I started my nursing career six years ago as a neonatal nurse. Most seasoned nurses would probably advise a new grad to start out as a nurse in a much more general field and then move on to something specialized like the NICU. I guess I just knew that it was the place for me. “My unit” has become a second home for me – my coworkers, like a family to me. It’s where I learned to be a nurse. It’s where I struggled through feeling incompetent and learning to thrive. In this past year, it has become the one of the places where I feel most comfortable. In the times when I don’t find myself in West Africa, I know it is where I belong. All that to say, I am a neonatal nurse – through and through. Give me a 600gram baby and I know what to do.

This week, in the Africa Mercy ICU, I have been taking care of Aminata who weighs a whopping 9 kg - which, incidentally, is double what she weighed when she stepped into the world of Mercy Ships about three months ago. Aminata is two years old. As far as taking care of ventilated ICU patients go, two is my maximum, so she made the cut. Her diagnosis, on the hand – cystic hygroma – made me slightly more uneasy. The only patient I have ever taken care of with a cystic hygroma was Baby Greg from Liberia. He was the first African baby to steal my heart and take it to heaven with him. I knew that Aminata’s diagnosis was by no means a life threatening condition, but it’s funny the effect that one significant experience can have on a person.

Aminata spent about a week after her surgery intubated and ventilated. As children tend to do, she lost her ET tube on Monday and bought herself a trach, which will serve as a temporary solution to her lack of airway due to excessive swelling dilemma. By Tuesday, it seemed that keeping her ventilated was causing her more distress than it was worth, so, the decision was made that it was time to wake her up (as it is referred to in the ICU) and give her a shot at breathing on her own.

At this point, it is important to keep in mind that my ideal patient size = 1/10^th of Aminata’s.

Tuesday morning, we stopped the Ketamine and Midazolam infusions. We cut the Fentanyl by half. And we waited for it to happen.

And that is when the term “wrestling with an alligator” bounced around in my head for quite a few hours. Aminata went a little bit squirrelly. We tried different combinations and doses of drugs. We watched her closely. We sang, and held her head and rubbed her back and turned the lights down. We wrapped our arms around her and told her that she was safe. And she squirmed all over the bed. We finally won, but she didn’t go down without a fight. (I am fully aware that any nurse who has any experience with larger children, let alone adults will consider my sentiments to be somewhat exaggerated, perhaps even humorous…but keep in mind that I am usually able to contain my patients with one hand and use the other one to chart)

By yesterday evening, in just the way that makes me ever so happy to be part of this whole thing – she had come around. When her night nurse came to get report, Aminata was sitting up on the lap of one of our day volunteers, breathing room air, and maybe, possibly, even trying to force a smile through her impossibly swollen neck, tongue, and lips. When I leaned over to tell her goodnight, she reached both of her arms up at me in a purposeful motion and grabbed at my neck. She didn’t seem so much like an alligator anymore. She seemed a lot closer to a healthy, on-her-way-to-happy two-year-old; whose life I was blessed to be a part of for a short season.

Still, I hope that a 9kg alligator is the largest I ever have to face.

Yesterday, we climbed Sugarloaf Mountain – the 17^th highest mountain in Sierra Leone.

Well, to be correct, we set out to climb Sugarloaf Mountain. But first we accidentally climbed the mountain a little bit to the right of Sugarloaf. Upon arriving at its peak, we realized that our intended destination was over to the left, which meant that we would have to climb halfway down Mountain Peak #1 and proceed the rest of the way up correct mountain.

No problem.

Despite it bordering on “sports” – it turns out that I actually really enjoy hiking. Especially this type of hiking. No real trail. Continuously assessing various options for routes to see which is more manageable. Hanging off vines. Climbing up and then sliding down granite rock faces. I find it sort of exciting.

Whilst climbing a mountain (which I should clarify, is an activity that I have experienced exclusively in West Africa), I waiver back and forth between images of Maria and the Von trapp children in the last scene of "The Sound of Music" and singing “The Climb” in my head. Yesterday, we threw some Pocahontas "Colours of the Wind" in there, just for variety’s sake. Needless to say, I was really enjoying myself.

For the first two and a half hours.

Then the climb got a little bit ridiculous. By this point, we were well off the so-called trail. We had been drenched from the rain for about three hours now. It was dark, and the path seemed to be less and less present. My legs were starting to hurt, and everyone’s breathing was getting faster and heavier. It seemed like a really good time for the relief of reaching the summit.

That’s when we arrived at the top of Mountain #2. Which unfortunately, turned out again, to not be the peak of Sugarloaf. It was at this point that I was wholeheartedly ready to bail on our adventure. We had reached the top of two mountains – neither of which had a particularly impressive view - and I was done.

Thank goodness for the rest of the group who remained committed to the goal. If I had been the decision maker for the group, we would have turned around at this point. I knew that however far we had gone up, we still had to climb down, and I just didn’t think I had it in me to keep going. But they didn’t waiver. They wanted to reach our destination, and there was no doubt in their minds that we were going to persevere until we found it.

I think that’s the only reason we ever did make it. It wasn’t physical endurance, because I definitely was feeling it in every muscle and wanted to quit. It wasn’t our navigational skills; because they failed us multiple times. The only thing that really got us there was the perseverance of my friends.

So, we made it to the top of Mountain #3. And it really was amazing. We spent 45 of the best minutes overlooking Sierra Leone, eating packed lunches, and listening to birds and the wind.

And, if it had been left to me – I would have never made it.

Thus, I am left concluding yet again, that life is all about the lessons we learn through it. Yesterday reminded me why it is so important that we live life together, and not alone. Why we need to function in teams. Why two heads are better than one.

Because if not for my “others”, I would still be sitting at the top of Mountain #2, wondering what I ever was thinking!

Once again, I find myself here.

Everything is exactly as it used to be, and completely new, all at the same time. Familiar and comfortable yet foreign and challenging – if that is even possible.

A new city in a new country. New friends and coworkers. New ways of doing things.

For starters, there is this ship – a 500ft vessel which has set the stage for some of my life’s most significant moments. I walked on board early last Thursday morning and breathed an immediate sigh of peace. Joy filled my heart. I was greeted by loving, familiar faces and had that wonderful sense of coming home to a place where you “fit”. I know where I belong for this time. I know what to do and how to go about things.

And then there is the city. I spent Friday exploring Freetown. I had been warned that excursions into town were fairly dramatic. “Freetown” and “traffic” are essentially synonymous terms here on the ship. I should have been prepared – I guess I thought I was. But, calling Freetown busy is the understatement of the century. It’s hard to truly describe the chaos of the heart of town. Between the open sewers and the vendors and the trucks and the “it’s here then its gone” excuse for a sidewalk, even getting from point A to point B on foot is a challenge. It sort of feels like you are in a videogame but there is more pressure because, if you fall in the gutter or get run over by a truck, you don’t get another life. Maybe I just don’t deal well with being over stimulated in every way simultaneously, from every direction. Either way, I found Friday overwhelming.

But then I did it again today. I went into Freetown - just myself and one friend, with a specific purpose. And, all of a sudden, it didn’t seem near as overwhelming. I would go so far as to say it was enjoyable. Relaxed even. I guess it doesn’t really matter how many times you come to Africa – every time you come back again, it takes a while to sink in. It’s just starting to sink for me. My being is ready, but I guess it takes time.

By Saturday, I was doing my first shift on the ward. D Ward. Where last year, we set up the summer camp craft corner for Tani and Gafar. Where O’Brien was healed. Where O’Brien died. Where there are now new faces: some repaired and ready to face the world and some still waiting. Two o’clock Saturday afternoon, I jumped in. As a result of our Gambian detour, our group left the wards a little short staffed. So, instead of having orientation shifts, I just went for it. I took care of patients in a world that I know incredibly well, and yet felt so unaccustomed to at first. Where do we keep this now? Do we still do it this way? How does this work now?

And again, just like riding a bike, as my friend Deb reminded me before my first shift, it has come back. It all feels as normal and natural as it possibly could. Half the time, I still don’t have the answers to the questions that arise in my own head or from others’ – but, I do know that I am doing it. Adapting. Coping. Caring for those that I have been sent to serve. Maybe not perfectly. Probably still with a lot of assistance for the time being. But, doing it.

We probably don’t ever figure it all out. Perhaps we don’t ever need to. If we ever think we have all the answers, we probably need to start again at the beginning and figure out what it was we missed. No matter how much experience we have, I doubt we ever have the ability to adapt to every situation seamlessly. I am thinking that I would never want to. Because these places that I find myself in are the ones where I learn the truths that I didn’t know I was missing.