maomai

I'm sad right now. O'Brien's going has left a bigger hurt in my heart than I thought it would at first. I keep thinking about him, about his poor, broken mama going home with empty arms. I can't stop replaying those last few moments of his life while he slipped away and we just watched him go. I still have the photos of him on my computer, and I keep stumbling across them and a wave of pain just washes over me again.

And then yesterday. I heard my name shrieked from the ward where they were doing a surgical screening, and I stuck my head in to see Antoinette, a patient from last year in Benin. I sat down to talk with them, as far as we can talk with my few words in Fon and her few words in French. We hadn't been there long when mama beckoned over a translator. We usually muddle along just fine without one, so I wondered what she needed to tell me.

She spoke a short sentence or two, and the translator turned to me with no preamble, nothing to prepare my poor, bruised heart. She says that baby from last year died. I think the one named Maomai? No explanation, no other information. Just a baby who was fat and happy and smiling in my arms the last time I saw her, and now for some unknown reason, has died.

I don't even really know what to write. I'm sad and I'm discouraged, and I can't see my way forward through all this. I know I won't stop loving; that's not an option. But if loving means I get hurt like this, I have to be honest - it's hard. It's hard to know that giving my heart to a baby here in West Africa means there's something like a thirteen percent chance of that child dying before it reaches its fifth birthday. (To put it in perspective, in the States, it's more like 0.78 percent. Not even close.)

How can I love in the face of all that? How can I just open up my heart and invite the pain that's almost certain to come?

I guess it's because Maurius went home yesterday. Fat and happy and smiling in his mama's arms, and before he went, we stood in a circle and we prayed over him. Prayed that he would be the one to prove all those statistics wrong. God, not another Maomai. Not another O'Brien. Let this one live. Let him live.

Last night as I was falling asleep, I saw an image of an old man, sitting on a wooden bench, children scattered at his feet, asking him for their favourite story. And so Old Man Maurius smiles and tells them the story all over again, the one where God saves his life and he grows up fat and happy, smiling and holding his grandchildren in his arms.

I don't know if that's really what God has in store for Maurius or if it's just the cry of my own selfish heart that can't bear to hear more bad news. I do know that it's what He wants for Maurius, for each one of these precious children of His. And I know that He's entrusted me the task of loving them while they're here.

So I guess I won't be stopping any time soon.

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

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

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

And this is why I won't stop singing.

I saw Maomai yesterday. I had wandered down to the wards to drop off some papers, and the charge nurse greeted me with a smile. Maomai's here. Pelagie, her mama, had her back to me, so I snuck up behind her and threw my arms around her shoulders. She responded in her characteristic fashion; she jumped up and down, yelled some random English words, hugged me and grabbed my butt. C'est beaucoup! she assured me, in case I had forgotten in the time since I had last seen her. I looked around for the baby, and Pelagie caught my look. She grinned proudly and pointed across the wards to where another nurse was holding a little brown baby in what I assumed was a very big blanket.

It turns out I was wrong. It wasn't the blanket that was big; it was Maomai. I took her in my arms, startled by the weight of her, solid and substantial where she used to be all tiny bones and loose skin. Her hair is coming in all curly, and her cheeks are growing at an astounding rate. They're almost symmetrical now, with little pink scars the only reminder of the enormous tumor that used to distort her face. Her thighs are a mass of rolls and her fingers are dimpled and round. She's crossed over from death to life in every way imaginable.

When Maomai was just a tiny baby, her mama had a dream. In that dream, she recounts, I saw a person, who told me I should be quiet and pray; that salvation shall come. Yesterday, as I held her and felt my arms getting tired from the weight of her body, free from tumors and tubes, I knew that the salvation Pelagie had dreamed about had come. Not just for Maomai, but also for her mama.

She should have abandoned her baby, given her up for lost when that mass started to take over Maomai's face. Her culture told her that her child was worthless, a burden, better off dead, and for such a long time we were so afraid that her culture would win. We fought back our frustrations while we tried in vain to rouse a sleeping Pelagie for nighttime feedings. We watched in dismay as she retreated into herself, unwilling even to change her baby's diapers, and we thought we had lost again. Lost to a fatalistic system with roots far deeper than we can understand. Lost to a darkness that we so often feel so powerless to overcome.

And then, almost before we realized it was happening, the light came back to Pelagie's eyes. She took charge of her baby's life, patiently mixing bottles and learning how to manage a gastric tube and cooing back when Maomai smiled and gurgled.

In a place where we lose so often, where the darkness feels like it's everywhere, it's no wonder that I stood there with that fat little baby in my arms and I cried. I cried because hope is real, because love is real, because salvation, at least for this tiny family, is so very real. As real as the little baby who laid in my arms, staring up at me while I cried and laughed and danced with her mama.

And Pelagie, understanding my tears, came close to my side. In a rare moment of tenderness, she threaded her arm gently around my waist and kissed me on the cheek.

Thank you, she said, looking up at me with the same quiet expression as the one on her daughter's face. Thank you.

There's an incredibly scientific term that some of us peds nurses here on the ship use, and I wanted to share it with you.

nooking: verb; the process of nestling a small baby snugly under your chin, their head tucked into the corner where your throat is the softest.

example: Remember that time I was nooking Maomai? I pretty much loved that.

I know I've mentioned it before, but being here in West Africa has got to be the best thing ever for a woman's body image.

This photo was taken a few day ago by my friend Tracy. Maomai is the little bundle between us, and you can see her sassy mama there on the right. Today, I was going about my business on the wards, happily sorting out the myriad of tiny issues that inevitably end up on my plate when I'm in charge. Pelagie, Maomai's mama, was chatting with one of the VVF ladies, Veronique, who had stopped by the ward to say goodbye to the friends she made while she was here. My friend and former coworker, Meg, was there too, collecting info for a story she's writing. What happened next was inevitable, I suppose.

I'm not sure what set them off, but all of a sudden, Veronique and Pelagie were strutting down the middle of the ward, rear ends wiggling in a fashion completely unreproducible by anyone with white skin. They motioned for Meg and I to join in, which we did with significantly less success than expected. Pelagie couldn't figure out why I was having such a hard time with it, and grabbed my backside encouragingly.

C'est beaucoup, she assured me. It's plenty.

And then she danced off across the ward, leaving me and my plenty-big rear end there in hysterical laughter.

Yesterday I had one of those shifts that remind me so undeniably that nursing is my vocation.

To start with, I was orienting a new nurse. On any given day, I'm a big fan of orienting; I love being the one to introduce someone to this crazy floating hospital that feels so much like the only thing I've ever done. Yesterday is was even more of a bonus, because the name next to mine on the assignment sheet was none other than Suey. She's been working out in the communities as a palliative care nurse for the past months, but with a summer shortage of nurses, she was called in to the wards to help out. She's also hands-down one of my best friends here. Throw in the fact that she's a pediatric nurse from one of the top two children's hospitals in the country, and you had the two of us in precepting heaven for eight hours.

We only had four patients to worry about, two of whom were getting ready to go home this morning, so task-wise it wasn't a terribly demanding shift. We had plenty of time to go over paperwork and find things in cupboards and practice putting IVs in brown arms. I've always said that I must have been a teacher in a former life, because I love educating. There's something so satisfying about taking someone who's in the dark and being the one to turn on that little light, opening their eyes to something new. It was fun enough teaching Suey, but we quickly realized that there were some teaching needs far more profound on the ward.

One of our patients was a little old lady who just had surgery to repair an obstetric fistula. The card above her bed proclaimed her age to be thirty-five, but the lines on her face told a different story. I had to teach her how to train her bladder, to learn to control the urine that's been flowing freely for so many years. The instructions are actually fairly simple. For the first thirty days, go to the bathroom every hour. Increase that time by half an hour over the next two months, fifteen days at a time, until you can hold your urine for three hours. But this particular old lady has no concept of time. When we say measure your time in hours, we might as well be telling her to perform backflips and cartwheels. She was born in a small house in a village way up country, and that birth was never registered so she never went to school. She's spent her life ruled by the rhythm of the sunrise and sunset, pounding cassava and washing clothes in the river. How on earth were we supposed to teach her? Through two translators, from English to French to Yoruba and back again, we had the following conversation.

Each box on this paper is one day. Here is a pencil; each time she sleeps, she should mark one box.
So, she should mark each time she goes pepe?
No, each time she sleeps. One mark for one sleep. Is there anyone in the village who has a watch?
Yes, she thinks there is one man who has a watch.
Can he read?
She's not sure.
Can anyone read in her village?
She thinks there is someone who can read.
Okay, these directions are in English. We will translate them to French. She should have the person who can read and the person with the watch help her. There are directions for when to increase the time. See? The boxes are different colors.
She doesn't understand. The person who can read will have to explain it to her. She won't remember.
All she needs to do is make one mark every time she sleeps. The man with the watch and the man who can read will tell her the rest.

And if we thought that was difficult, our next task was to teach yet another illiterate woman (Maomai's mama, Pelagie), how to manage her baby's new g-tube when they go back to their village. It's hard enough for someone who can read the numbers on the syringes she uses to measure milk, who can run to the hospital at the first sign of trouble, who can jump on the internet and Google solutions to problems. Pelagie has none of those luxuries. All she has is an incredible love for her baby, a baby we've all fallen just a little bit in love with too.

So Suey and I kicked our teaching mode into high gear. Armed with the supplies we could muster (gauze, cardboard, some gloves and tape) we constructed a little "practice tummy" so Pelagie could start to get comfortable with the procedure for replacing the tube. She looked absolutely terrified, so we made sure she knew that she had as much time as she needed to learn. We gave her visual cues on the bottle so she knows how much milk to measure up for each feeding, and we cheered enthusiastically every time she did even the smallest thing right. We stopped short of teaching her how to use the alarm clock that someone gave her; that's a lesson for another day, and my Beninoise sister looked slightly overwhelmed.

Nursing isn't just handing out medicines and checking off boxes in a chart. So much of what I do is connecting with people, finding ways to help them learn how to take care of themselves, concocting mad schemes for getting a skill to become second nature. It's a job that can so often be incredibly hectic, but yesterday my heart was singing because I actually had the time to teach.

She's smaller than he was, but her tumor was bigger. It jutted out from the side of her tiny jaw, as big again as her head and wrapped inside around bone and blood vessels. She was the kind of baby whose mother Dr. Gary sits down with before surgery, trying to explain, often through several translators, that this time it might not work. That we might not be able to fix it, and that she might not get her second chance. Invariably, the mamas sign the forms anyway, pressing their thumbs hard into the pad of ink and mashing them onto the page, their eyes steely and determined and sometimes a little hopeless.

So Maomai went into the operating room yesterday, and I took care of her today. Fitting, that in this land of French speakers, the phrase thrumming through my mind all afternoon was deja vu. It all felt so much the same that I half expected the crew nurse to appear through the door and give me some more bad news to top off my day. I wish there was some way to explain how surreal it all felt, using the same instruments, seeing the same numbers, hearing the same things. Haven't I been here before, bent over a tiny, brown bundle engulfed in blankets and tubes and surrounded by the hum of machinery? Don't I know that sound all too well, the sound of a baby who can't quite get enough air into his lungs. No, wait - her lungs. This isn't Baby Greg. This is Maomai, whose name is a lilting song on her mama's weary tongue. Maomai, a person of God, as the translator explains while I curl my body over hers, stroking her tiny, fuzzy curls in an effort to calm her cries.

I'm sitting in my cabin right now, tired and happy and perilously close to tears. Maomai is doing well. Her mama trusted me enough to leave her side and sleep this afternoon, the first sleep she's gotten since her little one went into the operating room almost thirty-six hours ago. Maomai's breathing is calming and she's starting to tolerate some milk through the tube that leads to her stomach. (Just like Greg, we're cutting out the middle man, letting her devote all her energy to that ever-important task of getting air into her lungs.) I should be happy. I should be elated that, at least this time, everything seems to be going well.

But all I can think of is that night, almost a year ago now, when I sat in a dark, hot room and saw grief all around me by the light of a single candle. Because I can't do it all again; I'm just not strong enough.

So either my little person of God keeps getting stronger and eventually goes home with her brave mama, or I'm going to claim Maomai's name as my own. In this place where names mean so much, I'll claim to be a person of God, and He will not let me fall.