The Eleventh Hour

[ :the latest possible moment.]

With our first week of surgeries here in The Republic of Congo done, there is a tangible excitement on deck 3 as the sounds of patients echo down the corridor.  The Africa Mercy feels like a hospital again.  There are always a few patients for whom the arrival of the ship could not have been timelier, as was the case for one young boy this week.

On screening day one of my rolls was to be on the Emergency Medical Team (EMT) in case anyone on site (crew member or otherwise) required immediate medical care.  About mid-morning we thought we heard an EMT call over the radio but weren’t sure, so Beth went to investigate.  A couple minutes after she left it became apparent that they were indeed requesting the EMT to respond to Gate 4.  Standing next to all the gear, I realised that the rest of the crew on the EMT were currently nowhere to be found… & Gate 4 was on the opposite side of the screening site!  [gulp]  I quickly grabbed my translator & told him to carry one of the large EMT bags & follow me.   Nate was nearby & grabbed the monitor & suction, & I threw the other EMT bag on my back & took off in the direction of Gate 4.  I have to mention, these bags are seriously heavy, & I usually struggle to get them off the ground, let alone run with one on my back.  It’s moments like these you need minties Adrenaline!!  One of the security officers met me half way across the soccer field & carried the bag the rest of the way.  Beth had heard the EMT call over the radio & already made her way to gate 4, along with one of our Anaesthetists, Michelle.  Our patient was a young child in respiratory distress, obvious from his audible stridor & significant work of breath.  Michelle looked in the back of his throat & saw that he had a tumour obstructing his airway.  Realising there was nothing we could immediately do & he was maintaining his own airway (as best he could), we consulted our surgeons & managed to fast track him through the screening process.  I’m not sure how this patient & his family ended up at the exit gate, but he was definitely in the wrong place at the right time.  

Fast forward one week & I am working night shift on the Max Fax ward.  This little guy had been admitted to the ward pre-operatively, & his surgery was scheduled for the following day.  I was warned that his breathing sounded horrific, & when you walked onto the ward, there was no mistaking it.  As a paediatric emergency nurse, I knew that his stridor & severe work of breathing would have earned him a category 1 in my emergency department back home, & likely a spot on an emergency theatre list.  But on this night, all we could do was wait for his surgery the next day & pray that he maintained his airway through the night.  Exhausted but unable to sleep, he sat on my lap & grabbed at me in desperation when he momentarily couldn’t get any air in.  Occasionally I heard nothing but silence as his chest heaved in & out without actually moving any air.  But each time he would gasp & manage to suck some oxygen down into his lungs.  I tried to find a comfortable position for him, so he could sleep on my shoulder sitting up & breath easier, but there was no sweet spot.  It broke my heart to not be able to relieve his struggle to breath.  But I knew his surgery was only hours away, so myself & the other nurse on duty kept counting down… only 4 hours until your surgery little man, hold on!!!  As I sat there with him on my lap struggling to breath I wondered, how long had this poor kid been compensating like this?  How long had it been since he had had any REM sleep, & how much longer did he have before his airway would have completely occluded?  It certainly felt like the eleventh hour for this little guy.  All I could do was hold him & pray, because although all creation has limits (including medicine) my God has none. 

On Wednesday morning he received his surgery, & after a couple days on the ventilator, he is now breathing on his own & I am told, recovering well.  I can’t wait to see him run down the halls smiling.  But for now… he just needs to sleep.  

Emmanuel  [ :God with us]

Let the eleventh hour quickly pass me by.  I’ll find you when I think I’m out of time.

Je suis desole

It always seems impossible until it’s done.  At least, that’s what selection day feels like in the weeks & days leading up to it.

Some moments in our lives are hard to forget, while others are less memorable.  Last Wednesday was one of those hard to forget days that will long be etched in my mind.  Certainly the biggest day of the entire field service, it was our patient selection day.  Advertised for months in advance, people started to arrive & line up the night before.  With the hope of being seen by a doctor & receiving much needed surgery, they waited throughout the night & well into the day.  As the night stretched on, a few nurses walked up & down the line looking for people they knew we couldn’t help, so that they didn’t wait unnecessarily.  Some understood & left, but others refused to leave the line.  This was their chance & they would wait!  Rarely did we hear of any sort of commotion in the line, which may be attributed to the presence of the local police, guns slung over their shoulders.  Or maybe they were simply grateful for the possibility of receiving well overdue medical care, & without the sense of entitlement you so often see in the west, they simple didn’t complain. 

I could explain the day to you in numbers.  My alarm went off at 4:30am & I jumped out of my top bunk like a wound up rubber band.  I found my pre-assigned land rover & we pulled away from the ship under the cover of dark.  We arrived at the screening site just before 6am as the sun was just starting to rise, & began what would be a 14+ hour day.  There were over 300+ Mercy Ships crew on site at any one time, & we needed every single one.  From the surgeons & nurses, to the amazing patient escorts, to the people entertaining the tired children, & our Academy students who handed out water & food to hungry patients, everyone had a part to play.  Like a well-oiled machine, my Mercy Ships family worked together to pull off one of the smoothest selection days ever.  I’m told we broke all the Mercy Ships records… in fact it was the largest turn out to a screening day Mercy Ships has ever had!!  Over 7534 Congolese people turned up, & 4236+ potential patient’s were seen by our team.  Mercy Ships has never been to Congo before, so no one really knew what to expect.  To be honest, we were a little nervous that we wouldn’t find enough patients.  Why did we ever doubt?!

But numbers cannot even begin to do the day justice.  Statistics could never convey the desperation, the hope, the jubilation & the disbelief.  It was a day full of joy one moment & heartache the next.  It’s not about the thousands… it’s about the one.  Because each one matters.  That’s why we’re here & I hope that’s the message we conveyed to every single person we came across. 

I was working in pre-screening, which was the first stop once those waiting got to the front of the line.  They would explain to us the reason they had come to be seen, & we would make a decision according to our specialties whether or not they were a candidate for surgery.  If their need fell within the scope of specialised surgeries that Mercy Ships can offer, then we would give them a coloured card indicating which specialty they needed to go to.  They would then be registered, have their history & vitals taken, & be see by a doctor.  But many people turned up with chronic conditions or illnesses that we simply could not help with.  If the answer was no, then with regret I would have to explain that we were not able to help.  As the day rolled on, the weight of every no began to weigh heavy on my heart.  I looked into their eyes & told them what they didn’t want to hear, & I wondered, what if this was my Mum, my grandparent, or my friend.  Everything within me groaned as the tears began to well up.  I quickly put the thought to the back of my mind… I didn’t have time to loose my nerve.  After yet another lengthy discussion trying to explain to someone why we weren't able to help them, I looked at my translator & we both let out a big sigh.  This is hard, I remember him saying.  I could only manage a smile, as if to say, I know.  Then we both turned towards the front of the line & put our hand up in the air to motion that we were ready for the next patient. 

What amazed me more than anything was the way so many people accepted a ‘no’ with such grace, humility, & understanding.  Some were upset & disappointed to be sure, while others just stared at me in disbelief.  At times all I could manage to say to the person standing in front of me was, je suis desole [I’m very sorry].  One man replied, “that’s too bad”, while another said to me, “That is the will of God”.  Whether you agree with him or not, his faith & strength in the midst of trial stood out to me as an example.  I am already learning from the Congolese people.  How do you look into a father’s eyes & see the desperation on written on his face for his child’s life, & tell him that you cannot help?!  There’s no changing the channel when you’re standing in the same dirt.  It’s one thing to do the research & know the statistics, but there is a certain sense of responsibility when you’ve seen the need with your own eyes & held them in your own arms.  The injustice of it all reminds me why I am here.  I may not be able to help everyone, but I can help one.  I can use what is in my hands & within my capacity to serve & honour God by serving the poor.

I don’t mean to sound gloomy, because selection day was amazing & I would do it again in a heartbeat.  The truth is there are thousands of people that we will be able to help over the next 10 months, & I am so excited to be a part of that.  In fact this afternoon as I write this, our first patient's are being admitted to the hospital for their surgeries tomorrow.  I can't wait to meet our patient's, to care for them & love on them, & then share their stories with you.

Our lives begin to end the day we become silent about things that matter.

I don't know why a good man will fall
While a wicked one stands
And our lives blow about
Like flags on the land

Who's at fault is not important
Good intentions lie dormant
And we're all to blame

You who mourn will be comforted
You who hunger will hunger no more

You who weep now will laugh again
All you lonely be lonely no more
The last will be first, of this I'm sure