vincent

I'll write about Ghana tomorrow, but right now all I can think about is Vincent.

He slipped away this morning, early, before I came on to work. His breathing slowed and then just. stopped. And I can't help thinking that, out of the whole year, this would be the best weekend to die; the weekend when no one doubts the truth of heaven, when the whole world is celebrating a risen Saviour. When all over the country there are huge gatherings of people in their finest clothes, dancing and singing under the palm trees because death has no sting.

No sting. Maybe that wasn't quite true this morning when I pulled back the curtain in the empty ward where he lay, when I saw his face, so still in death. It stung a little just then, until I remembered the truth, and for the first time I really understood what they mean when they say it'll set you free.

My heart was free then. To know that Vincent is no longer in pain, that he's resting in the arms of a God who is very much alive, very much in the business of putting things right. It was a feeling like breathing again after being underwater for far too long, like I noticed only just then that I'd been holding my breath for the past few weeks, waiting for the other shoe to drop. Only this time the falling shoe looks like peace and comfort and release.

All day, people have been coming to me to hug me and pay their condolences, and it feels like I should be standing at the foot of his coffin, receiving them in place of the ones who turned away. For the first time, the message on the captain's board didn't ask for prayer for the family, just for those who cared for him and today, for the first time, there was no difference between the two.

I lost a brother today, but it feels like flying to know that he is free.

This will be long. I won't blame you if you don't make it through; it's going to be disjointed and messy and long, because it's another one of those days when I'm not sure where to start and not sure what to write. I know I need to write; it's all I kept thinking over the second half of the week. I just need to sit down and write this out, and then I'll be okay. I've been moving through stories that need so desperately to be told, working with families who need a voice almost as much as they need a miracle. But by the time I got back from work, exhausted after another day, I couldn't find the words. I'd sit at my computer with this New Entry screen open, and twenty minutes later I'd find myself still there, staring at the empty screen, tears running down my cheeks.

There's been no official tragedy, nothing outright that gives me the right to feel like this, and so I feel weak and small and unfit for this work. If I can't face a few sad stories after all this time, then what good am I? And maybe just one of them would have been okay. Maybe if it was just Vincent I'd be strong and clear-eyed. But it's not just Vincent. It never is. It comes in waves and every time I think I'm breaking to the surface to breathe, I'm tossed back down, tumbled in the wake of these families' pain.

And the thing I hate the most is that I'm building walls, hastily throwing bricks and mortar together around my soul because something tells me to shut off. Stop caring so much before you get yourself hurt. Here in the world of NGO's and relief work, it's called compassion fatigue. To me, it feels like going blind. Like shutting my eyes on purpose so I'm not called on to bear witness to more than my heart thinks it can handle. But their stories need to be told.


Vincent

Vincent started it all. He's still with us, alternating good days with really awful ones. We almost lost him last week when he started to bleed and there was nothing we could do. I've been in charge in the ward where hes propped up on pillows in the softest bed we have. And so the lot has fallen to me, along with the physician, to try and figure out what to do. I've asked Beninois day volunteers whether we should try to drive him home to his family. (We have an address now. Drive to the small market near Bokpe. There is a road behind it. Turn left on that road; it is the second house on the left.) As one, they shake their heads. You could find his own mother and she would look at him and say, I do not know this man. They will not take him like this; they would not want to pay for his burial. And so our last hope is to send Caleb home to Benin, to find the small road behind the market and to convince some family to come back with him.

I think that alone would have been enough for me to start shuttering my heart just a little this week. My family is one of the closest I've ever known, and so I don't understand. I don't understand how his family isn't desperately searching for him right now. I can't wrap my mind around the fact that they let him live on the streets, let him come alone in a taxi to the ship. That they have no idea that he's dying surrounded by white faces when all he wants to do is go home, and when going home is the one thing it seems we can't figure out a way to do.


Espoir

But it wasn't just Vincent. It was Espoir, too. He's four months old, a huge, uneven lump distorting his forehead. His mama and papa are HIV positive. It's hardly surprising, given that, in this country of six million, Unicef estimates that up to 150,000 were living with HIV in 2007. That's well over eight times the rate reported in the States, and probably doesn't come close to capturing the true prevalence.

Espoir's mama and papa had another child, some time ago. But this child contracted HIV at birth and died not terribly long after. Determined not to go through that again, Espoir's parents educated themselves. They learned that having a c-section birth will reduce the transmission. They learned that breastfeeding can pass it from mama to baby. And so they gathered more money than most can come by, money for a c-section and formula, and they chose a name for their new baby. Espoir. Hope.

But when their baby was born, there was something so wrong. Instead of a smooth forehead and huge, dark eyes, Espoir has a misshapen lump, the consequence of a skull gone wrong. His brain is pushing out through a hole in the front of his head, the skin stretched tightly over the fluid there. They didn't lose hope, though; they heard that a ship was coming, a ship filled with doctors who could do surgery and fix things when they go so horribly wrong.

And so they came, and we took a scan of Espoir's head, and somewhere in the process we tested him for HIV. And despite everything his parent's did, because anti-retroviral drugs are so hard to come by that the hospitals here won't let you have them until your CD4 counts drops below one hundred, little Espoir also has HIV. And we probably won't be able to do surgery because the hole is too big and his body will be too weak. And my heart broke again, shattering across old fault lines that I thought had healed.


Michael

And even that might have been okay, if Michael hadn't been sleeping in the bed across the room. Little Michael who I first met a week or so ago in the hallway near the x-ray room. He had just peed all over the floor and was happily splashing in the puddle while his mama tried to stop him through her laughter. Even then, his eye looked bad, jutting fiercely out from his head, pushed by the angry, red tumor behind it.

Michael was a twin. His daddy was murdered not too long ago, and his mama didn't have enough money to feed her babies. One of them died just about a month ago, and Michael is all she has now. But that wasn't enough; somehow, this woman hasn't suffered enough, and so baby Michael woke up screaming one night, his eye just a little swollen. The doctors said there was nothing they could do, so Michael's mama watched in horror as, over the course of the next few weeks, the tumor took over his eye socket, destroying his sight and distorting his perfect little face.

I prayed with his mama yesterday as he slept in a lappa on her back, a clean white bandage wound around his head, covering the place they took the biopsy to determine a family's fate. There were two possibilities; burkitt's lymphoma or rhabdomyosarcoma. Both are cancer, but there was no other hope; nothing grows that fast if it isn't cancer, and so we waited together to hear his fate.

I rarely cry at work. When I'm in charge, I try to keep it all together, have to be the strong one to support the nurses around me. But yesterday, when Suey came through the door with her face wreathed in smiles, I lost it. It's Burkitt's, she practically shouted. Burkitt's! Burkitt's! I saw it on the microscope!

And before you think I'm crazy for sitting down with my head in my hands and sobbing with joy because a small boy just got diagnosed with cancer, just know that Burkitt's is the only cancer that's treatable here in Togo. It's the only one that isn't an absolute death sentence, the only one that carries with it a slight chance of a future.


One small ray of light into what seems like impenetrable darkness. One tiny hope to hold on to. I've got nothing profound to say here, no life lessons learned to share with you. Just my heart, held out in trembling hands, in sore need of mending.

I've been over here for a while now. I see people with what can only be called extreme diseases. Tumors that have grown to monstrous sizes, legs so crippled they look like they've been put on backwards. I've learned to look straight at suffering without flinching, to face it without turning away. Some days it feels like there's nothing that can shock me anymore.

At least that's what I thought. Until Vincent came back.

It's been less than a month since I saw him, waiting for us outside the gate, waiting like he'd been waiting for more than a week before the ship sailed into port. When I saw him then, I knew he was starting to look bad. I knew his cancer was starting to take over, but I wasn't prepared for how it would be when I would next see him.

Yesterday I met him in the hospital hall where my friend was bringing him, one slow shuffling step at a time, into an empty ward to lie down. I saw him and the first thing I wanted to do was turn away. I wanted to pretend I hadn't seen him, pretend it wasn't true. It took an agonizing eternity to get the shirt off his back, easing the cuff inch by inch over the hand wrapped in dirty strips of cloth. His bones stood out in sharp relief, every rib clearly visible under his skin. The wound under his arm, the place where the cancer had spread, was gaping and raw, and I wanted nothing more than to turn away.

Instead I put my arms around him. With a translator to lift his legs, we lowered him into bed, his body hot with exhaustion. I covered him with a blanket, and he closed his eyes as his head came to rest on the pillow.

No one should live like this, and no one should have to die like this. No one should live on the streets, begging for the hope of one meal a day. No one should waste away to skin and bones with no family to care. No one should ride in a taxi for hours and hours from one country to the next, alone and in pain and so very tired.

No one should have to die like this, so Vincent won't. We'll keep him with us until we can find a hospice for him to be admitted to. We'll change his bandages and give him medicine to dull his pain while he eats three meals a day. He'll be on a soft mattress with clean sheets, and he will not be alone.

We won't let him be alone.

The problem with the last few days is that they've been so busy that I haven't written. I've been crawling into bed every night, already dreading the alarm that will wake me in the morning, and there just hasn't been time to stop and write. Which is why it's so unfortunate that so much has happened; I don't know how to share it and make it all make sense without writing forever. I don't know where to start now.

Do I start with Vincent, the patient from last year in Benin who we found waiting here at the port gates in Togo? He'd been living on the streets for days, waiting for the ship to come because his trouble was getting worse again. Do I tell you how, once the wards were finally set up, we brought him into one of the empty rooms only to discover that the cancer in his hand had spread up his arm, that his eyes were squeezed tight shut while we prayed for him? Do I try to explain how he, inexplicably, left to go back home with a smile and a wave, claiming that we had done enough for him. Done enough by telling him that we can't help and that, short of a miracle, this will kill him. But, by all means, please come back in a week or two and we'll let you know if we can amputate more of your hand.

Or do I start with the time when five of my best friends and I headed out in the gathering dusk to search for a place that sold cold drinks. How we walked into a concrete-walled room, sat in mismatched chairs and declared that we thought the place was lovely, simply because their menus were laminated and there was a single fan hanging from the ceiling, pushing around the thick air. Will it mean anything to you when I tell you that, all at once, the lights went out and we went on without missing a beat, the near-dark from the windows more than enough light to talk by? That, somewhere, somehow, I've become accustomed to life in the third world and have already started dreading the leaving of it.

Maybe I should start with this morning, when I headed up from the dock to find a little group of mamas and babies huddled in the shade of the gangway. Cleft lips and tumors and little bowed legs waiting for everything to change. I could tell you how I saw them take their hope in their hands and climb the stairs, heading for the hospital where x-rays and CT scans would determine their futures. But if I started there I'd also have to tell you about little Felix and his brother Pascal, the two cutest boys I've seen in a long while (HoJ excluded, of course). I'd have to tell you how Pascal screamed, burrowing into my arms when his mama left him to take Felix into the x-ray room. How Felix's screams echoed his brother's through the door, and how the light fell from that mama's eyes when I told her that Felix wasn't going to be scheduled for surgery. His trouble wasn't bad enough; we'll probably see worse, so we have to keep the books open for them. How Felix put up his arms for me to carry him back down the gangway, back into the hot sun to begin the long walk home on his little crooked legs.

I could start with the French. With the way I've been called upon to translate by so many people who don't know I really don't know French. And how, despite that, I've been able to speak the words I'm called on to speak. How I've gone back into my Bible, poring over the passages about the gift of tongues and trying to figure out if this isn't actually what they meant, this speaking out in language I don't know. I could tell you how a surgeon called to me in the hallway outside the x-ray room and asked me to tell his patient about his findings, how I started to say I couldn't and ended up explaining it all to the patient, who nodded gravely and told me she understood, repeating it all back to me with much better grammar.

But none of those stories is the right place to start. None of them fit together, make any sense next to each other. I can't weave this narrative in the way I'm used to doing; I feel disjointed. But I think that's what my life is right now. Just a bunch of stories. Still frames and memories, collected up and stored away like precious keepsakes. These are the stories I'll tell in years to come when I'm living somewhere far from here, somewhere with reliable electricity and hospitals.

And by then it won't matter where I start, because the beginning can be anywhere when the story has already been told.