brokenness

Some days I hate Africa.

I hate that I live in a place where twenty-five year-old guys can be perfectly healthy in May only to show up in July at a clinic with sunglasses hiding an angry, red tumor where there was once an eye. A place where the best diagnostic tool in reach sometimes is the fact that, if I can't walk more than ten minutes without getting dizzy, there must be something wrong. I hate that money and the lack of it determines that some people can't be seen by a physician when symptoms first start, before the side of their faces swell until the skin breaks.

And, in some ways, being on the ship makes it worse. Because that twenty-five year-old man might barely make it up the gangway before needing to sit down, and we might have access to the lab tests that explain this by counting his hemoglobin at a shockingly low 5.3. Access to monitoring equipment that traces his heart racing far faster than it should. Access to a CT scan that shows the tumor snaking its way through his jaw and nose and the place where his eye should still be, if only he lived in a country where he could have seen a doctor when the swelling in his mouth first started. Sometimes I hate knowing the truth.

Two months ago, Koudjo was healthy. He was twenty-five with his whole life in front of him. Yes, the tumor grew fast; he knew that, but he still thought we'd have the answers, that we'd be able to do a simple surgery or give him some antibiotics and he'd go home healed. He had no idea that coming to our dental clinic today was going to change all that. He thought it was a problem from where someone had pulled his tooth a few months ago somewhere in Benin. He thought we'd help. He thought it would be okay.

He was wrong.
I hate that he was wrong.

And the thing that's probably going to keep me awake into the dark hours of the night tonight is that I don't know whether he would have even had a chance in the first world. I'll never know, because we have no way of finding out just what it is that's probably going to kill him. Soon. And what little help we have to offer by way of palliative care is going to be taken away in a month when the ship sails away from this port.

And it's just not enough.

I stood in front of all the nurses at handover, and I said that I love seeing the pain and the joy balanced, and I hoped all the time that they wouldn't see in my eyes that I was about to cry, that I couldn't really see the joy today.

I feel so small, so useless when faced with a world that is broken like this. I tell myself that God is working to redeem it in His own time, but my heart wants it to happen now. While Kuodjo is still alive, while he still has a chance. I want him to get married and have kids and be an old grampa with white, fuzzy hair and a wooden cane, sitting on a bench outside his house.

It was hard to imagine a world being redeemed when I looked at Kuodjo today.

I wasn't sure I wanted today to come. It's been hanging over my head for the last few weeks, ever since my routine skin test for tuberculosis came up positive. After a clear chest x-ray, it was determined that I've been exposed somewhere over the course of the last couple years here, but that the disease is currently in it's latent form. Which means I'm not a risk to anyone else, I'm not sick, but I have to start treatment to prevent it from switching to the active form someday down the road. Like, say, if I were to get pregnant. Which, while not in the immediate plans, is something I'd very much like to do someday. (Ever since about a week after the HoJ and I started dating and he turned to me up on Deck Seven and said, You know, hypothetically speaking? Our kids would be beautiful.)

I've been wandering around and cracking jokes and basically making light of it all, but somewhere deep down I've been angry at the whole situation. As if it wasn't enough that I got hepatitis, that the hepatitis went away, inexplicably came back and then went away again, a series of events that has left me completely unable to relax my guard when it comes to my health. But now, the fact that I live here in Africa (albeit behind the hull of a big, steel ship) means that I've been handed this, too.

And it's not like it's a huge deal. Yes, it's going to be annoying to remember to take my medication every day for the next nine months. Yes, I'm going to miss having a beer with my dad when I go home at Christmas. Yes, it's scary to realize that if I do get pregnant before my treatment is finished, there are huge risks to me and the baby. But at the end of the day, I'm talking about two little pills each night before bed. Pills that I can afford, given to me by a doctor I can visit if I have any questions. I'm so much better off than the vast majority of the world when it comes to my health.

Which is why I hadn't told anyone that I was scared. That I've been lying awake at night worrying about a future hypothetical baby. That I feel like I can't trust my own body anymore. The practical side of me tells myself to suck it up. To stop whining and take the pills and everything will be fine.

The other side, the side that doesn't let me sleep at night? That's the one that starts to wonder what life would have been like if I hadn't quit my job and come to live on a ship off the coast of West Africa. I think about 2008 and how I wouldn't have felt sick the entire time. I think of the money spent on expensive lab tests that would have been covered by insurance if I still had a job with benefits. And sometimes I find myself wondering if it would have been better if I'd never come.

That thought lasts no more than a fraction of a second before I think of a hundred stories that I would never have lived had I never come. I think of Aissa and Wasti and Maomai and Baby Greg and Baby Hubie and a thousand more. I've borne witness to the depths of suffering and the extremes of joy, and I've done it, more often than not, with a little brown baby strapped to my back with a length of cloth.

If hepatitis and tuberculosis are the only price I've had to pay to be a part of all that, it's a small sacrifice indeed.

Now just tell that to the side of me that keeps the other side awake at night.


(The first photo was taken by Liz Cantu, the second by Grace Berry.)

Another little sparrow fell today.

I was on an admin day and didn't know how things were going on the wards, so around shift change I stopped by the ICU to check on O'Brien. I was met by Hannah, who shook her head, her face speaking volumes before she ever said a word. He's going, she told me, and I looked to his bedside where his mama, Evegenie, held him, the monitor showing numbers so, so low.

I knelt by his mama's side and put my hand on her knee, explaining to her that his heart was slowing down. That it wouldn't be long now. And as I spoke the words, the numbers fell to zero, and I knew that he was gone. I took the little tiny stethoscope that hung on his IV pole and listened even though I knew I wouldn't hear anything. I'm so sorry. His heart has stopped.

The tears streamed down Evegenie's face, falling unchecked onto my hands as I gently peeled the tape from his cheeks and nose, pulling out the tubes that had been hurting him for so long. We took out his IV as Evegenie sobbed quietly, making the same, wounded noises that every mama makes when her heart gets shattered.

She looked up to the translator, and asked if I could take a photo for her, and so I flew to my room for my camera. I stood by the side of his empty bed as she held him up for me to focus my lens, and I took the picture, praying that it would come out even though I couldn't see a thing through my tears.

We spent the rest of the afternoon doing all the things that you do when a baby goes back to Jesus. We bathed him and dressed him in a soft little pair of overalls. We gathered food and water to sustain her on the journey back to Benin. We made prints of his hand and foot and laminated every photo of him we could find so his mama would have something more to take home than just the little broken baby who had flown too soon.

It feels like falling, trying to make sense of all this. Like the ground has just dropped out from underneath me and I can't find a place to stand. I don't understand why our prayers made the difference between life and death one day but not another. I don't understand why so many of these children have to go back, why the only reason O'Brien died is because he was born in West Africa and not the first world.

I do know that Christ has overcome, that the victory over death has been won, whether I can understand it or not. I know that I've seen a different kind of miracle today, one where the healing is forever, not just for a few weeks.

It's just hard to fall so many times and not know when it's safe to get back up.

I feel like I sometimes paint too bright a picture of my heart around here. Like I'm some kind of faith-filled warrior who can trust God through anything. Like there's always a lesson to be learned in every situation, a lesson from a loving God and so everything is okay. So maybe it'll shock you when I tell you that I'm angry today. I'm frustrated and disappointed and I'm actually just plain angry at God.

Maurius went into the operating room today. I was headed to a meeting in the office when I passed by his mama, Chantal, huddled with the nurses in the waiting area. I stopped to pray, one hand on her back, the other on Maurius' chubby foot, and then they went in through the heavy, sliding doors and I went on with my day.

Just a few minutes later, there was a flurry of activity and people being paged to OR Four, and when we turned on the camera in that room, we saw another huddle around Maurius, this one made up of surgeons and anesthetists and nurses and everyone was moving faster than they should if everything was okay. We stopped our meeting right then and there and sat in a circle and prayed to a God we've seen do miracles before. Truth be told, after what happened last week, I expected the same again. I expected to watch on the silent screen while the tension rolled out of shoulders and the crash cart rolled out of the room.

Except that's not what happened. Maurius is very sick. His lip is fixed, and he looks like a new baby, but that new baby is so awfully sick. The infant tubing for the new ventilator is held up somewhere a few miles away in customs, and the old ventilator just isn't precise enough, so we've had to roll a great, hulking anesthesia machine over from the OR just to breathe for him. None of us can see the light at the end of the tunnel right now, and it makes me so angry I just want to scream.

How is this fair? Why this kid? After all his mama's done, after all we've done, why on earth would this happen? And why doesn't God just step in like He did with O'Brien? Why is He waiting, off in the wings somewhere, while we watch this baby suffer?

I know this doesn't make me a good Christian, all this doubt. But I look at that little one with his lip all held together with steri strips and I want to shake my fist at the sky and demand to know why it had to come at such a price. Why, just once this year, something couldn't go right instead of so horribly wrong.

Why can't something just go right for one of these babies?

It happened this morning. While no one was paying attention, when she saw her chance, Anicette slipped home to Jesus. I could write it a thousand times, using a thousand different words, and it still wouldn't make any sense at all. Airway obstruction. Possible metabolic disorder. Chronic malnutrition. None of those words brings her back, nothing comes close to explaining what happened in the corner of A Ward this morning.

I've done this before. I've had tiny brown babies between my hands, my thumbs crushing relentlessly at their chests, willing back spirits that had already flown. But this time, the entire time, someone's hands were on my back, steadying me as I bent to my task, and if it hadn't been for those hands I wouldn't have kept it together as long as I did.

Even so, by the time the team came, swift on the heels of the call, I knew we had to stop. Knew we had to keep going. Knew there was nothing I could do that was going to make it okay, no decision I was going to make that would come close to mending a mama's shattered heart.

And so we stopped. We lifted our hands and I gathered her into my arms, all bundled in an impossibly cheerful blanket. I've lost track of how many times I heard her mama cry her name when I brought her into the room where she was waiting. Je fait tout, she cried, over and over again. I did everything. Anicette. Why, Anicette. Anicette.

When I undressed her for her last bath, every one of her bones was visible beneath her skin, her spine like a row of tiny stones down her back, and all I could think of was what it must be for her in heaven now. To finally be able to run and play. To not feel pain. For the first time to know what it feels like to not be hungry.

For her mama, though, no such comfort. No release from a pain that's just starting all over again. Because I found out today that Zenabou had another child before Anicette, a child who also died from a mysterious sickness in which it would not eat. She's been through all this before, and now she's doing it with Anicette's little brother or sister growing inside her, a third child to be born into this broken family.

We've gathered together so many times today to pray. To ask for comfort in Zenabou's life. To pray for healing and peace. But most of all, we have gathered to speak life. Life into Zenabou, the second wife who has given her husband nothing but broken children, children who went back far too soon. Life into their village, where hatred and bitterness run deep. Life into the baby, safe for now but facing a world so twisted.


How long? How long before He speaks the words that will make it all whole again? How long do babies have to starve to death before this world has groaned enough?

Speak, Lord. Speak life.

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.

We couldn't do it.

The discussions went on through the morning, with doctors weighing pros and cons and reviewing x-rays and trying to see their way clear. But at the end of it all, the message was delivered to me in the ward. It's a no. We can't do the spinal, and her condition's not bad enough to risk it under general.

And yet again I'm faced with the reality that where you are born so often determines the course of your life. Because this little girl was born in a village in West Africa, there was nothing that could be done when her parents saw that her leg was twisted. Because Togo has just one doctor for every twenty-five thousand people, there was nowhere to go, no way to have it corrected.

It feels so wrong that we started to show her a way out, allowed her to hope maybe for the first time and then were forced to pull that hope out from under her and pray that she doesn't break when she falls.

I could see the tears in her eyes when she left today, dressed in her Sunday best, the clothes she had picked out to come to the ship for the surgery that she isn't going to get. I watched her walk slowly down the hall, her head weaving side to side with the broken rhythm of her walk, and I wanted to scream. To beat my fists against the walls and rail against the unfairness of it all. But instead I watched her, watched her walk away with her strange, jerky grace, and I prayed that I could learn to hold my head just as high as she did in the face of disappointment and pain.

And as her hand came to rest for a fleeting second on her still-flat belly, I prayed that she would teach her baby to be just as strong as she is.

Today was strange. I know I've been here for a while, and maybe I should be used to it by now, but I still struggle with the vast disparity of emotions this place brings with it. It's so hard to find my footing when I'm swinging between two extremes, hope and despair in beds on opposite sides of the wall.

Ismatou is twenty six years old, her neck swollen by a huge goiter. She came to us earlier this year, but was too sick for surgery. Sent home on medication and told to come back in a few months, she showed up at the ship yesterday full of hope. During routine pre-operative screening, we discovered that she was pregnant, which she staunchly denied, pointing to her one-year old little girl as proof. The evening staff gave her a bed for the night, and it fell to me to sort it all out this morning.

It's simple, really. Based on her last screenings and the information she could give us, her pregnancy was early in the first trimester. There was no way we would risk her baby's life to perform the surgery, and with the outreach drawing to a close, there's no time to reschedule her. I got to tell her.

She cried and she begged, falling to her knees next to her bed and holding her hands out to me, pleading for me to do something. To find a way for her to have the surgery. Her eyes were haunted and her fingernails dug deep grooves in her skin as she clawed at her neck, trying to tear out the curse she's living under. Tante Alice, she told me through a translator, you don't understand. I am ashamed. How can I continue?

I told her that she needs to be strong for her children, for the little girl staring at her mama with wide, frightened eyes, and for the baby growing inside her. She asked if she could come back on Monday. I will come back and I will not be pregnant. She doesn't have money for surgery at a local hospital, and so I know that the abortion she was thinking of having would be performed in a back alley somewhere. I told her, no, that she shouldn't come back, that we would not schedule her for surgery, hoping against hope that she would realize that an abortion was pointless. She dropped her eyes from my face and flicked her wrists, palms-up. So then it is decided. I will go home and I will make a poison and I will kill myself.

What can you actually do when faced with despair like that? I have no clue what she suffers, not the faintest idea of what it's like to go through life with a huge tumor on my neck, considered cursed by the people who see me. I had no words of hope to offer her, nothing to say that would give her a reason to live, and yet I was sending her out to face the world again. Alone.

So we prayed and we cried and she asked a few more times. And then she grabbed her child, tied her roughly to her back and was gone.


And then, on the other side of the wall, a shout went up. Nasif is a little seven-year old boy whose jaw had been frozen shut after an infection while he was a baby. He had surgery two days ago to graft some cartilage from his rib into the joints in his mouth, and he was trying out his mouth exercises when he discovered that he could do something he had never done before.

I rounded to corner to see a little imp in a purple, flowered gown, sitting on his bed surrounded by adoring fans. His head was wrapped in clean, white gauze, and everyone was cheering like he'd won a gold medal when he showed them his new-found skill.

Que est-ce que tu peut faire, I asked him, since I had missed the big show. What can you do? And in typical little boy fashion, he smiled and stuck his tongue out at me.

It's the first time in his life that he's ever seen his tongue. He knew he had one, but it was locked away behind teeth that didn't move, and now for the first time, he can open his mouth and smile and put a spoon straight in when he eats. And he can stick out his tongue.

So tell me, if you can, how I'm supposed to feel right now. I saw absolute despair and pure, unadulterated joy one after another today, and I'm just not sure where that leaves me.

I've been sitting in front of a blank screen for a while now, wondering how on earth I can type when words are the farthest thing from my mind. It's just a constant loop, running images of his face, while I sit here and wish you could have known him.

Daniel Ossewanou was one of our translators. When I got back to the ship in June, I headed to the wards for my first shift and it wasn't long before I heard the sound of a trumpet and a guitar. Understandably confused, I searched the ward until I found a tall man dressed in African cloth, strumming away. The guitar mystery was solved, but I couldn't find the trumpet. I turned my back and heard it again, and when I looked back, I saw Daniel, a wide grin on his face, clearly enjoying my confusion. He winked, pursed his lips and all of a sudden I was hearing the trumpet accompanying the guitar. Patients forgot their pain and sang along and that's how I met Daniel.

Daniel was married. He celebrated his seven-year anniversary on October first, and he and his wife have two little girls. Yesterday, on his way to his second job, Daniel's motorbike was hit by a truck and he was killed.

We are undone. I'm okay when my patients die; it's expected, sometimes that babies so sick will go back to Jesus. But not Daniel. Not my trumpet-playing friend. He was young and healthy and so much in love with his God and his wife, and it's not fair that his little girls will never get to see their daddy again.

I stood with the rest of the translators yesterday while we broke the news. My friends wept in my arms and I had to be strong for them while my own heart was shattered into a thousand pieces. I watched the men and women I work alongside every single day crumple, folding in on themselves as they understood what we were saying, and with one voice they asked why.

We cried and prayed and read Scripture, and then Mathieu, one of the other translators, lifted his voice, cracked and broken, and began to sing.

Merci, Seigneur. Merci.

All around the room, people added their voices, joining together against the pain.

Thank you, my Lord. Thank you.

Right now, I have nothing else to say but a prayer of thanks to my God. I am so grateful to have met Daniel, to have worked alongside him. I have been so blessed by his love, by his grace and by the music that she shared with us. As much as I wish that my heart wasn't broken right now, I'm so thankful that I knew him.

Please pray for his family, especially his wife and little girls. Pray for the nurses who knew him and for the other translators who worked so closely with him.

And when you see your loved ones tonight, hold them close and tell them that you love them.

It happened at ten this morning. His papa had come in to visit, had listened while I explained that Hubert's small body was shutting down, organ by organ. His mama sat on the next bed over, in the same clothes she's worn for the last month, the silent tears tracking down her cheeks. And then, just like that, it was time.

We turned off the medications and disconnected the IV lines. We silenced the alarms and put him in a fresh diaper and I lifted him out of the bed and into his papa's arms. They sat there for a few endless minutes while the ventilator continued its relentless pulse and Hubert's heart slowed and his mama held his feet in her hands.

And then he slipped away. His heart stopped and we turned off the ventilator, took out the tube, removed all the wires and IV cannulas, covering the places with clean white gauze. His papa started to rock him back and forth, back and forth, speaking softly into his son's ears. I looked up at my translator who relayed his words. He is asking the baby to breathe. He says he should breathe now. He says he should try. And in my ear I heard the mother's cry, the same sound they all make when they know it's over. The high, keening wail that voices a grief that should never be felt.

They sat there, the small family, ensconced in their pain, while another translator rocked Hubert's sister to sleep on the other side of the ward. His papa finally looked up, asked us if we could bathe him and surrendered his son into my arms.

I had forgotten how heavy he was. He had been so small when he first came to us, but we had fed him and he had gotten fat and now the weight of him nestled against my chest was almost enough to stop my own breath. I laid him on the bed, and my eyes filled up and my translator chided me. Sis Alice, you must not cry. Don't cry now. I told him that I had done this before, I'd done this too many times before, and I always do it with tears in my eyes. His voice softened. Okay. You can cry. It's okay.

He looked like he was asleep and his curls were soft and fuzzy as I bathed him, removing all the traces of what we had done to him in our struggle to keep him alive. I gave him to his mama and she dressed him, looking startled when his little arms didn't reach through his sleeves like they used to.

One by one, the nurses who had cared for him came into the little sanctuary of his room, sat with his mama, poured out their love and their tears. And over and over I reassured them. It was quick. He went quietly. He was snuggled in with his papa, and he just slipped away. I signed forms and called the appropriate people and cleaned the ICU while my translator taught me how to sing in French, and I told everyone that I saw in the halls that I was fine.

But now I'm back in my cabin, and I can't stop thinking about what Hubie's papa said, right before they left. I want to say thank you, because I have seen the result of your efforts. I know why you are here. You have done well for us. And then they took their dead baby, strapped him to his mama's back so the taxi driver wouldn't charge them more, and they walked down the gangway.

I can see the tears in his papa's eyes, and that slight memory is enough to break me, to send me spinning across the floor in a thousand tiny pieces, my heart in splinters in my hands.

It's going to take some time to mend.

I should be asleep right now, not writing. I have to get up in a few hours, and the baby I'm going to be caring for is so sick. So very sick.

Oh Hubie.

I don't know if it'll ever get easier. Sitting with a family, explaining that the hope I told them to cling to is fading fast. Watching that single, silent tear track down a mama's cheek to hit the floor with a tiny splash. Pulling back blankets to let a papa touch his baby's foot before he rushes out into the evening, unwilling to sit vigil with his wife, his hard eyes suspiciously red.

It's so hard to pray for God's will to be done when I'm getting more and more convinced that His will isn't what I want.

So when I say Pray for Hubert, I mean so much more than that. I mean pray for his mama, because now, maybe so close to the end, she finally cares, and if he does go back to Jesus, it's going to hurt her. I mean pray for the doctors. We don't have a PICU doctor on the ship, so we've been pulling from the jumbled expertise of everyone around, doing the best we can. I mean pray for the nurses. We've been letting Hubie get a firm hold on our hearts for the past month, and now he's so sick, and we don't know what to do. It's so hard to look at a baby who was getting better, getting fat and happy, and see him pinned to the bed by tubes and wires, his little body shaking with each breath of the ventilator.

I keep praying for God to fill me back up, with love and strength and wisdom, so that I can go back into that room tomorrow and pour myself out again.

I'm starting to think I might be a little too broken to hold all that right now.

It happens infrequently, but I'm always caught off guard. I'm so used to pouring out my thoughts into writing that the days when I have nothing to say seem somehow wrong. The past few have been like that.

I'm not sure what's been stopping me. I don't want to sit here and moan about how sad things are on D Ward, but the truth is, they are. After my shift on Thursday, I came back to my cabin and I cried and cried and cried. The kind of tears that jut run down your face and you can't do anything to stop them because you know, deep down, that it's okay to be hurting.

There are three little ones on the ward who are getting treatment for Burkitt's lymphoma. It's a cancer that is both incredibly fast-growing and incredibly responsive to treatment, and the drugs are available in Benin. This shouldn't make me sad, I know. But I look at Rachelle's swollen face and the tumors showing through the skin of her abdomen and I wonder if we caught it in time. I look into the eyes of Madinath's mama, and I see desperation, a silent fear that her only child will be taken from her. Aime's name means like, but he screams when we come near him. This is his second round of chemo, and he knows that we hurt him and he's only two so he doesn't understand that it's the only way to make him better.

On the other side of the ward, in the corner beds like bookends, are the two little babies who were admitted through the feeding program. Their cleft lips and palates are in various stages of repair, and neither of them is eating enough to gain weight. At four and nine months old, they weigh as much as average sized newborns. And their mama's don't seem to care. They hand them off to any white person who comes near, hoping that they won't have to do the work of mixing the bottles. They lie curled up in blankets while their babies scream next to them, and they don't hear. Or they won't. I'm not sure which.

And little Joy, my darling little girl who had surgery to remove the tumor that took the place of her eye? She's home now, with an appointment card and a phone number. The card is for a date three months from now, when she'll come back to get the biopsy results and have her other eye evaluated for possible surgery. The number is for The School for the Disabled here in Cotonou. Because her right eye doesn't have a cataract like we thought. It's more than likely that the tumor that took her left eye will grow in the right too. And even if it doesn't, her retina is so hardened and scarred that she has no chance of ever seeing.

So I sit here and I cry, because I can try to smile, but sometimes I just can't. Sometimes I cry.



(Stay tuned and I'll share a much more upbeat story with you, the story of my shift today. It included so many ridiculous events and featured, at one point, my fine African shape. I just don't have the heart to type it all out right now.)

Ingrid puts it best.

we are so fragile
and our cracking ribs make noise
and we are just
breakable
breakable
breakable
girls and boys

I had one of those awful, frustrating days today, where nothing is wrong and nothing is right. It wasn't a bad day on the wards; I wasn't even working since, in a rare twist of fate, my weekend off actually coincides with a real Saturday and Sunday. I just felt absolutely, entirely too small for what I'm doing here, too stupid to make a difference, too broken to do any good.

It's an old fear of mine, this feeling of not-enough. I've struggled with it my entire life, for reasons that even I don't understand. Call it culture, call it teen angst that never quite went away, call it any of a million names, but the truth remains that I believe lies about myself. Instead of seeing myself as a child of God, cast in a divine mold, I stare at my face in the mirror and see only what I lack. Beauty, brains, charisma; I've been shortchanged in every department. (At least, that's what I tell myself.)

Some days are better than others. Some days I can rest confident in the knowledge that God made me, and He don't make no junk, a saying that I had printed in every colour of the rainbow on a t-shirt I used to wear as a child. But the bad days? They're no joke. They're the days that make me retreat into myself, turning over all my past failings and sins and shortcomings, holding each dark secret to the light and hating myself all over again for things I had thought were forgiven.

It all came to a head during our Sunday evening service. We were getting ready for communion, and the bread and wine lay covered with a clean white cloth on the table as I fought with myself during worship. You know you can't take communion tonight. You're not allowed if there's something between you and God. And, holy cow, is there ever a lot between you two. Don't try to fool anyone. You'll never be good enough.

When the speaker started outlining the form of the Trinity, listing characteristics of each facet of my God, I started to cry. Just turn to the person next to you, tell them which part you need the most tonight, as I rubbed my eyes and hung my head and ever-so-quietly admitted.

Forgiveness.

Comfort.

Truth.

And while the man in the front of the room held up the round loaf, tore it in half and repeated the age-old request to do this to remember, I sat in my seat, paralyzed with fear. Because I knew I didn't deserve it, that I wasn't allowed to join in the ritual without a clean heart, and that my heart was just about as full of pain and lies and ugliness as I've ever known it to be.

Until God, sitting next to me in a form that looked strangely like my husband's, took my hand and whispered in my ear.

You're more than enough.

The baby I mentioned yesterday, the one who I said was so sick, went to Jesus last night. Her little body just wasn't strong enough, didn't have enough reserve, couldn't take any more. It's all over now; the monitors have been disconnected, the last of the supplies cleared away and the sheets on the bed have been changed. Her family is making their way back to their home in Togo, their shattered hope wrapped in a little blanket. This is when the questioning sets in, when I start going over everything in my head, examining my steps one after another, reassuring myself that I did all I could. This time, I'm not sure I did.

Just typing those words makes me want to scream. To throw myself on the hard floor of my cabin and weep for the family that can never be the same again. Everything inside me rises up in revolt against the idea that I did things wrong, and a hundred reasons spring to my lips. There was no way she could come back from that kind of deficit; it's not your fault. She came to us already malnourished; it's not your fault. This would have happened no matter what we did; it's not your fault. There were other patients, other sick children who needed you, and it's okay that you were caring for them, too. It's not your fault.

Intellectually, I know that all of those statements are true. But intellect is a force that pales in comparison with guilt and grief. I know that there was nothing I could have done to change the course of Akouvi's passing, but my conscience burns me, peering into the dark corners of my heart and holding my fingers to the flame.

You knew her potassium was already low on Tuesday night. You should have pushed harder, told more people. You knew she was sick when Andrea called you over to her bed early yesterday morning. You knew she looked bad, and you should have said something. You let her lie in the corner all day, and you knew something wasn't right. You were so busy with your patients, with the babies who would have been fine if you had left them alone. You failed her. You failed.

As I curl up into myself, ready to shoulder what I can only see as my rightful share of the blame, another voice starts to make itself heard. This voice is softer, barely audible through the accusations flying through my soul, and I'm so weary from blaming myself that I would have missed it had He not been so insistent.

Child, stop. Quiet now. Just stop. Don't you know Me by now? Haven't you seen enough to know that I don't make mistakes? When have I ever given you cause to doubt Me? And as much as I want to be calmed and reassured, I'm still crushed, because it's not Him I'm doubting this time; it's myself. I'm the one who messed up here, not You.

Again, the voice, a whisper in my heart.

You think this was your fault? You think there was anything you could have done or anything you didn't do that would have changed that little one's outcome? Don't you know Me by now? I am the Author; I am the One who wrote Akouvi's story. I wove her together in the secret places, when she was nothing but a carefully nurtured dream in her mother's heart. I opened the book of her life, and I penned every beautiful page before she was even born. I knew the number of her days, dear one. I knew the days she would laugh, and all the days she would be in pain. Today, so early in the morning, her days were finished, her story ended.

I knew.

I have always known.

I can't stop thinking about yesterday. I'm sitting here by the side of a pristine, blue pool at a posh hotel here in Cotonou. I just finished eating some pita bread with fresh humus, my skin is starting to turn brown from the sun, and I can't shake the feeling that something's not right at all.

There were over a thousand people in that line yesterday. Our hospital manager, who spent the entire day making his way up and down the line, handing out cups of water, showed me the final figure that he had scrawled on his hand. 1,150. And we sent them all away. All except for the ones whose names we put on waiting lists, the ones whose hopes will almost surely be dashed even harder when they realize that the ship has sailed and they never got the call to come.

My alarm rang at seven this morning, plenty of time for me to grab breakfast and make my way to community meeting with the rest of the ship. But as I swam into consciousness, before I even sat up, their faces were before me, their eyes silent and reproachful. I saw the old man whose hernia bulged through the cloth of his pants who put his hand on my arm and pleaded with me. Je souffre, he told me. I suffer. I saw the little boy with pale skin, hanging limply on his mama's back. He had a problem when he was born, she told me through my translator, and he didn't have enough oxygen. He doesn't walk. He should walk. I want him to walk. I saw the young girl, her back twisted by the most severe scoliosis I have ever seen, bent forward and to the side, leaning heavily on her stick as she stood for hours in the line with the rest of them, uncomplaining in the heat. I saw the old woman, her legs swollen and infected by tropical ulcers who took every step in pain. She refused to leave the line even after Abdel and I had explained that we didn't have the right doctor to help her condition. That she would need to go home. Her voice was soft, and the language she spoke made it sound like she was literally trying to swallow her disappointment as she begged us to reconsider, refusing to understand the truth.

I saw them all and a thousand more, and I couldn't face their pain. So I turned my alarm off and went back to sleep. I, at least, have that luxury, and it's hard not to resent myself for it. To hate the vast divide between rich and poor. To rage and rail against that impossible fact that I'm once again so squarely faced with; that where you were born is so often exactly what decides how you die.

I know it's good to be faced with these realities, to be forced to confront, even if it’s just 1,150 at a time, the billions of people in the world who scrape together their livings from hopes and prayers. I know it’s right to wrestle with the sadness and the outrage that I feel when I realize that I’m not going to be able to fix it all, that so many will die disappointed and unloved. But in the early morning hours, when their faces scream a silent pain, I want to put my head under my covers and hide from it all. I can’t hide from His voice though, and it breaks through my fears and my walls and my stubborn resolve to shut myself away.

Have you forgotten what I’ve called you to? Pour out your soul for the hungry. Invite the homeless into your house and clothe those who go without. You think this is too hard? If you but try, your light will rise like the sun, your healing will soon be evident; the very God of Glory will secure your path. You’ll pray, and I will answer you. You will call out for help and My voice will be in your ear before your tongue has fallen silent. I’m here. I have always been here. And I will never leave your side.

So I guess it’s going to be okay.