Longing for the day

this is ugly and honest.

3:23 am and I popped up in bed, something wasn't right. It was a cooler night because of storms so the fans were off and it was silent. Silence...and the sound of rain drops on tin. The hum of the oxygen concentrator I have heard for two weeks was gone and so was she.

Friday night Marilice began vomiting and it was clear that she was bleeding internally, maybe an ulcer. It was a steady downhill fight from there with a seizure yesterday afternoon and her sugar dropping to 42. We spent a good hour trying to get an IV in but her breathing became more and more labored. We fought to put her ng tube back in but she was vomiting profusely. I went to sleep knowing deep down where the night was going. Anna woke me up around 12:30 because she was bleeding from the only IV site we had and couldn't keep anything down. She had that same longing look in her eyes and begged for more water from a syringe. The palms of her hands blanched white, a sign of severe anemia. I offered no help to Anna as there was absolutely nothing more we could do, just love her in those last hours. I kissed her forehead for the last time and went back to bed. Anna held her as she struggled for air for more than 3 hours. It is an unexplainably painful honor to give love and dignity to a child in their last moments. When I awoke at 3:23 I ran down to the clinic and found Anna taking care of her body. We both marveled at how long she really was and how tall she would have stood. She was placed back in the crib where she has spent the last two weeks until she could be buried today. Her body was put in a small white box and laid in the ground this afternoon.

I have never wanted death and life in the same moment like I did for this child. I don't know how to explain the frustration of not knowing what is really wrong with a kid. She was so very sick and I don't know if the extensive care we gave her prolonged her suffering or not. I don't know why she didn't die two weeks ago. The alternative is to do nothing and that I can't imagine either. Yet, I wanted her fight to end. She will never have to know the betrayal of a friend, the heartbreak when a boy doesn't treat her right and the misery I see in so many lives in Haiti. What were we saving her for? In that same breath I wanted this precious little girl to live forever. I don't know how to understand these things but the beauty is that I don't have to because tonight, she is perfect and her arms cling tight around the neck of her heavenly father.

I can't understand His timing or why she suffered so long, yet I turn to Jesus and I understand what he did on that cross thousands of years ago. God loved us so much that Jesus had to give His life to make this right. All of our burdens and our pains and every way that our sin has messed this world up were justified and made right. Because you see if that's not true, then all of this stuff, it's meaningless. If this is it, this life is all we have, then what's the point?

The point is in Christ we hope. We hope for His kingdom to come. We hope for the day when we live with God in beautiful harmony, the way He made us to. He promises to make us all whole and because of that we press on. We press on to save the other 79 kids in our care tonight. You and I press on to love one another in spite of failures, to speak truth when it's hard, to care for our neighbor and forgive our debtors because it was all justified that day on the cross. And we joyfully hope for that day we are all whole.

I love you little girl and I'm thankful, for your life has made me love my Jesus more. This heart longs to see you in heaven.

I will love Thee in life, I will love Thee in death,
And praise Thee as long as Thou lendest me breath;
And say, when the death-dew lies cold on my brow;
If ever I loved Thee, my Jesus, 'tis now.

In mansions of glory and endless delight,
I'll ever adore Thee in heaven so bright;
I'll sing with a glittering crown on my brow;
If ever I loved Thee, my Jesus, 'tis now.

Friday, Friday

I wish you could just be here. I wish I could remember everything that happened so I could tell you.

Marilice had a really good night last night. All of the below things we prayed for came to fruition and the fight goes on. Her bum is really really raw and so she is in a lot of pain from that. At one point today, one of the ladies yelled for us to go into the dressing room and there was a pool of blood under her diaper with a few clots and I was terrified for half a second until I realized that she had just scratched her bottom until it bled. Her vitals are stable so please continue to pray for those things, as well as for her pain level to go down.

Lori and I finished up the Healthcare worker training yesterday with some role playing. We were the cholera patients, it was hilarious...

My baby just died and they were breaking the news.



Another time I passed out...



And then Lori passed out.



They will be starting the 12 oral rehydration posts all around in the next few weeks. Hoping to see big changes in the communities with this program.

This baby passed through the clinic this week with a very very rare genetic disorder called epidermolysis bullosa. Their skin is so fragile and peels off any place something or someone touches it. This is the second family that Lori has seen in Haiti with this disease. The baby is not expecting to live very long. It's crazy to me that I get to see stuff here that I probably wouldn't ever in a lifetime in the States.






Fabienne is doing really well. Look at those eyes! Can you believe the change in her face that a little protein and some TLC has made in just two days??? She is freaking cute...






Numbers are down to 58 in the cholera house tonight, Praise God! An older man died on arrival at the house this morning. I went up to cover for one of the nurses for a couple hours today and it was amazing how much easier it is to care for 50 less patients :)


We are closely watching Marilice tonight and also have a tiny newborn that was born up the cholera a few nights ago with us. Mom is having trouble feeding and the baby got very dehydrated.





And lastly, go check out the big news over at the RHFH blog...

Fighting

I was going to tell you that she died. I was going to tell you about how with clenched arms around my neck and her head nuzzled under my chin, she suffered through her last hours as her little lungs gasped for every breath. Up and down, up and down, much too fast to count, I watched her ribs waiting for the rhythm to skip a beat. She buried her face in my chest and wouldn't let me help her breathe just held tight around my neck. Countless times I went to measure her oxygen sats and she lifted her sweet little finger and placed it in the machine, a routine we have done over and over the last few weeks. 56% 55% 54% 51%....I turned it off and I gave up. A sucker punch to the gut. I stopped trying to rack my brain for anything else we could try and I prayed that Jesus would take her fast.

But instead, I'm going to tell you that she is in the room next to me fighting. She stabilized overnight and Anna stayed up with her making sure to keep her fevers down and her oxygen up. We got a faintly positive malaria test on her yesterday so we have an ng tube in and have started her on malaria meds as well as TB meds since she has yet to respond to anything else. Please, please pray specifically for these things.

- Malaria meds to work quickly
- Fever to stay down
- oxygen sats to stay up
- heart rate to stay down
- a new IV site, she has been stuck so many times that we can't get an IV in.

just some things.

thallie died yesterday afternoon. after seizing for a day she began to bleed out everywhere and died while her mom was here visiting yesterday. she is very pregnant with another child, which is why she took thallie off the breast that led to her kwashiorkor. it was heartbreaking to see a a caring mother grieve for a child. life here is so messy.

another baby was born at the cholera house last night. apparently, the stress of cholera brings on labor.

a child died this morning in the cholera house.

marilice is up and down, up and down. we can't seem to get her temperature controlled, her hydration stable, or her oxygen sats up all at the same time. i'm just totally in love with her and i'm more attached than i ever let myself get to a critical kid. you can pray for wisdom for us in her treatment. thinking about possible TB at this point...



meet Fabienne. she makes 79 in the Rescue Center (we just took #80 a few mins ago). she is so freaking cute and had us all wrapped around her finger at first sight. her kwashiorkor is so so bad and she has a veerrry long road ahead if she is going to recover. you can see the massive swelling in her eyes and hands and the splitting open of her feet. she is crying in miserable pain but wants to be held all of the time. please pray specifically for the next week as they are very critical for her.



We got some TOMS shoes donated and gave them out to some kids today. I found it interesting that the shoes they give out are not the same that you can purchase, maybe the rubber sole is better?



Some of the other 79 faces of the RC.







and in other news, Trey lost a tooth.



and Ameyah is the cutest kid alive.




as I went to post this, we got a call from the nurses changing shifts at the cholera house that they were running down with a kid that was dying. we all jumped up and ran through the yard and next door to take Marilice off the oxygen for this kid and as Licia was running up the stairs the child died. she was the daughter of one of the ladies who washes the laundry at the cholera house. lori is in preparing her body now and she will lay her sweet little life in a white body bag much too big for her. i can literally hear her parents wailing from the room next door.

4 of this little girl's siblings are up at the house sick with cholera. there are 109 other patients up at the house right now. cholera is wreaking havoc on the lives in this community and it needs to stop. Jesus, come.

No rest for the weary

Late last night I tweeted that a woman was being brought down from the cholera house who was having trouble breathing and unable to hold her neck up. They rushed her down and as soon as I assessed her it was clear she was fluid overloaded. Her Spo2% was in the 60s and her lungs sounded like she was breathing under water. We quickly got an IV in and pushed lots of lasix, cathed her to measure her output and as a last resort tried and albuterol/steroid treatment. She improved significantly within a couple hours so I left her with her husband in the dressing room and gave instructions to wake me up if they needed anything. While that was happening Licia got a call from the cholera house that a disgruntled and/or crazy patient ripped out his IV, and choked the nurse, pinning her to the ground. She and Enoch ran up there to find the patient tied up and gave him some meds to chill out. He was kindly sent home and asked to seek care elsewhere as needed :) I head up to our house and check on Marilice who seemed to really be doing great, got a shower and finally got to bed before my 6 am shift at the cholera house. Anna stays up with her because she is looking a little dehydrated and tries to get her to drink. She dozes off about 3 am.

Meanwhile (unknown to the rest of us) Licia gets another late call from the cholera house about a young man who is having severe seizures. She stays up there until 2:30 when his seizures finally stop. Turns out he has had them before in his life and the cholera must have brought them on. He is doing great today.

Anna comes and wakes me up at 4:30 and I assume it is for the above lady but instad she has Thallie in her arms and says she thinks she is having seizures. We look at her and sure enough she is having mild seizures. My first thought was fever, but her temp was only 99, so the only thing I know to do is give her tylenol and phenobarb. I run down to the clinic to get the meds and I get stopped by the mother of the mastitis lady who is staying here and her 1 month old baby is going downhill quickly. Lots of puking, dehydrated, not looking good. Quick give him some zofran and tylenol and run back up stairs. Crap, fluid lady from last night is still in the dressing room. She has some complaints that I can't understand but her oxygen sats were in the 90s so I decided to deal with her later. It is 5:10 am and I am dripping in sweat. Then we look over at Marilice and she is really getting dehydrated and decide she will get an IV when Lori comes over later in the morning.Then the electricity goes out because the oxygen concentrator takes up too much electricity and her breathing goes so bad. She is coughing hysterically and her sats go down to the low 80s. So Anna calls someone to come turn on the generator and I get ready to go up to the cholera house at 6. I leave poor Anna with the two bad girls and begin the most insane 6 hours of nursing care I have ever done. More than 100 patients. Over 60 are on IVs and the house is PACKED. It's kind of a blur, but I remember a few almost panic attacks and desperately calling Licia at 8:30 for reinforcements. I took out at least 5 infiltrated IVs, started new ones, dumped poop buckets and treated muscle cramps. At one point I was standing under the IV pole pictured below (1 pole, 7 bags of fluids, 4 patients- arghh!!!!) straddled over a cot trying to give oral doxy to a teenage girl who is really really bad and she PROJECTILE VOMITS all over me. I have to start IV cipro since she cant keep that down and instead of stopping to clean up, I kid you not that I just squirted hand sanitizer in between my toes in my chacos. Can you see why I had to throw all my obsessive good nursing skills out the window and hide in a corner and cry? And this isn't even my life. Lori and Licia are officially insane because only insane people could do this everyday. I'm tired and weary and stressed with the responsibility of these lives.










In all of that there are some precious, healthy, grateful patients who make all of this okay.









Thallie continued to have seizures and needed to be put on oxygen this morning and we only had one working oxygen concentrator so we had to take Marilice off and she did not do well at all. Until we could get an old machine working and fix the generator to give power to two machines we had to decide which girl to give the oxygen to. These things are beyond unfair. They are both on oxygen and IVs and stable for the time being but Thallie is pretty sedated as she is still having seizures. Please, please pray for both of these little girls tonight.

In completely other news, Lori and I are teaching a training class for community healthcare workers to set up 12 stations in the surrounding area to triage cholera patients. It's a brilliant concept but it's going to take a lot of time and work that Lori doesn't have to spare so you can pray for that class and all the workers who will be helping get our cholera numbers down.

Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can. But it can also deepen the wound. - Abraham Verghese, Cutting for Stone.

Marilice is still hanging in there, hoping to see how she does off the oxygen in the next couple days. Please pray, I want this little girl to make it so bad.

Dressing Room Drama

I worked the dressing room today with some help of a couple other volunteers and it was oh. so. crazy. I didn't have time to take most of the pictures but here are a few...

I can officially check gun shot wound off my list of things I have yet to see in Haiti. This young gangsta lookin lad walked in sat down on the bench and said he was just standing around and got shot in the leg (just above the knee) and never saw a person. There was blood all over his pants but no entry hole from a bullet. I have seen one too many episodes of SVU/ER/Grey's to believe this story. He was not concerned at all about who shot him and wanted to take home the bullet as a prize. Again, not buying his non-story. But glad I got to see Lori take this thing out, pretty darn cool :)



Then everyone decided to have an asthma attack, I seriously can't count how many breathing treatments I did today.

Then everyone decided to get breast abscesses. Sooo many today. We saw a double breast abscess on the sweetest little teenage girl who has had them since the pregnancy. Her baby is 1 month old and she has been unable to breastfeed. She sobbed to us telling us that she had no money to come down here from the mountains and I can't obviously show or explain to you how bad this was, but I can just say I might have self inflicted death before going a day with the kind of pain she was in. No way to measure the amount of drainage that came from one breast. She is staying here tonight so we can keep her on antibiotics and lance the other side tomorrow. Please pray for her pain and for her heart.

Then everyone decided to get cut.

This one is a guy who tried to break up a fight and got a rock thrown at his head. The cut was pretty bad and Lori had to do several internal stitches. His eye was super swollen and after sleeping it off for a few hours, he was acting all crazy so i'm praying for no head injury. He is going to be in so much pain for the next few days.



Machete cut on the hand.



For those of you who know no-lips guy, I have seen him twice this trip. Once, he brought a man to the cholera house and today he passed in the clinic today with a massive underarm abscess.

Lots of burns. More abscesses. Dog bites. C- Section incisions. And more antibiotic injections in rear ends than I would like to count.

Just as I was cleaning up the room and closing up for the day, a pregnant lady came in who was in a moto accident and just to spare Lori 10 extra minutes I sewed the gash on her head.

I'm officially starting a helmet safety campaign, right after we solve the food, water and infectious disease crisis.

Marilice and some other news

Marilice is the third of the critical kids up in the house. She had a horrible night last night and Anna had to bring her down and put her on oxygen in the middle of the night. She was super dehydrated when we took her, and we weren't really sure what was going on, but after a couple days on IV fluids, she didn't improve and began with fevers > 104 and a floppy neck, so we are treating her for meningitis as well as the respiratory stuff just to cover all our bases. I was in the dressing room with her all day today and her breathing really improved, but we are still having trouble keeping her fevers down. She cries most of the time begging for water, but in order to keep all her fluids down we aren't able to let her drink by herself and just syringe a few ccs of fluid at a time. She also has a nasty mouth infection. She is a sweet little girl, with tons of fight but has a long way to go. Please pray specifically for her fevers to stay down and any infections to clear up quickly. I just love her a lot.



She looks like Aunt Jemima with her cold cloth tied on her head :)



And in other news...

- Cholera is out of control. 118 patients this morning. 2 nurses. 65 IV bags to keep dripping at all times. 118 buckets (well actually double, one for vomit and one for the other) of stuff to clean up.

- Yanick, the non-nurse who can start IVs than any other person I know, usually works the dressing room doing wound care and injections on clinic days but she was needed up at the cholera house so I manned the dressing room all day.

-This little boy came in today after what appears to be his foot getting caught in a motorcycle. The bleeding was pretty bad so we put a tourniquet on to stop it until he could have it sewn up. His heel was in really bad shape so we gave him some pain meds and sent him into Doctors Without Borders because he'll probably need a skin graft.



- Henley and Trey ran around all night having water fights with 20 cc syringes. I got caught in the warfare many times.

- Don't get syhpilis or you will have to get 4 giant penicillin injections at a time in your bum for 5 weeks.

- A team from the Austin Stone is coming for the day tomorrow and we are going to put the to work. It's pretty cool for me to think about God using my trip with the Stone 3 years ago to move my heart for Haiti.

Off to rest up for another big day.

Goodnight friends

Gachny

Gachny is the second of the 5 kids staying up at our house and he is freaking adorable (an ET look a like kind of cute). He has been here a little while and I can't tell you what is wrong with him other than he just looks bad. Anna picked him out in the RC and I agreed that he has that look of a kid that is going to die. He is really puny and won't eat anything. We've had him on IV fluids with some dextrose and he'll drink milk really well but he has bad diarrhea and won't eat any solid food. I had a nightmare last night that I woke up and Anna told me he had died. I was thrilled to see him doing okay this morning, but by no means do I think he is over the hump.





We got another curve ball thrown at us today when Erline's poop (I know, but get over it) all of a sudden looked like cholera. We tested her and sure enough it was positive. This is not good for so many reasons. One being that she is fighting so hard against the Kwashiorkor that she has no reserves. The other is that she has been up in our room for 2 days with us and 5 other critical kids and we were all exposed. We sent her up to the cholera house tonight and did a massive bleaching of everything. We went ahead and treated all of the other kids with antibiotics and will ask you to pray pray pray that the cholera stays away from this house. We also brought up another little girl with severe kwash so that keeps us at 5 critical kids. Tomorrow is a clinic day and you can pray specifically that there are no bad kids that we have to take as the Rescue Center is at capacity


God is good and His mercies are new every morning and a lot of days I just long for the morning.

Erline

Erline is one of the 5 very critical kids who are staying up at the house with me and the other 4 volunteers here. She is in the fight for her life and I'm asking you to pray with us. She's had kwashiorkor for several weeks now, and seemed to be doing better, but took at turn for the worse yesterday when she stopped eating and drinking. We put a tube in. but she is not able to keep much down. Although she looks "healthy" because she is not small, none of the fluid in her body is in the right place. You can see the severity of her dehydration in her sunken eyes and deflated umbilical hernia.







She is such a little cutie!

Welcome Back Party

Lori and Licia threw me a welcome back party. It went a little something like this...

Land in Port and get out to Cazale mid afternoon. Unpacked our bags and sat in the office catching up on all that has been happening around here. About 10 kids in the ICU tent, one was a preemie on oxygen with a bad respiratory thing but was deteriorating quickly. Made a plan to get up early and head up to the cholera house to help the day shift this morning. Ate a quick dinner and was going to get ready for bed when they came and told us that they preemie was bad. Went to the dressing room to check on him and knew it would be soon. Anna held him and we just prayed that Jesus would end his suffering soon one way or the other. He died within an hour and Anna and a couple of the other volunteers bathed him and dressed him to be buried today.

I jumped in the shower and right when I got out a volunteer came running upstairs and told me that Lori called and there was a woman in labor up at the cholera house, and asked if I could go up. I threw on some scrubs and grabbed a few lights and a birthing kit. We ran up to the house and found the laboring woman (who by the way, also has cholera) fully dilated and ready to push. She was very small, so I got nervous that the baby was coming early, but she assured me she was 9 months along. Lori said she would call one of the local Haitian midwives to come up in case I needed some help, given this was my first solo delivery. I could feel the head really well and knew baby was in the right position so I was really calm and just excited. I pushed with her for about 30 minutes, and when the midwife, David (who I'm pretty sure was under the influence of something other than water) came in to help. We moved her onto the floor to give us all a little more space. Mind you, there are at least 70 other patients and their families in this small house dealing with cholera so the background sights and sounds are just awesome. David was really hands off and was just letting mama do the work, so I backed off and just got ready to catch the baby. It only took a few big pushes and baby came really easily. She cried immediately and looked fantastic. Anna cut the cord and then David put the end of the cord in baby's mouth so she would drink the blood. We all gasped and the Haitians laughed. My first thought was what the! and second thought was um hepatitis? The midwife delivered tugged on the placenta and caused her to bleed quite a bit. He left, so I massaged her until she was firm again and gave a dose of pitocin. She did really well after that first dose and we let mamma and pappa bond with baby girl.

It was a beautiful paradox of death and life in a matter of a couple hours, and pretty much sums everything I know and love about this place. Welcome back.






This morning Anna and I went up to the cholera house to help out a little bit and tarp the porch. We rearranged many of the cots to make room for all of the patients. There is a steady 65-75 patients a day, which is just insane. I was really overwhelmed with the thought of caring for all of these patients, and really respect all of the Haitian staff who has managed to save almost 3000 lives in the most intense conditions.










Who gets to work in a hospital with this view everyday?





Currently sipping a diet coke and enjoying an afternoon rain storm. Off to work the 6p-12p shift in the cholera house tonight. Would love prayers for continued health and endurance!

Lots of love from Cazale.

travel prayers

Only 12 hours from now I'll be in my not so favorite city of Miami en route to PAP. Would love your prayers for the traveling as well as the next month I'll spend at Real Hope for Haiti. The last several weeks, and few days in particular, have been insane so I don't feel totally prepared for this trip, but I am thankful He covers all my insufficiencies. I plan to share all that happens from that little island I love so much.

Thank you in advance for your prayers and encouragement!