joy

There is nothing better than belly laughs from a chubby nine-month old baby, his whole face crinkling with the force of his smiles despite the IV in his head and boards keeping both his elbows stiff so he can't pull out that IV, his mouth wide open in a toothless, gummy grin every time you come near.

Nothing better than a little toddler, the stumps of his burned fingers covered in a bandage turning brown from too much play, who shrieks with excitement when he sees you across the room, pushing adults out of his way as he runs over, turns around and drops into your lap as you sit in the floor to welcome him.

Nothing better than a seven-year old girl, a paper crown on her head declaring her allegiance to the Netherlands in the World Cup final, who leans into your side and looks up into your eyes to show you that the swelling in her tongue is almost small enough that she can close her mouth for the first time in years. That's she's not scared anymore, her arms wound tight around your neck to prove it.

And when all three of those things happen within three minutes of each other?

I hope you'll forgive me for missing the first half of the game. I didn't want to cry in front of everyone, even if they are tears of pure joy.

The ladies danced today.

To you, that might not mean much. It might conjure up images of women in a club, dressed far too scantily for their own good, gyrating to repetitive beats from over-sized speakers. Here, it is so much different and so much more.

Our ladies are the ones forgotten. I flip through their charts and see their pain in black and white on their screening forms. When was the pregnancy? The answers vary. Five years ago. Seven. Fifteen. The baby? Stillborn. Stillborn. Died within one week. Very seldom is alive circled, and these women have carried their sorrow like a cross pressing heavy on their shoulders. Do you leak urine constantly? Yes. Yes. Yes. And with each yes, another reason to stay hidden, another board across the window and so daylight barely reaches their souls.

But today they danced.

Five of them gathered in an empty ward, a tray of makeup on a bed in the corner. Each woman donned a brand-new gown, the fabric still stiff with wax, the colours vibrant against their dark skin. Around their necks handmade necklaces, jewelry crafted while those of us not cursed to live apart whispered words of hope to their upturned hearts. Loving hands wrapped and re-wrapped headdresses, fabric formed into peaks that nearly brushed the low ceilings of Deck Three when they stood to admire themselves.

One by one, we held up the mirror. One by one, the women gazed into it, seeing, maybe for the first time in five, seven, fifteen years, their own beauty. Eyes bright with hope. New cloth unstained with urine. The chairs dry under their legs as they sat and stared.

I didn't have a chance to sit in B Ward while they danced, while they told their stories of joy and triumph. But I was there while they prepared. I was there in the quiet moments while they breathed deep and composed themselves before taking the stage in front of nurses and doctors and sisters still in bed, catheter tubing running from beneath blankets, hope growing with each hour that passes dry.

I was there. I felt the grip of arms thrown around my neck, the softness of freshly-combed hair against my cheek. I saw the smiles, first hesitant, but gaining strength the longer they looked at themselves, transformed. I shared in their joy and could not begin to understand the pain that made it so unbearably sweet.

For all of this, I count myself blessed among women.

At handover this morning, instead of a Bible verse, we settled for misquoting the Black Eyed Peas. I've got a feeling, that today's gonna be a good day. That today's gonna be a good, good day. Personally, I wasn't feeling particularly hopeful, having been up since before five and feeling more than a little ill. Right now, it's hard for me not to worry at any signs of sickness, because my Hepatitis B test has come back positive again. For those of you who don't know, I contracted Hep B back in Liberia after a needlestick injury on my second day of work on the wards. Subsequent tests looked like everything had been cleared from my system, but when I went to be a blood donor again this year, the test came back positive. Right now there's nothing to do but wait; I won't be back to the first world before Christmas, so unless there's a local lab that can run further tests, we'll watch my liver and hold on for December.

All that to say that any kind of flu-like symptoms make me feel the slightest hint of panic, since having The Hep in 2008 felt like having a flu that lasted for several long months at a time. It wasn't fun, and I'm not really hoping to go through that again. Today, I felt, was not really going to be such a great day.

Will it surprise you to hear that, just like so many times before, I was wrong?

Maurius came home to B Ward today. Ever since his surgery, he's been in the ICU, going through procedure after procedure. Twice they tried to remove his trach and have him breathe on his own. Twice he failed, one of those times miserably. He's had special IVs and feeding problems and so many struggles. But today, all that was taken away, the hole in his neck closed for good. Today, he came back to us, to the little corner bed where Chantal has been sleeping every night, waiting for him.

They came into the ward like a parade, Chantal carrying Maurius, Natalie (his nurse) carrying the feeding pump. And as soon as they walked through the door the place erupted into cheers and clappings and spontaneous songs of worship. Our baby had come home, and everyone in that place knew that a great victory had been won. Even Lovelace, who we don't think will live to see her own healing on this earth, grinned up at her papa, clapping her hands at the joy all around her, celebrating for another little one who has been given back life.

Chantal headed for her little bed in the corner, Maurius like a prayer in her outstretched hands. She knelt as the tears ran down our faces, singing in a voice shaking with joy, singing praises to Mawu who has done this great thing for her son.

A little boy came home today. It was a good, good day.

This morning, in the corner of A Ward, a little baby smiled at me. Not a huge accomplishment, you might think, since I'm goofy enough that there are very few babies in Africa who won't give me a grin, given enough time and stickers. For this baby, though, it was more of an effort. His top lip just barely moved, held in place by the steri-strips covering a neat row of sutures. The smile was fleeting, the smallest of moments, but his mama saw it and turned to me, her eyes full of wonder.

Konu, she whispered to me, hardly believing that her little broken boy was learning to smile like all the rest of them. A smile. She grabbed my hand and held it tight, gazing at her son who lay on the bed in a pile of blankets, kicking his legs contentedly. She let go after a while, and started to pack her things.

And so, once again, life comes full circle. The little baby who met us on the dock when we arrived (see his tiny little legs?) was back out there today, resting in my arms again. Only this time, he didn't feel like he was going to float away. This time, I noticed the weight of him, felt his soft, round cheek squished against my arm and the rolls of his legs in my hands. This time, instead of a lip split wide, his nose sits atop a perfect, unbroken line.

His mama climbed into the car first and turned immediately, holding out her arms for her baby, her face alight with the promise of new life. I relinquished Francois willingly into those arms because I knew that her heart was as new as her joy.

Just a few days ago, the nurse asked a question of the mama who had tried to leave her baby boy in an orphanage, afraid of his split lip, afraid that she couldn't live with a broken baby. What will you do, she asked. What will you do when you go home? And Pirette, her smile small, revealed that life had won, that hope had finally found a place in her heart.

I want to take him home.


In this season of Lent, I think that mama's words are so much more profound than she will ever know. Isn't that exactly what God said to all of us over two thousand years ago? Isn't that what held our Saviour to the cross while thousands of angels waited with bated breath for Him to ask for it to stop? I sit here, centuries after the fact, and in a mama's words I hear God speak to my heart and it's a revelation all over again.

I want to take you home. I will risk everything to do it. I don't care that you're still a little bit broken. See? I have started to mend you. I have started to make you whole, and I won't stop until you're perfect. I just want to take you home.

Pirette and Francois will come back at the end of the outreach for Francois to have his final surgery, the one to close the hole in the roof of his mouth, the surgery that will finally make him whole again. And until that day and for the rest of her life, that mama will love him with a love that has won out over death.

There's no way I can fathom how much more my Papa loves me.

There are patients in the hospital.

After what has felt like forever waiting, there are West African children snuggled beneath the blankets in the wards again. There are caregivers sleeping under the beds, translators speaking for us and teaching us a few faltering words in Mina and Ewe and Kabiye.

In the morning, when we first reported to work, we found nurses and translators and housekeepers and laundry workers but no patients. The beds were still freshly made, the patients all waiting outside in the admissions tent. We had a day to fill with more waiting, so like kids on Christmas morning we gathered in a circle in an empty ward, the feeling of anticipation filling the air and twisting in my stomach.

We sat together, brown and white and brown and white and we prayed and we sang. I sat with my hands outstretched while the Spirit flowed through my fingers straight from the lilting tongue of one of our translators. It was all consonants and sounds I'd never heard, but in her words I knew that she spoke of the same God who pulled us all here from our old homes around the world. When Kokou prayed in English, asking God to do something new here in Togo, the words of a song sprang to my lips. Before I knew what I was doing I had begun to sing.

Do something new in my life,
Something new in my life,
Something new in my life
Oh Lord.
Do something new in my life,
Something new in my life,
Something new in my life
Oh Lord.

Such simple words, ones I've sung so many times before in Liberia and Benin, but I felt tears in my eyes when I realized what I was asking. What we were all asking.

And so it felt natural when I raised my voice and prayed what the Liberians call a strong prayer to Daddy God, one filled with the name of Jesus and extravagant claims on His promises, echoed by amens from around the circle. It felt right to sit there surrounded by people I barely know and realize that we are about to start something that will change so many lives forever. It felt right to admit that things should change, that God should show up and do something entirely new. And it felt so right knowing right to the corners of my soul that He will.


(I should maybe have thought it through before praying so heartily for something new, since shortly thereafter we ran the first-ever hospital evacuation drill in the history of this particular ship. Far too much new all at once for my liking, I have to admit, and a little stressful for me; since I ended up being one of the ones to set up the whole thing and could see more than a few holes in the plan while we ran through it and couldn't help feeling a little responsible.)

But when that was all over, when all the fake patients were safely back in their classrooms (we used Academy students instead of the real deal, since that might have scared them beyond healthy levels), when I finally had time to stop and think, all that came to me was that time this morning. Sitting in a circle, feeling like the first day of school with my heart open wide.

It was all I could do to keep from dancing up the gangway while I led the first patient onto the ship, a little boy in a pink shirt who isn't going to be laughed at anymore. (That uncharacteristic attempt at professionalism may have had something to do with the fact that I was being followed rather closely by a camera crew from Discovery Channel Canada. No joke; more on that later.)

I tucked him in, kissed his round cheeks and felt the corners of his eyes crinkle as he smiled his shy little smile. I'm hoping to see that smile grow over the next few days as he realizes that, finally, everything is going to change.

Something new is going to happen.

My heart is so full right now that I don't know how I'm keeping it in my chest. It's threatening to burst, spinning colours and light into every corner of this ship.

It started last night when, in a truly symmetrical end to my day, I got wind of yet another baby on the dock. I headed out into the damp night air to find Wasti, a little one who had come to the ship from way up north earlier this week to have his cleft lip repaired. He was too sick, though, and so he was sent away to a local hospital. We knew it was too late, that there was no way he'd be well in time. And yet there he was, his eyes bright, his skin hot, but not burning like it had been. We brought him on the ship.

All through the evening we pondered, weighing life and death, trying to decide what to do. You see, Wasti is not a normal little boy. As far as we can figure, he was born with a condition known as holoprosencephaly. Normally this is fatal, but the fact that he just had a little cleft lip pointed to a less severe case. Either way, this little boy has a brain that is not normal, and a life expectancy even lower than usual here in West Africa.

As Wasti's story unfolded through no less than four translators, our path became clear. His mama is strikingly beautiful, her face covered in tribal tattoos. She has two children; Wasti has a big sister who was born with some kind of eye trouble. Much of the family's money was spent on her treatment, and when Wasti was born broken, too, his mama was cast out. Abandoned by her husband and shunned by her village, she had nowhere to go. Sending her home with a baby still broken on the outside, whatever might be happening inside, just wasn't an option, because unless he was repaired, there was no home to go to.

And so we prayed. We prepared little Wasti for surgery and we prayed strong prayers to Jehovah Rophi, the God Who Heals. There are currently three pediatric ICU nurses on board the ship, so the three of us got together and worked out who would be on call for all the shifts over the next few days, should anything go wrong. I drew tonight, and so I donned scrubs and booties and headed into the OR to see how the surgery was going and whether or not I was likely to be needed.

As I stood in the corner, quietly observing, the anesthetist, Michelle, called over to me. You can see much better from my seat if you come ventilate. I laughed, assuming she was joking, since the little boy, no bigger than a newborn at six months of age, was already totally covered with sterile drapes, a breathing tube in place. When she held out the bag attached to the tubing, I knew she was serious, and so I moved around to the other side of the table and took her place on her stool. She coached me for a while until she trusted me, and then she stepped away, leaving the bag in my sweaty little hand.

Throughout the entire operation, I sat no more than three feet from little Wasti, pushing air into his tiny lungs, my eyes torn between watching the monitors and staring at Dr. Tony's hands as he meticulously stitched Wasti's lip back together. I couldn't keep the grin off my face, incredulous at the thought that I was a member of the team performing the last surgery of the outreach, the surgery that seems so symbolic of everything we do here. Neat rows of sutures. A ticket home.

When the surgery was over and the breathing tube removed and Wasti was making a mockery of all our worries, I left to eat dinner. I shared the news of success with so many people I passed, people who had been upholding us in prayer. And when I had finished eating, I went back down to the recovery room to check on him.

Now, I know that God provides. It's just that I don't always see it as clearly as I did today. When the recovery nurse called the ward to ask if she could bring Wasti back, the ward told her no. That there was another sick baby. That the nurse didn't have time. I headed over to help, and ended up admitting Wasti back into his bed while his nurse worked with a team of anesthetists and other nurses to stabilize her other patient. Just the right people, at just the right time.

I settled Wasti's mama on the bed, propped up on a throne of pillows, her baby in her arms. I cooed and kissed, changing his diaper and mixing formula so she could start feeding him. And for the first time, I saw her smile. The austere beauty of her face was transformed, softened, as she gently touched her son's downy cheek with a finger roughened from hard work. She looked up at me with wonder in her eyes, and she laughed. She laughed and stuck her thumb in the air, repeating a word over and over in her language. Through those four translators, I learned what she was saying.

It's good. It's good. It's good.

And so surgery is finished for the year, and I can't think of a better way for it all to have ended. My hand is stiff from pressing the ventilation bag for an hour. My arms smells like sour milk from where Wasti drooled on me while I held him and his mama ate her dinner. My back is sore from bending over the bed, trying to get him settled.

But my heart is full. Full of hope and light.

I have two stories for you today. After such a long dearth, I suppose it's only fair. They really have nothing to do with one another except for the fact that they both happened during my shift this morning, neatly packaging the day together like bookends.

It started out with the dreaded 'outside call'. The phone rings a funny way and you know it's someone who has gotten ahold of the ship's number. Nine times out of ten, that person will not be able to peak English, and will assume that you, in fact, can speak whatever tribal dialect they've chosen. When I handed off the phone to one of our translators, I heard the phrase that clutches every charge nurse's heart. There's a sick baby at the gangway. Nine times out of ten, they're not babies we've operated on, and since we're not a medical facility, nine times out of ten we have to turn them away. But I'm a big softie, so I figured we could at least deliver the news in person. I already knew what I would say, some variation on the theme that runs through our days at the end of the outreach. I'm sorry. We can't help. There is no more time. I'm sorry.

I grabbed a trusty translator, Fulbert, and we headed to the gangway. Empty. We walked to the back of the ship, where we saw some people sitting on a pipe at the side of the dock. They were all old, with no children in sight, so we figured the only other option was the gate, all the way at the other end of the dock. We started to make the trek when Fulbert had a stroke of genius.

Before I knew it, I was perched on the back of his zemidjahn, the cool morning wind whipping through my scrubs as we raced down the dock. About fifteen seconds later, we had arrived. (Shortest trip ever, but at least we made it in style, and it's the only time I'll ever be on the back of one of those bikes.) The baby was on her mama's back, all covered with a cloth, and the papa explained that she was born with a tumor on her head. He showed me the size in his outstretched palm; at least the size of a small orange, and my heart sank. There was nothing we could do.

I went through my whole speech, and then lifted the cloth to find a beautiful little girl with a big lump on her head. Curious, I poked it. Soft. An idea hit me like a flash to lightning, and I turned back to the dad. Was she born at home? When he told me it was the hospital, I started to laugh. They used a machine, no? To pull her out? She was stuck? The papa was astounded, his eyes as big as saucers, wondering how on earth I knew all this, and I went on to explain that the bump caused by a vacuum-assisted birth goes away with time and that his baby was absolutely beautiful and would only grow more so.

After shaking hands and convincing the young parents that the lump would not, in fact, burst if the baby happened to roll onto that side of her head, we jumped back on our trusty bike and headed off into the sunrise. As we neared the ship again, Fulbert turned and summed up the entire experience.

A complete mission.


And then, much later, near the end of the day, I was reminded all over again why I love being a nurse. We've been caring for a lovely old lady named Christine who developed a huge infection at the site of a hernia repair. She's been growing such nasty bugs that for the last ten days, she's been shut into the corner of the ward, walled off behind curtains and forbidden from touching anyone or anything. Of necessity, she's been an outcast in the very place that was supposed to accept her. Over the last ten days she's gone from a joyful, outgoing woman to one who rarely speaks and spends most of her time sleeping. She's felt alone and cut off; she cried when I first hung the curtains on the day that her wound culture showed us the infection.

Today, after three more surgeries to clean away diseased tissue and more IVs that I can count to deliver the caustic medications to her veins, her final wound culture came back. With my heart in my throat I turned the paper over to read the words we were all praying for. No growth.

The party was immediate. Mel, one of the nurses, ran across the room and tore down the curtain. A very startled Christine looked up at me. The infection is gone? she asked, hardly daring to hope. Our smiles and cheers told her the answer, and she grabbed her walking stick and immediately left her bed. To the sounds of laughter and congratulations, she paraded up and down the ward, greeting all her friends again, lifting prayers of thanksgiving to her God. The two other women admitted with wounds raised their hands from their beds, praising God for her healing.

And when the surgeon came into the ward a little later, she leaped up from her bed again. He came to meet her, and she grabbed him in a huge bear hug, which he returned just as enthusiastically. She had tears in her eyes again, but this time it was so different. This time she was rejoicing.


Because of the Lord's great love we are not consumed, for his compassions never fail.

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 don't usually post on the weekends, but here I am, Saturday and Sunday, throwing out a little something to my faithful readers. (Hi Mom!) I wasn't planning on writing today. In reality, I didn't have much of anything planned. I'm on call for the wards this week, and my pager keeps me in a pretty small radius. (Out to the dock to throw away trash is about as far as I venture.) I spent about an hour sitting outside on Deck 8 yesterday and paid for it with a bit of a wicked sunburn, so I wasn't even planning on going that far. In fact, the most exciting thing I had planned was a deep clean of my bathroom.

I'm happy to report that that task has been accomplished, right down to a freshly washed shower curtain. There are few things I love more than the smell of fresh laundry, so I'll admit that I spent longer than was really necessary re-hanging that thing, taking frequent breaks just to smell it. (Not that I'm crazy or anything. Seriously.)

When I came back out into the cabin, I smelled something that rivaled the fresh laundry scent of the shower curtain. A friend of mine refers to Phil as The Husband of Joy, and right then I couldn't think of anything else to call him. On the desk that doubles as our table was a bowl of fresh potato greens and rice, our all-time favourite dish from Liberia. The HoJ was at the counter, squeezing the last of a pile of oranges into the bowl he was using to make fresh orange juice, and that, my friends, is all you need for a perfect Sunday lunch.

It might not seem like much to you, but on a rainy Sunday in Benin, I got to go back to Liberia, just for a little while. I closed my eyes and saw the country where we fell in love, the broken buildings and torn-up streets. I could almost smell the salt air of the beach where I sat with him and knew that I would say yes if he asked me.

I think that beats a fresh shower curtain any day.

The wards were busy today. I felt like a ping pong ball, bouncing around between the OR, offices, wards and treatment rooms, trying to keep my forty patients straight in a head made considerably foggier by the fact that I've fallen victim to the latest virus roaming the ship. By late morning, I was pretty sure I was going to die by lunchtime.

I needed to escape just for a minute, so I walked back to the hold (a big area at the back of the ship that doubles as a patient waiting area) to deliver a patient to the eye team. He had come in for a hernia repair, but in true two-for-one style, had made sure we knew about his eye problem too. On his way back down the gangway, we were able to get him assessed by the doctor, so everyone was happy.

As I moved to hand his chart to the eye nurse, a little brown blur detached itself from one of the waiting mamas and launched itself full-force into my legs. I realized that whoever it was was holding on for dear life, and when I looked down I realized that my little leech was none other than Perrin, a plastics patient I had taken care of a couple weeks ago. His hands were free of bandages, nothing but a stitch at the base of each thumb to show where his crooked fingers had been released, and he was obviously glad to see me.

When I knelt down, he melted into my arms, his little head resting on my shoulder. I felt a hand pull on the side of my shirt, and looked over to see the baby who had been in the bed across from Perrin, his foot wrapped in an admittedly dusty bandage. It wasn't long before that little boy's twin sister joined the crowd, and I had to sit down or else I would have toppled in an undignified heap all over the dirty floor. The babies crawled into my lap and Perrin hung from my neck and I wondered whether or not it could really get any better than that.

It did, actually. When I finally pulled myself up from the floor to go back to the mountain of work waiting for me, Perrin turned to his mama, gesturing for something that he wanted out of her bag. She smiled at me and shook her head before she gave him what he wanted.

Perrin whipped back around to face me, a piece of paper in his hand folded into the crude shape of a gun. Just like boys the world over, he squeezed one eye shut, got me in his sights, and pulled his imaginary trigger.

I paused long enough that he wasn't sure whether I was going to play along, so he shot me again a few more time for good measure. I took my time, made it dramatic and died right there on the floor of the hold with about thirty eye patients staring at me through cataract-clouded eyes. Perrin and the babies jumped back onto my prostrate body, we shared one last snuggle and then I really did go back to the wards.

Funny how my death was also the thing that made me feel just a little more alive today.

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.

One of my patients today was a little boy who looked a lot like a kiddo I took care of last year. If this were a contest, (and I'm not saying it is, because that just wouldn't be right) Abie would be a clear front-runner for the title of My Favourite Patient Ever. After this morning, I'm thinking Perrin could give him a run for his money.

Perrin is four, and he had surgery yesterday to straighten his two crooked little thumbs. His hands are wrapped in boxing-glove bandages and with his energy, he's clearly the patient that they made the siderails-on-kids'-beds rule for. He also speaks French and Fon with a perfect four-year old lisp, and for the first time this year, I cared for him and his mama without the aid of a translator. The fact that he spent the day calling me Tante Alice (Auntie Alice)? Didn't hurt him in the stealing-my-heart department. Not one little bit.

One of the best moments of the day came early on. I wandered over to his corner, peeled him off the ceiling and explained that he was not, in fact, allowed to jump on the bed. I handed him his morning vitamin; Il faut craquer, I told him, (one of my more recently acquired French phrases). You have to chew it. He gave me an impish grin which faded as soon as he bit down.

His face fell, and he looked at me with what I can only call disgust, his mouth hanging wide open. As clearly as he could manage through a mouthful of pill shards he glared at me and mumbled, Mon Dieu! with all the gravity of an eighty-year old man.

When I had picked myself back up off the floor, where I must have fallen in my laughter, I got him a glass of water to wash down the offending tablet. He accepted it solemnly, glared at me some more and then apparently decided to forgive me.

I spent the rest of the shift hearing his shrill voice calling me from across the ward. Tante! Jeu avec moi! Tante! Vien! Mange avec moi! Tante! Tante! Tante! We built towers from Jenga blocks spread out on a blanket on the floor. We let the charge nurse decorate both our faces with stickers. I sat next to him while he ate his lunch, and he obediently took the rest of his medicines for me, testing each one with the tip of a finger first to make sure I wasn't trying to poison him like I did with that vitamin.

When it came time to leave, he beckoned me over to his bed one last time. He was curled up next to his mama, ready for an afternoon nap. Will I see you tomorrow? he asked, visibly concerned. I told him I hoped so, that I'd try to come before he went home, and that seemed to satisfy him. He threw one of his bandaged fists around my neck, pulled me close and kissed me wetly on the cheek.

Demain, he confirmed, tomorrow, and then repeated in in Fon, just to make sure. Eeso. I kissed him on his forehead, close to where we were sporting matching little star stickers.

Eeso.

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

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

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

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

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

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

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

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

Thank you so much for your prayers.

Little Jonah came home today. I just checked his mama's Facebook (I know, aren't we so technological), and found this message that she wrote to another friend:

Dave and I have been in tragedy for the past few weeks. Jonah has been very sick and given a very grim possibility of life. He was on the ventilator for about seven days but has made a truly miraculous turn around. He was breathing with the help of some O2 [oxygen] for the past two days, and then decided he was ready to try on his own again. He was released from the hospital late today. He is very weak and fragile, but better at home than in the hospital. We have been praying, hoping, crying, begging for another miracle for our baby and God has listened. We still have a long, winding road ahead, but we have taken a huge step forward in coming home. If you have any prayers to spare, we could still use a few.

I read this and started crying just now. Maybe it was the horrendous shift I had at work (which I'll probably write about tomorrow, once I've amassed even more stories to share) or maybe I'm just tired, but I guess I never realized how sick my little friend really was. When his mama says a grim possibility of life, I know she's not exaggerating, because Jonah has been on that razor's edge so often that she knows its face far too well.

But Jonah is home now, tottering around on his little toothpick legs, learning to eat and walk and breathe again despite everything he's been through. Now if you'll excuse me, I'm going to chalk this one up in the miracles column.

And then I'm going to bed, because minor surgery on the ward, two feet from other patients on either side, is just not something calculated to make you feel well-rested after a shift.

Her name was Genevieve. She was a little older than my own mother, her eyes hard and dark and just a little desperate. The card above her bed was printed with all the details that defined her. Name. Age. Surgery to be performed. Left mastectomy. She sat silently, her hopes and fears hidden behind her impassive front as the evening wore on in its predictable pattern. Patients came back from surgery, anesthesiologists made their rounds, surgeons interviewed their new admissions. When Dr. Bruce made his way to her bed, Genevieve made her move and threw the wrench into the next day's carefully planned surgery schedule.

Non, she told us, her voice steeled against a hidden pain. Je ne veux pas. I don't want to.

We sat with her, reasoned with her, explained that her chances of survival, even in this country that has patchy access to a grand total of two different chemotherapy drugs, would be incredibly high if she let us do the operation. That the surgeon's knife was her best shot in an uncertain world. But Genevieve was adamant; she refused to sign the consent form.

Dr. Bruce eventually gave up and came to tell me the plan. Don't put in an IV yet. Feed her dinner. Give her time to decide. She'll let us know in the morning. So we put away her chart, gave her a plate of fufu and sauce and left her to her thoughts. Later in the evening, her nurse, Ursula, had a quiet moment and pulled a translator over to Genevieve's corner. After a long talk, she came back to explain to me why Genevieve would refuse a free, life-saving surgery.

It turns out that Genevieve isn't alone in her sickness. She had a sister, but her sister had the same problem. She waited too long, and by the time she had her surgery, it was too late. Genevieve also had a mother. Same story. They both had the surgery we were recommending to Genevieve. They both died. The family must be cursed; it was no wonder she was scared.

But I work with an amazing team of nurses, women from around the world who are filled with love and compassion and who will do anything to see their patients be healed. By the end of the evening, Ursula's quiet persuasion had broken through Genevieve's fear, and the next day, she went to the operating room as planned. The day after that, she was sitting up in her bed, calmly fashioning basket holders out of yarn and rope. In anyone's books, this would be counted a success.

The thing is, Genevieve also has a daughter. Her daughter also has a lump in her breast, has also been living under the same fear as the rest of the women in her family. When she came to visit her mama, Genevieve sent a translator to ask me if her daughter could also have surgery. My heart sank, and I replied with what has become our rote answer. Je suis désolé. There are no more doctors. Their faces fell, and they shrank back into their corner, defeated yet again.

But you see, unlike so many tragedies I have to share with you here, that wasn't actually the end of this story. We told Dr. Bruce about Genevieve's daughter, and he agreed to meet with her and assess the extent of her disease between his surgeries the next day. She had tears in her eyes when I handed her the little card that would give her admission to the ship the next morning, and Genevieve paused in her rope-weaving to flash me an enormous smile.

When I came to work the following evening there were a million other things to claim my attention, and it wasn't until visiting hours rolled around and Genevieve's daughter showed up in her now-familiar orange-printed dress that I remembered the appointment. Dr. Bruce was also in the room, so I shot him a questioning look. His smile told me the end to the story. It's just a cyst. She's not sick. Genevieve, already in happy possession of the news, beamed at me from her corner as her daughter hugged me and we danced across the floor of the ward together. Merci, she called to me from her corner, and then, summoning up all the English that she knew, Thank you. Thank you too much.

Because some days are way too long, and we tell far too many people to go home, to take their carefully nurtured hopes and throw them out with the trash. And other days are a celebration, a joyful dance across a ward with two women who have been saved from the curse of death and disease. I love the dancing days.