13 April 2010

another day in paradise...well, maybe not so much

Today started out as a fairly easy shift. One pre-op, one six days out from surgery and one here a day too early for surgery so not even pre-op yet patient. Not a heavy load at all. Down in A-ward, my little rockstar, Marius, was going to surgery to have his bilateral cleft lip repaired. Marius, my rockstar because in his first week of the infant feeding program he never gained less than 100 grams of weight a day. Chantal, his mom, who taught a bunch of nurses how to dance one morning after church. Mid-morning, we got a call into D-ward/ICU that D-11 wasn’t going to be going to surgery today b/c their first case wasn’t doing well…wait a minute, their first case was Marius…what?!?!?

Marius didn’t do well in surgery. He came back to us on the vent and we spent the next 3 hours working on him to get him some sort of stabilized. My shift ended an hour into that 3 hours but there was no leaving Marius. When he finally was a bit better, I went to find Chantal and pray with her and talk with her about what was going on. One of the other nurses said “Natalie, I’m sorry you always seem to get the bad ones.” But really, THIS is (or at least used to be) my normal. I work in a PICU at home and having a child with respiratory distress is more normal than having one without it. It doesn’t mean it is easier for me or that it hurts my heart any less to see a child hurting, but this is my normal. And if my being there means someone else doesn’t have to watch a child hurt, then that is what I accept from my Father’s hand, relying on His strength. (ok, now that just sounds sanctimonious but no idea how to really say what I want)

Anyways, all this to say, please pray for Marius and his mom Chantal…pray for healing of his little body, the lungs fighting so hard for air, pray for peace to cover and fill mom, pray for wisdom and strength for those of us who care for them.

11 April 2010

trusting in miracles

Before I ever got to work on Tuesday night, I knew I was in for a busy night. I had been called down earlier to help get Obre settled on CPAP (a way that we can provide a bit of pressure and oxygen to the lungs). Obre has a bilateral cleft lip and palate and earlier had aspirated (inhaled) some formula into his lungs and now had an aspiration pneumonia. So, I came to work knowing I would have him and that his very underweight body (he's 4 months old and weighs 3 kg or 6 1/2 lbs) would not help his healing from the pneumonia. I was prepared for busyness. I had no idea, though, what the night really had in store for me, for him.

I got report from the evening shift nurse and started off with my regular work. Safety equipment at bedside, check. Code sheet at bedside, no. Complete code sheet, check. Now on to Obre...full assessment, check. Even with the CPAP, Obre's body was still working fairly hard. The muscles around his ribcage were pulling in harder in order to try and help his breathing, his oxygen level was in the 90's but on 60% oxygen and he was requiring help in the form of CPAP. At 11pm, Obre's oxygen levels started falling and I was having to move his jaw forward every couple of minutes to keep his oxygen up. Then I tried going up on his oxygen thru the CPAP. Everything worked for a few seconds and then he would start drifting down on his sats again. So, let's adjust his mask. At this point, Jenny, the other ICU nurse starts helping and ends up stuck for the next while with me. After 20 minutes of adjustments here and there and Obre just not settling, we call down the anesthetist Fotius. More adjustments, more work, no improvement after 20 more minutes. At home, at this point, we would have intubated (put in a breathing tube and placed on a ventilator), no questions. But, with our limited resources and his very malnourished body, this was not a decision without risk to him. So, we called Dr. Gary, the surgeon to see what he thought. And thus ensued another 40 minutes of working with Obre's body working harder and harder. His retractions were now severe, his oxygen level averaging between 60-80, his heart rate in the 200's, his breathing rate in the 80s.

At 1220am, we decided to intubate. As Jenny and I drew up medications and gathered supplies, it got quiet over by the bed...we looked over to see Dr. Gary and Fotius were praying. Jenny and I came up as the prayer was finishing and Fotius moved the CPAP mask off to just beside Obre's face. And, his oxygen level went up and his heart rate came down and his breathing rate came down and his retractions came back to mild. And we just watched for a minute and Obre didn't need intubation...in fact, we didn't even put him back on CPAP, we put him on just a simple face mask (oxygen without pressure). This is 5 minutes after the decision to intubate! We are doing less than we were before! I couldn't, at that point, call it what it was but as the night progressed and I just watched my baby in awe move closer towards normal vitals signs and his work of breathing settle even more, my mind whispered (a bit in disbelief) while my heart shouted in praise....MIRACLE! Jenny and I kept saying we can't believe it. At one point, Obre's vital signs actually dropped into the normal range and I started hovering even more (all PALS trained nurses know a pediatric body at stress can go for a while but vital signs dropping may actually by an ominous sign). But no, Obre was just getting more and more settled.

The night ended with me giving report and Jenny and I continuing to say we couldn't believe it but now quite willing to call it what it was...a miracle.

I went home and was walking thru the night again in my head. When I thought about getting concerned when his vital signs dropped to normal, it was if the Holy Spirit nudged me and said, "you didn't trust Me to finish the miracle." And it is true, I didn't trust despite what I had seen. Dr. Gary and I talked about a bit the next night and he said if that was the case, "he didn't fully trust it either because he wasn't sure we hadn't done it later without calling him down again." He also talked about feeling the peace settle as they prayed.

This night, what I saw, it was nothing less than miraculous, amazing. I am thankful the Father healed Obre. I am even more thankful that He let me see it. It was beautiful.

18 March 2010

party time!

a note from the orphanage director...

"the grand father is already organising a party for their return because he is so happy. When François was born he was considered as a wizard by the whole village, he said." now he is whole and can go home!

15 March 2010

a brightly wrapped package with a bow on top...or why i'm here.




I met Francois and his mama Pierrette on the dock of Togo the day we arrived in port…well, really I met him via email on the Monday before we arrived in Togo. I received an email that had been a series of emails about a little boy named Francois who had a cleft lip and palate and wasn’t doing well. Could I possibly see him as soon as we arrived? Of course! While everyone else was busy watching us come into port, I was busy unpacking boxes in the wards trying to find everything I might need…baby scale, infant formula, rice cereal, medicine cups, sterile water bottle, tape measure, stethoscope (haven’t used that in about 3 months, now, where did I put it?!?!), etc. I was ready to meet Francois. He and his mama and grandma arrived on the dock about 3 hours after we did with a nurse from a Benin orphanage. Mama looked overwhelmed by the amount of people who wanted to cuddle her broken baby. Grandma looked on fiercely protective.
We drove over to the team house where I weighed and measured Francois and took a history on him. Most babies with clefts are “throw-away” babies here b/c they are considered to be cursed. His mama had put him in an orphanage rather than throw him away but he wasn’t “her” baby. Most babies with clefts also nurse very badly and end up quite malnourished. And Francois was quite underweight. I called him my little chicken baby—nothing but skin and bones. When I did the math to see how much he needed to eat to catch up to where he should be, my numbers were so high I thought I had done the math wrong! So, that day I began teaching and sharing the love of Christ with mama and Francois. I taught her how to make clean water and mix formula. I taught her that cleft lips/palates happen all over the world even where people don’t practice cursing to encourage her that it wasn’t her fault and her baby wasn’t cursed. I gave them formula. I cuddled with him. I prayed with them. Every three to four days I would visit the three Beninois family members staying in a house full of yovo’s. His weight loss at first was a sign to change the formula. And three days later, his weight gain was a victory—for him, for mom, for grandma, even for me. Pierrette (mama) rarely interacted but watched everything with large eyes seeing more than I will know.
Every time I saw Francois after that, he had gained weight. Victory! He began to have a little pudge to his cheeks. And sooner than I thought possible, I was able to send him to our surgeon to be screened and he was put on the surgery schedule. Because of the Togolese elections, we admitted Francois to the hospital about a week before his surgery. Everyone who came in commented on his fat cheeks. (fat is a compliment here). And mama was watching and starting to snuggle with Francois and smiling at the gestures that indicated he was fat. We told her she was not to allow him out of her sight (although the norm in the West, not so much here and we wanted her to have every opportunity to bond with her baby). The day the nurses came to weigh him and tried to walk away, she said no and chased after them. Normal mother behavior—victory!!!!
His surgery date came around quickly and I headed down to the wards to check on Pierrette. She was anxious and so we chatted about everything and nothing. I went to the Recovery Room to see if he was there yet and I heard a baby cry and my heart leapt into my throat…he’s out! I went back to get Pierrette and walk her down to see her baby now made whole. Her face when she saw him…like she just couldn’t believe it….her lips quivering and her eyes bright with unshed tears and she lifted her arms in a gesture of praise. His surgeon, Dr. Gary, was sitting on the stretcher across from her along with our charge nurse, Ali (read her stories here…addictive), both looking on with joy. And I thought, if I could package this moment, this is why I’m here. This moment.
Mama Pierrette put the bow on the package for me today. I was down in the wards with Francois tucked into my arms and talking to mom about going home soon. “Francois is too small for his palate surgery right now. We will send you home to Benin until later on. Have you thought about going home? Will you want to have Francois back at the orphanage or will you take him home with you?” And Pierrette ducked her head shyly and with a faint smile whispered, “I want to take him home.” Victory!!!!!! That is the bow on top of the package.
The pictures above are Francois at his first visit, Francois right before discharge and mama Pierrette and Francois
ps. in a little over 3 weeks, he went from 2.4 kg (5.3 lbs) to 3.8 kg (8.3 lbs) =)

10 March 2010

call me ishmael...

i almost didn't publish this post. THEN, i managed to post it with only a title. but now, i will try to share the words of my heart.

call me ishmael...seriously, call me ishmael. the name is of Biblical origin and it means "God hears". it is the name God gives to hagar to name her son after they have been cast away. and she worships God and calls Him the "God who sees me" or "El Roi". two attributes of God in a very short passage. two names that i am clinging to right now.

this last year has been one of the roughest years of my life...being far from home and yet at home on a ship in west africa. separated from family and friends and yet surrounded by family and friends. all at the same time. and the many phone calls that would spark a fist of dread in my heart...is this the phone call about mom? the up and down roller-coaster ride of this last year as her health failed. saying goodbyes to so many people who "invaded" my life and heart. or at least "until next time". but knowing i was blessed to have so many invaders that deeply touched me. and the work that tears at my heart daily even though there is a joy as well.

so, what does that have to do with ishmael? well, in all this, though i KNOW that my Father in Heaven has not walked away or stopped listening to me, He has chosen to be silent towards me right now. and so my prayers feel like they maybe reach the ceiling (or deck-head) and He doesn't speak to me and His arms feel intangible. and so i cling to the name of God as the "God who sees" and hope that i am ishmael "God hears". i am thankful for the amazing people He puts in my life to be His ears and arms when He seems silent.

there is so much joy as well in the day-to-day (francois' story coming soon). but i wanted to share a bit of the struggle as well.

24 February 2010

first days in togo

i'm going to work backwards from tonight to our arrival 2 weeks ago in togo.

tonight...it is the first night the wards are open in the hospital. and i am here, in the middle of the night, listening to the generator hum which is just a bit louder here than in my cabin. listening to the patients sleeping just a few feet away. talking with my fellow nurse and day volunteer who both have english as second or third languages. trying to fill the hours of a long night with very little nursing...it is good to be back. a friend asked me on tuesday if i was ready for the busy-ness that would begin today and not end for the next 6 months...he asked a bit sarcastically. i replied yes, without a doubt. although i have enjoyed the break from the work, this is what God has given me and called me to. i have missed snuggling with my little brown children and babies and having chats with moms through translators and seeing joy dawning on faces which previously bore marks of shame, distrust and fear. so, yes, i am ready!

friday night we hosted a hospital open house for the rest of the crew who work elsewhere on the ship and may not have a clue about life/work in the hospital. crew members could learn to stitch or start IV's (not on real people!) or "operate" on a stuffed monkey or play nurse for a shift and have to complete nursing duties on recalcitrant patients (played by nurses of course! nice to be on the giving end sometimes ;-)hehe). it was a fun night. jens, our carpenter, is almost ready to be a pediatric nurse as he wrestled his "patient" into submission and gave her pills and took her temperature!

thursday night we held a medical reception involving the medical community of togo from the ministry of health to local surgeons, doctors, nurses, hospital directors, and more. it was a nice evening and allowed us to start developing relationships with those who we will work with as well as leaving the work in their hands as we sail away in august.

arrival wednesday until thursday saw the nurses busy unpacking, cleaning and setting up the wards. it is a lot of work to pack up, it is just as much to unpack. and we have a handful of "old" nurses who know where things go and a lot of new nurses who are trying to figure out what we meant when we said this goes in "a" ward or take that to the pilot's entrance. what?!?!? but we had fun with the work as always when you get a bunch of nurses together. crazy hats, dance parties to liven up the work, prayer, seeing how many nurses fit in a small space. and all of it being filmed by a canadian film crew who are filming what goes on in this ship of ours for an episode of "mighty ships" on discovery channel of canada. yep, i'm gonna be famous!?!??! well, not really but i may be on tv. =)

and the day of arrival. we arrived in togo to the sight of part of our land based team coming out on the tug boat that was to assist us into our berth. and as we neared the dock which will be our home these next many months, a band was playing and people were shouting and waving. the band and group of people walked down the dock, pacing us as we moved into our berth. at our berth was another band playing traditional african music to welcome us in. the gangway was let down quickly and a welcoming ceremony was held. it was hot. but it is good to be back.

14 February 2010

february 2010 newsletter

February 2010

Dear Family and Friends,

I hope this letter/email finds each of you well. I was appalled to realize that my last newsletter has been so long ago. I apologize that I have not been better about letting each of you know how things are going here. (an upfront disclaimer…the photos on here today are from fellow crew members—the dolphins and patient photos are from ali and the sunset on the ocean from ryan)

These last few months have been a time of goodbyes, a time of rest, a time of refreshment, a time of sorrow, a time of joy, and now, it is a time of work. The outreach to Benin finished in late November 2009 and that began my time of goodbyes. Goodbye to Benin, goodbye to the friends who left as the outreach came to a close, goodbye to patients and day volunteers who had touched my life. Although there was sadness in the goodbyes, there was also joy at so many who had touched my life over the last many months. The ship sailed in early December to Tenerife, Canary Islands, Spain where we would dock for 2 months to complete maintenance and enjoy the holidays.

I was able to go home a few days after arriving to Tenerife in order to spend time with family and friends. Despite some struggles getting home due to weather, I did make it home (4 days late). I made it back to Texas just in time to say another goodbye. Goodbye to my mother who went Home to Jesus on the 26th of December. It was bittersweet—knowing she wasn’t hurting anymore, knowing she was gone. We (my brother, sister-in-law and myself) were able to clearly see and feel God’s hand upon us during this time of sorrow—to feel His peace and comfort in His own touch as well as those of family and friends.

In spite of the sorrow, the time at home was also a time of refreshment and rest. I was able to visit with many friends and family, to share some of the work God has allowed me to be part of with my home church, and to just rest. It was a time of joy for me.

And now, it is a time of work. I returned to the ship in late January shortly before we sailed to Togo. The work was fairly light upon returning and during sailing, but we hit the ground running here in Togo. In addition to being a ward nurse, I have added a couple of titles to my work here on the ship. I am now the Pediatric Coordinator as well as the Infant Feeding Program Coordinator. There was an infant waiting on the dock for me when we arrived to the ship so I was one of the few who were cleared by immigration to go down on the dock immediately. But, as we are back in Africa, my infant didn’t show up for several more hours. After arriving to Togo, the nurses immediately began cleaning the hospital and preparing for the patients. So I joined in for a few hours until it was time to go visit my baby and get him into the Infant Feeding Program. We continue to clean and set up the hospital and I will continue to check on my baby every couple of days until the hospital opens for patients on the 24th with first surgeries set for the 25th. It is good to be back at work.

This work is just as much yours as it is mine and it is all for His glory. I could not be here serving if it weren’t for my gracious financial and prayer supporters. I pray that this work will bless you as well. You are part of each patient’s story. I am only the hands. Thank you, for myself and those who cannot say thank you.