loss

I stopped into the ICU to get some supplies yesterday and saw my friend Suey, her face grim, drawing up medication in a syringe. Suey works with our palliative care team, so she's not usually on the ship, and definitely never in the ICU. She responded to my unspoken inquiry by cocking her head towards the side room. I peeked in to see a little form, still on the bed. Maddie.

Maddie is one of Suey's Burkitt's kids. She came to us first right after I got back to the ship after my honeymoon, and I fell in love with her. Her right cheek was swollen with the cancer, she was incredibly yovophobic, and her pregnant mama loved her fiercely.

Now months have gone by. Maddie's little brother, Abdul, is one month old, and her parents have fought so hard to get her the treatment she needed. Her hair is close-cut and her cheeks are even and smooth, with no trace of the cancer distorting their lines.

And yesterday, after fighting so hard for so long, Maddie died. It wasn't the cancer that killed her; it was meningitis. In the space of a few short hours her body gave out and she went to Jesus curled in her papa's arms.

Suey was, understandably, shattered. She's poured so much of herself into these kids, and to be blindsided by something like this, to watch a piece of your heart be torn out with no warning at all? It was more than we really knew what to do with. So we did what any pediatric nurses would do. I grabbed some sweet-smelling baby soap, and Suey washed her little body. We dressed her in a fresh, pink dress and wrapped her in a blanket that someone in a church far away crocheted and sent to us.

When we were getting ready to take Maddie home, the gravity of the situation struck us. This child had just died of an incredibly virulent illness, and her one-month old little brother might have been infected. So, for that matter, could any of the adults and children who lived in the same compound as them. I ran to pharmacy before it closed and got the end of a bottle of antibiotic tablets. We mixed an injectable form for the children and threw supplies in a brown paper bag; needles and gauze and alcohol wipes. Our weapons against death.

We wended our way through the streets of Cotonou, Maddie's papa holding her in his arms. I saw his shoulders tense, shielding her against the bumps, and when the car stopped at a light, he started to rock her gently back and forth, back and forth.

I have no way of describing what happened when we got to her house, no frame of reference to put it into. Relatives and neighbours crowded into a hot room as Maddie was laid on a couch. Her grandma stared me straight in the eye and told me there was no way it was true. That Maddie couldn't be dead. People streamed in and out while women clapped and sang and prayed for resurrection even as they made phone calls to plan for Maddie's burial. And somewhere in the midst of it all we found a quiet moment to explain about the infection and hold out our little packet of pills.

They lined up, hands outstretched to receive the pitiful solace we had to offer. And then we moved to the next room over where I sat on a concrete floor and drew up injections, handing them to Suey as she worked quickly to shield the babies and children from Maddie's illness. And through it all Maddie's mama sat on the couch, Abdul in her lap, her eyes empty.

I felt so small, so utterly insignificant in the face of it all. And that's when God reminded me of His love, of His concern with every single tiny little detail of what happened yesterday.

You see, in our haste to be on our way, when we threw our supplies in the bag and emptied out the bottle of pills, God was there. I had exactly enough pills for each adult in the compound, with one left over for Suey. I had exactly the right number of syringes and needles for the children, exactly enough antibiotic liquid that I drained the bottle when I drew up the final injection. In the midst of the overwhelming emotion and feelings of inadequacy, it was like God reached down and whispered in my ear, You see? I'm here. I won't let you fall. I know what's happening here. I know. Trust Me. And so, when it was all over, I walked back to the Land Rover with a light heart. Because Maddie is with Jesus, and He is there with her family.

Please pray for Maddie's family. Her mama and papa have been fighting for so long that they're not going to know what to do now that the battle is over. Pray for little Abdul, who has to grow up without knowing his big sister. And pray for Suey. Working palliative care, it's expected that her patients will die, but this one was hard.

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.

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.

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.

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

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

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

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

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

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

It happened again.

I made a conscious decision not to get involved. I listened as my roommates and coworkers shared stories about their efforts to save his life, but I refused to allow myself to care. It's happened too many times before, and my heart is still too raw, the wounds from Greg's passing too fresh. I couldn't be a part of it.

And, of course, I failed to stay away. I poked my head into the ICU to find someone yesterday and saw them huddled over his bed, fumbling with a finnicky piece of equipment, a piece of equipment I know all too well from my time as a transport nurse back home. I stepped up to lend a hand and introduced myself to the slightly-confused anesthetist who, no doubt, was wondering who this random girl in sweatpants thought she was playing with the I-Stat. (And, in a surreal moment, when I told him my name, he grinned. I know who you are. I read your blog.)

Once the results were back, I stayed for a while, helping his nurse untangle wires and get him settled. I made the mistake of touching his tiny hand, and my heart dropped out of my chest. He was so small. Insubstantial. Hardly there at all, a feathery jumble of bones and skin, and I knew that I cared and I knew that I would hate that I cared.

He went to Jesus later in the evening. Quietly, too. Like Greg, he just stopped. And they let him. They took out the tubes and the wires, all the invasions making their marks on his little body, and they let him go. He was too small and he was too sick and he went back. Some of the children got to go back.

They prayed over his twin and over his parents and over their lives and they sent them off into the sticky night air. And they cleaned the bed and put everything in its place and sent the parts of the ventilator away to be re-sterilized. Because it's probably going to happen again. And again. And I don't want to care.

But I do.

The past twenty-four hours have been so hard. I've lived the last ten minutes of Greg's life over and over in my head, staring at the ceiling all night long as I fought back the panic that threatened to overwhelm me when I turned out my light. But there's something utterly strange about this community I live in. I seem to be among people who have forgotten that our world is broken beyond recognition. Or, at the very least, if they do realize, they've chosen to live as though it were whole.

You see, grace has been poured into my spirit from every source imaginable. In the moments after Greg flew last night, there were a hundred things a nurse needed to do; I've done them all so many times before. But I was given the gift of being able to stay with Marion as long as she needed me while so many loving hands swaddled Greg and wrote out the death certificate and cleaned up his stuff and got Marion's bags packed for her. Hugs and sad looks and pats on the back and genuine, sincere questions about the state of my heart have bombarded me from every side. We have cried and laughed and prayed together, and I can't help getting excited for heaven. If this is 'a foretaste of glory divine,' Christ can't come back fast enough.


In the midst of it all, there's another, wild note in my soul; spilling out past the raw hurt is a kind of pure, fierce joy. I realized at some point as I sat there and sobbed for Marion's broken heart and my own that the pain I'm feeling is a privilege. I grew up in a country where I was safe, secure, loved. I've never known war (not really), and I've never watched my life fall to pieces in front of me. I have no idea what it truly means to hurt. Marion does. Every member of her family does. Grampa said it last night, his words halting and small. We have all lost someone. Every time, there is someone who can die.

I count it a joy that my heart feels like it's been shattered. It means that it's still soft, and it means that my life has been blessed. I must live the rest of my days in the light of that blessing.

I am utterly undone.

Baby Greg, my little Baby Greg, went to be with Jesus this evening. As I sat there on the bed next to him, in the time it took me to put a new monitor on his little toe, he seized the small moment that I was in the dark and slipped away. No fighting. No flailing. No fuss. He just. Stopped.

A thousand moments run on an endless loop in my head. Marion, brought into the empty ward where I waited for her, seeing my tear-stained face and falling to the floor, my arm the cushion for her head as we laid together and sobbed. His little mouth and nose and fingers, still and peaceful. Finally. Walking with him in my arms, a red-blanketed bundle, down the gangway and into the waiting car. Driving through the Liberian night, using my body to shield his from the jarring roads, errant lights from passing cars illuminating the curly wisps of his hair. Sitting by the light of a single candle, the flame still in the airless room, as all around me people cried quietly. Greg in his Grampa's arms, stripe-socked feet sticking out of the bottom of the blanket, as Grampa rocked him back and forth back and forth, crooning soft words in Kpelle.

Some of the children got to go back.

God, why?

Why are we left here with hearts poured out like water on the world?

I've never been much one for postural prayer. I don't always bow my head when I talk to my God, and I sure as heck don't find myself on my knees very often. Today was different; I spent yet another twelve hours at Baby Greg's side.

He didn't have a very good day. Once lunchtime had come and gone, Greg decided that he hated everything about life and would just cry for the rest of the afternoon. This meant CPAP that didn't work properly and a heartrate that had me wondering just how much longer he could keep it up. Beds in our wards are low to the ground, and I've never really been short, so by about one o'clock, my back was screaming and my legs were ready to give out. And still Baby Greg cried and thrashed and fought.

So I knelt next to his bed, leaned over his little body and started to pray. I patted his chest, the span of my hand measuring exactly space between his skinny shoulders, and I cried out to God for peace. Peace for Baby Greg so that he could just find sleep. Peace for his mama, facing the loss of yet another child. Peace for us nurses, shattered yet again by a baby who might not make it. In the midst of it all, Greg managed to work his arms free from the blanket swaddling him. As I knelt there, my eyes shut tight, I felt two feathery hands curl around my fingers. I looked down into the wide open eyes of every baby I have ever cared for, and he was pleading with me, like they all do, to just make it stop.

This is not what I thought I was getting myself into when I came here. Truth be told, I was maybe ready for a small break from the intensity of the PICU. Some time away from telling parents horrible news about their children. Hope and healing. Instead here I am, stuck in yet another situation where hope seems the very thing we can't grasp.

We took Marion, Greg's mama, into another room to talk with her about Greg's condition. We sat with her and explained that it's not her fault and it's not our fault and it's not anyone's fault. But things aren't good. And she sat with that stone face that so many mamas wear to mask the hurt. And I felt my life repeating, a record skipping over and over, and I wanted to scream.

And then something happened that I've never experienced before in a family meeting. One of our disciplers, a woman named Lucy, got down on her knees in front of Marion's chair. She took Marion's hands in her own and began to sing quietly.

Able.
Able.
I know He is able.
I know my God is able,
to carry me through.

We joined in, voices quavering and small, and Lucy prayed as tears slid down our cheeks. She prayed strong prayers to a God she was fully convinced was just waiting to work miracles. And then it was finished and we went back to the ward and Marion took Greg in her arms and nothing had changed and I'm left wondering where my miracle is.

Because I know God is listening. I spent hours today at that bedside, my hands covering Greg's body, like so many mamas, thinking somehow my hands could be enough to protect this little one who isn't even my own. I knelt there and prayed over and over the words from a song I once sang in a candlelit church in Germany. Oh Lord, hear my prayer. Oh Lord, hear my prayer. When I cry, answer me. Oh Lord, hear my prayer. Oh Lord, hear my prayer. Come and listen to me. And I knew He was listening. I knew His heart was breaking along with mine. And I know that He can do the miracle we're all asking for.



I'm just trying to come to terms with what it will mean if He doesn't.

I wasn't sure if I wanted to post this. I don't want this blog to devolve into a series of sob stories, each more heart-wrenching than the last. I want to be able to share the joy that this place brings me. The pure, unadulterated happiness I feel when I get to be the first one to show a mother the results of a surgery that has given her baby a chance at a normal life. The laughter and silliness that pervades the wards during downtimes when we sit on the floor and color or build lego castles or make balloon animals. The smiles on the faces of patients who come back to visit after they've gone home from successful surgeries.

Instead I have to tell you the story of Fatima, because she's the only thing in my mind right now.

I don't know exactly what kind of cancer is growing in her small body, jutting fiercely out from the place where her right eye should be. All I know is that it's going to kill her, and there's nothing we can do about it.

I sat next to Fatima's mother as we told her the results of the CT scan. Her body stiffened as Dr. Mark began to speak and then, as though her spine had been broken along with her heart, she crumpled. I went to get tissues, put my hand into the cupboard and came out with the a box of the same brand we used back in the PICU at home. And everything was suddenly the same as every other experience I've ever had with this sort of thing.

Mark and I sat there, helpless, tears in our eyes as she wept. She gathered Fatima into her arms, quietly keening the same cry that every mother makes when she's told that her baby is going to die. I sat next to her, mute, as she curved her body around her bewildered child, as though her own life could be an acceptable substitute. As though she could protect her.

Liberians make a hand gesture unique to this culture. They clap and then pull their hands open, usually ending with the palms facing upwards. It can mean anything. I'm tired. I'm hungry. I think what just happened is hilarious.

Or, apparently, My heart is broken. Because when Fatima's mother had gotten over the first bone-shaking sobs, she sat up and did just that. Clapped quietly and then just let her hands fall apart, defeat etched deep into her eyes, tears falling onto the bandage wrapped around her daughter's head.

And then my shift was over, and I left the ward to try and muddle through the rest of the afternoon with the sound of that quiet cry ringing in my ears.

And yet.

Don't be afraid. I have saved you. I have called you by your name, and you are (and always will be) mine. When you feel like you're drowning, I'm next to you in the deep waters. When you walk through the fire, I'm next to you in the pain, and you will not be overcome. Because I love you. And I would trade all of creation just to make you mine. (Isaiah 43)

This child, like all the others I have ever cared for, is God's. Created, known, and loved by Him. I am not called to save every life. I am called simply (if I can presume to call such a task simple) to be God's arms holding a grieving mother. God's hands winding fresh bandages around angry wounds. God's heart breaking when His children are in pain.

I think this is what it means when Jesus says Thy kingdom come.

(On earth as it is in heaven.)

It's hard to know just what to write right now. I feel like I've lived seven lifetimes over the course of this past week, and I don't know how to communicate that in black and white.

When I left home, we had just spent several weeks studying love with the youth group kids. We learned what love looks like in the world, and we learned what it means for God to be love. Little did I know how much those lessons would come to mean.

Here on the ward on the Africa Mercy, the charge nurses pick a "word of the week" for us to focus on. I found out yesterday that the words were chosen some time ago, which makes it all the more significant that last week's word was love, and this week's is joy.

Last week was one of the hardest of my nursing career. I realize more and more that, despite my best efforts to stay open and neutral, I came to Liberia with some pretty strong expectations of what this hospital experience would be like. I expected smiling faces; cleft lips being closed and club feet being straightened. I expected, if not an easy time, at least a less intense time. I expected to leave the moral and ethical issues of the PICU at home. After all, the motto of Mercy Ships is Hope and Healing, not Hope, Healing, and Helping Small Boys Slip Quietly Into the Arms of Jesus.

I was, of course, wrong. I had to come face to face with my own fallibility and weakness during the long, dark nights last week. I sat there next to Sadie’s and Benjamin’s beds and I just felt so inadequate. Knowing that God had called me to pour out my soul on these boys, but faced with the stark reality that all the love I could ever give, whether in prayer or in tangible, medical intervention, was going to fall short of making them whole again. I couldn't understand why a God who claims to be Love would let it happen. I searched the pages of Scripture backwards and forwards, frantically reaching for a toehold in the swirling mess of anger and heartbreak.

And so I learned something about God last week (perhaps not for the first time, although it felt so utterly new when I came across it again). He is Love, this much I had already accepted. But alongside His love, bound up inextricably in His character, He is also a strange God. He says so Himself. My ways are nothing like your ways. Your grandest thoughts don’t compare to mine. How high would you say the sky is? That’s a good measure of how much bigger my plans are. (Isaiah 55:9) He’s simply not bound by my expectations or my limited understanding of His heart. And He whispers to me again and again from that heart. I knew Benjamin and Sadie. Every hair on their heads. Every move they made, every day of their short lives, I knew. After all, I'm the one who wove them together; I'm the one who decided the number of their days. I wrote down each one of those days, recorded them faithfully in my book before one of them ever came to be. (Psalm 139)

In the wake of tragedy and uncertainty and feelings of failure, I am comforted by that knowledge. And I am ready for joy to come back to the wards.

Watching a child die never gets easier.

I sat by his bedside all night, flipping through my Bible, reading him psalm after psalm. I read to him about God's love, and I read to him about heaven. I held his hand and I cried and I prayed.

And now he's gone. And we are left, bewildered. Watchers from the shore, holding tight to hearts' seams ripped wide. Wondering just how this abrupt crossing has come to pass.

I was planning on saving the world; I would have been content with saving him.