patient stories

Today was frustrating. I hate not being able to fix things. When it's babies that are broken, it just hurts my heart that much more.

Abel is one of the roundest-faced two-year olds I have ever met, complete with a bottom lip jutting so permanently out that I briefly considered hanging my stethoscope on it. He is also one of the most stubborn. Getting Abel to drink a nutritious, delicious can of Pediasure is nearly impossible. Getting him to swallow medicine is a kamikaze mission. I attempted both today; I also showered directly after work, and I might actually have run the water for my full two minutes. My hair still smells faintly of augmentin syrup, but I think I got the worst of it out.

Abel was born with a condition in which the skin never closed over his bladder, and his plumbing, as a result, is not terribly functional. Four days ago, he underwent a very painful surgery to jury-rig a solution to the problem, and he's been angry with us ever since.

It's the rare child I'm unable to connect with, but Abel had me totally stumped. The Lion King wasn't interesting. Stuffed animals were scary. And even my failsafe standby, a huge book of stickers, was an object of utter disdain to my pouting little friend. It was at this critical moment, when all my tricks were exhausted, that Abel's mother left his bedside to go bathe in the tiny, shared bathroom. And the lip that I had thought was at maximum levels of jutting not only stuck further out, but also started to quiver as his eyes filled up with tears.

Come, I said, and held out my arms.

He was surprised, I think. I hadn't tried it before, mostly because I was sure that the result would be kicking and screaming. But I had caught him off guard, and before he realized what he was doing, he had lifted his pudgy little hands up to me. I scooped him up and held him close to my chest, his body stiff in my arms. I rubbed his back in small circles, crooning soft words in Liberian English as he relaxed into me and his head found the corner in my neck reserved especially for small, brown boys.

When his mama returned, I placed him gently back in his bed and his dark eyes followed me until I had disappeared around the corner.


I just can't help thinking that it's exactly what God did with me.

For so long, I resisted all His advances. He tempted me with unfettered love and sure promises, and I rejected Him at every turn. Nothing He offered was good enough for me; I was the kid who didn't even want stickers.

And then, when I wasn't expecting it, He just held out His arms. Come.

And I did. And I relaxed into that corner that He had reserved especially for me, and now I can't figure out why on earth I didn't want to be here all along.

Walking up from the gate the other afternoon, I once again met up with Joanna, the Queen of Mercy Ships. We got caught up on her daughter's life and my work on the wards, and then she dropped a bomb into our casual conversation.

Friend die. My face fell and I stopped walking, my feet planted to the concrete. She nodded sagely. Friend really die-o, she confirmed, as my heart sank through my feet.

Friend was another of our long-term patients; he was with us at the same time as Joanna and Baby Greg and Bendu. For years, a tumor had been growing on his back. We took a biopsy, knew that it was cancer, but realized that the quality of his life would be so much better if he could live the rest of his days as a part of society. So we removed it, grafted skin from his leg over the open sores, and battled the infections that followed. Friend hung out in his bed in the corner of the ward, number fifteen, for quite a while. So long, in fact, that he earned himself a new title: King of Mercy Ships. He and Joanna were quite a pair. We got to know him, and he would pray with us at devotions and encourage us with testimonies of how God was making a way for him. And he would complain about pain in his hip.

We figured it was because of the awkward angle at which he carried himself, half hunched over like a boxer nursing a bruised set of ribs. We goaded him constantly to stand up straight and exercise his muscles. Eventually, he went home.

We found out a few weeks later that the cancer had returned, bursting through the skin of his hip. Joanna, who had remained in contact with Friend after they both left us, would come for her own appointments and let us know how he was doing. He trying small. He really not too well. Or, finally, He really die-o. The King's fight was over.

She told me that he was really disheartened during his last days, that he had completely lost hope. And while I hate to think of my Friend living out his final hours in despair, I'm holding on to the fact that healing doesn't always happen in this life.

My best friend here on the ship left today to go home for three weeks. While I can't begrudge anyone their time off, especially knowing how much I'm looking forward to my own in a few short weeks, I found myself feeling rather lost and forlorn this afternoon. I was sitting in bed reading a book when I got a call from the gangway. There's a patient here to see you. Since it's Sunday and I wasn't working and definitely not in a good mood, I thought about telling them to go away. I figured it was some random Liberian who got my name from a former patient and was here to tell me about their cousin's neighbor who has a tumor. Someone else I would have to say no to. The guard upstairs continued. His name is ... Harold. That was all I needed; I grabbed my slippers and headed for the dock.

Harold was one of my patients last week. He wasn't really sick; all the patients from here until the end of the outreach (I can say that now, since it's only three weeks away) are less complicated cases. Harold is a beautiful six-year old boy who recently started getting teased at school. His gums were swelling and sometimes they would bleed a little bit, so he would come home crying to his mama because the other kids laughed at him and wouldn't play with him. They were screened at a dental clinic and came to the ship for a simple surgery to correct the problem.

Harold was quiet the day he and his caregiver, his father, were admitted; I don't think he said a single word to me. Just beamed up at me with a huge, lopsided smile as I found balloons and coloring books and Jenga blocks for him to play with. It doesn't take much to cement a friendship with a six-year old, and by the time he went to the operating room the next day, we were good buddies. That served me well after his surgery, when I found it remarkably easy to convince him to take his medicines, finish his dinner and hold still while I took out his IV. Except for some confusion with a visitor card and a less-than-friendly encounter with his mother, Harold and his father were perfect patients. They went home the next day, and I couldn't imagine what they were doing on the dock.

When I appeared at the top of the gangway, little Harold caught sight of me and his face lit up like Christmas. I ran down the steps (carefully of course, in case the safety officer happens to be reading this) and he threw his arms around my waist. I sat down and gathered him into my lap, grateful for the hug I'd just been thinking I wanted. His mama sat by his side, beaming. We chatted about Harold and about how much she regretted being surly the other day. She shared with me that I have what's known as a Lomo Shape, after the Lomo tribe, renowned for, you guessed it, their wide hips and large bottoms. We even talked about the weather for the customary small while, and then I asked her why she had come. Her smile got even wider.

Ever since he come home, Harold been missing his White Aunty! He just telling us about the ship and he say he missing you and he wan' see you. So we catch car from Painseville and we tol' them your name at the gate and so they say we can come to see you. Harold just sat on my lap, his head nestled into the corner of my neck, not saying a word.

Painesville is a good forty-five minutes away from the ship, and you have to take two different taxis to get here. Factor in the time spent waiting at the side of the road and possible breakdowns, and it's a journey that can take up to three hours. Each way.

They had no agenda. They didn't ask me for money or food or a ticket to America. Harold's mama had been feeling guilty about being snappy with us, and so when Harold said he was missing me, she piled them both into a taxi and headed over to make it right. We talked for a long time about social dynamics in Liberia, how everyone's trying to get on top, and no one on top looks down to help those below them. When it came out that I'm not getting paid to work here, that I'm actually paying crew fees so that I can do this work, she almost fell off her chair. What she said will stay with me for a while.

You people are really different. I come to the ship and everybody smile at me. You abandon your homes. You abandon your families, and you come to us in Liberia. And I see the way you all can love. And that is how I know you are Christians. This is God's work here.

I choked back the tears that were threatening my composure and invited them to come inside for the evening church service that was about to start. Harold shook his head, still without saying a word; apparently the memory of surgery was too fresh. So, less than half an hour after they had arrived, Harold and his mama got up to leave, their mission to visit with me accomplished.

I walked with them to the gate, Harold's small hand firmly clutching mine. When I turned to leave, I knelt down to give him one last hug. His arms went around my neck, and his mouth found my ear to whisper the only words he would say during the entire visit.

I love you, Aunty.

My cup is overflowing right now. For some reason, the eight hours I just spent on the ward were some of the best this whole year. Maybe it was the end-of-the-school-year feeling that pervaded the hospital as we packed up D Ward, hopefully for the last time, and moved all those patients up the hall to A and B. Maybe it was the beautiful kiddos, peeking out from behind bandages and tubes in their noses, lifting up skinny arms to be held, snuggling their tired heads into the corner of my neck. Or maybe it was just a good shift, something that last happened so long ago that I seem to have forgotten what it feels like.

In beds nine and ten are two little boys of similar age, both named Mohamed. I was taking care of Mohamed Number One in bed ten, and ended up by proximity chatting a lot with the mama of Mohamed Number Two. In French. My paltry grasp of the language made me the best interpreter until Dennis showed up at eight in the evening, so we spent loads of time laughing together as I searched for words for things like recovery room and endotracheal tube. (Had no idea how to say either, so I settled for when his eyes open, you will go to him, which seemed to get the point across.)

In the meantime, Mohamed Number One followed me around like a shadow, chucking his bright orange balloon at my face and laughing hysterically when I head-butted it back to him. Thanks to Amy's photographic skills, I can show you how both his ears were covered in a thick bandage, which actually made no difference in our communication in the long run; he doesn't speak a word of either English or French. Good thing I speak fluent balloon.

Mohamed Number One's mama is a stout lady who wraps her head in a red scarf that tends to clash with whatever else she's wearing. Early in my shift, while the room was a chaos of patients being moved, babies crawling around and beds being shuffled, she quietly approached me. Sister, I need to pray. She gestured helplessly at the melee around her, silently asking me for a quiet place where she could kneel in peace. I led her to an empty room, unused because of the thunder of the generator below. It's really loud in here, but God will hear you anyway. She beamed her thanks and spread her lappa on the floor.

Later, when the father of Mohamed Number Two came to visit, Number One's mama asked me if she could show him to the room so they could all pray. I assented, and as they headed for the door, her voice floated back to me above the beeps and wails. That girl, she really know how to love us.

I'll hold on to that on the days when nothing seems to be going right.

Since I'm updating, I think it's only fair to let you know what's going on with Kwelywoh. While his friend Moses is headed home in the next few days, happy and healthy (except for his lopsided eyes, which we can't do anything about but which do lend him a certain air of whimsy), Kwelywoh's road has turned out to be rather longer.

He's not doing as well as we'd like. The hole in the front of his skull, where his brain was poking out before the surgery, has stayed open. The gap allows the fluid from around his brain, CSF, to leak out, causing swelling and sometimes dripping from his nose and eyes. There's a huge risk of infection, and it's not good for the pressure around the brain to be changing constantly, which is one side effect of this leak.

He went back to the operating room today to have a small drain placed over his eye. (Not sure when Amy's arms got so long, but she did manage to take this photo and be in it at the same time.) This procedure isn't something we usually do here in Liberia, and it's not something he can go home with when we leave in a few weeks. We're out of options at this point.

And so we're back to our old standby; we'll pray for a miracle until one happens. Given the things I've seen in the last nine months, I'm figuring it's not such a long shot.

Almost two weeks ago, Eddie had the first of many surgeries he will have to endure. The doctors took skin from his leg (wrapped up now in bandages to resemble, almost perfectly, a little chicken drumstick) and used it to cover the sore on the top of his head. They used some more skin to fashion brand-new eyelids for him. He, understandably, wasn't to happy about all this.

The bad news? Eddie is a baby, and babies can't be reasoned with. Don't touch your eyes holds no weight with a five-month old. While we weren't looking, Eddie managed to scratch the delicate graft over one of his eyes, causing it to partially fail.

The good news? This list is a little longer. The other eyelid took splendidly. Now, when he sleeps, his right eye is shut tight against the light and dust. His left left still hangs open just a little, but he can blink it when he's awake. His head is healing well. His belly is getting fatter and fatter.

And yesterday, when his mama dropped him into my lap while she went to chat with a friend, he looked up at me and grinned. His little scarred face was transformed from a grotesque mask into a real, honest-to-goodness baby smile, complete with gurgling cooing noises.

He's already starting to overcome.

As the outreach winds down and exhaustion sets in, it gets easier and easier to be annoyed. I've recently been increasingly frustrated by a lot of things. Politics in the organization (probably made all the more drastic in my own eyes because I was naively expecting to escape that aspect of life by coming here) and interpersonal relationships (although friction is to be expected when we work with people from thirty-three nations) have formed the bulk of my discontent.

It's so easy to focus on the negative. It could be the most beautiful day in the world and all I'd notice was the fire ant bite on my ankle; people are like that. It's not terribly surprising that my fuse is a little short these days. It just seems like, no matter how good things might be, it's never good enough. This morning on D Ward, I got a bit of a reality check.

Moses and Kwelywoh are the two boys on the ward recovering from encephalocele repairs. (These photos are Holly's.) Moses had a lump the size of a large clementine jutting out from his forehead, flattening his nose and pushing his eyes to the side. Kwelywoh you know; he's the one we had to refuse earlier in the outreach, but he was able to be scheduled about a week and a half ago. They both had the skin of their faces peeled down, their skulls dismantled and then put back together in marathon surgeries. And they're both okay.

I was struck by how insane it is to be able to say that when a vision trip came through the hospital. Vision trips are groups of people who come to the ship, not to work, but generally to see how their donations of money or supplies are being used. A group of people who had been involved somehow in supplying things for the hospital showed up at the door near the spot on the floor where Moses and Kwelywoh were sitting together, playing with toy cars. Kwelywoh gazed at them silently from behind his bandages (he should be released from that prison tomorrow!) while Moses fixed one of his eyes on a lady at the front of the group. As I grabbed his chart to show them a photo of his face before surgery, he broke out into an enormous grin. And I stood there and explained just what Dr. Gary had done to save these little boys' lives, something that should have been impossible in Liberia.

The vision trip eventually moved on, and in a quiet moment, I felt a small body lean up against my leg. I looked down to see Janet, a seven-year old girl who came in for a terrible tooth abcess. She's getting better, but she still screams and moans during her dressing changes, and I didn't think she was really my biggest fan. However, she was bored, and I guess I looked like I could help with that.

She leaned up against the right peds nurse. I ran to my room to grab the sets of watercolors that my blog-reading friends had sent me, and stopped by the office on the way back to print out some coloring pages. I set Janet up on a little table on the floor with her pictures and paints and a little tub of water. I stepped back to watch her paint, and she stared up at me, hands folded on her lap. You know this? I asked her. She shook her head.

I took the brush, dipped it in the water and swirled it in the circle of yellow. Her eyes widened as she saw the bristles take on color. I touched the brush to the paper, leaving a small streak of gold, and I thought her head was going to fall off from grinning. I left her the brush clutched firmly in her hand, painting butterflies in all the colors of the rainbow.

I'm caring for children who have had brain surgery in the midst of a war-torn country in West Africa. And I taught a seven-year old girl how to paint.

It's enough.

And just when this night was threatening to last forever, Richie turned over in bed, dislodging the oxygen probe taped to his toe. I ducked behind the curtain to silence the insistent beep beep beep of the monitor before his neighbor, a cranky little man who just had his palate sewn back together, woke up and added to the noise.

I rolled Richie over, loosening him from the stranglehold of IV and feeding tube and blankets that he manages to get himself into the moment I walk away, every single time. I retaped his toe and rubbed his head a few times for good measure, hoping he would be able to rest. When his eyes had drifted closed again, I got up to leave.

As I turned, a little brown hand reached after me, grabbed ahold of mine and refused to let go. He looked up at me as he tugged me back to my knees next to the bed. His other arm, free now from the tangle, threaded itself around my neck as he pulled my face close to his, our foreheads touching in an almost-Maori salute.

We stayed that way for a while, until he was really and truly asleep. I slipped my fingers from his, tucked his arm back under the blanket and went to check on my other patients, my heart a thousand times lighter.

Richard and Nicholas have got to be two of the oldest souls I have ever met. Maybe it's the amount of time they've spent in hospitals. Richard (who prefers to go by Richie) has spent a quarter of his life as a patient at the Island Pediatric Hospital here in Monrovia; he's four going on four hundred. Nicholas is the younger of my charges; he's only three, and all his memories involve doctors and tests and medicines and pain.

They both drank caustic liquids over a year ago, and they're two of the worst cases Dr. Jose is working on here in Liberia. They're the reason that I'm sleepwalking right now, almost through my second night after days with no rest. But nine months on board makes me the pediatric ICU nurse with the most experience, so I'm the woman for the job.

It's incredible how fast these nights are passing. Between Nicholas' squeaky breathing and Richie trying his utmost to fall out of bed (despite the fortress of siderails and pillows that I've built for him), they've kept me busier than I can remember being all year. If they weren't both so cute, I might almost be annoyed.

But like I said, they're old souls, and it's enough to amuse me to the point where Richie's constant thrashings and coughings and tuggings aren't quite so frustrating. I've never been able to reason with three and four-year olds before, but Nicholas and Richie (in their more lucid moments) seem to have a perfect grasp of abstract concepts like waiting for their medicine and listening to the nurse when she tells you to stop scratching your skin raw. They look up at me with liquid black eyes as I bend over their beds to rub their backs and straighten IV lines and untangle them from their tubes and wires. The solemnly nod their little heads when I ask them if they're feeling pain. If they want to have medicine. If they want to sleep.

Richie is finally at peace. He and his mama are sleeping top-to-tail in his bed. His limbs are splayed out wildly, except for one little hand, holding tight to hers. Nicholas is draped across his mama, nestled in the crook of her hip, his little teddy bear clutched firmly in his arms.

It's only a matter of time before they both start up again, Richie with his incoherent cries and Nicholas with his coughing. But for now, I'll revel in the quiet.

It seems that a lot of my favourite moments on the wards involve little naked kids running around. Yesterday was no exception.

The wards are full of kids right now. We have a new doctor, Dr. Jose, a pediatric surgeon who mainly operates on babies who were born with gastrointestinal malformations and kids who drank caustic liquids. This latter bunch are a sad lot. They usually go wandering to a neighbor's house and see a cup sitting on the ground. Not knowing that it contains lye, a horribly corrosive liquid used for making soap, they pick it up and take a drink. The result is an internal 'burn,' all the way down to the stomach. When the wounds heal, they're left with scar tissue and tightening of the esophagus. These kids often become malnourished and require feeding tubes because there simply isn't enough space in their now-tiny esophaguses for food to pass.

Mark is one of these cases. He's two-and-a-half and he's been in a few times in the past weeks for a procedure where Dr. Jose uses a thick tube to stretch out his esophagus. He's not a big fan of us, but he's comforted by the fact that he's got friends here, other babies and their mamas who have all been doing the round of local hospitals, trying to find treatment that will prevent their children from starving to death.

Yesterday, close to the end of my shift, Mark was running around the ward, stark naked. Before you call me a bad nurse for letting my children hang out like that (pun most definitely intended) you have to know a little background. We're on a water restriction on the ship right now. The water we use for drinking, bathing, flushing toilets and everything else is supplied from a hydro plant here in Liberia. Recently, the supply has dropped drastically, and so we get announcements at community meeting reminding us that we really can't use more than two minutes in the shower and the tap needs to be shut off when we brush our teeth. We've had low reserves before, and it always resolved within a few days. This time it's different. As of Monday, we had about six days worth of water left on the ship. We're in crisis mode. No one is allowed to do laundry. We're using disposable plates and cups at meals so we don't have to run the dishwashers. It's been suggested that daily showers aren't a necessity. We have no idea what we'll do if the situation doesn't improve.

However drastic this might sound, it did provide the basis for my incredible amusement. Mark had been drinking a cup of water. He's not really the best at drinking anything, and the majority of the precious liquid ended up poured down the front of him. When his mama went to the cart to get a new gown, I gently reminded her that we have no water to do laundry and so he needed to keep that gown. He, however, didn't feel like wearing a sopping wet garment, and so we took it off him and draped it over the end of the bed to dry.

Which is why, as his little friend from the next bed packed up to leave, Mark was running around in nothing but his birthday suit, absolutely content. It was only when his own mama left the ward to say farewell to her friend that Mark realized the truth; not only was his little friend, Momo, leaving, but his mama was disappearing for a while too.

He bolted through the half-open door and took off down the hallway with me in hot pursuit. What followed was enough to make me laugh for days. As his mama and his friend disappeared through the door to the aft gangway, he started yelling and stomping around, NG tube and all his little dangly bits ... well ... dangling. Mama-o! Mama-o! Mama-o! I was trying to hold in my giggles while trying, unsuccessfully, to herd him back into A Ward. He, in turn, was trying, also unsuccessfully, to fend me off with small, flailing arms.

It turns out that it's nearly impossible to reason with a distraught, naked two-year old. I varied my tactics as he ran in circles and we both got out of breath. Hey man, come inside. I will get you gown. You can't be naked in the hall. Don't beat me, man! You're alright. Mama will come back. You're alright. Come inside. You can't be naked. Don't beat me. You beat me, I will beat you. (As an aside, I would never beat a kid. But people were staring, I was desperate, and it's a threat the mamas tell me to use that, while never carried out, generally has enough weight to ensure compliance.)

Eventually he ran out of steam. I knelt next to him in the hallway as he dropped his tired head onto my shoulder. With one last half-hearted call for his mama, he gave up the fight. I carried him inside, found some PJ bottoms for him to wear until his gown dried and climbed into his bed. He nestled into me, head on my chest and little arms wrapped tight around me, and fell asleep.

I think I won that battle, but it's hard to tell. Maybe it wasn't one I should have picked to begin with.

You just can't be naked in the hall. That's all.

This place is such an odd kaleidescope of conflicting emotions. Twist the glass one way and your sides hurt from laughing. Turn to face the light and your heart is shattered. Today was a day of both.

Dawayne is eight. He's in third grade. (Do the math and you'll realize that he's in the right year for his age. It's the first time I've seen it since coming here.) He's a bright kid, and I'm not just talking about the lightness of his skin; he read me the story of Jonah this morning, only stumbling over words like Ninevah and repentance. He's really not too sick; as I was leaving work he was being called to the operating room to have his hernia repaired.

This morning, Dawayne provided me with two of the funnier moments I can remember. I went over to him, needles in hand, and explained to him that I needed to juke him small for an IV. That I would make sure I got it on the first try. And that, if he held still, I would give him not just one, but seven whole stickers. His eyes lit up and he stuck out his hand, brimming with confidence. His bravado failed him, however, as I approached his skin with the needle. His eyes rolled heavenwards in supplication as he screamed out in utter seriousness, JESUS, take me now! I had to stop and compose myself before starting that IV.

A little while later, the mamas in his corner called me over. They prophesied over me that, once I get back to the States, the first thing I will do is born a baby. While my ovaries don't mind the thought of that, I explained that I had to get a husband first. One mama laughingly offered her three-year old son. I told her he was too small and that I needed a big man. At which point little Dawayne rolled over, looked up at me, and with raised eyebrows and a sassy little head tilt delivered a perfect impression of Joey Tribiani. How you doin'? I almost peed myself.

And the kaleidescope shifts and Eddie fills my view and laughter is the last thing on my mind.

Eddie is four months old. From the neck down, he's like any other baby. He's the firstborn in his family, a little porker with chubby thighs and a miniature pot belly. Eddie is cherished. When he was born in the middle of the rainy season, his mama made sure to always cover him with a mosquito net when he slept, to make sure he didn't get malaria. About two months ago, an aunty was doing something by candlelight as the baby slept, secure under his net. She placed the candle on the ground, and in just a few seconds, little Eddie's life went up in flames. The net caught fire around him, and his face and head were horribly burned.

I hold Eddie and rock him and kiss the angry pink skin on his cheeks. I tell him he's beautiful. To anyone other than us, though, he's hideous. He doesn't look like a baby anymore. His eyes can barely open and close. His lips are a static mass of scar tissue. His nose is gone, leaving only two small holes in the centre of his face. The top of his head is an open sore. Everything else about him is the way it should be. His skin is creamy brown, his fingers delicate and perfect. It's just his face, the first thing everyone will see for the rest of his life. It's just his face that's been destroyed.

His mama loves him. She holds him and rocks him and dresses him in little outfits that we've scrounged from the bottom of donation boxes. She can't bear to be there when we change his bandage, so we take him to another room. He wails as we soak the infected sores on his head with vinegar, shaking from side to side, trying to make it stop. And then he quiets, submits, gives up, and that's maybe worse than all his screams.

I'm afraid for little Eddie. I'm afraid of what his life is going to be. He will never know what it means to be normal. He will live forever with people staring at him. People hating him. People ignoring him or making fun of him or calling him ugly. We sit here and we tell him he's beautiful (and he is, really; you just have to ignore the obvious), but he's not going to hear that very often when he leaves here.

Which made it all the more poignant when I heard his mama singing. I looked over to their bed in the corner to see her lying down, Eddie propped up on her stomach. From behind, all I could see was the plumpness of his diapered bottom, encased in a clean, white onesie, and the fresh whiteness of the bandage around his head. She bounced him up and down as she sang quietly.

I am on the Lord's side.
I will never give up.
I am an overcomer,
For the Lord God is on my side.

I pray that Eddie would be an overcomer. That he would somehow have the chance to grow up and go to school to learn to read like Dawayne. That he would be surrounded by people who can see past the scars.

That he would know love.

We've said no so many times that yes has come to feel almost foreign on my tongue. Finally, though, we've been given the chance.

Kwelywoh is back. I saw his name on the admissions list yesterday, and ran down to D Ward to find him curled up in bed 15, looking a little surprised to be on the ship again. I knelt down next to him, and a little arm snaked out from under the covers to curl itself around my neck. The lump between his eyes pressed into my temple as he hugged me silently.

He had surgery today. In another marathon operation (the second in as many days for Dr. Gary) his skull, too, was carefully dismantled. His brain was gently returned to its proper place, and his head was meticulously reassembled.

An encephalocele repair is a surgery so specialized that I've never even seen one in the States. We've done four this year, and there's another waiting to get over his malaria on B Ward. It's incredible to me to think that we're able to do operations like this in a war-torn country with no infrastructure, no electricity and no running water.

Someone on the ship here today laughed at me when I told him I wanted to live out in Liberia proper, out there amidst all the squalor and dirt. I do, though. Someday, eventually, when this season is over, I can't wait to get out of this plush life. But as much as my heart is on land with the people of Africa, I'm coming to realize more and more just how much we're able to do in this floating city.

It feels good to be able to say yes.

Remember Yeme? I figure it's time for an update.

She's had more surgery, and the tumor above her eye is gone, the scar already fading quietly into her skin, barely noticeable between her plaits. She's blossomed in the almost-three months she's been on the ward. The walls in her corner of B Ward are covered with drawings and crafts and language charts, spelled out phonetically so we can communicate with her in her own language. (She just laughs when we try, but we're all getting a kick out of it, so no one really minds.) She's learning English, too, picking up one word at a time by mimicking our voices with uncanny accuracy.

It's almost time for her to go home. In the eighty or so days she's been with us, we have had no communication with her family. They haven't tried to call or write or use any other means to find out how she's doing. It's like they don't care, which could be closer to the truth than I want to think.

But she doesn't need us anymore. We've loved on her as much as we can, and her wounds have all healed. As hard as it is for us, the truth is that as soon as we can get her a flight, she'll be winging her way back to Guinea. Back to her village. Back to the people who abandoned her at our gates.

Hopefully, back to love.

We have something here on the ship called the Adopt-A-Patient Program. For those who work on the ship but don't have anything to do with the hospital, it provides them with an opportunity to come to the wards and spend time with our lovely patients. Crew members sign up and get the name of someone having surgery. They visit that person as often as they'd like while they're stuck in the windowless tin box we call our hospital. Some crew members visit once, some end up coming every day for weeks on end. Dorothy is one of the latter.

She's a teacher at the Academy, our on board school for children of the families who live and work here. When she picked up the slip of paper with Mickey's name on it, she had no way of knowing that Mickey would end up being one of our long-term patients. (Forty-nine days at last count.) He's a little man who had plastic surgery to release burn scars on his hand. The first time his bandage was changed, everything looked so good we considered sending him home. The next time we changed it, we were afraid he would lose a digit; infection had spread and threatened the skin grafts between his fingers.

Mickey started out shy. He was tiny, with little stick-thin arms and legs and he screamed every time a white person came near him. Dorothy never seemed to mind. She doggedly visited him, day after day, until finally her persistence paid off. I was working the other day when she called. Is it okay if I come see Mickey boy now? Or course it was okay. It's always okay for someone to come to the wards and tire out the children who seem to be feeding off an energy source I'm sure the US government would love to tap into.

When Dorothy's face showed around the door, Mickey gave a shriek of glee and toddled at top speed across the ward to fling himself into her arms. He's not shy anymore. In fact, he pretty much runs the place, getting pulled around the halls, perched like a sultan atop a pillow in a laundry basket, by willing servants.

One of the other nurses working that night noticed that Dorothy was wearing her white Mercy Ships shirt. In fact, Dorothy wears that shirt every single time she comes to visit Mickey. The nurse, curious as to why her apparel was so limited, asked her about it. Dorothy's simple answer stunned me.

I figure the Liberians don't have a lot of different clothes. And you nurses always wear the same uniforms. It doesn't seem right for me to come down here and flaunt my wardrobe. So I just put on this shirt.

That's the closest thing to Christ I've heard in a while.

I'm trying to resign myself to the fact that I'll never be able to properly explain this place to anyone who's never experienced it.

I was working on B Ward yesterday evening. There aren't so many babies anymore, but those who are there have been there for what feels like forever. Something like a month and a half. They think they run the place, and the noise level was significantly intense for most of the shift.

During a quiet moment close to the end of the evening, an anesthetist came in to speak to one of the patients about her operation in the morning. This particular lady speaks no English and, as it turns out, was holding a small grudge against us for jabbing her with needles to start her IV. Thankfully, my patient in the next bed, a sweet, smiling woman about my age whose face and arms and torso are covered in tumors, could communicate with the surly Oma. The only one she couldn't understand was the anesthetist.

So I stood at the foot of her mattress as the doctor sat on the end of his patient's bed. He asked a question, which I relayed in Liberian to my patient, who then asked her neighbor in their tribal language, Mano. The answer would return through the same channels. The interview took a surprisingly short amount of time, given the convoluted methods we were using. When prompted at the end, the old lady had only one question, and it wasn't for the anesthetist.

She scowled at me as my giggling interpreter/patient translated. She want to know why you people juke her (stick her with needles). She say that thing on her hand is not good. I scowled back at the Oma until we both started laughing and explained through my trusty translator that the thing on her hand was good and that if she took it out, I would come juke her again, any time of the day or night.

At which point she mumbled something and disappeared under her covers. My patient turned to me, grinning broadly, happy to be providing clarification. She said 'good night'. And she will keep the thing on the hand.


It must take incredible courage to come into this ship for surgery. To be surrounded by white people who don't speak your language and who do things to you that make no sense, whether you like it or not. My friend, Amy, took another patient for a dressing change yesterday. When they came back, he was proud to share the new knowledge she had just imparted to him while juggling the gauze and tape.

I learn about my heart. And I learn about my lunges. And I learn ... Here his memory got fuzzy, until prompted by a laughing Amy. You should only have one wife. Two women is too many problems.

When he says he learned about his heart or his lunges (lungs), he's not talking about cellular physiology. Today, Jacob learned that he has something called a heart that pumps his blood and two things called lungs that help him breathe. He didn't even know. Most of them don't.

And yet they gather together their pain and their fear and they walk up the gangway anyway, lured by the promise that maybe, just maybe, they'll get to leave whole again. How can I go back to North America and explain what it feels like to look into a patient's eyes and see that? How can I share my experiences here in a way that will make sense to the people closest to me? How can I make them understand what I've been doing when my own life sometimes feels so foreign to me?

I think I'm going to need a translator.