Dr. Gary said something to me a couple of weeks ago that I have had a hard time erasing from my mind.

He came into D ward on my evening charge shift and we started talking about how appropriate it is for me to be taking care of all these people having cleft lip repairs because, in his words, I have “lived it”.

I guess I feel like I havn’t earned the right to say I have lived it though. From what my long-term-memory-challenged mother tells me, I never really had any issues. I had my cleft-lip repaired when I was 12 weeks old and carried on to live a relatively lovely life. I ate, spoke, and for the most part looked like anyone else. Never once did a teacher tell me I wasn’t the same as the other kids. Never once was I cut from a team because of the way I looked. Never once was I denied a job because someone thought that having a congenital deformity would affect my work performance.

I had the opportunity to be who I was created to be --- that’s how Dr. Gary worded it anyways.

The unique qualities that I was designed to share with the world didn’t have to be suppressed as a result of a society that told me I was undeserving. We see people here every day who don’t have that same luxury.

Lack of access to healthcare means that people go their entire lives without a surgery that takes little more than an hour. Lack of awareness about the physiological basis of congenital disorders, and sometimes just disease in general, means that people are ostracized from sources of income and socialization. Something so minute can literally have the ability to take a person’s life away on so many levels. Something that is also a part of me but never had the chance to define or dominate me.

This morning, I was going through my 10-yr-old patient’s chart, making sure she was ready for surgery. I quickly scanned the admission assessment, looking for anything pertinent. I found something that was more significant to me that I would have been hoping for. Under “occupation” was the following response

“Quit school three years ago due to teasing”

Her whole life, education, and future, defined by the split tissue on one side of her upper lip. An entire nightmare that she has been living that I never had to experience. A soul that has been denied the opportunity to be shared with the world, because of a socially constructed hierarchy of value. To say “it doesn’t seem fair” is an understatement.

Dr. Gary told me that he loves when – within weeks after a person’s repair – you start to see them coming through. The parts of them that were always there, but that they felt ashamed or unable to show.

It gives me hope, for the ones who are here, having surgery - being given the opportunity to look more like the world expects them to look. But it leaves me asking that age-old question, yet again, of how is it fair that where you are born determines so much about whether you live or die.

I remember reading the well-known story of one man's humble attempt to rescue thousands of beached starfish back into the ocean, one by one. Mama Sue had it posted on our fridge for years. I remember not really grasping the significance of the punch line.

“It matters to this one”

At the time, it didn’t even occur to me that some would have considered the man’s efforts futile. I wholeheartedly sided with the labourer, not the skeptic.

I guess then I grew up a little. Went to University. Took “Statistics for Nurses” (aka, we’re only going to teach you what you absolutely need to get by, cause it’s just that hard and we don’t believe you have it in you to pass an actual stats course). Learned about upstream healthcare interventions. Started thinking about the world of limited resources that we live in. Adopted a “greatest good for the most amount of people” line of thinking. Came to Africa for the first time and stood face to face with thousands of people needing help.

Somewhere along the line, I started thinking about numbers.

It’s easy to focus on the numbers. Numbers indicate the significance of an issue. Numbers can prove that an intervention is effective and valuable. Numbers provide evidence. We hear that 22,500,000 people in Sub Saharan Africa are HIV positive and we are shocked by the magnitude of the statistic. But, unless we choose to go beyond the initial shock value of the number, then for me at least, the effect of the number ends there.

Maybe it is because I am, and forever will be a frontline person. I am invigorated when I am connecting or caring for another person. I relate to others – I find it natural to feel someone else’s pain. So a couple of weeks ago, when we were handed the lab slip for one of our patients, indicating in permanent ink that she is HIV positive, it didn’t matter to me at all that she now joins the 2% of people in her country with the same diagnosis. I know the numbers. I give socially responsible gifts for Christmas. I’ve got the GAP t-shirt. But I havn’t spent so much time thinking and reading about HIV in my life as I have these past few weeks. For me, it takes knowing the one.

She has, what will most likely prove to be for her, a terminal diagnosis. And, that news will shatter her world in the same way that it would shatter mine. She isn’t a number. It’s not easier for her to have HIV because so many others around her do too. She will experience it fully. The fact that she is one of millions doesn’t make her any less significant

It absolutely matters to her.

The day was already going well. As opposed to doing charge, which is how I spend a good seventy percent of my shifts, I got to be a real nurse yesterday. Don’t get me wrong, the opportunity to put my borderline OCD organizational skills to use in coordinating patients, caregivers, and a constantly fluctuating surgical schedule is one that I am grateful for; However, it also turns out that as a charge nurse, you can accidentally go an entire shift without ever cuddling a baby, if you don’t go out of your way to do so.

So, there I was, being a nurse. Doing my thing. Waiting for Aminata to come back from the OR, where she was having her trach tube removed.

And Natalie, our team leader, asks us what music we wanted to listen to / subject our patients to. She rhymed off the options. Came to the end of her ipod genres and offered “Christmas Music?” with a laugh.

We didn’t miss a beat. Christmas was the obvious choice. Regular Christmas fanatics use November 1^st as the beginning of permissible Christmas celebration time. Always just a little bit more extreme and unreasonable – I prefer to use October 1^st.

And this is the story of how on October 5^th at one o’clock in the afternoon, on the max-fax ward of the Africa Mercy, docked off the coast of Freetown, Sierra Leone; four questionably stable nurses belted out “Baby it’s Cold Outside” as our patients looked on in wonder.

I have always wondered what people with very opposite lifestyles & traditions would make of our highly culturally-specific representation of the birth of Christ. I have multiple distinct memories of my brother Dave, belting out with Bono, wondering “Do the Africans even know it’s Christmas?????” (in the overdramatized, sarcastic way that only Dave can achieve). I have known since that first year my brother serenaded me with Band-aid’s hit that there would never be snow in Africa at Christmas.

Turns out there are a few other things that don’t translate either. I guess I can only be left with the thankfulness that acknowledging the arrival of my King to earth has next to nothing to do with the weather or pageants or songs about eggnog. I will probably continue to wholeheartedly embrace these endearing symbols, simply because of the memories they hold in my heart – but if it so happens that this Christmas, I find myself in Africa, without any snow, things will be alright.

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!