When You Can't Save Everyone

This is a blog post written by a wonderful friend on the ship, Kirsten, who works on the maxillofacial ward with me.  When I read her blog post I was immediately brought to tears and had to re-share.  It gives a perfect depiction of the heartbreaking side of things we do here on the ship.  You often hear of our amazing success stories and the breathtaking transformations that take place, but rarely hear of the harsh reality we experience in these countries who lack the access to healthcare.  What I love most about this post is how beautiful Kirsten tells the story of what goes on spiritually in these wards.  If you read anything on my blog, this would be it.  
Please check out her blog for the original posting as well as so many other beautifully written blog posts: 
https://kaeliveinlove.wordpress.com/2016/10/10/when-you-cant-save-everyone/
"News travels fast when you live on a ship. Saturday night I heard that we had an emergent admission to D ward from the Hope Center. A young boy from the north, (about 10-12 hours drive) with a massive facial tumor who is here for a CT scan, began bleeding out of his mouth and nose. He was brought in and started on a TXA drip to help stop the bleeding. The CT scan was completed and reviewed by the doctors. It was the worst news possible. The tumor is too extensive to operate on. Nothing can be done.
At 2pm I walked onto the ward to begin my shift. I expected this patient to be discharged to home by palliative care by this point. Well, I was wrong. As I was standing against the counter and waiting for group report, the dayshift nurse looked over at my report sheet and pointed to D5. That’s him, she said. I scanned the column – Bed D5, Isaac, 15 years old. My stomach tied in a knot and I could feel my eyes start to well with tears. I looked up at bed D5 and the curtain was drawn, but I could hear a young boy asleep and struggling to inhale with each breath. How was I going to do this?
Isaac’s tumor has been growing for three years. In report I looked at his CT scan, and I realized why the surgeons couldn’t even attempt to operate. The tumor has literally engulfed his brain and all his major blood vessels are feeding it. As Isaac was sleeping I glanced behind the curtain to see his face. It took everything in me not to cry. His tumor was coming out of his nose and his mouth. His eyes were pushed back toward his ears and he has been left blind for the last eight months. Constant drainage was running from his one open nostril. He would occasionally stop breathing while he was sleeping. Dr. Parker said that the way his tumor is growing now, his airway is slowly occluding. He will most likely suffocate to death in the next few weeks to months. Despite all of this, Isaac is completely with it mentally.
My plan was to get all of my work done with my other patients as fast as possible so that I would have time to spend with Isaac and his grandmother. Before going to dinner I asked Isaac and his grandmother if there was anything I could do or if they wanted to go sit outside with me. The answer to all of my suggestions was no. But, they would really like it if they could have a Bible to read. We couldn’t get a hold of chaplaincy to obtain a Bible in French or Fon, but I promised I would work on it. My first stop before eating dinner was my cabin where I grabbed my Bible. I thought at the very least I could read to them in English and have one of the day crew translate. The next question was what passage to read them? I ate a quick dinner while flipping through my Bible, but nothing really was coming to me. I went out on Deck 7 before going back to the ward and it hit me. As some of you know, I lost one of my best friends in college to cancer. Shortly before she died she wrote a baccalaureate speech, which her parents gave me copies of to share with others after she passed away. The verse she focused on in her speech was Isaiah 40:27-31. I read it. It was perfect.

I went back down to the ward apprehensive. I didn’t know how this was going to go. I didn’t know if I was strong enough to do this. But I do know God put Isaac in my care for a reason. I asked one of the day crew, Johannes, if he would come read the Bible with me to the family. He said yes and as we were walking over to them, Johannes remembered that another patient had a Bible in French. This patient said it was ok if we borrowed it. We sat down in a circle. Isaac to my left, his grandmother in front of me, and Johannes, and another day crew member, Janet, to my right. We started by reading Psalm 23, and then moved on to Isaiah. We spent about ten minutes rereading this verse. We said it in English, Johannes read it in French, and Janet translated it into Fon. Slowly and emphasizing every word with great passion.
“Israel, why then do you complain that the Lord doesn’t know your troubles, or care if you suffer injustice? Do you not know? Have you not heard? The LORD is the everlasting God, the Creator of the ends of the earth. He will not grow tired or weary, and His understanding no one can fathom. He gives strength to the weary and increases the power of the weak. Even youths grow tired and weary, and young men stumble and fall; but those who hope in the LORD will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint.”
After this we spent a lot of time in prayer. Johannes prayed, Janet prayed, I prayed. We have an amazing day crew. They spoke when I couldn’t come up with words to say. I asked Isaac if there is anything in particular I can pray for him for. He took some time and then he answered. His grandmother burst into tears, Janet began crying, and Johannes got up and walked away. Oh no I thought, what just happened?? After a few moments Janet translated for me, he says that he just wants to be able to go to school and finish his education.

I just met Isaac, but I love him. I had a lot I wanted to tell him, but I didn’t know how. Then out of nowhere Johannes pointed to Isaac and asked me if there was anything I wanted to say to him. It was like God giving me my opening. I took Isaac’s hand. I leaned in and looked him in one of his eyes. I told him how happy I am to have met him. I told him that he is inspiring and he is strong and that I care about him. I told him I love him, the nurses and doctors love him, and that God loves him. I promised that there are so many people praying for him. I held Isaac’s hand for several minutes, sitting in silence. To finish, I asked Janet if she wouldn’t mind singing a song in Fon. She began, Johannes joined in. Isaac’s grandmother sang through a cracking voice. Then I started to hear more voices, my other patients began singing too. I looked at Isaac and he was clapping along.
This was one of the hardest shifts of my life. My heart breaks as I think about Isaac, but I’m also amazed and overjoyed that God brought him here at this exact time to remind Isaac of His perfect love and hope during these last days. To remind him that this life is temporary, but that Heaven is perfect and forever. My heart breaks as I think about how Isaac’s tumor never would have gotten to this stage in America and my heart breaks as I think about how many more people will die in this manner. But as I look around and think of all of my other patients in the ward, I realize if this ship weren’t here, they all would have eventually ended up this way. We can’t save everyone. But we can raise awareness, we can show love, we can care for the sick and the poor and the broken and the dying. We can do small things with great love.

Isaac is more than a tumor. I want you to meet the Isaac beneath his skin. Isaac is strong and brave. Isaac is gentle and loving. Isaac is scared, but he doesn’t complain and he doesn’t cry. Isaac is a 15-year-old boy with hopes and dreams for his life and for the world. Isaac enjoys playing with Playdough and dancing. Isaac has some of the most beautiful eyes I’ve ever seen. He may not be able to see the world anymore, but he still sees a God that is worth turning to and thanking. After being told on a Saturday night that he is going to die, Isaac chooses to go to church on Sunday morning and sing Hallelujah.
Please join me in praying without ceasing for Isaac and his family. I wish you could have seen his face when he heard that there are people in the United States praying for him. This may be because for the first time over the last three years he realized that the world cares about him. Pray that his pain will be minimal and that he won’t suffer long. Pray that all he will feel over these next weeks or months is love and peace.
I wanted you to know about Isaac, because his life matters. These issues are important. He is important."
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Memory

Every Wednesday night the ship has a medical in-service night where surgeons or program directors give lectures on specific topics such as maxillofacial surgery, orthopedic surgery, VVF, plastic surgery, the ponsetti method for clubfeet and many more.  These nights are some of my favorite nights on board.  I find it truly amazing that after operating for hours on their feet, these amazing individuals continue to stand up and teach us the intricacies of their work so I, in turn, can be a better nurse.


Dr. Gary Parker who has served the last 30 years as a MaxFax surgeon on board

Last week Dr. Gary Parker spoke about Mandibular tumors, a popular surgery performed here onboard.  We have already had a handful of patient's this field service with mandibular tumors that I have been lucky enough to take care of.





Most mandibular tumors we operate on are Ameloblastoma's.  Ameloblastoma's are rare, benign tumors that originate from the enamel, or outside portion of the teeth.  They are typically slow growing tumors that rarely become malignant.  In developing countries, these tumors are removed when they are found and never progress to these extremes.  While not malignant, these tumors become deadly when left untreated.  If you are lucky, the tumor only grows in an outwards progression, away from the inner mouth and airway.  If the tumor grows in a posterior or superior direction the individual is faced with the possibility of either starving or suffocating to death.


Our respiratory drive is one of the strongest reflexes in the human body.  When threatened, it becomes an all encompassing drive that causes every thought to be dominated by finding that next breath of air.   Imagine when you were held underwater as a child in a swimming pool.  The tightening of your chest.  The panic of possibly being unable to resurface.  Every cell in your body fighting to find an oxygen molecule.  The slow suffocation.  All while being hidden away from society because of your appearance.  The isolation...  I cannot imagine a more heartbreaking way to leave this world.



Dr. Gary has spoke of previous patient's in the past who show up at our gangway, bent over, gasping for breath and using every accessory muscle in their bodies to pull in oxygen.  In some of those dire situations, emergency surgery was performed to simply give them a tracheotomy (or an airway through the neck) to immediately save their lives in order to prepare them for surgery at a later date to remove the mass.  


Just last week, I asked one of my favorite patients Julien about how he was feeling.  Half drooling from the excess skin left in place, he smiled at me and said simply "I cannot wait to be able to smile again.  And to someday get married".  Isn't that amazing?  Both of those desires are desires to give love and to receive love.  That's all this man has wanted in his life.  The simplicity is beautiful and echoes the true desires of the human heart.  

Julien (yellow hat) in line at the screening center


As always, when I finish his dressing change he stares at himself  for a long time in the mirror.  The picture isn't quite perfect yet.  He will come back at a later date to have more surgery to fill the titanium plate in his jaw with a bone graft and remove whatever excess skin is left.  Before I leave him to stare into the abyss of his reflection I always ask him "Julien, what do I always tell you after your dressing changes?"  His eyes light up, he smiles and says "My skin has memory".  I smile and say "that's right."  Just as a pregnant woman's skin retracts after giving birth, so will the excess skin stretched by years of tumor growth.  I never walk away without reminding him of this. Your skin has a memory.  

Although I'm not quite so sure he cares about the outward appearance anymore.
He is simply glad to be free.  

Compassion is not a relationship between the healer and the wounded.  It is a relationship between equals.  Only when we know our own darkness well, can we be present in the darkness of others.  Compassion becomes real when we recognize our shared humanity.

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A New Adventure

I am terrible at blogging so I figured giving you an update on what has been happening since my last post only seems appropriate.  What started as a 3 month journey to Madagascar with Mercy Ships and a trip to Kenya to teach neonatal resuscitation, resulted in quitting my job, spending six months overseas, rearranging my priorities in life and in general rocking my world as I knew it.  To say there has been a clear cut, non tearful path to this point would be a lie.  There have been so many days back home in Cincinnati where I have sat down and told myself “this is okay… you could be happy right here in this comfortable spot.  Why do you need to go halfway around the world to be satisfied?”  Doesn’t help that every time I leave my family at the airport, my dad cries and I half consider abandoning ship (pun intended) and jumping back in the car.

But alas, here I am.  Halfway across the world living on a ship off the coast of Cotonou, Benin with a bunch of crazy, but amazing people who decided to jump on the non-conventional bandwagon. I have made it safely and finally settling in to a normal ship routine.

The ship arrived in the middle of August to begin its field service here in Benin and will spend 10 months providing free surgical and dental care to thousands of Beninese people.




   


I was lucky enough to be surprised at the airport by some of my favorite people on this earth.  Being reunited with old friends and seeing their smiling faces made all of the doubt and fear completely disappear.  My first week on board was pretty uneventful.  While most of us unpacked, cleaned and organized the hospital, our screening team was in full motion finding patients for this field service.
 


The screening team is a group of nurses and translators who are real life superheros.  I mean that in every sense of the word.  They have spent the last three weeks on the ground working tirelessly to sift through the thousands of people who show up to our screening days for a chance to be assessed by our surgeons and ultimately given an appointment card for a surgery.  The lucky few receive surgery appointment cards, while many are turned away for various reasons… possibly too sick to undergo surgery, suffering from conditions and diseases we do not treat on the ship or they are turned away simply because we have run out of room in our appointment slots.  While handing out those appointment cards brings incredible joy to our screening team, there is a heaviness and weight to turning away countless suffering people.  So if you are the praying type, please keep this team in your prayers.









Last week the hospital officially opened its gangway to our first patients and we all are excited to be back working on the wards.  We are currently doing general surgery, plastics surgery and maxillofacial surgery. Throughout the year we will also being doing orthopedic surgery and women's health/VVF surgeries.  I currently work on the maxillofacial surgery ward, or D ward as it’s called on the ship.  Maxillofacial surgeries are those that specialize in treating diseases and injuries of the head, jaw, neck, face and the soft and hard palates of the oral cavity.  



Once things start settling in more I will touch on more specific surgeries and patient stories that occur on the ship. But I cannot begin to tell you how exciting and rewarding it is to be back working on the wards of the Africa Mercy.  Nursing here is just different.  I can never seem to put my finger on the reason why.  Whether it’s the language barrier, the incredibly grateful patients of Africa,  working with nurses and doctors from all over the world, working with local day crew who teach you SO much about their country, surgeons who come to check on their patients at all hours, worship music filling the background of the wards or praying as a team at the start and end of shifts… It all makes for an indescribable work setting.  The combination of the physical, emotional and spiritual healing that is witnessed on this ship is the reason why I became a nurse and I could not be more happy to be "home".

Thank you to everyone who has reached out to show their love and support. I don't think I could ever articulate how grateful I am for that. I plan to be much better at updating/blogging about the ship so if there is ever a specific topic or question that you would like me to touch on, please let me know!

"The things that excite you are not random. They are connected to your purpose. Follow them."
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November Recap

The blog posts have been few and far between recently... Asafady (sorry in Malagasy).  A ton has been going on so it's been hard to sit down and write an update for everyone!  I'm working on some longer more personal posts but for now here is a quick update on all we've done in November!
 
 
November Recap
 
 

 
 
170 patients recieved surgery and were cared for on the wards
512 Inpatient Rehab treatments
165 Outpatient Rehab treatments
Local surgeon and nurse preceptorship onboard the Africa Mercy
Surgical Counting Course held at Hopital Be
105 Club feet treated using the Ponsetti Method
961 Dental appointments
143 Xrays taken
19 CT scans taken
Gown and Gloving course held at Hopital Be
60 patients scheduled for surgeon screening in Mandritsara
47 patients scheduled for surgeon screening in Andapa
Biomedical course held at Hopital Be
Dental Course held on board
97 patients scheduled for surgeon screening in Toliara
53 palliative care visits
22 patients cared for at our obstetric fistula center
 
 
 











 
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October Recap

Just landed in Kenya this morning after a long 24 hours of traveling.  Very excited to get to work with Ohio State and Free the Children to educate nurses on how to better take care of neonates.  Not to mention getting to see a friend from home in just a couple hours.  My heart is happy to say the least.
 
Here is a quick recap of all we have done on the ship in October!
 
 Fast Facts on October
 
170 Operations and patients taken care of on the ward
1,204 Patients received dental treatment
179 Counseling sessions
160 Patients from Mahajanga and Antsiranana will be scheduled for surgeon screening
198 Xrays completed
22 CT scans completed
79 Palliative care visits
46 Women cared for at the obstetric fistula clinic
158 club foot treatments by rehab
441 rehab treatments inpatient and outpatient
Glaucoma course in Tamatave with 75 participants
Dental course held on board with 21 participants
Biomedical course held at Hopital Be with 6 participants
Numerous primary Care Trauma courses held in Tana 
Safe Obstetric Anethesia course in Tana with 39 participants
Numerous World Health Organization Safe Surgical Checklist/Lifebox Team training courses throughout Madagascar
 
 
October was an incredible month on the ship.  Plastic surgery wrapped up and our orthopedic surgeries started on board.  I was lucky enough to participate in Orthopedic evaluation day which was a very humbling and eye opening experience.  Patients treated last year by Mercy Ships in Madagascar came to be followed up on.  After sitting down with me and answering personal questions about shame, marriage potential, happiness with their outcomes etc, they moved on to be evaluated by the rehab team and our orthopedic surgeon.  It was incredible to hear their stories and see the children running around with now straight, healthy bones.  Now with endless potential in front of them.
 
I'll leave you with some pictures of our plastics patients and some of my best friends on the ship.  Cannot even begin to tell you how much I love these kids.  After 2 months on board I can say with certainty that they have stolen my heart.  I will miss them so much.
 


























 
 
 
I'll be spending two weeks in Kenya doing neonatal education with healthcare workers here and then will return back to the ship.  When I return back to the ship I will be moving wards and will work in our ICU and on D ward which is our maxillofacial ward.  I am excited for a new challenge and cannot wait to continue to share all the amazing things happening here!
 
 
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