1. welcome home

    I imagined it at least a hundred times.

    When I was sick with malaria, when I was exhausted after a 28 hour shift, when the hospital ran out of water, when I lost a patient I’d tried so hard to save, I closed my eyes and imagined coming home.

    Stepping on the plane in Togo, falling asleep with headphones and a blanket, waking up on U.S. soil, hugging family for the first time in four months.

    In spite of how unlikely it seemed at times, the day finally arrived.  A van ride to the airport.  Check-in at the airport in Lome.  Two airline agents and a security guard asking the same question: Are you coming back to Togo?  

    I don’t know, I said.

    Please come back, they all said.  Please come back.

    A seven hour red-eye flight to Brussels.

    I had a three-hour layover.  I paid $25 to get into the United Club, a quiet, beautiful space with drinks and snacks, showers, overstuffed arm chairs and fast wi-fi on the second floor of the airport.

    I wasn’t quite home yet, but I was already running out of steam.  I was too fragile to handle crowds, jostling, long lines and loud noises so I escaped to the Club and spent there hours at a small table by the window sipping a cappuccino and sparkling water.  I tried to tempt myself with each of the foods offered, like a mom trying to get a sick child to eat.

    How about a muffin?  No?  Well, what if we gave you a few bites of a ham and cheese sandwich?  No?  Okay well, what if you tried an apple.  Just try it. 

    I did. I tried a few bites of an apple and my stomach said No, thank you.

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  2. the gift of not nailing it

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    It’s my last day in Africa.   I’m staying at a little motel right on the ocean in Lome, Togo’s capitol city.  This morning I’m drinking coffee on the patio outside my room, looking at the waves, thinking about my time here.

    It’s been a hard three months.  The work was hard, the hours were long, the weather was hot.  Plus, it was a hard season for me personally — physically, emotionally, spiritually.  And getting a bad case of malaria didn’t help.

    I thought I was going to be really good at living in Africa.  I thought I was going to love it, that I was going to be an exceptional version of myself, that I was maybe even going to move here permanently because I loved caring for people here so much.

    But instead, I feel like I just barely survived.  Africa broke my heart.  Africa broke my body.  Africa broke my spirit.  And by God’s grace (and with the prayers and support of lots of family and friends in the U.S.) I got through it.

    I feel kind of how I felt when I was going through chemo for breast cancer.  I sucked at having cancer.  I was moody and despondent and an almost unrecognizable version of myself.  All I can say is that by God’s grace, I survived.

    It’s not easy for me to acknowledge the times when I don’t shine, the seasons of life in which I don’t thrive, the efforts I make that barely add up to anything.  It’s not easy for me to shake my head and admit, “Yeah, I didn’t nail it.”

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  3. the real question

    Last week, the doctor who was on-call admitted a 5-month-old little girl.   The fever, the positive malaria test, and the seizures all pointed to what is, in Togo, a common diagnosis: cerebral malaria.

    The little girl seemed to have a bad case of it.  She seized all through the night, in spite of multiple doses of anti-seizure medication.

    The doctor added antibiotics to cover her for bacterial meningitis, which is also (unfortunately) a common diagnosis.

    The following morning, when my shift started, the doctor was telling me about the little girl when the nurses called us urgently to pediatrics. We ran over to find the little girl having such a violent seizure, her head arched all the way back, and the back of her head was touching her back in between her shoulder blades.

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  4. we have water!

    Thanks for praying, sending good thoughts, doing a rain dance….or….whatever else you did over the weekend. We now have running water in town and here at the hospital compound.  From now on, whenever I take a shower or flush a toilet or turn on a spigot, I will whisper a prayer of supplication for the millions of people around the globe who live without a clean, readily-available water supply…and a prayer of gratitude for the simple blessings in my life that I so often take for granted.

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  5. the very last drop

    We’re out of water.

    It’s one of the driest “rainy” seasons on record in West Africa, so there wasn’t much water to begin with.

    Then, a few days ago, the pump that pumps water from the Oti river into the town’s water treatment center broke, so they shut off all running water.  The only option was for townspeople to draw water from wells scattered across town — which are contaminated with parasites and bacteria.

    The hospital compound had a 3-day supply of filtered water, but the filtration system broke, so then we had a 3-day supply of unfiltered water, which had to be boiled before we could ingest it.  Then even the unfiltered water ran out, and now there’s nothing.

    Pregnant women are going into pre-term labor because they’re dehydrated.  New moms are running out of breast milk because they’re drinking so little fluid, their bodies are not able to produce milk.

    Throughout the hospital and the housing within the compound, there’s no running water.

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  6. (still)

    Yesterday was my first day back at work, post-malaria.

    When I got malaria, I was in the hospital for three days, and then I spent a week after that lying in bed, sleeping, reading, taking short walks, drinking lots of water, and trying to keep my mind off the nausea and joint pain that just.won’t.go away.  (I lost 6 pounds in 10 days, if that tells you anything about how lousy I felt.)

    I showed up at the hospital yesterday to work a 28 hour on-call shift with one of the doctors.  We split up the patient list and started rounding on patients. The hospital’s pretty full right now with lots of sick patients, so I had a lot of exams to do, a lot of notes to write, a lot of thinking to do about complex medical conditions that we just don’t ever see in the U.S.

    A patient in pediatrics died of cerebral malaria early yesterday morning, just before my shift started.

    Then, mid-morning,  a 40 year-old man with a brain abscess started to decompensate. Even though the surgeons had taken him to the O.R. the night before to take some of the pressure off his brain and evacuate the infection, even though he was on every antibiotic we could think of, even though he was on multiple medications to decrease the swelling in his brain, the infection was taking over his brain and making it swell until it herniated down into his brain stem because it had nowhere else to go.

    Even though we had done everything we could possibly do for him, this man was (still) dying.

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  7. to get to you

    While I was in the hospital receiving treatment for malaria, the nurses told me the story of what happened Friday night after I passed out.  They said four nurses had put me onto a golf cart and driven me to the hospital. Someone wheeled a gurney outside, they lifted me onto the gurney, and then rolled me down the hallway to the room where the doctor and other nurses were waiting for me.

    I don’t remember much of anything until Saturday morning, when I woke up in a hospital bed, feeling clammy and achey and nauseated, watching IV fluids and malaria medicine drip into my I.V.

    In most of the hospital wards here, there’s a TV/VCR unit on the wall that shows either the JESUS film, a dramatazation of the life of Jesus translated into the peoples’ local language, or Bible cartoons in French.  I don’t know how much of the JESUS film makes sense to the people here — I’m not sure if they understand where Israel is, or that the story happened 2,000 years ago — but they really seem to like the resurrection scene.  And when the film ends, they ask the nurses if they can watch it again.

    In the hospital room where I stayed, there was no TV.  I had no podcasts downloaded onto my phone.  My head ached too much to read a book.  So I just laid there in bed, feeling small and depleted.  For the first time in many years, I wished someone would pull a chair up to my bed and tell me a story.

    When no one came to entertain me, I said, “Well, God, maybe you can tell me a story.”

    But God didn’t say anything.

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  8. malarious

    Last week I didn’t feel awesome.  Nothing specific, nothing severe, just not awesome.

    I attributed it to a busy clinic schedule, staying up 28 hours straight once or twice a week while I’m on call, plus the usual not-awesomeness I feel from my anti-cancer medicine.

    Thursday night as I was trying to find a comfortable sleeping position in bed, I realized that all my joints were achey, like I was coming down with something.  But it couldn’t be malaria, right?


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  9. dear ninjas

    On my first day in the clinic here, one of the medical assistants came to me and said in French, “Do you mind seeing the ninjas?”

    I wracked my brain for a few minutes, trying to figure out what he meant, trying to remember a French word that sounded like “ninja.”

    Finally I had to ask my translator what the medical assistant was asking.

    “He’s asking if you will see the ninjas,” my translator said.

    “What ninjas???” I asked, exasperated.  What on earth were they talking about?

    “You know,” my translator said, pointing in the distance to a woman in a burka walking towards the hospital.  “The ninjas.”

    He said that the other PA who was working that day was male, and he was unsettled by women whose faces he couldn’t see, and refused to see them if they wouldn’t take off their veils.

    “Will you see them?” the medical assistant asked again.

    I nodded.  Yes, I would see all the ninjas.

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  10. one day (part III)


    I’ve lost count of how many times the little girl with DIC and cerebral malaria has seized, and how many doses of anti-seizure medicines we’ve pushed into her I.V.

    She’s getting worse.

    Her pupils are not shrinking when we shine a flashlight into her eyes.

    Early in the night, when I first started having to bag her, her oxygen saturation would go up to 100%.  Now, no matter what I do, her O2 sat stays around 80%.    Between the bleeding and the lack of oxygen, her brain is dying. And again, there’s nothing more I can do.

    Her father is still standing behind my left shoulder, watching us try to resuscitate his little girl.  In the U.S., we’d have intubated her and put her on a ventilator a long time ago, but we don’t have that equipment here.  We have to breathe for her by hand, squeezing the Ambu bag 20 times a minute to push oxygen into her lungs.

    In between seizures, I put my hand on her forehead and silently pray for her.

    I want to yell, “Tabitha, arise!”  like the Bible story.

    Or, “Lazarus, come forth!”  like Jesus said when he raised Lazarus from the dead.

    “Little girl, WAKE UP!”  I command her in my head.  “In the name of Jesus, WAKE UP!”

    But instead, she keeps seizing.

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