Taming the beast

As I walked out of A ward last night to get something down the hall, I was attacked by an African lion. He was lying in wait just outside the door, and silently watched me walk a few yards away. I heard a growl and turned to see the fearsome pink head, scalloped edging, and a smile drawn on with red crayon. Pawing the air, he rushed me. Not easily daunted, I turned to face him head on, crouching down low.

His casted arm carefully held away from impact, his thin form made contact- brown limbs melting with blue scrubs. Tipping his mask up, he drew me close, growled in my ear, and planted a warm wet kiss on my cheek. When I kissed him back, tickling his neck, he giggled and darted back into A ward.

Later that night, that lion cuddled on my lap in the wee hours of the morning, breathing soft and regular against my chest. Success.

Quote of the night

"That bedspread looks like geometric puke."

Alrighty then.

Can't remember if I've blogged this before

"The problem with procainamide is that it's an old drug. Old drugs don't make money, so nobody studies it or uses it anymore. Thing is, it's still one of the best antiarrhythmics."

~an old ACLS instructor

Nice.

From the [hands] of babes

My roommate is one of the three physical therapists aboard (only here they call it "physios"). One of her patients decided that Megan's body was a suitable canvas upon which to practice her writing, and Megan obliged. The results are sweet. Seeing that made us think again about how hard it is to know who benefits more- the patients or us.

I suspect it's us.

The new normal: round two

The walls are magnetic. In the hospital, at least, the ceilings are too. I'm not talking about a coat of magnetic paint, either. I'm talking about liter bags of fluids and curtains hanging from magnetic hooks placed wherever is most convenient. All you need are some magnets and you're set for decorating the walls. Genius, I say!

Your times to get the essentials (toilet paper, food for snacking outside of meal times, and of course caramel waffles) are limited to a few hours a day during the week and not at all on the weekends.

You have to switch off the electrical plug before plugging in or disconnecting. Apparently this was supposed to be common knowledge and not worth explicitly mentioning, but I'd never seen anything like it before. British outlets everywhere except for a few North American ones in the wards. What happens anyway if you don't flip off the plug? Does the ship blow up?

The tv's in the common rooms are invariably tuned into soccer/football, cricket, or animal planet (seriously, I feel like it's "Shark Week" every week). When times of future programs are advertised, it's not listed as "8 pm, 9 EST" but rather" 8pm Istanbul/9 Timbuktu." Ok, I made up the Timbuktu one, but they're always places I never thought I'd be remotely involved with (even just in regards to my tv shows... as if I have any tv shows) Anyway, I always do a double take.

Wearing anything that shows your knees is now distinctly uncomfortable. For the vast majority of us, knees aren't anything to think twice about, but the culture here finds it offensive to show. We can wear shorts during off-hours on the ship, but for the most part it's easier to just wear pants and skirts that cover your knees at all times. So while I know knees are nothing, it still feels strange to walk around wearing anything that doesn't cover my scarred patellas.

You are twice as likely to fall up than down the white stairway from the deck three sleeping area to the dining room or international lounge. Although poised at the top of the stairway before heading down, you get the feeling not unlike the one you get looking over a cliff. That handrail must be the most used by far on the ship.

Adapting

An interesting research study that shows the differences in brain activity in response to painful procedures. A control group of people with no medical background and an experimental group of doctors were exposed to video clips of acupuncture in the hands, feet, and mouth. As they were exposed, their brains were scanned for areas of increased activity. The control group's brains lit up in areas involved in processing pain and controlling the panic response. The doctors' brains (dubbed the "detached experts") lit up in areas involved in higher functions (self-awareness and emotional regulation).

The accompanying surveys indicate similar levels of empathy and sensitivity to pain, though the experimental group ranked the pain and unpleasantness of the recipient lower than the control group did. This showed the researchers that the experimental group wasn't "just more emotionally numb than [the] controls or more cavalier in the face of pain."

So what? The results suggest that higher brain functions block the activation of the pain circuit. This would allow for emotional detachment from the pain of others (we wince when we see other people get hurt because of the way felt or observed pain is integrated in the neural circuit) by maintaining a distinction between self and others. This would in turn allow people to observe or even inflict pain in order to provide medical care for an ultimately good outcome.

Fascinating.

A quick tour

Down here on deck three, we fall asleep to the hum of the generators and slamming of the gigantic metal door across the hall. It's a nice place to live, though. Step right this way, we're on the left.

Room 3433 is a little tight on space, like the rest of the ship, but the six of us get along fine. Laughter goes a long way in community :)

And there are no monsters under the bed here (no sirree, no room for monsters)! In our berth, either your bunkmate sleeps below you or you sleep on the bottom bed. Cramming stuff under the bottom bunk is a fine art here on the AFM- bags, shoes, books, things you don't necessarily need on a daily basis. The thing is, there's less than a foot between the floor and bed, and the beds fold into the wall... so you'd better make sure everything is tamped down well. Otherwise when the zipper breaks on a bag and it expands another two inches, you might just find yourself squished between the wall and mattress. These are very real concerns, I tell you!

However, while there are no monsters under the beds, cabin 3433 has a bathroom monster. You think I'm kidding but I'm not. Usually he waits to reminds us that he's there until the middle of the night. Then he lets out an ugly, hollow roar. It's so jarring that we have to keep the bathroom door closed at night so that he doesn't wake up the girls right next to it. Other times one of us may be in there, not running water or anything, when he opens up in a gigantic yawn. I half expect to be sucked down one of the drains someday. Startling to say the least! Less often he possesses the toilet and decides to drain and continue suction for no apparent reason. Given the freakiness of the toilets here in general, that doesn't bother me so much.

I need to name our monster. Ideas?

Bingo

Sometimes somebody says something that resonates deeply with you. You feel as if they've walked quietly into your mind, sat down and observed for a while, slipped out, and then said exactly what you've been unsuccessfully trying to put into words.

I don't know Lindsay well at all, but she describes my experience here perfectly.

PSA

Hugs are the nearly best thing ever. Happy hugs, sympathetic hugs and everything in between- I love them, and I love that so many people here offer and receive them. We're creatures that thrive on touch.

Sadly it never occurred to me to photograph the place

As all of you fellow Seattlites know, Green Lake is the city's mecca for urban runners, walkers, bikers, dog walkers, and couples strolling along romantically. On nice weekend days, about 9,400 people visit, but you're reminded how small Seattle really is as you cross paths with friends and acquaintances. Twenty-four hours a day and three hundred sixty-five days a year, Seattlites circle the 2.9 mile long trail (3.1 miles on the outer trail by the roads). It's where people go to think, socialize, and even advertise. Buffered from the multi-million dollar homes by rolling fields and copses, a few notable landmarks make it everybody's lake. The old Green Lake Library, build by Andrew Carnegie sits across from the community center, a common meeting place. The tiny Seattle Public Theater at the Bathhouse is recognized by many, noted for the handy water fountain, but visited by few. Green Lake Aqua Theater has been largely dismantled, out of use since shortly after the Grateful Dead played there in 1969. And like every living thing, the lake changes with the season.

Die hard Green Lakers grumble about how crowded it is in the summers, having to weave between punks skateboarding, kids running around oblivious to the flow of traffic, and of course stray balls and frisbees. The glacially carved lake's waters are disrupted by dogs and swimmers braving the "Green Lake itch" on their way to the floating platform. All sorts of water fowl nest in the reeds (much to the delight of The Beast), and old men sit with their fishing lines cast out in hopes of snagging trout, carp, musky, bass, perch, and bluegill. The fields and copses are filled with rabbits, squirrels, and raccoons- again, to the delight of The Beast.

I've sat on the pier reaching towards Duck Island countless summer nights, my feet dangling and the moon reflecting off of the calm, dark water. Sometimes when the moon was full, I felt like I could just step onto the water and walk along its shimmering path. I imagined building a little cottage on the tiny island, rowing to shore each morning to head to work. Literally an island in the city.

The fall finds crew teams launching their shells, their shouts audible as they speed past the walkers on shore. High school cross country teams jog over and groups of gangly young boys and chatty young girls pass by in waves. Kids enjoy kicking through the gathering leaves, and there's a subtle sense of on oncoming slumber, a period of hibernation coming soon. The crowds start to thin out, babies are hidden in their strollers by colorful blankets, and the birds slip away unnoticed until one day you realize it's nearly winter.

Green Lake in the winter is a season I still enjoy. There are restaurants to duck into, out of the cold rain and wind. There's the omnipresent Starbucks, small cookie shop, Green Lake Bar & Grill, and of course my favorite- Spud Fish & Chips. If you walk the lake clockwise, you'll arrive at most of those just after finishing walking the most exposed part of the path where your cheeks have been chapped from the wind, despite an upturned collar and scarf, and your hands have been kept from freezing only by jamming them deep into pockets. It's invigoratingly miserable.

Then there's spring. Green Lake awakens from its green and grey slumber. Bright pink and white cherry trees lighten your mood, and the awkward Seattlites, withdrawn for the winter, tentatively make eye contact once again and quietly offer hello's. It's a season of hope and a sense of excitement covers the city. The growing number of Green Lakers optimistically wear fewer layers but still carry rain jackets and gloves for those unpredictable lapses back into winter.

I'm reminded of all this simply because I read a poem by Mary Oliver yesterday. She reminds me that poetry isn't necessarily for stuffy academics, lessons in memorization, or sappy lovers. No, poetry is a sculpture of words meant to allow us to see the beauty of a moment, a relationship, or a feeling from a unified position. A few years back, on a cold April afternoon, I was walking around Green Lake with a friend. There was an old school desk in a field, shielded slightly from the light rain by a tall tree. An eccentric woman sat bundled up with simple letters fastened to the front of the desk reading "POET." The Poetess of Green Lake. Admittedly skeptical, curiosity won out and she chose a poem to read out loud to me. I don't know why she chose it, and I don't even remember what it was, but I remember the simple pleasure of being read to by a perfect stranger on a cold, rainy spring day at Green Lake.

It's unlikely that I'll ever become the Poetess of Anywhere, but I think we all have poetry to offer. We have our hands, our ears, and our hearts to give- sculpting goes beyond words and statues after all. God is pursuing us all, appealing to our hearts in intimate ways. What poems do you hear? What poems do you write?

Stuff and things

As I was talking with a friend from back home, these thought slipped out into the chat that I thought I'd share.

I think the reason this whole current living situation works, Peleke over There and me over Here, is because the intensity of life aboard the AFM is almost as intense as the separation from him. Yes, that makes for an emotionally intense several months after an already intense few months leading up to it. But strangely enough, it's almost as if the simultaneous experiences are evening each other out. Maybe it's just a simple case of distraction, but I like to think being surrounded by intensity is validating and supportive. Does that make sense?

I don't talk much about Peleke on here, other than the obvious fact that we're separated because of his work and that I miss him immensely. The lack of details is on purpose; I have a set of guidelines for what I will and won't blog about. Rest assured he's never far from my mind. I'm sure everybody on the ship knows that already... and I thank them profusely for supporting us through the ups and downs of current life! And also, thanks for the thoughts and prayers- I, for one, find them very encouraging!

Right, so there's that.

because the ickiness of cockroaches is neverending

It's no secret that I can't handle cockroaches. As in, lose-all-self-control-and-freak-out can't handle them. So the fact that I haven't seen any bugs aboard hadn't escaped my notice.

I remember the legendary cockroaches in Hawaii in family lore. You know, the ones that crawl up the toilet after you flush them or don't die under the weight of bricks. And the flying ones in Florida when my grandparents lived there were also noted. College in Arizona was a very stressful time for me in the bug department. Sewer cockroaches in the house and ones that scurried across our paths at night served to strengthen my disdain for them. And then there's our new home in Florida. The cockroaches there freak me out- just ask Peleke. My cortisol levels just shot up thinking about it.

When we had our boat in the Caribbean, shoes were absolutely not allowed aboard. They had to stay in the dinghy. Same went for anything cardboard- boxes, coasters, etc. Cockroaches are tricky little devils and can easily get aboard. And once they do, that's the end of the story. So yes, I was enjoying the cockroach-free Africa Mercy. Was. My new bunkmate informed me that the bathroom near the gangway has monster ones living in them. Funny since I had noted that particular bathroom's lack of the horrid creatures.

So when I went in there this evening (sorry KT- TMI?), I looked all around before completely walking in and locking myself into a stall. It was quiet and so when I heard faint sounds in the neighboring stall, visions of giant cockroaches appearing from drains, trash cans, and the ceiling filled my mind. I was acutely aware of being locked in. It took all I had not to bolt out of there with my pants down around my ankles.

Turns out there was just somebody in the other stall... but I won't be frequenting that bathroom anymore. My poor heart can't handle it.

Made up word of the day

When't: contraction meaning "when not"

Usage example:

Interviewer

Do you like dessert?

Me

When't?!

Perhaps the longest blog entry in the history of man

Somebody said something the other day that surprised me, though I suppose it shouldn't. It was only a snippet of a conversation that I wasn't privy to in the ward, but it made me pause to think this evening. She said, "that's not what the sponsors want to hear about."

I understand that the feel good stories are the ones of miraculous healings. Let's be honest, who isn't moved by the dramatic transformation of a malnourished or struggling child who is felt to be cursed because of a cleft lip or palate? Who doesn't look at those photos, regardless of his medical training (or lack thereof), and run his tongue along the smooth arch of his own mouth and along the backs of all his pearly whites? It doesn't take much to know how invasive, how complex, how deeply personal those surgeries are.

But we all know that some of the deepest wounds aren't visible. The patient who suffers from tertiary syphilis is battling much more than just a growth on the head- there's also the aortic aneurism and neurological changes. The patient whose body is riddled with keloids is tricky. We may remove the biggest ones that impede function, but they will still go home with so many keloids slowly taking over. Worse, the ones that were removed will likely grow back. Have we helped? Without a doubt. Is it a pretty picture? Perhaps not to everyone, especially to those who don't have front row seats. But here's the deal- as long as we're supported, I'm happy. I'm happy because all of my patients need to be given medical care, loved, and prayed for.

I've sent home a woman who had a tumor removed from her neck. I taught her how to make clean water, how to clean the wound, how to spot an infection, when to come in, and did some preliminary teaching on hypertension management. Why are we managing hypertension here? That's a good question. When her medication runs out, we've at least gotten her over the surgical hump. She made it through surgery and recovery without cardiovascular complications, and that's something that's somewhat in our control. What the local clinic instructs her to do, if she even goes, is out of our control. When she left, I got a hug and a blessing.

I've taken care of a man who opened and closed his mouth for the first time in nearly twenty years after an untreated ear infection left his jaw ankylosed- frozen shut. We sat there talking through a translator, reviewing how to do stretching exercises to prevent the jaw from scarring shut again. I removed a drain from the donor site for the reconstruction and then removed a large bore IV put in during surgery in case he needed blood or fluid resuscitation. Every time I looked over at him, he had those popsicle sticks in his mouth- we even had to discuss the importance of stopping for sleep. He is one motivated patient who couldn't stop watching himself open and close his mouth in the mirror!

I've taken care of a woman who also had a tumor and subsequent infection removed. I pulled a drain from her head and bandaged her back up. She walked out to join the others for an afternoon on deck seven, a ragtag group of patients of all ages in all manner of splints, casts, and bandages- literally, from their heads to their toes. They came back tired but seemed to appreciate the fresh air. Climbing five flights of stairs to arrive many stories up above the water in an African port is a novel experience for many people- our patients included!

I've admitted a newborn weighing in at well under two kilos- another cleft palate baby on the feeding program. When mama laughs at my broken French, I love her even more. And when she hands me the baby so she can use the bathroom or eat, I love watching her smile at everybody flocking over to cuddle and fawn over him. Seeing her eyes light up at the steady weight gain- attributed to her hard work- is priceless. Watching mom's restoration is as dramatic to me as the patient's.

I've taken care of a blind man, a man who looks well over his stated age of forty years. Sometimes it's hard to tell patients' real ages- hard lives, poor nutrition, and very little healthcare results in some mighty scrawny and prematurely aged patients- grit and determination notwithstanding. For the most part, though, I'm learning that age is just another one of those numbers I thought was so critical for taking care of my patients. Clinical relevance is a key concept here. Even in pediatrics, weight is more clinically relevant than age. Psychosocially, age is a helpful indicator for determining the approach and interaction with a patient, but of course patients across the lifespan vary in their developmental stages (regardless of age).

The manifestations of these developmental stages are sometimes difficult for me to spot here because of confusion with cultural differences. For example, all kids go through that stage where they freak out with strangers- except the babies here seem to get endlessly passed around, mama to mama, without too much fuss. But bring a Yovo into the picture and *bam* you have a hysterical child on your hands. Is this a developmental stage or merely culturally learned behavior? (no, the adults don't lose their wits and start screaming, but we're often regarded warily).

Anyway. My old man, he has a story to tell and his facial reconstruction is stunning. I could barely keep from jumping up and down as I unwrapped him for the first dressing change. I suppose there's always some disappointment when somebody finally sees (not just hears) that they won't look "normal" but will be functional and certainly look better than before. We all want to look "normal," if not perfect, don't we? I don't quite know where he stands on the whole thing yet. The wounds are still to fragile for him to touch yet- that will have to wait a while longer. For now he is relying on us and his sister for an honest appraisal.

And then there was the young boy whose jaw has been reconstructed. It's another life-altering surgery done by our resident max-fax surgeon who hails from non other than Seattle. For various reasons, these patients need reconstruction now, but will also need another one down the road for two very important reasons. First, the initial reconstruction is usually done with a metal plate. The problem with a metal plate in someplace like your jaw is that germs don't have very far to go at all until they hit the perfect site to live- your new jaw. Plates protruding through the skin are a problem as well because you are stretching skin over the hardware, not unlike a drumhead. There's precious little muscle and fat to ensure that it doesn't lose circulation under that stress. Regrafting bone to the site at a later date is the best course of action to both prevent infection and promote circulation.

Secondly, a followup surgery is needed because kids have an odd habit of growing. While your new jaw may look like a sixteen year old's on your twelve year old frame, by the time you are twenty-one, that jaw is now too small. It needs to be size appropriate for eating and pain reasons, let alone aesthetics. In the meantime, my young patient finally got his feeding tube out and is beginning to enjoy food again.

During supply runs down the hall, I've been ambushed by a young boy, maybe six years old, who climbed into my arms for a veritable smooch-fest. I gave him one kiss on his cheek, and then it was on- kisses on the neck, cheeks, and tummy! Embarrassingly, he landed one or two right on the kisser. Peleke? I can't promise that he didn't just steal a part of my heart.

Some of these patients have primary problems that are obvious. Some of them aren't so obvious to the untrained eye (an art perfected by the patients themselves). All of them have emotional and spiritual wounds directly related to the physical malformities. So while I celebrate victories with everyone, there's a special place in my heart for the ones that don't make the calendars, the videos, and the information packets. A picture paints a thousand words, but pictures can't capture it all. Neither can words- despite the absurd length of this entry.

Are your eyes burning yet?

laughing, crying, praying, singing

I was a little disappointed to be back in D ward today, but I think most people have a soft spot for the place where they began- that unit or ward becomes a favorite of sorts*. Going back is kind of like putting on your favorite backpack- you know where all the pockets and straps are... and also where the weak spots are. So back to D ward I went and was pleasantly surprised to find we were restocked with sterile bowls and q-tips.

During report, two things stuck out to me that I thought I'd share for some more change of shift humor.

This morning I heard something I will surely never again hear again:

The doctor was saying she'll need lip volume reduction surgery in Togo.

We all glanced over and indeed she does. The patient had a series of surgeries in a facial reconstruction. I'm sure she'll look better when the bandages are removed, but for now her big puffy lips are only accentuated by the white bandages around her head, chin, and under her nose. I don't mean to make light of the situation because it's important, but you have to admit it does look a bit comical.

Secondly, we turned off the music that had been playing for change of shift at two... and sang Kumbaya. Why? Well, why not? Everybody knows it, and I dare you not to laugh when the magnetic walls of a hospital ward in a big floating hunk of metal are filled (or not filled...) with all the trappings of a mission hospital, African patients are filling beds in various states of healing, and then the Yovos start to sing a hippie campfire song.

Go ahead, keep a straight face.

Move over Puss in Boots

I worked in A ward yesterday, a new experience for me. Not surprisingly, a good portion of the shift was spent finding supplies for dressings, IV fluids, Ensure, and all of the other things that make the ward go 'round. It was fun, though! A ward is mostly plastics and ortho, so it was overflowing with kids (more than in D). One particular little boy thought the best spot of the house was on the floor in front. Indeed, he would be correct, but we were picking our steps around crayons, balls, and various other toys as we were trying to measure out medications, answer the phone, access the sink and fridge, or really do much of anything all day.

He was constantly under foot and demanding attention of some sort or another. And with a face like his, it's hard to shoo him away without a hug, a couple of kisses, and a pat on the bum. He loves to be held and swung around. Two moments will be forever in my mind. I admitted one patient post-op and assisted with another. Both times that little boy seemed to be everywhere. As we lifted the patient from the gurney to the bed, there he was trying to get on the gurney (he scored a ride). As I turned to cycle the blood pressure cuff, there he was staring at the patient. As we were getting report from the recovery room, there he was listening intently.

He's a small child, probably no more than a few years old. He knows what he wants- the glasses off your face, the pen you're writing with, whatever is just out of reach on the counter. He knows what he doesn't want- to be bothered with eating, to be kept in his bed in the corner, to have his dressings changed.

Sometimes it's easy to overlook the obvious fact that this little busybody has had surgeries on both hands and both feet. He was unleashed onto the ward with bandages on all four appendages. We call him BG... boots'n'gloves.

Amen to that, sister!

In change of shift this morning, I could have sworn she said "help us with our mercy." Turns out she said, "help us with our nursing."

Indeed.

New word of the week

Kneeples: In some cultures, to show a woman's bare upper half is considered inappropriate. Here, knees are like that. Et voila.

Vascilando

I've been feeling very socially awkward the past week. Maybe it's because I'm feeling better and am socializing more- awkwardness is my forte after all. But despite it, I've had fun the past few days. Trying to keep a low profile because I don't know if I could stand being sick again- I hear my dad's famous warning not to burn the candle at both ends (another forte of mine).

In the true spirit of vascilando (a wanderer for whom the experience of travel is more important than traveling for the purpose of reaching a destination), a few of us set out to find the elusive FanMilk factory, tempted by the rumors of free t-shirts and FanMilk of course. It's difficult when you don't speak the language (Fon) and directions are complicated when the streets don't appear to have names. I once heard the generalization that women prefer directions by landmarks whereas men prefer compass directions and street names. If that were the case, we women should be just fine here.

In short, we didn't find the factory, but we did stumble upon an area of town that was off the beaten path (probably for a reason). But for the record, we did find a dump. We also got to sit on somebody's front stoop and watch the locals go by- boys pushing styrofoam pieces with sticks down the dirt road, cobbled chickens who have escaped, and various gawkers at the Yovos just sitting there.





Apparently in this area they've given up with the "uriner ici est interdit" signs and resorted to just spray painted pictures:



Then we sat at a restaurant on the river drinking bottled water and musing about our plans and dreams for the next year.



Somewhat related to the social comment made above, my room is the coolest! We've been cracking each other up for days. Our toilet may routinely stop working, but I wouldn't trade this room for any other.

The numbers

There are a lot of numbers in the ICU. Actually, it brings another meaning to "safety in numbers." Numbers don't lie, though they can certainly distract from the primary problem. Patients are much more than numbers, of course, but we spend a lot of time recording, evaluating, and predicting them. And it's not that we don't care, but we often refer to patients by bed number when we're outside the room. After all, if you're not taking care of that person, how can you be expected to know the name of each patient tucked away in their private rooms? Numbers are a fact of life in a big way.

I vividly remember my stomach lurching at the sight of fifteen patients without monitors here in Africa. My heart was pounding, and I had visions of people crumping left and right. I knew it was overreacting on my part, but it was evident from the start how much comfort I get from the familiar blips, whirs, sighs, and alarms of a hospital room. Instead we are surrounded by laughter, foreign banter, five person translations, tv, falling Jenga towers, prayers, and singing. I'd be lying if I said it wasn't a bit disconcerting.

The lack of numbers also gave me some anxiety- where are my q15 complete vitals? Where are my hourly I's and O's? Where are my ventilator settings? Where are my CRRT numbers? Where are my individualized code sheets? Where is my H&P? It's not that we don't have numbers out here- we do (though less of them). We follow the values and trends because they're no less important. Sometimes we still refer to patients as bed numbers, though it happens less often since we're all in one big room and get group report in the mornings. I think the difference is that more time is spent interacting with patients (they're largely "walkie talkies" here) and establishing a different kind of relationship than I'm used to. Yes, we're nurses ("toto" in Fon), but nursing here is different. It's more comprehensive.

Sometimes I really miss my numbers. I'm a geek at heart and enjoy their company. And for the introverts and socially awkward among us, interaction isn't usually easy. But I don't think any of us came out here for easy. We're being stretched and tried in our individual ways. God knows what we need to grow. For me, I think part of that process is setting those numbers aside, looking the patients, staff, and translators in the eye, taking a deep breath, and interacting.

I'll be honest, it scares me a bit every time.

Sleep time

Why are these comforters not long enough to simultaneously cover your shoulders and feet? Seriously. My feet are cold enough as it is! I feel bad for everyone taller than me.

And speaking of feet, I'm a socks kind of girl. Yes, I wear them with my sandals, and I'm not ashamed to admit it! I've never been a fan of going barefoot either- inside or outside, but I'm getting used to it here. I wasn't sockless this often even in Arizona! I put some on tonight for the first time in weeks. Strange feeling.

Back to the sleep thing- I thought the regular earplugs were helpful except for the fact they fall out in the middle of the night. Then one of my roommates gave me some of her wax, moldable earplugs, and I was in heaven. No generator noises make it through! All I can hear is my own breathing and heartbeat. Ahhhh. The morning alarm clock is a bit of a problem since I don't always hear it, but at least I'm sleeping better...

At any given time, usually one of the six of us is working. We rarely have to wait to shower or use the bathroom- a lucky break for us :) Until recently (an awesome physiotherapist joined us last week) I was the only medical worker in the room; everyone else is housekeeping, HR, hospitality, sales, or dining staff. We hail from Korea, Germany, the UK, and of course the States. Admittedly, I was worried at first, but it was unfounded- we have the best room ever. Lots of laughter and respect.

And with that, I'm headed to bed! We walked around Cotonou for about three hours today- hot and tiring. I'm beat.

PSA

Let it never be said I can't be lured anywhere by the promise of food.

True story. Sad... but true.

Dinner

One of my favorite quotes from the stretch of four shifts-

"Hey! No spitting bones on the floor! Tell him no spitting bones on the floor! That's unacceptable. I saw him do it. Tell him no spitting chicken bones on the floor!"

I don't honestly know if the patient was doing it as a form of disrespect or if it's culturally acceptable in some settings here, but I do know that you can't spit chicken bones on the floor.

Shelved under non-fiction

Apparently there is an unwritten law of the universe that states:

Three quarters of all long, flowy skirts (hippie style) must be in some variation of teal.

For real.

T.I.A.

"I don't know, I didn't really like all the poop on the beach. Does poop on the beach bother you?"

"No, I'm more bothered by the needles."

Strangely enough, the exchange wasn't sarcastic. It was an honest question regarding a potential trip to a particular beach.

Night

Close your eyes. Imagine you're slouching on a scratchy couch, your legs stretched out on the coffee table in front of you. The edges of the table are digging into your calves and you smell something unidentifiable, but not altogether offensive, wafting up from the couch around you. To your left, somebody is taking up the length of the couch by the port windows, the yellow lights of the harbor casting a sickly glow on the murky water. To your right, the recessed lights of the midships lounge are bright in contrast to the dimmer hallways. Over there, at the tables across the stairway and down in the lounge by Starbucks, that's where it happens- the sounds of the nightlife here.

They start out subtly then crescendo over the next three hours. It begins with the ever present mechanical hum of the ship, a game of soccer on tv, and the clicking of the keyboards in the internet cafe. The ceiling rumbles with false thunder- the tricycles, bicycles, and wagons on deck seven are racing bow to stern, hard plastic wheels grinding against the green metal flooring. Then people start to drift in downstairs, their conversations piercing the empty openness of the atrium. Various pianists take their turns on the bench- kids for lessons and crew to entertain friends. At some point you notice that between songs and laughter, there's more music coming from Starbucks. The metal curtains have rolled up and the whirs, clinks, and laughter fill the gaps. Traffic up and down the split stairway picks up- crew with laundry, computers, games, or just a need to be social. Suddenly the couches aren't big enough. People are perched on armrests and tables, and the air gets warmer and thicker. Snacks appear from nowhere, a crinkling mass of chips, pop, and sugar.

At some point, you remember how tired you were in the first place. You made the effort to escape the grips of a nap in your bunk and had plopped yourself on the couch, but now it's back. It's time for bed. It's time to pack it in and head downstairs. And even though you may not have been all that active this afternoon, you realize you've accomplished quite a bit. You've talked with a roommate about heartbreak. You've laughed with other nurses about work. You've chatted with random acquaintances about coffee, the ship's food, Cotonou, running, fellowship, grace, and "real life."

So you walk down into the room, hoping to avoid your roommates and crash straight away. But some small part of you also wouldn't mind seeing the people trickle away, leaving the lounge to its silent thoughts.

Bloodsuckers

I know I'm a nurse, but I still am a needle-phobe when it comes to needles puncturing my intact skin. We have that nice barrier for our sack of organs for a reason, you know? After serious debate, though, I decided to donate blood here. They're in desperate need of type B, and I'm O+ so I told myself the chances are low they'll need my sanguinous fluid. And then lab called when I was desperately ill. I admit, I told them I needed all the blood I could get and would like to pass on donating at that time.

So when I got a note on my door today from lab asking me to come in for donor testing, two thoughts came to mind. One- maybe since I had declined because of being sick, they had to retest my blood or tell me I couldn't donate again. Or two- what if my blood test results came back with something like the hep (no thanks to Ali for that paranoia!). Not that I can recall any exposure, it's just that nurses statistically have a high rate of hepatitis.

Fortunately it just turns out that they not only screen our blood, but mix portions of it with potential recipients to watch for certain reactions. After three weeks or so, the donor's blood must be pitched and fresh stuff drawn. So it sounds like I'll lose about fifteen cc's of blood every month or so. But that's not the part that scares me- it's the purported use of a fourteen gauge needle for the actual donation that gets my little heart a-pounding!

Learning

Today started off a little raw since I had thought I was working evenings (2p-10p) these next few days, but I'm actually working days (7a-3p) instead. Oops. The upside is that I figured it out before bed. The downside is that bed was at nearly one in the morning. Oh well, the day was a lot of fun, and then I got a very refreshing nap!

Our individual assignment sheets always have our names printed at the top and usually have some funny comment or little quote. Mine today said, "I can do all this through Him who gives me strength" (Philippians 4:13). I thought it's a fitting verse given my lack of reserves! With the exception of mornings after working a nightshift, I enjoy report here. It's often filled with humor, nearly always with encouragement, and unflagging supplication for God to fix the things I've been too doubtful to ask for. The nursing side of us knows the pathophysiologies by heart- each person is unique but bodies break down in largely common (and often predictable) ways. Sometimes the logical conclusions, borne out by experience, paint a bleak picture, and yet three times a day we ask. We huddle using whatever chairs are handy, the wheely office chair next to the tall, rigid-backed bar stool next to the little wooden toddler chair. Like some strange circular bar graph, we sit at our various heights asking for a cancer to be healed, full function to be restored, and life to be not only spared but made vibrant again.

Then after the earnest prayers, patient handoff begins. Ratty sheets full of medicine calculations, to do lists, and pertinent patient information serve as our "brains" to make sure critical information is passed on. In the afternoons and evenings, it's like calling break after a sports huddle- we fragment off to give patients to their respective oncoming nurses. In the mornings, report is given in front of everyone (I suppose to let others know the lay of the land). Two rather memorable things stick in my mind this morning.

"He's not tolerating the Ensure through his feeding tube [a diet supplement often given until regular diets can resume], so he's been getting a liquid diet through the feeding tube. The peas from the soup were a little difficult to get through, but we figured it out. He also got FanMilk last night."

First of all, whoever thought to give "regular" food through the NG tube when he kept vomiting up the Ensure (for days apparently) is genius. The thought never would have crossed my mind to put soup or ice cream down. The strangest thing I've ever put down an NG is Coke (it's great at dissolving clogs in the tube. Just think what it does to your stomach...). It still makes me laugh.

This reminds me of an interesting thing we see here. I learned that many of the infectious bugs here are resistant to antibiotics since they're used indiscriminately. It appears that prescriptions are not needed for narcotics, antibiotics, and everything else under the sun. Consequently, we use our antibiotics even more sparingly- even vanco isn't the wonderdrug that it is at home. Infections are therefore more dangerous here because so many of them are resistant to all the antibiotics (you now see another reason why vinegar and honey are used for wound care)! And yet, while this resistance to the "big guns" is going on, Tylenol (or paracetamol if you're from outside the States) is very effective in managing the various types of pain we have here. Sure we use narcotics, but Tylenol seems to go a longer way here than what I'm used to. Some theorize the Africans have a higher pain tolerance and others say their systems aren't desensitized to pain drugs. Whatever it is, it's fabulous!

"He had episodes of query syncopy. His family says it's seizures, we think it's fainting, and the patient says evil spirits knock him over. Might want to add removing evil spirits to the list today."

We all got a good laugh. Don't get me wrong, spiritual warfare is real, but something about all three causes being blamed at once in such stark contrast for these episodes struck me as funny. At home, he'd be getting worked up- blood work, heart assessments, brain assessments, etc. Here, things are a little different. Yes, knowing the cause is important, but we're rather limited in our assessment and treatment. Consequently the workups are somewhat less comprehensive. We can't treat long term seizures and we certainly can't be managing many long term cardiac issues (ie: afib), so what is the most responsible use of limited diagnostic resources**? It's an interesting line to walk, neither ignoring nor overtesting for something you can't and won't treat. On one hand it's logical but on the other, it can be discouraging. And yet we can't deny the spiritual forces at work here either. This man needs prayer regardless. So pray for this patient it is!

Somebody once told me, "you have to keep the main thing the main thing." I think that's exactly what we're trying to do here.

**Speaking of limited resources, we seem to be left with only size large exam gloves. I suppose it's better for much of the hospital staff than smalls!

Wedding '09 - the end

So ends the seven part Wedding '09 picture installments (unless you want honeymoon pictures but I'm not sure I have the will to go through all those pictures just yet).

And they lived happily ever after. The end!

Wedding '09 - playtime at Culver

Several cars drove down to Culver to celebrate the afternoon and evening of the wedding. We took the boat out to go skiing, but none of us had much success with so many people weighing down the boat (nine or ten of us in all). It was windy and chilly but a lot of fun! Two guys jumped ship to see if that would relieve enough weight for me to get up, but alas, no such luck!







At the very end Paul not only got up but dropped a ski to slalom. Hooray for success!

Paul: water skiier extraordinaire!



After quite a day, we were treated to a beautiful sunset across Lake Max. We had an excellent dinner family style, though we couldn't all fit at the one table. This first couple is one of Peleke's good friends and his fiancee. Exciting!

We watched the day slip into night and then decided a fire was in order.



The bugs chased us inside after a bit. I mean really, I was waiting for the house to take off over the lake, carried along by the swarms of them. Creepy. As we sat in the back porch, the buzzing was incredible!

I suppose it's fitting the day we got married ended at the place where we met thirteen years ago. I'm sure I speak for the both of us when I say it meant so much to share the entire day with such good family and friends!

Sunday

I went to the HC today for their Sunday service. The service was interesting- the messages are kept simple because even though it's translated into French or English, many of the patients don't understand either. Somebody was there to translate into Fon, but the patient languages are so diverse it would be near impossible to do them all at once. I find those kinds of services difficult because it's presenting important concepts without much historical or philosophical context, and those were critical for me when I became a Christian. I feel hypocritical expecting anyone to embrace Christianity without them. And of course, many of them don't.

A mama is raising her right hand and dancing beautifully to the African worship songs that draw us all in. Dressed in brightly colored African dress, she is inspiring to watch. She is balancing her baby, casted legs sticking out on either side, with her left hand- a baby that has voodoo beads around its neck and waist and telltale hashes on his cheeks. It's strange. I suppose it's not a whole lot different than people who are slaves to possessions and style. It's merely a statement of where their priorities are. I guess both are indications of what you choose to worship- materialism and voodoo in those cases. In the end, the important point is that it's not God.



But different people need different things on their walks, and far be it from me to presume to know what those things are. My job is to love them. Right now that means giving compassionate and competent medical care through Mercy Ships. If an opportunity for thoughtful and genuine dialog presents itself, so much the better. As for relationships outside of the hospital setting, I'll take it as it comes. This morning, it came in the form of Henriette and Julien blindsiding me for hugs, twirls, and learning how to play their games.

I'm working the next few days. I'm a bit nervous because I haven't worked a day or evening shift since we've gotten as busy as we are now. I think we're gearing up for the end sprint of the Benin outreach. The funk from the recent deaths is still here, but I think it's beginning to ease up (as much as the deaths of two children ever will). The demand is high, and it's inspiring really- I'm excited to be here for it, but it is a little intimidating!

It was my weekend to check the crash carts (checking defibrillators, accounting for code meds and supplies, etc), so I spent a few hours this afternoon in each ward. As I sat there on various stools and chairs going through the carts (universally they are large rolling tool chests), I observed several things. First of all, never in my life have I seen (and surely never will in American nursing) such a random assortment of medication. The vials and ampules and premade syringes are in several different languages and concentrations. The thought of drawing those up with the adrenaline that goes with a code is sobering. It struck me again how critical it is for people to be very purposeful and careful here- we don't have the "high dose heparin" stickers or color coded medications (ie: red print = dopamine, blue print = dobutamine) for that extra measure of safety. And it's more than just medication. We have ambu bags (for "bagging" patients), masks, oral/nasal/pharyngeal/endotracheal tubes in as many languages and sometimes measured in different ways. You need a 4.0 tube? That number varies depending on the country and system of measurements you're in. Good grief.

What I really enjoyed, though, was that as I was rummaging through all the drawers and laughing at the absurdity of what I saw, kids with all sorts of casts, splints, and tape jobs from their toes to their noses were jumping on the beds, shrieking with laughter, and assaulting anybody who walked by with kisses, hugs, and smiles. Balloons were everywhere and stickers covered everything. Supplies and charts were scattered and the wards were leaking a variety of partially clothed kids who would slip through as we passed in and out. Nurses tracked down their charges as the mamas and translators just laughed. See, there's little fear of kidnapping here. Unlike home where Code Pink (pediatric abduction) is a very real problem, it's very unlikely anyone will abduct these beautiful kids. For the first time the mamas and kids are in a place where they are free to be themselves and interact without fear of revulsion or fear. So when they wander off after balloons or new friends, the mamas continue laughing with each other because they know their babies will be taken care of and brought back. It was truly beautiful chaos. I had to just sit there closing my eyes for a moment or two to soak it all in.

In the end, I suppose what matters most is that we love them and help them heal. Sitting quietly in bed isn't the normal method of healing here. To see their little personalities unfold into that chaos is healing itself. So what if their gowns are tied incorrectly or they can't be bothered to pee in the toilet (the shower is a popular choice) correctly? We're picking and choosing battles I never even knew existed. So yeah, I'm excited to work the next few exhausting days.

There are some pictures I'd like to post here, but I don't have them yet. Stay tuned...

Pictures are working again!

We went to Bab's Dock today. It's a little place started by a European couple. They made a mini-resort on a lake about an hour away. Most of the drive is along a sandy beach road lined with giant palm trees and littered with goats, pigs, chickens, mostly naked children, and trash (it's inescapable here- there's no trash service and so it's everywhere. Another story for another time). The people were kind of funny- it looked as if somebody went down the road shooting a tranquilizer gun at random- kids and adults alike just lay where they fell in mid-morning naps. Once we got to the dock, we hopped into a taxi boat that took us through a mangrove and then across the beautiful clean (as far as we could tell) lake to Bab's Dock. Given that the size and beauty of the lake, it surprising isn't private. We pulled up and walked off the pier, sections buoyed by empty oil drums and bobbing individually so that you had to be careful not to trip over the gaps.









Reed mats with cushions on them were scattered across the waterfront. There's no beach, just some stairs into the shallow water to play volleyball or go swimming. Off the pier you could play in the kayaks and canoes or the little sailfish type boat. It was an idyllic day watching the boats cross back and forth across the lake and capsizing, an assortment of people playing volleyball, and the rest of us stretched in the sun and rolled into hammocks. For my part, I spent half the day swinging in those and the other half on the ground. I read most of my brainless book and relished the fresh air, relative quiet, and beautiful view. In short, I did a whole lot of nothing in the shade. And then I came back for a long nap through dinner. While I'm still very tired, I think I'm over the exhaustion. I'm learning the benefit of forced relaxation :)

So tomorrow I shall tackle cleaning the bathroom and some work related things (both need to be done and it's my turn). I'll walk to the HC in the morning with Rebecca for the morning service there. And that's all I'm planning for since things always seem to happen. Since you're constantly surrounded by friends, somebody is always going somewhere or having an interesting conversation. I'm working monday through wednesday evenings, so i'm reserving what little energy I have for that.
.

A good day!

Wedding '09 - the reception

It's difficult to pick out all of these pictures, especially from the reception. So in an unfair representation of the billions of photos taken by several different people (including the photographer), here we go.

The reception hall was connected to the garden where we had the wedding ceremony, so that made things easy! We labeled the tables again with a Calvin & Hobbes theme (Hampster Huey, the Gooey Kablooie, Calvinball, Planet Plootarg, etc).

I think everybody had a good time. I do think the best part of it all was watching all of our friends and family getting to know each other. We took some pride in the table organization!

















Of course the cake- red velvet cake on the bottom and spice cake on the top. Yum! I am still craving more of that red velvet...





Since we stole my brother's twentieth birthday, we had to sing him a round of happy birthday of course!

Only Gina and Anne went for the bouquet, but what a fight!

And then off we went to Culver...

Knowledge

Getting married, going temporarily jobless, moving across the country, losing said husband for a while, going to volunteer in Africa. The anticipation of going back to a new city, a new home, new friends- all in all another big change. Change is the word of the year. Yes, it was a lot to take in, and it's not even as overwhelming anymore. It feels more like my life again- not somebody else's I stepped into.

So it's not that I'm heartsick, homesick, worried, or anything like that. To various degrees, I'm all of those. I'm definitely not mad; I'm not even really sad. But I don't understand the plan, and just because I believe it's there doesn't make the emotions with the whole experience go away. I don't understand war, I hardly understand religion, I don't know much about relationships, and I'll never know enough about medicine. The enormity of it- the reality- all sometimes threatens to consume me.

After sleeping all day and moving out and about for a whopping seven hours, I'm going back to bed because all I really know is that I'm exhausted.

Seasons and mysteries

Deep roots in rich soil- they notice things like seasons changing.

Feels like an anonymous message.

I don't know what this was in reference to, and I don't even know where I came across it, but this quote is written in my journal. It was probably gleaned from somewhere off the 'net, but I like it. It's hard to believe when I come home on Halloween, fall will be in full swing... in Florida. What is fall like there anyway?

Oh, and speaking of anonymous messages- stay tuned for a guest blogger!

midnight snack

Raisins have become my snack of choice recently. Scratch that, the caramel waffles are my snack of choice, but if I'm not careful I'll come home one giant waffle myself. So, raisins it is.

In addition to being a great high pitched whistle, each box has a little quote on the closing tab. Tonight mine says, "keep your hands open, both to receive and to give." Fitting, as I just read this a few nights ago:

It's not only more blessed to give than receive, it's also a whole lot easier.

Simple things

I was happy to hear somebody playing the piano this evening when I was walking past the shipshop, already pleasantly surprised to find the store open (needed to get some Ramen noodles, envelopes, and caramel waffles- you know, the essentials). As I started through the glass doors, I heard two familiar notes being played. Pausing for a moment, thinking how unlikely it was, I heard the rest of the song begin.

In quieter moments, I've found myself longing to hear this song. It's a short little piece from that old movie The Man From Snowy River, and it never fails to make me smile. Maybe it's because I've associated it with good memories growing up... maybe it's just a nice reprieve from the kids who sit on the bench plinking away on the same key over and over and over. Whatever the reason, I went over to watch and listen more closely. One of our talented nurses was at the bench, and I had to give her a hug and tell her how happy it made me. Then she started it over again as I stood there.

I don't know what exactly happened, but I had to hold back tears. If music could wrap its melody around you in a coat of contentment, then I wore a full length fur-coat last night for five minutes :)

Decisions decisions!

In my Facebook chat list, I have friends divided by cities (ie: Chicago and Seattle) and events (ie: Mercy Ships and college). So when a friend from Chicago moves to Seattle... what then?

These are the dilemmas I choose to focus on at 4am when all my patients are snoring.

Night one

Work went much better than I was hoping for. Maybe it's the beginning of the end for this virus or maybe it's the glorious antibiotics doing their job. Either way, I haven't felt feverish and the cough isn't as aggressive. I feel worn down and achy and tired of coughing, but the end feels like it's finally in sight. Unfortunately there are still a lot of nurses out or only beginning to get sick, but in the words of my partner last night, "it's not that I'm not compassionate, it's just that I don't want them to get me sick!" It does sort of feel that way. You know, scooting an inch or two away from somebody who is coughing... washing your hands just that much more... throwing up a small prayer on behalf of friends who are sick but also a small one thanking God it wasn't you.

But last night was better than ok- it was great. I came in with an overwhelming sense of peace despite the physical feelings of general crumminess from being sick and all that entails. My patients admittedly weren't all that strenuous, but I felt reassured that I can, in fact, do this. And not only can I do it, but I was able to have a few unhurried conversations along the way! I still wondered whether I was doing the right thing, but as the night wore on, I started feeling more convinced.

And then a four year old with attitude named Miracle woke up from her fitful sleep at four in the morning. Crying, she reached out her thin arms in the dark to be picked up. So I lifted her off the bed and swayed to the music we had softly playing at the desk. But the only music I heard for those fifteen minutes came from the little girl with a tube dangling out of her nose who was drooling and snoring loudly in the crook of my neck. What is trust? Walking into a floating hospital off the coast of Africa when you feel absolutely crummy is one thing. To then feel the trust of a child given to you is an immeasurable return. All I could think about was this little girl here for her third cleft palate surgery, limp in my Yovo arms, fast asleep.