Boxcars

We currently don't have internet available so I came up to an office to enter some observations before going back home after work....

The number of people admitted to our treatment center continues to fluctuate.  Currently our numbers are back up.  Nobody wants to be busy here.  When we are busy it means the virus is still busy.  And it continues to be spread in demonstrations of love and culture.  Caring for one another.  Sending off a loved one into the afterlife with sacred rituals.  Yesterday we admitted a family of four from a quarantined home in a distant village I wasn't familiar with.  A mother and her two children and her brother.  Children.  Before I departed for Sierra Leone I thought often about how I would cope with child suffering. And death.  I concluded there is no way to prepare for it.  A test you cannot study for. Concerns about personal safety, the inhospitable working conditions, the lack of resources  and every other fear of the unknown all taken together never posed a formidable challenge in my mind to that of dealing with child suffering.  This continues to be the case.

As my time winds down here, the cumulative effect of watching this virus poison and drain the life out of young, healthy bodies has not diminished the effect from every new case I see.  And they come fast.  You have no doors on your car.  It all rushes in and you hold up a small flame to expose it, and then  in protest.  You hold it up again.  And again.  And one day it burns a little longer until it is phosphorescent.  Your hope builds slowly and is kept inside.  Then she gets better and you carry that light until the next one is admitted and there you are again driving off road with no doors and it all rushes in again.  This is repeated every day in every shift here.  The wind and the flame.

Boxcars carrying birds out to the sea.  And there you are, riding on top, leaning over to look inside to see if they are still there, trying not to fall.

Hawa (a new Hawa, it is a common name here), is a 10 year old girl who was admitted along with her sister, mother and uncle from a quarantined house.  They are all critically ill.  This strain of Ebola doesn't cause as much bleeding as previous strains, but when it does it is ominous.  She was in the back corner of our probable ward, laying on her side uncovered.  Colorful beaded little girl bracelets circled her wrists.  A larger beaded necklace hung from her tiny neck and disappeared underneath her old, non-descript t-shirt. Dried blood flaked at the corner of her mouth.  The nurse and I had her sit up and gave her a cup of oral rehydration solution to drink.  Even through two pairs of gloves I could feel the heat transfer from her bony back into my hand.  It traveled up to my brain and then pooled in my heart.  I breathed in and out of my mouth through my duck-billed mask. Her lips were dry, cracked.  Her eyes were red and injected, and not looking at anything.  We waited as she drank and then her throat twitched.  Out came a long, arcing stream of bloody vomit. And then another, And another.  She was hemorrhaging and vomiting up dark clots of blood and fresh bright red blood.  Projectile vomit.  Explosive release.  We jumped out of the way and let her finish.  She was shaking, her feet twitched.  She didn't say a word as we cleaned her up and laid her back down.  We gave her some IV fluids and some medications to try to help with her vomiting.  We don't have what she needs here.  Even if we did, it would likely not stop the process that has started.  The virus has put the boxcar of birds on the track and sent it downhill to the sea.  It laughs as it opens the doors.  I don't want to be a part of any of it.  I don't want to ride on top again and peer in to see all the wedding cake white birds flapping  into one another before spilling out into the wind-stream.  Every day I pray in a slightly different voice, that this is the last one.  Maybe someday soon it will be, but not now and now is all we have here.

A white feather no longer carried by the wind falls gently on the side of the tracks, waits to be covered up by the night as the stars blink on in every pew of the sky.