The Long Haul

"She doesn't want to go? Why not?"

I'm confused. My patient, Marthe, has been stuck in an isolation room for over a week. The hospital is already a bit of a windowless pit, but at least there are other patients and caregivers to chat with. The iso rooms cut you off from almost all of the community the other patients share. Marthe had a massive tumor removed from her back, and required extensive skin grafts to fill the space left behind. The chance of infection is high with such a large surface area of tenuous tissue, and Marthe ended up with an antibiotic resistant infection, which could easily spread to other patients with healing wounds. She's finally been cleared to go to the Hope Center as an outpatient, to get out of that windowless room and have some freedom & fresh air, and she said "no." 

After

Before

My translator rattles off some Fon, and as Marthe replies, I catch a glint of defiance in her eyes, but there's something else there too.

Love. Beautiful, compassionate, self-sacrificing love. After a brief dialogue, I get Marthe's response:

"She say that, she don't want to go until the other girl can go too. She don't want to leave her alone."

Next door, in our other isolation room, was a young woman and her daughter, who also had trouble with slow-healing wounds and infection. Although they couldn't physically interact, and it was hard to even see each other, Marthe and the mother would usually spend the day sitting in their respective doorways, keeping each other company.

Marthe knew (from firsthand experience) that once she left, momma next door would be lonely. We do our best to help keep our isolated patients' spirits high; Chaplaincy sits with them for a few hours, the day crew chat and play music for them sometimes, off-duty nurses with hearts of gold come in to blow bubbles and play with the young ones.

But despite our best efforts, there is still a very isolating effect to, well, being isolated.

"I'll...talk to the charge nurse," I tell her, feeling skeptical, but also humbled and astonished at the simple act of kindness I have just witnessed.

As it happens, I'm on a ship full of professionals who place a higher value on such kindness than expediency or quotas, and so, Marthe stayed.

Momma on the left, Marthe on the right.

A day or two later, momma next door made sure Marthe looked her best before leaving the ship, and this beautiful friendship moved out of our steel, fluorescent-lit corridors and into the sunny rooms of the Hope Center.

Marthe's story was recently shared on the Mercy Ships Canada website. In that article, it says that we hardly saw her smile, and yes, that may have been true at times. She had a long and difficult journey. But she sure could celebrate when celebration was called for!

Marthe's long-awaited discharge from hospital!

What else have I been up to, you ask? Well, quite a lot of different things, actually. Our Women's Health program is over, and the last of our 30 or so fistula patients went home in their beautiful dresses a few weeks ago now.

Giving our ladies an Africa Mercy send-off.

D ward is still full of maxillo-facial patients who have had tumors removed or cleft lips/palates repaired. Sometimes flesh-eating diseases have taken away most of our patient's faces, and grafts are used to reconstruct them. I have worked over on D ward on and off, but most of my shifts are still on B ward, which is now full of general surgery. Fairly standard, simple procedures, like lipoma removal and hernia repaires. These are not so foreign, as they are seen often enough at home. The only difference is time. Lipomas at home would be identified and removed very quickly, often in a doctor's office or as a simple outpatient procedure. Here, like everything else, they are left for years or decades, so they get bigger and are a little more complicated to remove. Hernias are pretty much hernias, wherever you go. We have had some fairly young boys with hernias, who were pretty darn cute.

There's a few other patients we have on our wards right now are what you might call "long-termers." These are patients who ended up with some set-backs, or required multiple surgeries to fully restore their function. Large facial tumors often require part of the mandible (lower jaw) to be removed, and a temporary metal plate is put in place to keep the jaw stable. Eventually, once the tissue has healed well enough from the first surgery, a second may be performed to take bone from the hip or ribs and graft it onto the jaw. We've had a few of these come through last week, several months after their initial operation, and most recover well within a few days.

One of our returning patients, here for a bone graft.

One or two, though, are having a tough time getting well enough to go home. Patient J, who had a massive facial tumor removed back in the fall, ended up with an infection in the wound after the second surgery. He had to stay in isolation for several weeks, and just now, as the wound is nearly completely healed, he's begun to have severe nerve pain. Facial nerves are the bane of the max-fax surgeon's existence. Most other tissue can be sliced through without consequence when trying to dissect the good from the bad - but nerves are delicate, touchy things, and they often end up embedded deep within the tumor. Removing the tumor usually means restoring dignity, freedom, and often saving the life of the patient. If any of the facial nerves get damaged in the process, though, they may have difficulty speaking, chewing, smiling, or even blinking. Damaged or irritated nerves can also cause severe pain, which can be unpredictable and incredibly difficult to control. In J's case, this pain has crept up out of nowhere, when everything finally seemed to be going right. We're doing our best to get it under control, but it is going to be tough these next few days.

On a lighter note, a bit of news. I've decided to return to the ship during the next field service in Cameroon! You probably already saw that on Facebook, but just in case you didn't, I'll be back on the Africa Mercy next March. Apparently I miss it already...and I haven't even left yet! I'm particularly excited because we will be starting a fistula clinic in Cameroon, and the women's health program
will be much bigger than it was this year.

In the mean time, as our numbers are dwindling here on the ship, and the end of the field service, and my time here, is coming to an end...my head is full of incredible stories that I need to get written down before I lose all the precious details!

Hopefully more blog posts incoming.

A la prochaine,
-D