Jackson and Judeson: A Prayer for Motherless Children

They arrived last Saturday night, in the arms of an Aunt and Uncle, who each rocked one of their newly born nephews. With glazed eyes, the infants' relatives shared the boys tragic story: they had set off from their remote mountain village that morning with the twins. The labour had progressed without event, but immediately following the birth of the second twin, the mother, a healthy 32 year old woman, took a deep breath. It would be her last. The mother was dead. They family could not explain it.

Jackson and Judeson weighed 4lb 8.5oz and 5lb 1oz on arrival to the nursery. They hadn't been fed since birth. Both were slightly cool. Judeson's blood sugar was dropping, and Jackson, the smaller twin, had a very. very low blood sugar. We warmed the boys and gave them sugar water, followed by a bottle of warm milk. Jackson was too sleepy to suck and was having mild breathing problems, so he received a feed through a tube, and was placed on a modified bubble CPAP system for a day.

It is obvious looking at them, that these boys are identical. The only way to tell them apart is the difference in size and skin colour -  each boy goes through different shades of yellow, as they overcome jaundice. It is special to have identical twins in the nursery. This is the first set of identical twins we have had at GLA in several years. Since they shared not just a womb, but an amniotic sack, the boys are bed-sharing for now. Everyone agreed that was appropriate. For the Haitian staff, their sense of wonder about these beautiful babies has increased  due to an anomaly that, being identical, they share. Each boy has 12 fingers, instead of 10.

Did that mean that they had a triplet?

'Why, yes, Susan! You're so smart!' one nanny exclaimed. Haitians believe that polydactaly (having extra fingers) is a sign that a pregnancy started as a twin pregnancy (in this case it was a triplet pregnancy, so they believe.) The babies engage in a fight in utero, that ends with one twin consuming the other. As a sign to the parents and family members or this battle and it's outcome, the victorious twin gains extra fingers from the vanquished twin.

In a country in which infant mortality is very high, these extra fingers provide reassurance to the family. The child in their arms is strong. He or she has already proven that. The family experiences a feeling of pride, and increased confidence that their tiny baby might survive.

Despite this reassurance, the Haitian staff were very concerned when they started work on Friday morning. The were severely dehydrated. The nursing notes read that they had fed well. There was no mention of diarrhoea or vomiting, but we soon learned that diarrhoea and vomiting is just what they had. Judeson, the largest twin was the sickest. His weight was down 12% from the previous day. His brother had lost 10% of his body weight. I had to start IV's on both of them.

As I re-sited one of those lines this morning, I felt a twinge of sadness. The boys mother had been healthy. She had safely delivered two infants into the world, despite the odds. Despite poverty and lack of prenatal care and despite not having a skilled birth attendant present during her labour. If she had survived, she would have nursed the boys, but she was not given the chance to do that. Now she was dead and the boys were orphans. They were also very sick.

I know, of course, that God can redeem the loss for Jackson and Judeson, and of course, I am going to ask you to pray for them, and all my sick, motherless children on this Haitian Mothers Day. The twins mother made the ultimate sacrifice for her sons last week. It was a sacrifice that cost her her life. I have to believe that her legacy of love will live on in them.

Rebeca

It has been a busy weekend, with 5 very sick babies - 4 of them being tiny infants in GLA's NICU. For now, let me tell you about one of them. Let me tell you about Rebeca:

I was recovering from my surgery when she arrived. Rebeca was  born around 2 months prematurely, and she weighed a mere 892g (1lb and 15 oz.) She was  barely breathing when she arrived, with a pulse oxygen level of 37% and a falling heart rate. She needed immediate resuscitation and careful post resuscitation care on the night she arrived. Since then, her NICU stay has been anything but smooth. She has been resuscitated no less than seven times. In addition to many of the usual problems that premature babies face, including immature lungs, an immature brain and digestive problems, Rebeca has a chest wall deformity known as Pectus Excavatum, which, is a depression in the sternum, or breast bone. Hers is fairly wide defect, and I suspect it presses on her lungs.  Our poor baby contracted a respiratory virus that caused bronchiolitis, a condition that is often fatal in premature infants and newborns. This was further complicated by pneumonia and by fluid overload (the result of an IV infusion that was not monitored in my absence (officially, I was still out of action).  Rebecca didn't gain weight when she was ill, and as a result, she remains very weak, and is still on CPAP, over two weeks after we admitted her.

Last week, her mother suddenly left the orphanage for several days. Rebeca was producing lots of stomach acid at that point, and did not tolerate the switch to formula feedings very well. I was so relieved to see her mother return on Friday. I greeted her and asked her, please to express some breastmilk right away. The Mothers eyes darkened and she stormed away from me, returning 30 minutes later with a very small volume of milk.

That night, she refused to express at all. Saturday morning, we re-iterated that Rebeca had digestive problems that could be helped by her mother's milk and that could worsen on formula milk. The Haitian nurses and I emphasised that breast milk was recommended for all small babies, and that it was especially important for premature babies, far superior than anything that can be bought in stores anywhere in the world.

The nannies did all the things for this mother than Haitians believe will enhance milk production in lactating women. They made special meals for Rebeca's mother and encouraged her to rest and take care of herself. Still, Rebecca's mother was adamant, she had no milk, and she wasn't prepared to sit for 10 minutes at regular intervals throughout the day to re-establish the excellent supply that she'd had before she went home.

We were exasperated by 7pm that night! Rebeca's mother is in very good health. She is tall by Haitian standards, she is fat and she is eating us out of house and home. We had asked nothing from her, except breast milk for the baby. Did she really want us to give formula, knowing this could compromise her daughter's frail health?

We encouraged, we coaxed, we cajoled, we reasoned, and then came some tough talk.

'She's not my responsibility,' Rebecca's mother exclaimed sullenly. 'You're telling me that because I gave birth to her, I have to produce milk for her? It was God who decided to give her to me!'
'No', we told her. 'You have made choices, now you are a mother.'
But the words were not striking the mark. We were faced with a hostile teenager, with empty eyes, who sneered, and outright refused to express milk for her baby. The milk she said wasn't there. The milk that hit staff members three feet away, whenever she squeezed her nipple.We softened the approach.

'The baby is hungry. Look at her flailing her arms. And because she's crying, her oxygen levels are going down. You've been through a lot to get help for her. We've been through a lot. She's still sick. We know you want her to live. And clearly, the baby has a strong will to live...'

Miss Cammi was cut off abruptly. 'A will to live?' the mother said, spitting the words out of her mouth as though they were something foul.'Well, I don't know why she wants to live! I delivered her in my toilet bucket!'

I was stunned motionless and  defeated. And it wasn't the words, it was they way they were spoken. Not just the fact that the baby was born in a toilet, that happens sometimes. But it was the disregard for this beautiful and precious soul. The tiny life in the incubator, in the corner of the NICU.

I turned to the Haitian staff. Maybe this baby didn't need her mothers milk as badly as we thought. Too much bittterness. Too much hatred and resentment.

Today is Haitian Mothers day. Mothers Day is supposed to be a celebration and  rightly so, because all mothers make sacrifices, and a loving mother is a golden thing. Today, though, i am painfully aware, that motherhood does not come to all women by choice. For some, mothering is a struggle, and the mantle of motherhood, a very heavy burden.

'

Awake and Alive!

 The anaesthetist called my name. I snapped awake, and was almost instantly aware of a gurgling sound, then the sense of my breath being sucked out of me. I froze. I remember coughing and gagging as the tube was removed and then the bitter taste of bile in my mouth. Then, in Kreyol, 'Ok, ok, a new gown.'

As they changed me, I felt a deep ache low on my right side, and I heard my surgeon reassuring me that it was all over, but that the appendix had ruptured. 'You don't feel any pain, do you?'

'Oui'. I did

Immediately, I was given pain medications in my IV line. As the medication was being injected, I began to shake violently.

'What's the matter?' a voice enquired

In my grogginess, I answered in English, through chattering teeth. The voice didn't understand. 'Pardon?'

'Fwet! Fwet! Fwet!' I answered. (Cold! Cold! Cold!) 

'Ok!' The voice was a friendly one. Blankets were piled on top of me and the shaking stopped. 

I was so glad that I spoke and understood Kreyol. Although my Doctors spoke excellent English, the hospital nurses spoke none at all. It would have been a very frightening and bewildering hospitalisation without a very good knowledge of Kreyol. My language abilities failed me only once during that hospitalisation:

Through in the recovery room, I continually fell into such a deep sleep that I would stop breathing. The pulse oximiter would startle me awake as my oxygen levels dropped.  'Are you ok, my dear?'a nurse asked, coming to the head of my bed. 'I keep losing my breath I answered.' Her forehead creased into a frown. Try as I might, I could not think how to say, 'I just keep forgetting to breath', in either English or Kreyol!

There were tears. I had been under anaesthetic for three hours, but anaesthetised people, however long they have been out, wake up feeling as though only a second has passed. As a result, the terror I'd felt in the minutes before I went under, was still fresh in my mind. 'I was so scared,' I kept saying. Crying hurt my stomach, so I just had to stop,  not an easy thing to do, with such strong emotions swirling inside me.

 I had been frightened but I had received competent care from the people in the operating room, within the technological limitations they were working under, and my God had guided the hands of my surgeon, all the while, holding me in the palm of his own hand. And I was alive! My Grandfather had died, almost as far away from home as I was now, and in this third world country, I was awake, and aware post surgery, and for the first time in two days, it seemed possible that I might live.

Around the time that James Westwood died, his best friend, a man who was almost closer than a brother to him, had a terrible nightmare, in which my Grand-father was torn away from him, screaming and wild eyed, and left alone on a remote beach. James had suffered the same pain and the same isolation and the same terror in the same state of loneliness that I had. For me, though, the last goodbye I had said to family and friends as I headed back to Haiti after the Christmas holidays wouldn't be forever. I would see them again in this world. I was so grateful for this. So grateful that there were no words to express it.

Do Not Fear

My Haitian hospital experience was for the most part, a comfortable one. Laying under crisp white sheets, in a freshly painted, air-conditioned en-suite room, I gave thanks for the graces I had been given. Like most ex-pat workers in Haiti, I did not have an insurance policy that would cover surgery and hospitalisation, in-country. Government travel warnings make it all but impossible to obtain insurance for travel to Haiti. This being the case, I was mentally preparing myself to endure surgery and recovery at the Haiti Baptist Mission Hospital. I had visited this center shortly after the 2010 earthquake, and had found a set up very like that of a World War One field hospital. The Haiti Baptist Mission was primitive;  this private hospital in Port-au-Prince was one of the country's best.

The journey there, along Haiti's torn and pot-holed roads had been a jarring one and an exercise in enduring pain. I made it through the journey by extending my arms down against the car seat in an attempt to splint my inflamed belly as best as I could, while our Haitian Paediatrician, who, insisted on personally escorting me downtown for lab work and investigations, urged her driver to go slowly and avoid the bumps. The poor man did the best he could but there is no avoiding the bumps on our mountain road!

I gritted my teeth, grimaced and grunted through a painful sonogragram, mindful  that had these diagnostic tests been performed 24 hours earlier, when my pain had been so bad that I hadn't been able to stand up straight, the procedure might have been absolutely unbearable. At a dingy clinic in the Chanmp De Marrs district of the city, the only clinic that was able to fit me in on an emergency basis, the diagnosis was made. I had a severely inflamed appendix and should go directly to the hospital.

I had been slightly dehydrated when I left God's Littlest Angels but from mid-day onward, I had been instructed to stay strictly nil by mouth.That meant no fluids, and no medications. Hearing this, I had pleaded for an injection  of something for nausea, before I left the orphanage, but the Paediatrician said there wasn't time for that.  Several hours in the Port-au-Prince heat had taken it's toll on my body. I was completely parched by 6pm that night, when I was admitted to the hospital. I remember pleading with my surgeon, in the admissions office of the Canape Vert Hospital, to give me a glass of water. Just a little one. Maybe a few sips, or at least some ice chips? I'm sure I was quite pitiful. The surgeon look at me fondly, shook his head, laid his hand on my shoulder and told me I would get all the fluids and medications I needed intravenously.

The nursing care I received in that hospital harked back to an earlier time; nurses in starched white uniforms wore caps pinned to their hair and delivered particular care, under the leadership of a matron. Matron checked in on each and every patient daily, including on Sundays.

On admission, an IV was quickly inserted and I was given potent IV pain medications, three IV antibiotics and a liter of IV fluid. As the Doctor explained to me that I was not well enough for surgery, I had a flash of insight into why my Grandfather might have died. It is unlikely he would have received IV fluids during the course of his illness. If he was given antibiotics before surgery, which I doubt, they certainly would not have been as powerful as the ones I was being given now. I was in the hands of a skilled surgeon, and an attentive nursing staff; he was treated by a General Practitioner on a remote Island in the South Atlantic Ocean. His surgeon was a man, who, was known to practice while under the influence of alcohol. James Westwood barely stood a chance. I knew this, as I slipped into a  delirium of dancing lights and fire-work displays. 'Do you feel up to talking?' a  visitor asked one day. I smiled and shook my head slowly. 'I don't talk now. I just dream.'

The next morning, my pain killers had worn off, I was being prepared for surgery, and I was in more pain than I could bear. The infection was advancing throughout my abdomen and my peritoneum and the slightest movement or the lightest touch to my abdomen sent pains shooting throughout my belly and up into my chest and shoulder. My Anaesthetist stopped by to check in on me. Recognising that I was suffering, she smiled understandingly. 'It's almost over, I'm here,' she reassured me.

My transport to the operating suite was truly agonizing. I remember wincing as the trolley went over bumps along the route. Flat on my back, moving at  a speed I could not control, nauseated and dizzy. I was gripped my terror, and all confidence in God and my surgical team suddenly abandoned me. I was sure I was going to die! I wanted my Mum!

I was wheeled directly into the operating room, where, I was strapped to the operating table, arms outstretched and legs extended. Being restrained in that position intensified both my pain and my fear. To my horror, a male operating room assistant then began partially undressing me to attach ECG leads. Despite the gentle handling and reassuring humour of the Doctors and nurses, I could not shake the feeling that I was about to be crucified in this austere, brightly lit room. All kinds of thoughts raced through my mind about what was going to happen next. As lovely as the staff tried to be, I was not soothed. They offered no explanation for anything that they were doing to me. The nurses on the inpatient unit had been reprimanded by the surgeon: according to the order he had written, I was to have received 3 liters of IV fluid overnight, not 2. Now, I wasn't even stable enough for surgery, he complained, but the surgery would have to go ahead because there was no more room for delays.

'Why did they start an IV in that vain, anyway' an operating room nurse snapped. 'It's not suitable for re-hydration!'

'Her veins were shut down, yesterday,' the anaesthetist answered. 'They weren't good at all.
'Oh, she was sick yesterday,' the nurse shot back. 'Well, she's much worse today! Today she barely has a blood pressure at all!' Then, turning to me, and patting me on the arm, and reassured me, 'we'll find another vein, Cherie. Pa pe.'

Pa Pe . 'Do not fear.'

As the nurses worked to get a more reliable IV line into me, I looked up at the ECG monitor. Oxygen saturations in the low 90's. Heart beating at a steady 76 times per minute. oh, that was ominous! A day ago, my heart had raced at over 130 beats a minute at rest, in response to the infection. Today, I was critically ill, and my heart wasn't responding, not to the infection, and not to the fear that raged through me. I knew then, that the infection was beating me. It was a moment of cold clarity, in which I realized that I was dying. Dying was not just an invention birthed in my mind, by terror. It was a very real possibility, and I couldn't fight it. I wouldn't win. I was blind with panic, desperately reaching for father God. Where are you, now! Why have you left me? Why?

It was then that snatches of bible verses drifted into my head, spoken in a voice I perceived rather than heard. 

I will never leave you, nor forsake you. I will be with you unto the end of time. 

Do not fear. Do not be dismayed

Yes, he saw me, He knew, and he understood that I was in pain and that I was very, very afraid. He had endured far worse agonies. He had sweated blood. This, though, what was happening to me, was not a crucifixion, not a punishment and no-one intended to hurt me or shame me. He had been punished. They had intended to wound him, and to utterly humiliate him in the process. His suffering had been holy and it had brought me to God. Now, he was here to help me bear my suffering. I have taken on your infirmities, and I can bear your fear. I am a man of many sorrows. Give yours to me.

God had me where he wanted me and his eyes were on me. His spirit had had discerned the prayers I was too frightened to pray. Now, his face was turned towards me. He was telling me he would be be with me always.

Though I thought I was alone for a few, terrifying minutes, I never was. If suffering had to come, at least, I knew, I would face it with my God. Come what may, whether I lived or whether I died, I was going to be OK.

The anaesthetic was injected into my IV line.

'The mask has oxygen, breath gently.'

And with that, I drifted mercifully into oblivion.

Note: James Westwood was born on the 15th of May, 1927. Today would have been his 85th birthday. Happy Birthday Papa!

Dreams And Visitations From Father God

'The LORD will guide you always; he will satisfy your needs in a sun-scorched land and will strengthen your frame. You will be like a well-watered garden, like a spring whose waters never fail.' (Isaiah 58:11).

Late morning on April the 30th, I was filling out vaccination cards at the nurses station, directly in front of the NICU. I reached for my glass, found it empty and sighed with a faint longing. I would complete the documentation, because I wanted that out of the way, but my mouth was dry. A few minutes later, my head was aching and my sense of malaise was growing. Suddenly, I missed home. Homesickness comes in ebbs and flows to expat workers and I have learned to accommodate it, along with all the highs and lows that go along with my work here. It's when I am feeling unwell though, that I struggle the most with the distance between me and and my family in Scotland. At a time when I want, need and would  benefit from caring gestures, I must do without them and I must take care of myself. I feel so alone at those times.

Absent mindedly, feeling weak and nauseated,  I reached again for the red plastic tumbler - the empty red tumbler, and found it half full! ' There were few things I would have appreciated more at that moment than that icy cold water, to ease the pain and settle the nausea..'and the water doesn't taste Haitian, it tastes of home,' I told my Facebook friends at lunchtime. It was the last most of them would hear from me for a week. 

Mesi Bondye!! I didn't understand the reason for this little act of loving kindness, but I was confident that was what it was. A gesture of compassion from a loving father. I had taken some aspirin. The  headache  had lifted and I enjoyed a mid-day meal of pasta and pesto sauce. As my shift came to a close, a vague discomfort in my upper abdomen shifted lower in my belly, and became a dull ache, but I made it through to the end of my working day with a smile on my face. I joked with the nannies and chatted with the volunteers over dinner. 

At 8pm that night,  I was suddenly gripped by a sharp and severe pain in my belly, and I seriously contemplated whether that glass of water had somehow been contaminated on route from heaven. Later, I came close to posting something to that effect on my Facebook page. I had been violently sick and the pain had pain eased, but I was tired, and I couldn't be bothered logging on to my laptop. I fell asleep, waking sometime around mid-night with a high fever that caused my muscles to rigor. I had suffered from frequent migraines since before I was a teenager. Debilitating though they could be I'd had to learn to live with them. As a result, I could bear the pain I felt now.

I developed diarrhoea. It was not severe, but there were signs that it was caused by a bacterial infection. I didn't believe in taking to my bed. I did believe in the capacity of my body to heal itself, which, had always been remarkable. However, the exhaustion and lethargy I felt during those days was incredible, like nothing I had ever experienced. I reasoned that the long hours I had put in stabilizing Jusmy, followed by a week of night shifts that I had pulled to cover staff sickness, one of which, backed onto a day shift, had drained me.  I started a protocol for travelers diarrhoea. It consists of oral rehydration solution and an antibiotic. Diarrhoea is such a common problem in the developing world that it is not considered necessary or practical to visit a Doctor and obtain stool cultures before antibiotics are started. Doctors provide the guidelines for self-treatment and nurses and travelers commence treatment by themselves, and seek medical help if their symptoms worsen. The pattern of my fever strongly suggested that I had a bacterial infection.   I knew well enough that my immune system was not handling the infection this time. I knew well enough that I better not try to work anymore than was absolutely necessary, so, I swallowed the pills and I took to my bed. 

My fever climbed over the days that followed,  and my dreams became increasingly more vivid, brighter than techni-colour. I remember flying over the ocean in a flying saucer, being amazed by the depth and intensity of its blue shades. I remember being aboard a ship. I remember standing on its deck, and feeling a strikingly cold, briny wind lash me. Thank you! Thank you! I was so hot. So, so hot!

On Thursday Afternoon, I lurched between delirium and lucidity,  and developed some worrying signs that suggested I needed medical help. The pain had moved very low in my pelvis on the right side, and my abdomen was tender. I realised that I hadn't eaten for 3 days. I'd had no appetite. Despite Almost 72 hours on antibiotics, my fever had not broken, and diarrhoea was still a problem. It hurt to move, it hurt to breathe. Miss Vicky, an American nurse, walked by outside my room. It was raining heavily. I couldn't muster a deep enough breath to call out to her. Something was wrong. I suspected appendicitis. I told my roommate I needed to see a Doctor. She grimaced. I knew it would be dangerous to drive down the mountain in this weather. Tomorrow, we agreed. Tomorrow morning. 

That night, I dreamed I was standing on a road that cut through a heavily wooded area. Soldiers were marching that road, to the horizon and beyond. A man appeared beside me. He looked as though he was in his 60's. He had soft, white curly hair and an impeccably kept beard. He was of average height and he had a muscular build. He was was wearing a tartan shirt and blue jeans. Resting his foot on a tree stump, his aura was at once relaxed and commanding. Smiling at me he made a sweeping gesture with his arm. 'How many men do you think I have there,' he asked, motioning to the soldiers that marched over a snow-capped mountain on the horizon.

'I don't know I replied, It was an awesome sight, and my mind struggled to grasp the magnitude of it 'Maybe 10,000?' I guessed.

'I've got 70,000 men out there,' the man told me. His face was beaming with pride, 'Every single one is exactly where I want them. And you,' he declared, his eyes shining, 'You are exactly where I want you.'

And then I woke up.

I was feverish, yes, and extremely sick, but I took the dream seriously. I noted than my pain has decreased significantly from the day before. I recognised that a sudden release of pain might mean that my appendix had ruptured. I understood that soon, fecal contents and puss would seep into my abdominal cavity, the lining of my digestive tract and eventually cross over into my blood stream. 

Upstairs in the NICU, a pulse oximeter and blood test confirmed the seriousness of my condition. If my CRP is more than 100, I know I need a Doctor, I told myself. CRP (C-Reactive Protein) is a marker of inflammation that usually increases significantly with severe infection. A result of over 100 would be concerning, given my symptoms. My CRP result was greater than 210. It was so high that our portable analyser was unable to measure it. My CRP was off the scale!

I had an overwhelming infection. My heart was beating 165 times per minute and my tissues were poorly oxygenated at just 86% following the walk upstairs. 95-100% is considered normal. 85% is considered pre-terminal. Five minutes later, my oxygen levels were hovering at 88-91%. I knew there was little time to lose. I knew that my life was in danger. Convincing my colleagues of this, though, was another matter. I made two attempts to persuade my room mate, who worked in the office, that I needed to be transferred to the city for urgent medical evaluation. My colleagues, though, had other plans for the day - matters to be dealt with that they believed were more pressing. In a last ditch attempt, I asked my room mate to write down my vital signs and to call my boss, a Registered Nurse, who was in the Dominican Republic. I was certain that she would tell the staff that taking me to see a Doctor in the city had to be the priority. But no,  an adoptive family was to appear before the local judge to get approval to adopt the child who had been matched to them. There weren't enough drivers or vehicles. I was told I would have to wait. I had no fight left in me......I should call Mme Bernard...... I needed oxygen and IV fluids.......I should call Dr Nathalie on my cell phone. She would understand....... My phone was just out of reach...... I would get it in a minute....

I fell asleep. I woke, I got up to use the bathroom. My mind was drifting. I forgot about the oxygen, and the fluids, and Mme Bernard. I fell asleep again.

Thankfully, my heavenly father, the warrior king, commander of the troops and the God of the universe had me in the palm of his hand at that time when I couldn't take care of myself; when there was no-one else to take care of me. He and showed me his divinity and his sovereignty but also his tenderness. He had me right where he wanted me. That's what he had said.

Deep Thoughts, But No Words

In the mid 1950's James Westwood, a young father from Alloa, in Central Scotland,  left his wife and three year old son, and set sail on assignment with a merchant shipping company. Thousands of miles from home, on the Atlantic ocean, he fell seriously ill. It would be three days until his ship reached inhabited land, with a resident Doctor.

On the 1st of May 2012 at shortly after 10am in the morning, the man's granddaughter, me, a young nurse serving at an orphanage in Haiti's Kenscoff suddenly felt unwell. Over the afternoon, I developed a set of vague symptoms; a migraine, slight discomfort in my upper abdomen, along with nausea  and lightheadedness. By 10pm that night, the pain had moved to my lower abdomen. I spiked a fever and began vomiting. A busy orphanage schedule, and torrential rain prevented me from receiving medical treatment urgently. Three days after the pain started, the grand-daughter was admitted to a Port-au-Prince hospital.

Details of James' condition at the time of surgery are scant, but I, having developed a severe intra-abdominal infection, was suffering from peritonitis. I had been in septic shock for 24 hours when I underwent surgery for removal of a perforated appendix.

James Westwood died shortly after his surgery. He was 29 years old. He died, and I survived and I am somewhat awestruck, and humbled beyond belief, thinking deep thoughts that over the next few days, I will try to put into words. Somehow.