My heart could burst!

During my night shift last week, I came into the ward to find a woman on the ventilator.  She had had quite a large tumour removed from her palate and a tracheostomy put in for her airway.  She wasn’t unstable or particularly sick post operatively but was a little too lazy to breathe on her own.

The following night, she was back in the ward, coping well with her trache and change of airway.  She spoke a language that wasn’t spoken by many of our translators, but she also wasn’t able to speak with her trache in. We were able to communicate well enough with her to meet her needs.

Over the following days, she recovered very well and at the beginning of my shift one day this week, it was time to remove the trache.  With a surgeon, ready with a scalpel to cut the sutures holding it to her skin and several nurses standing around ready, she sat wide eyed on a stool next to her bed.  With the swift motion, cutting the sutures and a gentle sweep of the wrist to pull out the trache, it was gone! The small hole in her neck gapped open as she took more breaths. Eyes still wide, pulse racing, nurses’ hands reassuringly resting on her, we told the translator to ask her to relax and just breathe normally.  Soon enough her wide eyes, calmed and she realised all of a sudden, this strange plastic tube in her neck was really gone! She was back to herself! Her smile spread ear to ear, almost as though her face would burst open with happiness.  She reached for every nurses and doctors hand, shaking it and murmuring her thanks.  We covered the small hole, letting it close over itself as it heals, and she stood to her feet.  One of our other patient’s mothers came over, and began to sing a song of praise and we stood around in a circle clapping along, as our dear patient danced, her arms raised high and her smile splitting all of our hearts open wide with joy! As she hugged every person she could reach, my heart danced. This, these moments, are exactly why I love my job here, where my heart could burst any moment because it just can’t contain any more joy!

And one more photo just because it makes my heart throb!

"Then you will look and be radiant, your heart will throb and swell with joy!"

 Isaiah 60:5a

Multi-talented?

Did you know that as well as being a nurse, I'm also one of the hospital ward photographers?! I was sort of thrown into the 'job' back in 2011 during the Sierra Leone outreach when our communications department was swamped with work and now it's a permanent pleasure.

A couple of weeks ago, another nurse arrived on board with his wife.  He is a professional photographer and so he's joined me in taking photos of what we get up to in the hospital. I have also been able to ask him questions about how to improve my skills and use my camera to its full potential. Here are a few photos from Monday.



At 'work'

With some of the team in D ward

My favourite patient of this week! Oh, the personality!



A sweet old lady and her grand daughter

  

This man, is the patient that had the huge surgery I have blogged about several times in the last few weeks.  Look at him!!!  This is two weeks post operative and he has now been discharged to the outpatients department! I can hardly believe how well he has done! His face will continue to heal and the extra skin will continue to shrink back in the coming months.  He is eating soft food for the first time in years and loving every mouthful! What an amazing recovery and story!

I am sorry

She sat upon her soft bed in the ward, dressed in a blue outfit, including a head wrap. Around her neck was a white shawl with green embroidery. Under the shawl, hidden from view, was the biggest thyroid I have ever seen. She had a mass growing off her neck bigger than the size of her head. I could see the veins snaking up her neck just under the skin, pushed right to the surface because of the tumour.
She sat there patiently waiting for me, her nurse, to explain what would happen on the day of surgery. Her smile showed broken, chipped and missing teeth, but her joy was real and her hands, clasping mine, were thankful.
I had to wait for the surgeons to come before I could tell her about her surgery and what to expect, but as I sat down with her, in came the two surgeons and two anaesthetists. After some discussion amongst themselves, they made a plan. The biggest challenge would be finding an airway to oxygenate her body while they removed the tumour. Her whole neck space was filled, so putting in a tracheostomy was not an option. Her CT showed that her trachea was closed up to 5mm in two places. The mass was pushing her airway until it was almost closed. It would be a fight and if they could intubate safely then making sure that the trachea sprung back to its normal shape would be the next challenge.
Hearing the seriousness of the situation we prayed for her and I finished my shift, knowing if things went forward she would be almost through surgery by the time I was coming into work the following day. My heart was heavy for the weight of what the next day would hold.
This afternoon I came into work, she was still sitting on her bed, the white shawl hiding the massive tumour. I looked to our fearless maxillofacial team leader, with sad eyes she shook her head. The chest X-ray report sent in that morning had shown 5 malignant areas in her lungs. With nothing but sadness welling up in my heart, we took her and her son into the hallway and gave them transport money to get home. We prayed for them before they left, the translator reminding all of us that God is in control of all things and to trust in him. But as I said goodbye to this women I had only met 24hrs prior, the tears spilled over.
I am sorry. I am sorry we cannot help her and that unless God intervenes she will suffocate until her death. I am sorry that she will suffer. I am sorry that she was not born somewhere where she could have sort medical care much earlier and been helped. I am sorry that I cannot help her bare the pain.

Tonight he said my name

Screening day was the first time I saw him, then he came to the ward for his biopsy and I followed his case as he was checked up by outpatients and our dietician. He had to put on weight before he was strong enough. But the problem was, his tumour had been growing for five years and two years ago he'd stopped being able to chew food because the tumour was taking up his whole mouth. The more nutrients we gave his malnourished body, the more his tumour grew. He was admitted to our ward for a peg tube and a tracheostomy.
I spent quite a bit of time with his surgeon, listening to him speak out his concerns of the risks of surgery as the benign tumour was pushing the right corotid artery back further into his head, it had invaded far into his head resting near his brain, surrounding his right eye and coming dangerously close to his left. If you've ever had surgery then you'd know the risks spelled out before you, even if it's something routine and not something this huge! I was afraid that our beloved patient wouldn't come through the surgery, but then the Dr pointed out that by now if we hadn't put the trache in for him to breathe, he'd most likely already be dead. We had to continue the fight!
The evening before surgery we faced more challenging questions about saving his right eye or removing it if necessary. You have to remember our patient cannot speak. Our communication was a whiteboard, a blue marker and wonderful French translator (who is actually a Dr too!). We had to discuss some hard final questions.
The day of surgery finally arrived! Can you imagine the anticipation and the prayers being sent? His mama sat with his aunt who was called in to support her, as his surgery lasted 9 hours. He lost more than his total volume of blood but was given back 9 units from crew members, even some of his very own nurses!
Finally he came out of the OR, his face wrapped in clean, white bandage, but the whole tumour gone. He was breathing on his own.

After some time he woke up and when he was awake enough he lifted his hand to feel the tumour; gone. His one open eye sort out our smiling faces and he reached out his hand to touch each nurse as they came in to see how he'd gotten through this enormous surgery.
It was special watching him take each nurses hand and shake it, meaning, thank you from the bottom of my heart. It's amazing how much you can read from the eyes when one has no voice.
My heart felt pure relief and joy! We'd prayed for this man for weeks and here were our answers!
Over the next days he was back in his ward bed (on post op day 1!!!), walking around the ward and up to deck 7 in the afternoons (that is walking up four flights of stairs!). His face looks amazing! Yes, it will certainly take time for the over stretched skin to shrink back but what has already shrunk back looks so great!

The most exciting thing happened today. We removed his trache and closed that hole over, giving him the ability to speak. He said my name! He can say all the nurses’ names! And we delight and gush over him as we hear these precious words pouring forth.
In a few days he will be able to take soft food to eat. This will be the first time in about two years! What would you choose to eat after waiting two years?
Each day as we see the improvements he makes, we jump for joy. The road to full recovery will certainly take time but we are so privileged to be a part of it with him! And as you read this and pray for him you also get to join us! So thank you! 

Someone else’s shoes

Sometimes when I look around in the ward where I work, I try to see it through the eyes of someone else.

Sometimes I try to look through the eyes of a brand new patient on the ward.  I don't know exactly how to identify with all that they have seen or lived through in their lives so I feel I have a warped view. But i still try to imagine anyway.

Mostly I try to see the ward as though I have stepped in for the first time as a new nurse (it was 3 1/2 years ago now that i was brand new on board the M/V Africa Mercy).

Here I am, back in 2009!

I see caregivers are sleeping under the beds, sometimes with extra babies.

See the caregiver's baby sleeping under the bed?

The patients' beds are so close together that only one person at a time can squeeze between them.

Here I am with some beloved patients of mine, squeezed between two beds.

The curtains are hung on the ceiling with magnets and only moved around a bed when necessary.

I can stand at the nurses desk and see all 15 of our patients at once.

Our patients share one small toilet and shower, all patients, caregivers and extra babies. They sit outside the bathroom in the mornings with their bowl and soap to wash, patiently waiting for their turn.

Often there are blocks, a small toddler bike or kids toys strewn across the small floor space between beds.

There are pictures from colouring books splashed with bright colours, proudly hung above beds, even though there is always a shortage of colouring pencils and crayons.

Stickers tattoo the children's faces and arms, and sometimes walls and floors too.

Everyone works together in community, caring for the baby who's mama is in surgery or papa playing games with another's child while mama sleeps. If there is a need, it is taken care of by someone.

 Yesterday I had the privilege of taking one of our sweet patients to feel the fresh, warm outside air and see the ocean and sun light. You see, this boy has been on bed rest for 3 weeks now while we wait for his healing. We have no windows in the hospital of this train ferry converted hospital ship. The wards have no natural light and if you can imagine living in artificial light for days and days at a time, the pleasure of seeing the outside world is almost too much to contain! With permission from the captain and one of the officers coming down to the hospital and opening the pilots entrance for us, our precious patient could lie in his bed and watch the waves rippling in the breeze, feel the wind on his face, watch the birds soaring through the air and the boats sailing past. The smile on his face was one of the sweetest and most grateful I have ever seen and the moment will be treasured by me forever. 

 

Hope is on it's way!

You know the patient with the huge facial tumour that I wrote about a few weeks ago? Well, he’s now on the ward.  After a lot of discussion and decision making, planning his care, we admitted him to the ward and inserted a PEG feeding tube (a tube that goes straight into the stomach from outside the abdomen). We also gave him a tracheotomy so that his airway is secure. As we feed him and make him stronger for surgery, his tumour is also slowly growing, using the nutrients we are now pouring into his wasted body. It is a delicate balance though, giving him exactly the right amounts to keep his electrolytes balanced and calories that he needs to put on weight.

Our patient with his caregiver Mama and one of our amazing nurses, Hannah.

This man used to play football for the Guinea national football team and 5 years ago this tumour started growing. For two years now he has only been able to take liquids for nutrition.  We are quite sure it is a benign tumour, otherwise it would have killed him already.

The next few weeks stretch out in front of him.  They will consist of fattening him up, making sure he is as fit for surgery as possible and of course, loving on him, looking way past the tumour into the depths of his soul and telling him, he is worth every ounce of effort we put into his care.

It is interesting feeling to have a case such as his in front of you.  I can see the LONG road ahead of him, consisting of a massive surgery (more than 12 hours long, I would imagine) and then weeks of healing time and months and years for the skin and tissue to settle into a new shape for his face.  But as long as this road is, HE IS WORTH IT!  His life is worth fighting for!  I am joined by an amazing team of nurses, doctors and ancillary hospital staff and we are all behind him, helping him fight for his life.

Please join us in praying for these next few weeks as we work with him and for the right surgeons to be available to do the surgery. Pray that he is strengthened and will know the love that we share with him, because of the overflow of God first loving us!