Home

I am home and hope to continue to tell a few stories and reflect on my trip over the next few weeks... Here is a website I found that captures much of Sierra Leone in picture and word.  I couldn't hold back my tears while reading much of this woman's description as she captures much that will be forever close to my heart, especially regarding the children of this country:

http://www.lawrence.edu/dept/religious_studies/aysesierraleone/sierraleone.html

Good Morning

Sunday morning... Up early and sitting in the dining room with just a few other people around and awake.  Mainly night shift nurses eating before going to bed for the day.

I only have a week and a half left before I head home.  If I had not extended I would have left this past Thursday.  I am happy to be here a little longer.  What a journey!  It was difficult to be here at first and now it will be difficult to leave.

The little ICU girl went home on Friday.  She has the most beautiful smile in the world and it was nice to see that emerge and to be with her playful spirit before she left. 

The ship continues to be in constant transition with volunteers coming and going daily... an ever changing world.

I will soon be home with photos to show and hopefully more stories to tell. 

Thanks for all your thoughts.

XOXO

Update

The young girl is doing well.  With the help of some connected with Mercy Ship and the Sierra Leone government, a surgeon from Nairobi, Kenya was flown to Freetown and was able to remove the stone from her lung.  I was able to observe and even participate in the surgery.  She is awake and talking and gaining strength. 

a pebble tale

April 29th 2am... night shift

Life has become a bit routine the last couple weeks.  Work sandwiched between the rhythm of meals and sleeping.  Days off usually end up with a walk to town to a market or to visit my friend Flora and her family.  Last Saturday was a beautiful day at the beach.  Sunday, Easter, we had a scrumptious brunch with baked goods, quiche, and fruit.  The crew all put on their finest attire, fun to see all dressed in our best :)

Yesterday, not only did we celebrate Katrine's birthday, but we joined the entire country of Sierra Leone in celebrating their 50th year of independence.  Royal blue, kelly green, and white have literally been painted in the most unique places over the course of the last few weeks in preparation for yesterday's festivities... America's red, white, and blue on the fourth of July pales in comparison to the expression of pride in the land here.  Our local day volunteers that work about the ship,...many as translators came up with unique attire resembling their flag as well.  I was on the ship, but the streets were apparently full and booming with energy.

April 29th 3pm...

I was updating my blog last night on night shift... ironically and obviously commenting on the steady routine of life as of late.  I had one ICU patient, a two year old that had swallowed and aspirated a small stone eight days ago.  A local ENT surgeon and our team of doctors had spent five hours in unsuccessful attempts to remove the stone.  They left her intubated because of the risk of swelling and constricted airway after so many hours of tampering in her lower throat and lungs.

From 315am till about 430am I went through one of the most terrifying, miraculous, surreal moments in my life.  My little patient that had been quiet, sedated and resting soundly for hours.  She suddenly became restless, which happens on occasion with any patient, often with a quick resolve, but she continued to squirm and fight.  There was one other nurse nearby who came to help but as she wiggled her intubation tube became loose and I needed help, but help from another ICU nurse or someone who knew how to secure an intubation tube and give boluses of medication to sedate and how to respond to the situation.  Literally, the moment I was saying "help" internally, I looked up to see one of the three pediatric ICU nurses that work on the ship standing in the doorway in her pajamas.  Over the next 15 minutes we ended up coding this two year old.  She had coughed a plug into her intubation tube so no oxygen could pass through hence her restlessness.  We pulled her tube and used a mask to ventilate her, performed chest compressions as her heart rate subsequently dropped with her oxygenation status.  The on call anesthesiologist, also happening to be pediatric trained (also a rarity), responded to her emergent page within minutes.  I know in my heart I would not have been able to respond appropriately on my own... mainly out of inexperience with pediatrics.  

Corina, the pediatric ICU nurse and also a dear friend, had woken in the middle of the night restless and thinking about the ICU patient she had heard ended up in our unit last night.  She had gone to the dining room, drank a cup of tea and tried to watch some BBC news but her insides felt restless and she decided to "poke her head in" and see how I was doing.

I managed a few hours of sleep today.  Preparing to head to camp out for the weekend.  Feeling exceptionally thankful for a miracle last night.

a chance happening

I was just walking down the stairs to my room, the stairs are shared with the hospital traffic... as I was descending the little boy I have told you about and his mom, with baby brother in popo on her back, were coming up.  He was dressed in his normal clothes versus the familiar hospital gown.  He is headed home.  I had no idea they were leaving today and it was mere coincidence to run into them, but I got to say goodbye.  He started talking and laughing a bit the last two days I have heard, but when I am around he gets quiet and serious, so I still have not heard him talk.  I hugged him and squeezed him anyway... he will be forever on my heart and I will always wonder about the life he has before him.

Had the day off yesterday.  Relaxed on the ship most of the day.  I did walk to the market and visit my friend Flora and her family.  Katrine went with me and she showed us her few treasured photographs.  Last evening my friend Corina... a fellow nurse from the Netherlands... Katrine and I walked to "The Hope Center".  This is a building not far from the ship where the Dental Clinic is held and also a space where patients that travel from far away can stay before or after surgery.  There are quite a few of our patients there right now that don't need daily hospital/nursing care, but come to the ship for a dressing change every day or every few days or are waiting for a follow up appointment of some sort, so they have a safe and close space to be home in the interim time.  It was fun to sing and play with some of the children, many of them are getting fat!  They are not used to the nutrition and faithful heavy meals they get here so one little girl and her brother who have been at the ship for almost two months now look quite different than their arrival!

I work evening shift all week.  Katrine's husband Ruben arrived on Sunday.  He is in the Danish army so is on leave for a couple of weeks and is a general steward on the ship.  It's nice to finally meet him and he is definitely as kind and sweet as his dear wife has painted him out to be!  :)

Photos

Thought I would give you the link to my friend Tom's blog.  He is a photographer on the ship and has many pictures of patients that I am unable to take myself and he also has the capability to upload pictures, so enjoy.  http://tombradley.wordpress.com/

I have been off all week following my stint of nights.  I stop in every day to visit my 5 year old patient from the weekend.  I don't know that I ever mentioned what he had done.  His lower jaw was significantly smaller than his upper jaw, giving him almost the look of a turtle.  It's called Pierre Robin Syndrome, or so they thought... when the surgeon actually went in and did the surgery they are actually wondering if it was trauma from a forcep delivery.  Traditionally with Pierre Robin the patient's tongue is also smaller than normal, but his tongue was normal sized which is what actually caused him significant problems.  We think for the last five years when he would fall asleep his tongue would obscure his airway so he has lived with lack of oxygen for years.  Almost like sleep apnea in overweight adults.

Anyway, he is quiet and shy and scared, yesterday he said he wanted to go home, but he doesn't speak much at all.  His mom is overjoyed and grateful for the help her son has received.

Update

Thought I would update you all on the little boy...

Yesterday, Sunday, he had a bit of a rough day.  They did a scope to look at his airway and decide if they could safely extubate him.  While sedated they were able to obtain some bloodwork they had been unable to get thus far and his blood count was low so he received a unit of blood.  Following all this his blood pressure and heart rate decided to keep everyone on their toes by hovering very low, maybe from such an eventful day, but who knows exactly why and his urine output had also tapered down to a concerning low rate. 

When I went to work at 7pm there was a lot of commotion around him making me a bit nervous to be his careprovider overnight.  All the doctors and supervisors left me their pager numbers and then were off and it was me and him.  I am HAPPY to say that he had a great night... very few issues, a couple restless periods, but all went well. 

I left at 7am and went to bed... the plan for the day was to take him to the OR, extubate him, and if he was unable to breath on his own to place a tracheotomy.  I got up around 330pm and headed to the ward with anticipation to see what transpired in my sleep.  He was awake, sitting up in bed, mom snuggled next to him... breathing fine on his own... even on room air!  No feeding tube to his nose, no IV fluids, just a little monitor for his oxygen status which was 99%... Yay!  His mom got up to attend to his fussy little brother across the room so I got to take her snuggle spot for a few minutes too :)