Intersection

Last month I celebrated my birthday. That night the Africa Mercy sailed across the Equator at the point where it intersects the Prime Meridian. Point 00.

In the maritime world, sailing across this intersection makes you a “Royal Diamond Shellback.” If you simply cross the equator you are a ‘Shellback’ and if you cross the equator where it intersects the International Date Line you are an ‘Emerald Shellback’.

A few weeks ago on August 28^th, we undertook our biggest patient selection in the history of Mercy Ships. Selection day is a day mixed with intersections of a different kind. Hope and disappointment. 7,354 people queued up, and 4,236 made it through the gate. That means 3,118 were turned away by the crew who walked the line. That’s a lot of hopes dashed. A lot of people leaving disappointed. People with conditions we obviously couldn’t help such as adults with abdominal problems, children with cerebral palsy or epilepsy. But for the 4,236 who came through the gate, hope was maintained. They waited patiently to get through the gate. Once through the gate they were met by one of a team of experienced nurses. After listening to the problem, the same answer was repeated many times, ‘I am so sorry we cannot help you’. Selection Day is one of the hardest of the year.

More people are turned way than are accepted for surgery. It is the harsh reality. The need is always overwhelming and we are only a surgical hospital ship. We do not have the skills or resources to help everyone. And even if we did, medicine also has limitations. For the nurses who have to say ‘no’ literally thousands of times, selection day is long and emotionally draining. But for every ‘yes, we might be able to help you, come on in and see the doctor’ ……the hope and expectation in palpable.

At 9.30 am I received an emergency call to the gate to see a child with breathing difficulties. The child was semi-conscious and gasping for breath in a distressed stated. Despite his dark skin I could clearly see he looked blue from lack of oxygen. I thought we could not help him. There could be many reasons for his semi-conscious state, cerebral malaria being one or some other infection that could depress his conscious level and cause him difficulty breathing. We cannot treat medical problems such as these and there was nothing to see externally. I tried to explain this to his parents but they indicated he had a problem inside his mouth. On peering inside I saw a huge mass, the size of a golf ball, completely obstructing his airway. No wonder 2 year old Noah could not breath. We fast tracked Noah to the maxillo-facial surgeon and scheduled him to be admitted as soon as our hospital opened. Exactly one week later we operated on him to remove the tumour. He is now doing fine on the wards and his mother hugs me every time I walk by.

Noah is in bed 1. Hope given at selection day has now materialised. His mother has heard him say ‘mama, mama’ again. Words Noah hadn’t been able to say for months. Words his mother thought she would never hear again. But even here on the ward, the intersection of hope and disappointment is palpable. Little Esther-Michelle lies in bed 15. Actually she isn’t lying, she is sitting up because every time she lies down she struggles to breathe. She is the same age as Noah. She and her mother had high hopes of help. And so did the missionary doctor who brought her to us. But we can’t help her. Esther-Michelle, like Noah, also has a tumour inside her mouth but for complex reasons we can’t help her. She and her mother are a picture of despair. Helpless disappointment is in their eyes. It is distressing to watch. Two other beds on the ward are also occupied by another child and a young adult. Both with inoperable malignant tumours. It has been a week of hope intersecting with disappointment and despair.

For me, I crossed the intersection of the equator with the prime meridian and became ‘royal diamond shellback’. In real terms that means nothing. But I like the phrase. It speaks of something special, something unique. Something to be treasured. So, as my medical world on the ship keeps intersecting hope with disappointment, I am calling each of these precious little ones ‘royal diamond shellbacks’. Despite their physical condition may they, and their parents, know they are unique and special, someone to be treasured till the day they die. Be that very soon or in many, many years. And as doctors and nurses caring for them, I pray we make that known in the way we treat and care for them when our medical skills have nothing more to offer.

And I pray it for us too. May we consider ourselves as, and treat each other like, special treasured royal diamond shellbacks.

(NB names have been changed to protect patient indentity)