. It was the first time I had seen her new face without the bulky layers of gauze and tape, and I couldn’t stop the tears that filled my eyes.

Oh, Esther, I told her, You are so beautiful.

Maybe I’m seeing her through the eyes of a nurse, looking ahead to the future, after the weeks it will take for all the swelling to go down, the months that still need to pass before the extra skin will retract back and tighten. But the little girl lying in that bed is beautiful nonetheless. She no longer needs the scarf that she wrapped herself in when she was admitted, the cloth she’s been using to cover her shame all these years.

Esther’s eyes widened and the hint of a smile crossed her lips as Alana (her nurse) brought her a mirror. She peered into it, just like she has every day since waking up free from her tumors, and dropped it to look back at me. What do you think? Alana asked her. Is it good?

Esther nodded once, that one tiny gesture speaking more than words ever could, and then settled back on her pillows, content to let us care for her.

This is what I’ll miss when I go. I’ve been a part of incredible things like this for so long that I have no idea how to be anything else. And for once, I have no answers for myself, no neat little platitude with which to sum up this entry. Just, I don’t know how I’m going to walk away from this next Thursday.

Today marked fifty-six days since Papakey's first surgery, the one to create a nose to cover the hole left when robbers with a machete made their indelible mark six years ago. Just before rounds, his nurse and I peeled away the dressing on his leg that covered the place where they took the skin that was used to cover the place on his head where they took the nose. (Confused? Everyone is when they first hear about this particular surgery.) What we saw led to much rejoicing. Papakey, self-proclaimed Captain of the Ship (but don't tell the real captain lest I be accused of fostering mutiny) was ready to go home.



We celebrated all morning, wide smiles on everyone's faces every time they looked over to his bed to see him slowly beginning to pack his things. We printed out the pictures we've taken to mark his journey while he's been here. We made sure he had the supplies he needs to keep his new nostrils clean and open.

And when the Patient Life team came into D Ward, we had a party.

The drums were pounding as we clapped and danced and worshipped together, nearly blowing the roof right off that place. As we came to the end of the singing, I felt very strongly that we should pray over Papakey, and the team agreed. They pulled a chair to the centre of the room and had the dear old man sit in it while we gathered around him and laid hands on him. Together we raised our voices and prayed life and protection and continued healing over him. He sat quietly, palms clasped in his lap, nodding solemnly as he caught words and phrases among the cacophony of requests going up around him.

When we finished praying for Papakey, Kodjovi, a patient from the other side of the ward, approached and asked if we could pray for him since he was having some pain. He sat in the chair, we gathered around him and we prayed for him, too. One by one the patients came forward, settled themselves in the centre of the group and voiced their requests. Healing. Safe travel. Encouragement.

Dame got out of his bed, feeding tube pinned to his gown, and told us how he had stopped going to church a while ago, how he couldn't see the need for God. Rebecca translated quietly to me as he spoke. And then I came here. I saw how you care for each other, how you care for each of the patients. I saw the way you love, and I can see the way Jesus loves. He dropped into the chair and looked up at us. I want you to pray for me so I can love like that.

After Dame, it was my turn. The Patient Life team prodded me towards the chair and told me it was time to pray for me and for the baby inside me. I sat in the middle of my ward, surrounded by nurses and translators and counsellors and patients and they all put their hands on me and started lifting us up to God. As they started to pray, Poppy, who had been quiet all morning, responded, jumping around inside me with a strength I've rarely felt before.

I left that chair filled with a joy that's impossible to put into words, no matter how hard I'm trying right now. When I head for the States in just two and a half weeks, this morning is a treasure I'll have tucked deep into my heart, something to carry with me when I'm far from this place.

Because there's something so right about the way God made us to live in community with each other, to rejoice with each other and to carry each others' burdens as we walk towards the Kingdom. Today, down on D Ward, I caught a glimpse of what it'll be like when we're all finally Home. I honestly can't wait.

Today was a big day down in D Ward. Nothing spectacular happened as far as surgeries go, and to be quite honest the pace was slow enough that it wasn't until shortly before lunch that I even remembered why the day was supposed to be so special. Today was Dr. Gary's birthday.

Dr. Gary first came to Mercy Ships more than twenty years ago. He originally volunteered for just a few weeks, and he's still here. He's the Chief Medical Officer, the head maxillo-facial surgeon and he's arguably one of the top cleft surgeons in the world. He pays to work, just like the rest of us, and it's largely due to him that I love my job as much as I do.

Dr. Gary is one of the humblest people I know. He goes out of his way to learn names of new staff, takes time to greet each patient in the mornings and comes back in the evenings to tell the nurses what a great job they're doing. I often hear him give the credit for a patient's success to the hard work of a nurse, completely downplaying the long hours he put in in the operating room.

So when I finally remembered that it was his birthday today, we knew we had to make it special for him. I raided the craft cart to collect supplies and the translators asked each patient whether they wanted to make a card.

The responses were immediate, with hands held out all around the room to choose paper and markers and shiny stickers. Heads bent low over clipboards as each one crafted his or her masterpiece for the man who had put their faces back together.

Papakey, his breath whistling softly through his new nose, wished him health and a long life. Blessing, who is here to have an infected bone plate removed, told him she loved him but that God loves him more. Fifteen year-old Kevin was in the operating room having a small tumor removed from under his chin, but his mama decorated a card, sending Dr. Gary a big kiss from the two of them.

My favourite, though, came from Fatoumatou. She's in her forties (no one, herself included, is quite sure exactly where in that decade she falls) and when she was a child, some infection or injury fused her jaw shut and destroyed the skin at the corner of her cheek. She came to us quiet, withdrawn into herself like so many others. About a week ago she had surgery to release her jaw and the first in a series of operations she'll need to remake her cheek. It's been a tough week of tube feedings and stretching exercises, but slowly, as she sees her mouth opening further and further, Fatoumatou has come out of her shell. She's started to interact with us, smiling her crooked smile and cracking jokes with the other patients.

Today she drew a beautiful flower on a piece of bright magenta paper. Underneath the drawing, in her neatest handwriting, she carefully wrote three things to Dr. Gary.

I love you.
I wish you grace.
I have found my smile again.

Happy birthday, Dr. Gary. On behalf of the hundreds and hundreds of people who have found their smiles again, thank you.

I saw Grace yesterday. Her feeding tube had fallen out at home, so Esther and Anthony made the long trip from Benin back to the ship three days early. Our feeding program coordinator, Jess, stopped by D Ward to see if there were any pediatric nurses around who could place a new tube and I was quick to volunteer. I gathered my supplies and headed out to the dockside tent where Grace's small family was waiting. I got huge hugs from both of them and quickly got the nasty part over with.

Once Grace's new tube was taped firmly in place, I stole a quick snuggle. With her tucked my arms, I got the chance to ask her parents how things were going. It turns out little Grace isn't quite as little as she used to be; she's gained a whopping two hundred grams since we last saw her. It doesn't change the way her heart looks, so it doesn't mean that we can do surgery, but it's more than we expected. We caught up on family news, learned how excited the other girls were to have their sister back, and sent them home again. I'll keep you posted with her story if I hear more about how it's unfolding. Anthony would like me to thank you all for praying. He was speechless for a moment when I told him about all your comments and e-mails and then just ducked his head and said, You need to thank them for me.

Down on the ward, Bernice had a new blue cast put on yesterday and went home today, her caregiver laughing and hugging her thanks to all of us.



It's hard, sometimes, to let them go. Harder still when you know they're going back to an orphanage with sixty-one other kids who all need love and care. Hard to trust that they'll watch over her vigilantly enough, clean her mouth well enough, make sure she eats the right foods. I found out today that Bernice actually does have a mama, but that her real mama wants nothing to do with her. She rejected beautiful Bernice when she was born with a cleft lip and palate, unable to see past the deformity, unable to imagine that her child could ever be worth anything.

But Bernice is anything but unloved. She's had affection poured into her little soul from every angle over the last week and she's been soaking it up. It was finally my turn for a cuddle today during morning worship. I had her in my arms, her head on my chest, her bum resting comfortably on Poppy's head, apparently, if my own kiddo's wild dance moves were any indication. As the drums beat and the music swirled around us, her tiny hands patted my back in time with the rhythm, her fingers soft as little feathers.

Eventually the singing slowed and I handed her off to the next willing set of arms so that I could finish writing her discharge orders.

There's a rhythm to this place. They come, we fall in love, and they go. As Bernice's caregiver was collecting their things, four year-old Mounira rolled back into the ward from the recovery room. The steri strips on her lip mirrored Bernice's, and I saw Bernice's caregiver nod knowingly.



Here's another one saved, that nod seemed to say. Saved from a lifetime of rejection and ridicule before she's really old enough to realize that she's different. Mounira's papa stood by her side, his own smile wide as he looked down at his sleeping daughter.

Here's another one who doesn't have to hide her face, another one who gets to look like all the rest of us. This is how it should be.

Each Friday I print out the list of possible admissions for the upcoming week and write a quick e-mail to the photographers about which of them are going to be Smile Train admissions so that they can make sure their pre-operative photos are taken. Smile Train is a charity that funds cleft surgeries around the world, and we partner with them here in West Africa. We provide the doctors and nurses and the hospital in which the operation takes place, and Smile Train provides the finances. It's a win all around.

Smile Train patients are one of the highlights of my work here on Mercy Ships. I absolutely love the transformation that takes place in a patient before and after cleft surgery, and it definitely helps that the majority of them are babies and small children. (Except for one gorgeous, tiny old lady who had her lip fixed on Friday after living with a face split wide for more than fifty years. She wasn't a child, but she was still pretty cute.)

Unfortunately, many of the patients who were screened before the ship arrived are from up north and many of them have been failing to show up on their admission dates. Some arrive late, others have phones that no longer work, and the most heartbreaking ones are the few we've called who tell us that they can't come because they simply can't find the money for transport.

It just makes us cherish the ones that do make it to us, and among those Baby Bernice has a special place in all our hearts.



She's two and she has no mama or papa. She lives in an orphanage and the woman who brought her to us is one of the workers there. On Thursday, Bernice was scheduled to go to the operating room when Melissa, her nurse, found that her leg was hot and swollen. Little Bernice sat in her big bed, staring up at us with big, wide eyes, surrounded by a whole team of us as we talked through what might be wrong. We decided to hold off on surgery until we could figure it out and I felt my heart sink at the prospect of having to cross yet another hopeful patient off my list.

An x-ray of the sore leg made the path forward much easier for us. Bernice's little femur had been fractured, probably a couple of weeks ago judging by the film, but there was no reason she couldn't have surgery to fix her cleft lip and palate. In fact, as we discussed our options, we realized that yet again, God had placed the right people on the ship at just the right time.

The general surgeon who has been operating on hernia patients in A Ward just so happens to be a pediatric orthopedic surgeon, too. Except that we're not doing orthopedic surgery this outreach; six months just isn't long enough to ensure good physical therapy follow-up afterwards. There was no reason for an orthopedic surgeon to even be on board, but God made sure we had not only the correct specialty, but also one who is trained in pediatrics.

So Bernice had a full afternoon on Thursday. Dr. Gary closed her palate and carefully stitched together her lip while Dr. Alex busied himself with her leg, correctly aligning the bones and placing a long cast from hip to toes. Instead of a lifetime crippled from an unhealed injury, she now has the chance to run and play again. She's been recovering in D Ward since then and is much happier now than she was at first. She's still a solemn little thing, but she reaches up to be held and carried, and the nurses are more than happy to oblige.

There's a phrase in Dutch that one of our nurses taught us. It translates literally to soft-cooked egg, and it's how you feel when you pick up a gorgeous baby and your insides melt and go all runny and warm. We're all pretty soft-cooked around Bernice these days.

I left her sitting on the charge nurse's lap this afternoon. She had been there the whole time I was giving report to the oncoming shift, her little hands busy with everything on the desk she wasn't supposed to touch until Melissa opened a drawer and handed her a ball of yarn.

She sat there, enthralled, casted leg sticking out at a crazy angle, steri strips on her top lip looking like little kitten whiskers, playing with her ball of yarn while her caregiver looked on from their corner, a smile on her lips. And all I could think is that Bernice might not have a mama or a papa, but God is absolutely looking out for her. And that's enough.

I am exhausted in body and soul, but I need to tell you more of Grace's story before I can go to bed.

The past two days have been hard, dark days down in the hospital. All of a sudden, it seems, things got sad. One of our long-term patients who's been with us since the start of the outreach went to be with Jesus last night. We rejoice in her complete healing, but the ache of her passing is strong, especially among the team of nurses who threw themselves so wholeheartedly into her care.

On D Ward, a shadow seems to have crept quietly across the sunshine that we've been enjoying. There is an edge of pain starting to sharpen some of the stories we've been watching unfold, but none cuts so deep as Grace's.

After her first good day, Grace took a turn for the worse. Yesterday her breathing started becoming more laboured, her little body struggling harder and harder. We took an x-ray and found something that none of us had expected. We knew Grace was damaged; we just didn't know how badly. In addition to her club feet and cleft lip and tiny bottom jaw, Grace was also born with a heart that's massively enlarged. We don't have the technology to diagnose the problem any further than that, but the silhouette on the screen confirmed the path ahead.

Grace will not be able to have surgery. Her body would not be able to withstand the anesthesia, so even if we could get her fat enough, there's nothing we can do.

We had many talks with her parents over the last twenty-four hours. Long, wrenching discussions where the truth sits between you, dark and heavy. This baby is too broken. There's nothing we can do.

Anthony, Grace's dad, came up to me around lunchtime today and told me that Grace's three older sisters were missing her, that they wanted to see their baby sister. I asked him how old they were, and he told me ten, eight and five. I asked their names, and his smile broke wide.

Testimony. Miracle. Favor. And the small one is Grace.

He asked if they should make the long journey from their home in Benin and come to the ship to see Grace, and when I told him that there was nothing more that we could offer them and that it's best if the reunion happens in their home, he paused for a long moment. So what does this mean, he asked me, hope and fear fighting in his eyes. What will we do now?

We talked again about Grace's problems, about the fact that even in America this would be a badly broken baby. We agreed together that medicine holds no more promise for Grace, especially not here in West Africa, and then I saw the hope win out.

So we will take her home and we will trust God for the miracle.

The rational, medical side of me wanted to contradict him. To shake him and make him understand that his baby might not survive the trip home, that she is very, very sick and that we will all be surprised if she is still alive to come to the appointment that they desperately want next week with the Feeding Program. To make him admit that coming back, getting another chest x-ray and finding a normal heart is the most unlikely thing in the world. That's it's impossible and useless even to hope.

Instead I found myself nodding, agreeing, speaking out words of life over Grace and her family. Because the thing is, miracles aren't miracles because they happen every day. It's not a miracle if you can plan it, explain it, expect it. The rational side of me knows that, barring a direct intervention of the hand of God, Grace will not live much longer. She has days, weeks at the most, before her tiny body just gives out. But the rest of me, the side that's seen the unexplainable more than once before? That side joins her parents in pleading God for the miracle of her healing.

And so we taught them to give her formula through the feeding tube, packed bags full of supplies and sent them home to Testimony, Miracle, and Favor. They thanked me over and over for what we've done, little as it seems to us. We prayed together for that miracle, and I gathered small Grace in my arms and walked with them down the gangway to the waiting car. Next week, they called to me as they drove away. We will bring you a fat baby next week.

Before they went, Anthony came to me, sleeping Grace tiny in his massive hands. He held her out, proud papa that he is, so that I could take photos of her. Show them, he told me. Show the people who are praying the baby they are praying for. Show them our little Grace.





You're praying, aren't you? You always do. I know that and it sustains me in the long nights when I lie awake, wondering whether my pager will go off, whether something tragic will happen. Pray for our little Grace. Pray for the miracle, and pray for strength for her parents if God chooses a different path.

Grace is doing well today. She's enthroned on a pile of pillows in the corner of D Ward, watched over by her mama and the nurses, and she's starting to tolerate more formula through her feeding tube. It's obvious that we made the right choice when we admitted her.

I was praying about her, about the whole situation and a few others going on right now down in the wards, and I felt like God was just reminding me all over again how He's the One in control. I know that everyone hears God's voice in a different way, and in my life I've heard him in a number of different ways.

This time, it was a picture.

A vast library, dark wood shelves stretching from floor to ceiling, books tucked tightly against each other. Not one out of place, not one place empty. As far as I could see, there were books. Some were slim volumes, some massive tomes, and each spine was marked with a name.

This is my library, He told me. These are the books of your lives. Of Grace's life, of each patient's life that comes up the gangway, each one who stands in line on screening day, each one of you who cares for them. Each one.

Every page, each day of every story was carefully written before one of them was ever lived. Millions and billions of stories. And on a shelf somewhere are all ours, all of the ones He's penned together for this time in this place. For just a few days or weeks or months, He's written us each into one another's books. Each patient and nurse and surgeon shares a part of our stories, and He is the Author who has lovingly planned and recorded each one.

He is the Author and He is the Librarian, carefully arranging our books in the proper place at the proper time, setting Grace's in the middle of a shelf full of pediatric nurses who in turn are nestled among hundreds more stories of people from around the world, living out their calling on a ship off the coast of West Africa. Writing our days to weave together in His perfect plan of love and healing.

As I turned to go I saw Him smile, take down a book, move it to the next shelf over.

I left the library in His care.

Most days, being the Ward Nurse Maxillo-Facial Team Leader doesn't mean a whole lot out of the ordinary. I lead rounds, write orders, cover lunch breaks. I do all the same things the evening charge nurse does, just with a fancy title tacked onto my badge. Things can fall into an easy routine and I forget that I'm really in charge of anything.

Until someone comes asking for my input, because I'm one of the ones who can say yes or no.

Today, as I was getting ready to leave, one of our hospital physicians came into D Ward looking for me. There was a little baby with a cleft lip and palate waiting in C Ward. She was being seen by the feeding program and just wasn't gaining weight.

When I introduced myself to the baby's parents, they smiled up at me, eyes full of hope. I placed the oxygen sensor on her little foot, and as I bent to assess her, I asked her name. Her mama answered simply. Grace.

Grace. An undeserved blessing. At ten weeks old, she weighs just a hair over six pounds (if that), despite her parents feeding her as much as she can handle, a few drops every half hour. Too much of that formula seems to be going into her lungs rather than her stomach, and the telltale signs of a baby in distress were easy to see when I unwrapped her to check her oxygen levels. Add to all this a congenital condition that caused little Grace to be born with an underdeveloped lower jaw, further increasing the work she has to do to breathe, and it's no wonder that she's very sick.

The problem is, we're not a medical hospital. That may sound strange, but it's really more accurate to call the ship a floating specialized surgical centre. We're set up to do surgeries, lots of them, and our patients are, for the most part, perfectly healthy apart from whatever body part we're operating on. Grace is far too small for surgery right now, and this close to the end of the outreach we're not even sure we can get her fat enough to withstand the operation to close her cleft lip before the ship pulls up anchor and sails away.

It's wrenching being caught like that between a rock and the very hardest of places. Yes, we could admit her to the wards, put in a feeding tube and help her gain weight. But every day she spends in a bed is another day that someone else might not get to have surgery. New patients show up on the dock every single day with tumors and cleft lips and a myriad other conditions; we could stay here for years and not come to the end.

In the face of such overwhelming need, how do you triage? How do you decide who gets to come on board and who gets sent home? How do you choose one life over another? And, once you've made the decision, how do you sleep at night?

Sometimes it's all I can do to stop my mind from racing through the day's decisions, replaying every conversation, questioning every move. Tonight is not one of those nights.

This evening, Grace is under the watchful eye of a pediatric ICU nurse in D Ward. There's another PICU nurse working tonight who will take over her care, and one of the nurses working tomorrow morning is the one who used to run the feeding program before the current dietician took over. God knew Grace was coming to us today; it seems He set up the schedule long in advance to make sure the right nurses were working at just the right time, just like He's done so many times before. Grace's papa saw me at the gangway as he left for the night. Thank you, he said. Grace is in the room now. They are caring for her. Thank you.

Tonight I sleep easy, knowing that we made the right choice. Whatever happens with small Grace in the future, she is ours to care for now. The need in West Africa is no less overwhelming because we've admitted this one tiny baby, but I know in the deepest part of me that we are not called to fix all of West Africa. We are called simply to be faithful to the ones placed in our way.

Today, that was Grace. Tomorrow, it will be someone else. And the next day, and the next, and the one after that. Every day we will reach out to the hopeless and speak to them of God's love. Every day we will be called on to extend to them the same grace we were once shown.

Grace. An undeserved blessing.

Almost every man here in Togo wears his hair cut very short, a millimetre or two away from a smooth shave. So when I walked into D Ward this morning and saw the curly mop on Abola's head in Bed Six, I was a little surprised. I knew we'd have to do something about it before Dr. Gary could tackle the fist-sized tumor poking out of the curls on the right side of his head, and since I seem to be the one with the most experience in hair cutting this year, I ran back upstairs for the clippers.

During rounds, Dr. Gary told the patient that we'd be cutting his hair before he went to the operating room and looked at me to confirm that I was up for the task. I laughed and pointed to the clippers, charging on the desk, and he went on to offer Abola his choice of hairstyle. We can just cut the hair around the tumor, or we can cut all of it. It's your choice. Abola replied immediately. Cut it all.

And so, after rounds, and after the customary disclaimer that I'm not a professional barber, I draped Abola in a sheet and set to work. A few minutes and quite a bit of hair later, he had a completely new look, one that was admired by everyone in the ward. I took him into the bathroom to wash off the extra pieces and give him his pre-surgical scrub, and he peered into the mirror, turning so that he could see the tumor. It stood out in sharp relief from his newly-shorn head, obvious now that his hair was gone. He touched it once, gently, then turned to let me finish my work.

As I left for the day, Abola was being wheeled from the operating room to the recovery room. The clean, white bandage was wound tight and smooth against his head, the tumor completely gone.

He won't need to let his hair grow long again. There's nothing left to hide.

I first met Nathanael when he was a patient on the wards two years ago here in Togo. He was just a little baby when we repaired his cleft lip, his mama ever-watchful by his side. We knew even then that Nathanael's life wasn't going to be an easy one. His tiny eyes and misshapen features spoke of an unidentifiable disorder, and we doubted that he'd ever walk or talk.

We did what we could do. We fixed his lip and made plans to see him again to repair his palate and we sent them home, just like we always do.

Nathanael was admitted again yesterday, his mama grinning wide as we recognized each other and shared an embrace with Nathanael sandwiched between us. His sweet face squinted up at me, smiling his benign smile, the same Nathanael I remembered from last time. Just bigger now. Just as damaged as we'd expected, badly needing the operation to close his palate to make it easier for him to eat without food going into his nose and down into his lungs.

Not long after he went to the operating room this morning I got a call from Dr. Gary. He had bad news, the kind that makes your heart sink when you look over to the corner of the room to see a mama kneeling by her bed, praying for her son.

Somewhere in the course of the last two years, Nathanael had surgery to try to close his cleft palate at a hospital in Burkina Faso. It wasn't their fault, but the operation failed, leaving the hole even wider than before. Once Nathanael had gone to sleep this morning, Dr. Gary found what he'd been dreading, that there just wasn't enough tissue to attempt a second repair. And it fell to me to tell his mama.

I took her out into the hall with a translator and I explained that what we'd hoped for hadn't happened, that she was going to go to the recovery room and hold her son while he woke up looking just the same as before. I told her I was sorry, and she looked me straight in the eye and spoke confidently.

We have been praying for so long for this surgery. If it has not happened, it must be God's plan. We cannot understand God's plan. If we did, He would not be God.

I had no answer, nothing to add to that incredible truth. I walked her down the hall to recovery, and as we reached the door she put her hand on my shoulder and spoke in English. Ali, you are in my heart, she told me, and went in to see her son.

We walk among giants, Dr. Gary told me when I found him and recounted the conversation, when I gave voice to my secret, suffocating fear that I will never have enough faith to be a mother like Nathanael's. When we get to heaven, we'll see who had the most faith, and it won't be us. And it won't matter.

We walk among giants.