For Mama Liberia...From The Pure Of Heart...

This morning was probably the toughest one to get out of bed.  I stayed up really late last night packing, listening to music, and looking at pictures; all trying to stay up as late as I could just to savor my final hours.  I ended up sleeping only about 2 hours.  When I did finally awake this morning I had this almost surreal feeling; this was the last time I would arise from this tiny little bed, emerging from my mosquito net checking for any bites...I sat on the edge of my bed as I took my final survey of this little quarter that has been home for the last 6 weeks.  It has become my little safe haven-except from the mosquitos!!

Final walk through the OR...

I finally did the one thing that I haven't gotten to do since I've been here-go to church.  It was such a nice and special-almost ceremonial-way to end my time here in Liberia.  Especially with this morning's sermon-the pure of heart...The service was held at Providence Baptist Church, one of the oldest in Liberia-the constitution was signed there.  I was kinda welling up as the choir was singing-it seemed like everything that was said/sung during the service was directly for me.  After it was over, several people who had recognized me, even some who didn't, came up to me to extend their regards.  One of the guys who I play football with attends the church and saw me there.  He showed me around a bit.  I felt complete as I walked away from the grounds-like my time and experience here has been certified and validated.  Can't really explain it-was like my heart just felt pure...

Corridor where my patients line up for clinic...

I was wearing another one of the African shirts that was given to me again this morning.  I decided to wear it as I made my final pass through the hospital and made rounds.  I'm not sure if it was because it was Sunday or what, but the hospital seemed quiet as I slowly paced through the halls on this final morning.  All was still.  Peaceful.  Serene.  Something that I have not noticed in all my time here.  It actually allowed me time to reflect on the various experiences I'd had along every corridor and around every corner...the waiting area where Ma-Nowah ran up behind me and hugged me.  The hallway where we came busting through with the girl who had the traumatic amputations.  The place where I first saw the guy with tetanus.  The corridor where all my patients lined up waiting for me.  Every corner a story.  Every turn a memory.

The battlefield...the Trauma ER!

When I finally made it up to the ward I couldn't help but smile.  This was where my most significant and memorable interactions took place.  Where I encouraged and was encouraged.  Where people laughed, cried, lived, loved, died, and bonded.  Feels like I could write a book about each room.  All the nurses were clapping and smiling as I made my way to the nurse's station for the last time.  Another bitter sweet moment.  It was the same thing each time as we walked from room to room while I said my farewells to my patients.  They all rolled up or sat up in their beds as we exchanged the traditional Liberian handshake.  I'm proud of all of them and am thankful to have shared and learned from so many.  As I was in between rooms I got a phone call from my last med student who wanted to tell me how grateful he was for my coming and how much he and everyone was enriched by my presence here-he had very kind and humbling words that made these last few moments all the more memorable. 

Me and Amie

My final visit was with Amie-you all should know who she is even though I've yet to mention her name.  Her mom was bedside and I met her for the first time today.  We had our moment as she told me that she didn't want me to go.  The last thing she wanted me to do was change her dressing on final time-as if she wanted my blessing before I departed.  I had to give her a final hug and kiss before I did it because to change her dressing we give her medication that puts her out-she wouldn't even remember me leaving her side.  You guys continue to keep her in your thoughts and prayers.

After I left the hospital I stopped by the field in Fish Market to catch all the guys playing fooball.  Of course they were trying to get me to stay and play a series, but I didn't have the time-plus it was hot as all get out!!  I then made my way to see Monie and his family one last time.  We had brunch together and shared our final thoughts and words.  I will always be grateful to them for their unwavering generosity.  Their driver, Mr. T, even requested to take me to the airport.  He and I hit it off too during my time here.  The final stop I had to make on the way out was with the Executive Director of the HEARTT program who was staying at the Kendeja Resort.  She is in town for a gala that the program is having in March and requested my company before leaving the country.  I'm not sure if I mentioned the website for the program I came through, but it's http://www.heartt.net/ if anyone wants to check it out.  We sat down over lunch for about an hour and talked about my experiences and suggestions to make things better.  She said that she had heard so much about me and it was nice to finally meet her as well...

Me and the Executive Director of HEARTT

After a long and arduous check-in process at Roberts International Airport I was finally able to sit down and relax.  No more farewells.  No more running around.  Just me and my thoughts.  This journey has been an unforgettable one to say the least.  To say how much I have grown professionally as a physician and surgeon, personally as a man, and spiritually as a Christian would be an understatement.  I know that I still have much to work on and am continually being shaped and molded.  I also realize that in the process of being refined and self-mastery that I have a role in helping to shape and mold others through my attitude, work, encouragement, and love.  I hope that I have at least done that with my patients and many of you as I have shared some of my heart and thoughts through this blog.  I think I may finally write that book some of you have been asking for.  Thank you to all who have shared in this journey-your thoughts and prayers have sustained me.  I smile as I glance at the titles of my different entries-they each evoke a variety of emotion-from '1 more day' to 'I DID IT!' and 'Original recipe or extra crispy?!!! 11 herbs-n-spices' (that one was hilarious!) to 'For me...' and '51...and a special naming ceremony...' They all speak their own language.  And they will forever speak as I revisit them each time I find myself taking anything for granted.  I see why they call it "Mama Liberia."  She has a way of guiding you past yourself and to yourself-just as a mother would.  And for that I will always and forever be grateful...

Thank you Mama Liberia, from the Pure of Heart...

Into the horizon...

"When I stand before God at the end of my life, I would hope that I would not have a single bit of talent left, and could say, "I used everything you gave me."

-Erma Bombeck

JJC no more...

I spent extra time rounding this morning.  Again, moreso just making social visits with everyone-you guys know the one patient that I'm concerned about.  It was my last time rounding with this particular shift of nurses-none of them will be working tomorrow morning so we had to do our farewells.  We all spent more time with our patients trying to draw out our time together.  None of us wanted to say goodbyes.  These nurses here have really taken me in and been so receptive-they all have been very helpful and gracious.  They work very hard and have made my time here extrememly memorable.  They will truly be missed.  They even gave me some traditional African shirts!!  They are so nice!  It was such a nice surprise!  Now I really have some 'home threads!'

Overlooking Waterside market.

After I left the hospital I made my way intown for the last time to pickup some things and walk around.  It's cool going around now and having people know who I am.  I'm no longer JJC ("Johnny Just Come")-that's what the vendors and people call a foreigner who just arrived and doesn't know anything!  You don't want to be labelled 'JJC' when you're at the market!!  I've gotten so many comments that my Liberienglish is markedly improved-I'm a lil' Liberian boy nah! Ehh-heh!!! LOL.  As I made my way through all the hustle and bustle amidst all the yelling and bartering, all the swerving and honking, all the bumping and shuffling, I felt this paradoxical peace...I am mastering the ability to find that peace even when everything around me is so whimsical.  One of the many things that I have gleaned from this experience...more on that later.

Once I made my way back to Sinkor (where the hospital is located) I went to get another haircut and then you know I had to throw on my new shirt!  Monie invited me to his home for my last dinner-Liberian collard greens and pineapple juice!  I met a couple this evening who had just moved to Liberia 2 days ago-an Ob-Gyn physician and his wife.  They were asking me about my experience and we shared our thoughts on medicine in the states and here in Liberia.  I tried to impart some good advice for him as he has never done any international healthcare work-I didn't want him to have any unrealisitic expectations.  He was asking me how many arthroscopic surgeries I'd done here and about my advanced radiological imaging....JJC fo'real!!  He has a lot to learn.  They seemed to be rather receptive-I hope that he has an enlightening experience and is able to serve the people here well.  I'm sure Liberia will be grateful for his service.

 

2 of my gracious hosts-Lydia and Joyce



I didn't stay long at the house because I had so many people to see and say goodbye to-you know how it is.  The driver took me over to see 2 more friends I had met during my time here to say a quick farewell and then I went to Rosie's birthday party-the woman who owns the restaurant with the good brunch-you all should know her by now!  It turned out to be quite the celebration.  It was at this newly opened Japanese restaurant (yeah, go figure...).  The ambiance was really nice too!  Everyone knows Rosie so it turned out that any and everyone that I wanted to say goodbye to was at that party!  Told you L.I.B. is too small.  It was a beautiful time.  A bitter sweet time actually.  I was walking around with my African attire and majority of the people knew who I was and began thanking me for my service to Liberia.  It was a good feeling; like a culmination of all the hospitality and graciousness that everyone has shown since I've been here.  True African spirit.

Because I knew so many people there and had a good time talking to each one of them-it also made it hard when the time came to say my final farewell.  One of the people who I worked with started crying as I left-that wasn't an easy one to deal with...



It is more than obvious that the people and I have grown together throughout this experience.  We've learned together. We've died together.  We've lived together.  We've been enriched together.  I won't get too emotional now...

I'm gonna go pack and wind down now so I can get up early and make my final walk to the hospital...I have a few more special people to say goodbye to...one has my namesake at her side...

One more to go...



JJC no more...

"Peace.  It does not mean to be in a place where there is no noise, trouble, or hard work.  It means to be in the midst of those things and still be calm in your heart."

-Unknown

52...and still a kid at heart!

Ok, really my last case...

It was quiet in the hospital today with the holiday and everything.  I went in at normal time so I could get rounds completed quickly and get on with my day.  I thought it was tough getting a case started on time during a regular working day-forget about holidays!!  No one wanted to do anything!  I had scheduled that one case for today for 9am-we didn't get started until 11!  The anesthesia and OR staff was trying to find any reason to delay the case.  I ended up bringing the patient to the OR myself so we could get started.  It all worked out though.  The case only took about 1 hour to complete and afterwards we all took a bunch of photos and danced around in the OR-I'm gonna miss being able to do that at work.

Still a kid at heart!!

After spending the entire morning at the hospital I went to a water park!  I know that sounds funny, but I did-a Liberian waterpark.  It's just one of those big playground sets with the monkeybars and slides in the middle of this big shallow pool.  It was fun though!  They had a volleyball court, 2 trampolines, a lake where you could go on a boatride, and a nice little restaurant.  The kids were loving it.  And so was I-I was all over the place!  I know the people were like-"ain't that the surgeon from the hospital?! Now he know he too big to be in that little pool with those kids!!"  All the little kids surrounded the trampoline I was jumping on asking me to do more and more flips-I think those little guys were trying to make me dizzy!!  They all came onto the trampoline with me after I was all flipped out!  I was like a big kid out there-haven't done that in so long.

Afterwards I headed back to the dorm to change-the OR staff had a little get together at this local spot.  We had a good ol' Liberian time!  I even learned a couple new dances!  Everyone was so friendly (except for that one girl who almost got into a fight with another guy!!  She was ready to take him too!).  We ended up heading back out to Myrtle Beach later on because another group of friends was there and they had a live band playing old school music.  Everyone got to meet each other and we all spent the time there hanging out on the beach-it was a nice time just talking and reminiscing on all that has happened over the last 6 weeks. 

Learning a new Liberian dance...

As I walking around a guy came up to me and introduced himself as the uncle of the young lady who had the traumatic amputations.  He said he had recognized me and wanted to thank me for all I did for his niece.  It was so unexpected meeting him there-told you L.I.B. is small.  We spoke for awhile and I gave him my information so they can keep in touch with me-they're going to try and bring her to the states once she recovers.  He kept telling me that she talks about me all the time and mentions how comfortable she feels when I'm around, which I was glad to hear.  The family continues to be so supportive of her.  The gentlemen even brought me a drink.  He was very thankful-as was I...

I ended up making one more stop at Groovies before I landed home.  The place was already packed by the time we arrived, and my friend who owns the place grabbed the microphone and made another announcement that I was leaving this weekend and made everyone give me an ovation-it was a warming gesture.  I only stayed for a little while because I was getting a bit tired, but I had a great time there as always.

A busy start to my last weekend here.  I'm going to be in the hospital tomorrow and Sunday morning wrapping things up and making sure everyone is tucked away for the last time.  It's going to be tough saying my final goodbyes...

"Vision is the art of seeing things invisible."

-Jonathan Swift

One for the road...I know...

Today was a a pretty laid back day.  Not too much action.  Things are starting to wind down now.  Many of my patients are pretty stable, so my rounds are becoming more and more social than anything.  It's remarkable to see how far some of the patients have come-a few have been with me for a long time.  We each have developed a special relationship; all of them have a story!

My last clinic was this afternoon.  Last time walking down the corridor lined with all the patients waving as you enter.  Last time having Massa breakout his airfreshener everytime a malodorous patient walks in.  Last time having to hear stories about herbie!!  There were a lot of people that came today-many because they'd heard that it was my last day.  One lady even came to see me and kept calling my phone (Lord knows how she got the number..) just to tell me that she was outside in the waiting area.  I was like "ok, I'll see you when you're name is called..."  When she finally came in-she told me she had fibroids!!  Someone sent her to see me for fibroids?!!  I was like-where's herbie?!!  I could use him right about now!! LOL.

Ma-Nowah came to see me today.  She has been my swan song.  When I walked into the hospital today she ran (yes....ran!) up behind me and gave me a big hug!  I turned around and looked down to see that it was her.  She had come early just to see me!  It made me feel so special.  Everyone was smiling at us as if they knew her whole story and what she had been through.  She is going to be starting school again and is able to enjoy her childhood pain free now.  I am so pleased.  Whenever I think of the many struggles and frustrations I've encountered-it all seems to fade away when I think of her.  All it takes is one to make a difference...

You know clinic wouldn't be clnic without a final V.I.P. story.  In the middle of the afternoon I got word that the general administrator was requesting that I perform one last surgery on a guy with a femur fracture tomorrow on the holiday.  When the representative from her office walked in and told me, I just sat back with this smile on my face and was like..."sure, no problem."  I wonder if I can squeeze in another one of my "regulars" free of charge...I'll let you guys play with that one.

I sat down and chatted with Annie today-the woman who has been cooking and washing our clothing.  She was telling me of how she felt that life was so much more simple and less stressful here.  How in the states it seems like we don't even have time to sit down and have a decent conversation with one another-always on the go, always texting, on the phone, etc.  Chasing after a better life.  She said that even though the people don't have much here, they accept life as it comes and are grateful for all that they have.  They are at peace with themselves.  She doesn't worry about where her next meal comes from, because she knows that someone may be able to share theirs with her.  She doesn't worry about being able to pay her rent, because she knows someone will shelter her.  She doesn't worry about money, because she knows someone will lend to her.  Seems like knowing really is half the battle sometimes...

Mom, you were right when you said that God gave you 2 ears for something.  If you just stop and listen you can learn something from anyone...even from the mouth of babes-I know...



Sunsent at Kendeja.

"They may forget what you said, but they will never forget how you made them feel."

-Carl W. Buechner

51...and a special naming ceremony...

My final day in the OR at JFK Hospital...

I can't believe it! 51 surgeries since my first day here in the OR:  January 3, 2011-and each one of them has their own tailor-made memory...especially number 50!  Today I came in a bit early to try and start the OR early-who was I kidding....I almost forgot that this is L.I.B.!  Of course I didn't start on time! LOL. I was trying to push as much as I could, but was just reminded that some of the same obstacles still exist even over here...I got another bump in the road when I heard that the guy who my ironmen were battling yesterday signed out AMA this morning!  Can't win 'em all.

The Ortho Team!  Keep smiling.

I think I saved my hardest case for today!  There was this kid who had a bad hip deformity that resulted in early severe arthritis.  He would be a prime candidate for a hip replacement if he had the resources to get out of Liberia.  His only option here would be to resect his hip joint, which is what I did.  Usually the procedure is not very difficult, but today this kid was really tight so it made it much harder than I was expecting.  His case was indeed a struggle and took a long time to get through.  I was sweating and everything (I always sweat in there, just more today..)!  Everyone was just saying how fitting it is have such a case like that on my last day.  My very last case was the same as my first-an above knee amputation.  The irony...

He makes it look so easy....

There are still cases waiting to be done, but I unfortunately won't be able to get to them all.  The social worker stopped me today and was like "the rumor is that today was your last day in surgery."  She was trying to get me to operate on someone else.  I had to tell her that I wouldn't be able to get to everyone before my time was up which she understood.  She was satisfied with 51 for now...

The staff is planning to do something for me on Friday, but it seemed like all of today was a party.  They all were dancing and joking around between cases-even during the cases honestly!  It was a bitter sweet day.  I've had many experiences in that little sauna with all of the surgical instruments they call the operating theatre.  I'm not done with it just yet though; I have some things to organize up there before I leave, so I still have some stuff for you don't worry.

I went down to check on my amputation patient again after my day.  She was in better spirits today so I stayed and chatted with her a bit longer.  She says that she's getting along alright, and that she's just happy to be alive.  She has this thing where she always wants to hold someone's hand, so I routinely just stick my arm out whenever I'm at her bedside and she just latches on...

 

I noticed she always has this big teddy bear with her so I asked her today "what's it's name?"  She told me that it didn't have a name so I said you should give it one.  And guess what name she gave it as she squeezed my arm tighter than before....David.  

Nothing more to say after that one...  

Still need more practice!

"The higher a man is in grace, the lower he will be in his own esteem."

-Charles Hadden Spurgeon

The Ironmen vs. Herbie...



Me and two of my little guys!



This morning on rounds I had to start saying my goodbyes...I discharged 2 of my kids on the service and won't be around for their follow-up visit in the clinic.  Remember the little boy with the bilateral femur fractures and girl with the bad knee flexion contracture?  Those two.  It's so gratifying to be able to help so many people, but it's really special when you can touch a child.  With all that these kids have to go through growing up in this environment, if you can instill a pleasant or special memory in them that will last a lifetime, what more can you ask for...

Clinic was good today. Finished up at a reasonable hour.  I was surprised today because my medical student showed up for clinic after already having finished his Orthopaedic rotation with me.  He said that he enjoyed his experience and wanted to spend the last few days with me!  Nice gesture.  There were alot of patients today that came in for surgery, but I unfortunately had to tell some that I wouldn't be able to do it because of my departure.  It's very humbling to see how many people have come during my time here requesting my services-I wish I could help each and every one of them.  I had another guy come in today with a mangled finger after getting it caught in a generator.  Another clinic amputation!  The clinic and ER have been my second battlefield around here-lidocaine does wonders when you know where to put it!!



After clinic was over I took my amputation patient to the OR.  Poor little girl.  I had to completely open both of her wounds because she had so much nonviable tissue.  It was killing me with every stroke of the scalpel as I removed more and more dead tissue.  She left the OR with a great deal of tissue loss.  Her wounds were left open because of the infection-she will need to come back for a few more debridements...it was a pretty tough case.  Usually I'm playing music and talking in the OR.  This afternoon, apart from me asking for surgical instruments, I was silent...



Preparing for my last day of surgery...

Afterwards I made my way back down to the floor to make sure everyone was tucked away and ready to go for tomorrrow's cases.  The one patient that was transferred in with the floating knee was saying that he wanted to sign out AMA and go to herbie!  He and his family were concerned about the "iron" that he would have implanted in him.  Many people here think that the "iron" will cause cancer or amputation.  At that point I wasn't trying to hear it!  I went and wheeled every patient on the floor that has had surgery into his room to meet and talk to him about surgery!  You should've seen it-I'm running in and out of rooms wheeling in patients one by one with external fixators on their limbs, hardware implants, those who had been treated previously by herbie, even one of the little kiddies!  There was a gang of people in the room trying to encourage this guy and share their stories with him, telling him that there is nothing wrong with the "iron!"  It was quite a scene.  It was actually pretty funny-the nurses were all smiling about the whole thing.  I ended up leaving all the patients in the room together to talk after I had spoken with everyone.  It was like a little houseparty in room 210 this afternoon!!

I went through the ER on my way out and ended up having the same conversation with another patient and his family who had sustained a femur fracture after being hit by a car...I swear man, that chicken must be great!!

Goodnight guys.

There's something about this shot...I call it 'The Poetry of Surgery'

"A great man is always willing to be little."

-Ralph Waldo Emerson





Home stretch...with home threads!!

Posing in one of my new scrub caps!

The Orthopaedic Service blew up over the weekend!  There were alot of cases that were admitted yesterday and are already financially clear for surgery, so it looks like I may go out with a bang this week.  I found out today that Friday is a national holiday-Armed Forces Day-so looks like Wednesday will be my last day in the OR here unless there's some crazy emergency.  Today was probably the latest day yet for me in the hospital.  When I found out that my operative week would be cut short, I started adding on cases to the schedule so I could knock out as much as possible.  I had a couple of tibia and femur fractures come in, one floating knee (a fracture of the femur and tibia in the same leg...) transferred in from another hospital, a bad acetabular fracture (but I probably won't get to it because she has blood in her chest), a guy with chrnoic osteomyelitis in his entire leg who will need an above-knee amputation, a guy who had a horrible forearm injury/fracture after being shot, one guy with a humerus fracture nonunion who needs bone grafting after being treated by "herbie", a little girl with a spine tumor that left her paraplegic, another girl with a myelomeningocele (her spinal cord is protruding from her back.).  It never stops here!  There is so much work to be done...

I will actually be going to the OR tomorrow even though it's not my scheduled day to do so.  My amputation patient is regressing and needs to go for a surgical debridement.  I feel so bad for her because I'm not going to be around to follow up her care.  I want to at least jump on top of this infection early so it doesn't get too far out of hand after I'm gone.  It is becoming quite tough on her family as well.  Everyday her home is packed with people.  The nurses have continually needed to limit her visitors-she only wants to see select people at this time. 

Always smiling...and being silly!

I was really tired today and had to keep moving around in between cases because if I sat down I knew that it would be a wrap for me.  I stopped watching the Superbowl around the 3rd quarter and went home, but it was still rather late for me so I wasn't quite running on all cylinders today.  I finally got around to doing that patient I mentioned previously with  the old femur fracture.  I was hoping that everything would go smoothly and he wouldn't lose much blood.  Turned out to be easier than I expected because his bones were so malpositioned that there wasn't much healing, which made it easy to manipulate his leg.  I pushed the envelope today with all of the cases and was able to start the last case after 3pm-which is not the norm.  They were being a little more lenient because they know I'm leaving soon...I'm gonna try and go for a long day on Wednesday-I potentially have 7 or 8 cases to bang out!!  Better pack lunch...

I wore one of my scrub caps today-everyone loved it!!  They were all like "where'd you get that from Dr. Balah?!!!"  The tailor really did a good job-I'm going to call him tomorrow to make some more before I head back...

I'm really beat right about now and have to get some sleep.  I think my week may continue to get busier as the days go by, so I better call it a night.  Hope everyone had a good day.

"What we are is God's gift to us.  What we become is our gift to God."
-Eleanor Powell