paradox

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.

Sometimes being a nurse feels like belonging to a strange, secret club. We have our own language (where things like tracheomalacia or amp and gent or positive pressure ventilation actually mean something), and our own set of weird customs (such as hanging out in hospital wards on our days off). Most days, it feels good. It's incredibly satisfying to scrounge around the cupboards of an ICU, make a call back home to your old unit who, six months down the road, still seem excited to hear from you, and manage to MacGuyver a bubble CPAP setup that actually works. It's the biggest rush ever to realize that your being the one to care for a particular baby during a particular shift has actually made a difference in the baby's condition. And it just makes you happy to have a mother's face light up when you walk through the door, knowing that she trusts you with her child's life for the next however-many hours you'll be on duty.

Unfortunately, while the past couple of days have been something like that, they've also been laced with a very real sense of frustration. Sometimes being on Team Nurse isn't all it's cracked up to be. Sometimes, despite all the paper clip and duct tape creations you rig up and all the moments of getting the baby settled and sleeping for the first time in forever, it just isn't enough. Sometimes they get worse instead of better, and you can't stop questioning your every decision. Sometimes you just can't stop worrying.

Baby Greg isn't doing so well. He's slipping backwards, his jaw starting to swell again as his small body burns with fevers. He's struggling to breathe but fighting all our efforts to help him. And we're at a loss. We talk about him constantly. We sit at dinner, and instead of socializing with friends, we huddle there, heads bent together as we try to come with a new plan. We talk about him in the halls as we pass nurses who are on shift. We visit on our off hours, just to see how he's doing.

I know I'm taking this too personally. I know I'm not the only one who cares about Baby Greg and I know I'm not the only one who can care for him. But these days, this whole nurses' club seems terribly exclusive. There are only a handful of us here who are experienced and comfortable with caring for such a sick baby, and we're being looked to as 'experts.' It's scary, really. I came from a health system with a ton of oversight. It sometimes felt like I couldn't make the slightest move back home without going through a complex hierarchy of charge nurses, residents, fellows and attendings. If I didn't know an answer, there were always about twenty people within reach who could help me out. Here, the doctor (an orthopedic surgeon) asks the nurse (who, thankfully, was Jenn, an incredibly skilled NICU nurse) which antibiotics he should give. Here, the few of us who are comfortable caring for Baby Greg can't get sick, because there just isn't anyone else to call to cover for us.

It's such a strange paradox. I love working here because I love the challenge of making something out of nothing. I hate working here because, all too often, I'm expected to make something out of nothing. With Baby Greg, right now it feels like we have nothing. We don't have the right doctors. We don't have the right supplies. We don't have enough nurses. We don't have the answers. But I can't look his mama in the eye and tell her that. I can't bear the thought of explaining to her that she might lose yet another child.

So we'll keep fighting. We'll keep coming up with new plans and inventing new equipment and praying for miracles. Because, right now, that's all we've got. And I hope it's enough.

I realized something just now.

I was sitting on an empty bed in the corner of the ward. The flashlight swinging from the IV hook above me illuminated the purple and pink plastic bowls sitting on the chair between Alfred and me. Heads bent close, voices hushed to a whisper and hands carefully washed, I was swallowing fufu with my friend. It's become something of a nightly ritual for the two of us; once everyone is in bed and meds have been given, he treats me to his aunt's most recent creation. This evening, it was simple fish and chicken foot, with enough fufu for both of us to eat our fill. Alfred decided early on in tonight's game that twenty four years are long enough to go without eating chicken foot. I protested weakly, but my excuses couldn't hold up to his pleadings.

It was when the pale, rubbery foot was halfway to my mouth, while I was steeling myself to crunch off a few toes (bones, nails and all) that it somehow came to me: God has actually given me my heart's desire. I am here doing exactly what He created me to do, and, for once in my life, I'm living firmly embedded in the center of His will.

How many people can say that? How often do we get to look at our lives and think, Wow. This is right. I've got the package deal and there's nothing I'd rather be doing. Granted, as I crunched the unfortunate bird's foot between my admittedly unwilling teeth, I wasn't feeling terribly fulfilled. But once the pieces had slid their way down to settle like a rock with the rest of my late-night meal, I looked up at my little friend and caught his eye. He grinned at me.

You're almost African. Next time don't make a face.

I'll keep trying. For as long as it takes.

This entry promises to be something of a mixed bag, much like my own thoughts these past few days.

Coming into this experience, I knew there was something I'd struggle with enormously. I was talking with Nicole earlier (not only taller than me, she is also a wicked ultimate player ... I sense a bond here) and she phrased it so perfectly. "We don't live in Africa. We live beside it." My brother wrote me an e-mail recently where he wondered what he was doing with his "ipods and fancy car" when there are people living in poverty. I'm wondering the same thing about myself. Here I am, living in complete luxury (because you can't convince me otherwise when I can take a hot shower, check my e-mail and then wander down to the Town Square and buy an authentic Starbucks chai tea latte for 75 cents), when just outside the gate there are kids dying from hunger. How can I come to terms with that?

Maybe it makes more sense when I think about the hospital here. We have electricity 24 hours a day. We have IV pumps and oxygen and a ventilator. We have supplies. We have staff. We're not going to see babies die because there was no fuel for the generator that day. We're not going to watch women suffer in pain because there aren't sufficient resources to manage it. So maybe it's okay that we have so much. I don't know. I'm still working through this one, and I'm not sure when I'll have it all sorted out.



At any rate, screening is in two days. We are waiting eagerly for the wards to be full (except for Megan, who I'm pretty sure is deliberately picking her nose in this photo). We had a briefing yesterday where we got to meet the teams we'll be working with on Monday. I was part of the "handing out water/children's ministry" team. Somehow my enthusiasm for small humans must have been evident, (perhaps my mention of finger puppets and an over-abundance of sharpies?) because I'm now one of the leaders of said children's team. Which means that I'll leave the ship at six in the morning on Monday and spend the entire day colouring, playing, painting faces and putting stickers all over Liberian kids. I don't think anyone could have dreamed up a better job for me.

I was talking with yet another new friend last night (one of those talks where you end up just blown away by how faithful God is) and we were wondering together about screening. I've honestly not given it a huge amount of thought because I'm afraid I won't get into my Land Rover on Monday morning if I do. We don't know how many people are going to show up. What we do know is that the Samuel K Doe Stadium is going to be filled to overflowing with that strange mix of hope and despair. Some will be scheduled for surgery and will get with that little card the chance to reclaim a place in society that may have been lost to them since birth. So many more will be turned away empty-hearted.

Pray for us that we will be able to see them all through God's own eyes. Loved and lovely, precious beyond belief.