"NO!"

I've spent the last two days at the Y telling my classes and their parents that we wouldn't be jumping in the water this week (and maybe next!) because I had been in a car crash.   I had bruises on my chest and it was really hard for me to try and catch anyone right now.  Only two-year old Charlie asked, "Can I see your bruises?"

All in a day's work . . .

Sam is currently reading "The Bridge to Terebithia" to his fifth grade classroom.  As part of their homework, he gave them two vocabulary words from the book to look up and define and he asked them to find a third word they did not know.  Here's how that played out:

Female Student:  "Mr. Zupke, what does 'boossomly' mean?"

Mr. Zupke:  "Look it up."

Female Student:  "Mr. Zupke, it says 'having large boossoms'.  What are boossoms?"

 

A Round of Applause

There is a universal principle of childhood physics that we all remember well: the joy of spinning in circles. Perhaps it was spinning while locking hands with a playmate, in a teacup at Disney World, dancing in pirouettes, or simply turning in place – it was a thrill to send our surroundings into a kaleidoscopic blur. This was followed by a dizzy fit of giggles – at least until our internal compasses caught up, and the world came back into focus. Do you remember?

Four years ago, a little girl named Jaka was spinning around in circles with some other children while her mother was at the market. Around and around, arms out, chin up, her face full of smiles. Tragically, when Jaka lost her balance, she plummeted into her aunt’s cooking fire. Jaka landed in the burning coals on her left side with her arm up. The pot of boiling water her aunt had prepared for rice spilled over the little girl’s shoulders, arms and back.

Fanta, Jaka’s mother, ran home from the market and took her daughter to a local hospital in Conakry. In order to be seen by doctors, the hospital required a payment of 1.5 million Guinea Francs at the gate – just over $200. The family could not afford admission.  Fanta returned home with Jaka, unable to ease her daughter’s agony. For the next eight months, Jaka laid on her little stomach, tethered to the ground by unimaginable pain. Each day, her mother fanned her, trying to offer Jaka whatever relief she could from the inescapable African heat.

As Jaka’s burns healed without medical care or rehabilitation, her left shoulder and arm contracted. Jaka’s skin began to grow back in such a way that her arm became stuck to her side from her armpit to elbow.  Fanta feared that Jaka would lose the ability to move her arm. Still unable to afford any medical treatment, Fanta tried to treat the problem herself.

Fanta forced Jaka’s arm away from her side three times, trying to prevent the contracture. Fanta described each attempt, saying that she and Jaka both cried themselves to exhaustion. On the fourth try, Jaka begged her mother to stop because the pain was so unbearable. “If you try to pull it open again, I will die. The pain will kill me,” Jaka said to her mother. With that, Fanta resigned herself to allowing Jaka’s arm to heal on its own, stuck to her side.

Today, 9-year-old Jaka is a patient on the Africa Mercy hospital ship, recovering from a free plastic surgery that released her arm and grafted skin. Deep burn marks cover her entire upper body – her head, neck, shoulders, back and arms – but no one notices because they are entranced by the little girl’s adorable gap-toothed smile.

Sweeping, washing and fighting – these are the activities Jaka says she will get to do with her restored arm. Laundry might not be appealing to many, but participating in household chores is a normalcy Jaka has never known. “I am so happy,” Jaka says. “When I go home, I will work all the time because I can.” (Fanta admits she is glad for this enthusiasm.) Free of her deformity, Jaka will also now be able to go to school for the first time.

As for fighting, Jaka is one of ten children, and she happens to be very ticklish. With her new arm, she will be able to hold her own the next time she is picked on by one of her older brothers or sisters. She was ashamed to go among her siblings and friends when her arm was stuck to her side because they would tease her. “Now they will see me and say, ‘Jaka has become well!’” she declares. Then they will invite her to sit with them and watch the cars go by their house.

From her hospital bed, Jaka is all giggles – she can hardly contain her excitement for her now-bright future of playing, going to school and watching cars. But Jaka’s favorite part about her restorative surgery and rehabilitation is even simpler than that: “Clapping!” she exclaims. With her arm free, Jaka can finally clap with both hands.

Now there’s a happy ending worthy of applause.

Written by Catherine Clarke Murphy

When the bandages come off . . .

Bless Laura for this beautiful story of what happens to two different patients when their bandages come off . . . 

One of my favorite moments of a day shift is that first dressing change...when the bulky bandages finally come off and a new face is revealed for the first time.  What would it be like to see your face for the first time, after a tumor or deformity you had lived with for years was finally gone?

Abraham intently watched through the mirror as I gently peeled back the last of the tape and lifted a drainage-stained eyepatch to show the results of his surgery - a bone graft to the place where he had a maxilla previously removed.  He lifted his mirror to look more closely as I snipped the suture to pull out a drain, and cleaned the dried blood from around his eye.  "What do you think, Abraham," I asked.

He was very serious as his hand reached up to hold the mirror closer to his new cheek, the cheek that yesterday was flat, and he looked up at me with the beginnings of a shy smile.  "C'est bon, Laura," he said very seriously, and then lit up with a huge grin. "C'est tres, tres bon."

It is very, very good.

Rugi refused to watch her first dressing in the mirror, leaving it forgotten in her lap as she concentrated on holding still while I soaked off the places where gauze had stuck, and cleaned the staple line down her half-shaved scalp.  When the last of the gauze came off I encouraged her to look and look again, and she rather uncertainly held up the brand new mirror to examine the steristrips where her eye had once been.  She, too, broke into a smile and reached up a hand as if to touch the tumor she used to have.  As soon as my gloves came off she was shaking my hand over and over again..."merci, merci, merci, merci!"  I winked and called her beautiful, and left her admiring her new face in a small mirror.  There was one thing more that could complete her happiness, and she pointed hopefully at the urinary catheter and asked me a question in Pular.  "She say she can piss on her own," the caregiver from the bed next to her informed me, "if you can just remove this tube for her."

One catheter removal and mad bathroom dash later, Rugi was ecstatic.  She wiggled happily through her vitals check and IV flush, and hugged me over and over, then settled back in bed with her hand mirror to admire her new face once again.

C'est tres, tres bon.

It is very, very good.

Not Me!

In all my times serving with Mercy  Ships, I have never ever wanted to observe a surgery!  We had many opportunities and I just could not sign up (yes, that would be me - the CPR-PR instructor who also teaches First Aid and Oxygen Administration) - totally unlike Marion MacIntosh from British Columbia . . .

Not only did I get to observe a surgery…… I bless fully got observe 4 surgeries! A practice not normally given to any… one right after the other. 

A Goiter (def: an enlargement of the thyroid gland that is commonly visible as a swelling of the anterior part of the neck that often results from insufficient intake of iodine and then is usually accompanied by hypothyroidism) was the first one. It was a small one (about the size of your fist). I thought I might be passing out a bit as nauseous-ness started waving over me. But the worst I had to contend with was my sneeze! 

The next surgery would have been grotesque to see if I had seen the patient beforehand. He was from Sierra Leon, he was attacked by Rebels when the war had broken out. They literally had put a pad lock on his mouth, going right through his upper pallet and added few other atrocities. For a moment, I saw some real mercy and the ministry of Mercy Ships. They do help come rescue those forgotten or distressed. This has not slackened me in any way in ceasing to pray for Authority! 

Lunch broke the momentum, as my hostess came to release me. She said “as you come back from lunch we will bring you in to see a Max-fax!. I was delighted! 

Arriving back at the OR entry, we were ushered into the Head Surgeon’s room already underway with the Max Fax! This would be Dr. Gary Parker (you saw him on 60 Mins.). He was working on a woman who had come in earlier this year with a tumor (the size of a football) on the side of her neck (I had heard about her from my roommates earlier on this year). Now I was seeing the plastic surgery/ re-shaping her face. He cut & used a skin graft w/muscle from the shoulder area to reset the jaw and cheek. Amazing! What I also noticed in his OR room…., the Presence of God there. In the background of the room played heavenly worship music! Oh boy! 

I was exhilarated to hear that I would be attending yet another surgery. This one had to do with a jaw that was to be re-constructed around a Titanium plate. If they don’t do this, chances are years down the road the metal jaw will start to break through the skin. So God is His Wisdom gave us extra bone at the hip (“spare parts” it will regrow itself) and that portion was transferred to the chin. Amazingly, even though they had to break up the bone to shape it in the chin area, it will grow back as one solid piece around the Titanium plate in about 6 months. Amazing!

Old Enough for a Nose . . .

Take a moment to read Laura's blog post about a seven year old patient named Kadi . . .

 

November 2011...
We sat together in the back of the church service, listening intently to a three-language sermon.  I was trying to understand the Krio that sounded so familiar, and Kadi was trying out her own bits of Krio. AAmen, she murmured at the end of the pastor's every sentence, every pause, and every exclamation. Aaaahhhh-men.  A-MEN-a.   EhyMEN.  Each time she got a little louder, we were starting to get a few looks from the curious patients next to us, and I started to wonder what point is appropriate to shush a 5-year-old's mid-sermon enthusiasm.  Granted we didn't look much like your usual church-goers.  I was in scrubs with my hair pinned up, perched on a high stool next to the crash cart.  Kadi's NG tube was pinned to her intricate braids, out of reach for small hands to pull on.  The center of her face was covered in steri-strips...only smooth skin and suture lines where a nose should have been.  But we were both pretty excited about the sermon and the worship-dance party that inevitably followed.
As our ship sailed from Sierra Leone a few weeks after that last ward service, I often wondered what happened to Kadi.  Would she ever have the chance for a nose?
I asked once why we hadn't made a nose yet for Kadi.  Our doctors have creatively pieced together faces for so many.  The reason was simple, our surgeon told me.  Kadi was too young for a nose.  If she got a new nose then, it would be too small as she grew older.
I reached up a little self-consciously to touch my own nose.  What would I have thought, at 5 years old, if someone had told me I was too little for a nose.  Didn't everybody else have noses at that age, usually?
Fast forward a year and a half, to one morning in March when a tall gentleman came from D9 to greet me enthusiastically in Krio.  I recognized him immediately, but it took a little while longer to recognize the Midazolam-doped girl in the bed as my Kadi, headed to the OR in 5 minutes to finally claim her nose.  She's joined the crowd of Noma survivors and war mutilation victims here on D ward and B ward, with scalps pulled down over faces and bits of face flipped and sutured in a myriad of creative flaps, grafts, and miracle-working.
I was her nurse the next day - one of my treasured pediatric nursing shifts.  Kadi was not even 24 hours post-op, terrified and exhausted from fighting and pretty miserable.  Along with a piece of scalp temporarily down over her face to make a new nose, Kadi also had her tongue sutured to the top of her mouth to close a hole there.  Two long arm splints and a patiently dedicated nursing staff had kept her from pulling out her nasal airway, IVs, and gastric tube.  Still a spunky fighter, Kadi was not a fan.  I used most of my small Krio that night - playing guessing games of what she needed (Yu wan piss?  Yu wan popo?) and making bargains, with a lot of pointing, strict instructions, and a wonderfully serious translator just to make sure (If I remove this, yu no pul am.  Yu sabi?).  By the end of the evening we successfully had both arm splints off with all tubes still intact.  Part of the bargain was me letting her popo (ride on my back) the rest of the shift, and so I finished my paperwork and gave report with her clinging limply to my back and the NG feed running slowly from the bag on a magnet hook over our heads.
We're fast friends again now, and last week she spent the beginnings of each of my night shifts popo as I took report.  I started the shifts off with gigantic drool spots soaking the back of my scrubs, but the cuddles were well worth it.  She's full of fun, inquisitive energy, and great at the pantomime communication so common on the ward now.  We're training her as a nurse as well (7 years old is certainly not too early), and she can turn on and administer her own nebulizers, connect and flush her NG feeds, and do a pretty good oral assessment by flashlight.
Less than a week now, and it will be time for another surgery.  I am excited to hear her Krio-Temne chatter and sweet singing again, and I can't wait to see her new face.  No more waiting; she is finally old enough to have a nose.

An angel named Hazel . . .

On my way to my annual mammogram and physical this morning, I was rear-ended on 35W.  I in turn hit the van in front of me who hit the truck in front of him.  Yup, it was four car collision - and I got the worst of it!  Since I was already on my way to the doctor's and my car was drivable, I decided not to meet the fine folk on the ambulance crew and take myself in.  (Note:  I have been going to the same doctor for twenty-three years up at Oxboro Clinic in Bloomington.  Never in those twenty-three years have I ever seen someone at the clinic I knew at the clinic until today.)  I was ten minutes late for my mammo and decided with as much pain as my chest was in, there was no need to inflict more pain on me.  Instead, I went up to Internal Medicine to check in and there was Hazel, a friend from church.  Before I could tell her what had happened to me, she was called in to her appointment.  When I was sent downstairs for x-rays an hour and a half later - there was Hazel!  I finally shared what had happened to me and she waited for me to be finished with my appointment (bruised sternum, nothing broken) and she followed me safely home to make sure I would be okay.  Bless her for taking care of me when I so desperately needed it!

Now, if you're wondering where my husband was during this whole ordeal - I had left a message on his phone at school.  He had meetings, he was running late, he kept getting phone calls, and he was FINALLY able to check his messages (and found my message!) around 11:00.  There just happened to be a SPARE sub (like has that ever happened?) available in his building and he was able to come home and take care of me after Hazel left.  Glory be to God!