Muse.

"Duel Nature"
I have a dual duel of my own.
Days seem brighter, nights shorter.
Doubt, a delusion, swerves outside it's lines.
I have a habit to learn.
You're right, I am always looking for the next big thing.
It's wanting what you have, I know, but I need more for now.
It's a phase, let me stumble a little please.
3-year-old tantrums or 15-year-old angst, it's not forever and no matter how much you explain and entreat, I still have to kick my heels on the ground to see whether or not it will open below me.
Someday, everyone should see the Grand Canyon with their own eyes.
You should compare Niagara Falls to the post card, because you cannot print the lace and fog, the browning leaves, the rolling thunder bass, the little details that create an experience.
I may have slipped a little on the rocks, I may be cold and wet, but I got to see it for myself.
Understanding vs. Acceptance.
Support vs. Consent
Thinking vs. Feeling
Why vs. How vs. Now...
Someday I'll be satisfied, my hunger for new things. Thank you for your love and patience.
Thank you for an intriguing opportunity.
"A wise man in the making."
I swerve outside my own lines sometimes, reject the default for no other good reason.
I know where my home is, though. I know where safe is.
I am learning to talk less and breathe more.

Dual lessons in the earth and the clouds.

Through the trees

This is my tell.
I want to write.
I want to tell the story of my lonely heart.
I want to breathe warm air
I move less, sleep more.
I ache.
Maybe I start reaching for things that fill in.
"Shove another needle down a hole"
More caffiene, endogenous opioids.
Cheap thrills, expensive mistakes.
Chipping away at my eggshell exterior.
No attention span,
Needing attention, protection.
Acute disappointment, guilt and confusion,
Razor-sharp and hair-thin.
A blue eyed woman combs my souls from the wall.
I won't give in, this time.
It's always the last time, the last one.
You never plan it, and it's always deeper
Than we imagine.
I am ineffective. Good for little more than
Navel-gazing.
And it kills me to see again.
For the thousandth time- people never change.
There's a power where I don't want it.
Such power, always more than we imagine.
If you've never been there, you cannot understand.
You will never know. And maybe, while I am learning more about myself- I am powerless to effect sustainable change.
Maybe I don't have it figured out.
Maybe it's because I like being this way.
This is my tell, she said.
Can't see the forest through the trees, so we look for the tell-tale signs: fallen logs, and a leaf or two give it away. Back here again, eh?
Well, then I have learned nothing. Nothing.

Which way out.

"Please... Please let me in."
Don't shut me out I won't let you down.
Alway here, never left. Never left you
You never left me.
Finding what's right, what's still left to say
Trying to believe in the best of intentions
But still wondering if, deep under the water
If I had something to do with it.
If it had something to do with us.
Fixing by adding, one-plus-one-plus
Keep piling on until one day we turned around and found nothing left.
Two wrongs. Trying to make it right.
Trying. That's all I can ever promise.
Taking on another project- who's collecting broken wings now?
Who's the one with the mangled menagerie?
Darting, cagey, but holding my cards out for all to see.
Jumping- was that the word?
Shall- ten extra points?
Wet- aren't we?
Deep under water, yes. There's a dim silence in the night, between the swaying trees and creaking rafters.
There's a quiet longing.
A jeweled threat.
A standing offer.
Whether right or wrong the "only thing left to do is jump..."
I'm excited about possibilities. I have faith in the right opportunity. I am keeping my head out of the drink. Treading water well.
But it's still just under my chin.
And I'm not sure I would like it any other way.

Home.

Back home now. There was some confusion in the morning Thursday that had us waiting for our pilot for 4 hours at the Les Cayes Airport. It's the same in many tropical places - island time! Our trusty old jalopy of a Cessna carried us through the green mountains north of Les Cayes and out over the Caribbean. I was so sad to leave so much suffering behind. Sad I couldn't do more, sad to leave the few friends I had made. There's so much to do there, so much. I felt selfish about wanting some vietnamese soup, a bigger seat on the airplane, and a long, long, long shower. Guilt creeps in a little around the corners - but I have to remember the standard is so different in the US. We all do what we can. I paid what I am sure is a year's salary in Haiti for a sooner ride home. Got home at noon on Friday - tired, but running on adrenaline and the excitement of being home.

Everyone asks me "How was Haiti?" At first, I said "Great!" and kept a positive attitude about things. As Friday wore on, I started feeling a little worse, a little overwhelmed and got more honest about it.

"Interesting."

"Nuts."

"Intense."

I tell the stories about the things I saw- the maggot-infested leg, the amputations, the lack of care, medicine, supplies, organization. The people I met - the thankful teenagers, the singing man, the surgeons both Haitian and foreign doing all they could. The frustrations we all had.

I don't tell enough, though the things I learned. I learned some about myself and I strengthened my faith in the inherent goodness of the human spirit. Most of all though, I was reminded that the only thing that matters in life is relationships. I am convinced that if there ever is a Judgement Day, we will not be judged on the merit of our actions, the purity of our intentions, or certainly not the size of our cars or houses. In the end, the only thing that really matters is love. I believe that if there is ever a judgement to be made, it will be based on the love that we give and the love we receive.

Each of us exists tenuously. Some of us are lulled more than others into a mistaken sense of invincibility or immortality and this breeds irresponsibility. Everything you have could be taken from you in a moment by a car wreck, a gunshot, an earthquake, a hurricane... And what will you have left? What do you have that cannot be taken from you but the love of your family and friends? What thing in your house, what shiny possession or green dollar bill or job achievement will carry you through the darkest, loneliest times in your life? The people I met in Haiti have nothing but the clothes on their backs, but they smile and sing anyway because they still have love. They have eachother.

There is so much that drives us apart - our cell phones, computers (the one I'm typing on...) transactions, closed-up cars and fences that get in the way of real human interaction. One of the 10 principles of Burningman is decommodification - "resisting the substitution of consumption for participatory experience." (www.burningman.com)

/soapbox

I could preach forever, but I'm not here to criticize or give some sermon on how we need to change the world and tell you the American way of life is bad and all that.

It's just that I got a big reminder to keep the people in my life close to my heart, and let them know how much I love them because at the end of the day, they are all I have ever had, or ever will have.

Day 5 - Wednesday

Wound care again today with people I know. One woman sang hymns to cope with the pain of her dressing change. These are incredibly stoic people. The 4-year-old near the nurses station was hit by a car recently and thankfully had no other injuries besides extensive abrasions on her face. I was asked to put some neosporin on her scabs. She eyed me suspiciously when I sidled up to her, so I blew up a glove as a balloon and handed it to her. The international sign for "It's gonna be ok." Her little face lit right up. She bounced her new toy off my arm and turned her head to the side patiently while I applied goop. She grinned and waved when I moved on. I stopped to play peek-a-boo with her later, and she waved every time she saw me the rest of the day.

The little things.

There was a kitten in the back room where I was organizing. It was shy, but every time I went back to work it would come out from behind the boxes and meow loudly. Whether it was mewing for its mother, some food, or just to be heard, I'll never know. I don't speak enough Creole.

As I walked back to the guest house for lunch, I took a left turn off the road and got about 50 yards down when a boy on a 10-speed rode up next to me. He introduced himself and asked where I was going. I was a little wary but told him I was staying at the guest house. He said "it's not this way." I had taken the wrong turn. He rode back up the road with me and we chatted until I got to my gate. He said goodbye and rode on. These people are kind-hearted. I am a little ashamed of my mistrust.

My EMT friend and I talked more about the difficulties of the situation. There's no heroism here. You can't expect to come in and do a lot of good in a short period of time. Establishing relationships is required to make long-term, lasting changes. I am ashamed of my unwillingness to spend more than a week here.

These people love to sing. They sing their prayers to God - singing hymns of sorrow, praise, humility and thanks. Families, friends and strangers gather around one bed and then the next and all who can join in the melody. One man sang all day from his bed. All. Day. I stopped for a moment to smile, breathe and just listen. I will remember that.

I have all these little memories. The kitten in the storeroom, the boy on the bike, the man in the corner... All these snapshots, moments of connections that I have made. Everything helps. Every smile, every "Bonjour" and "Bonsoir", every touch, every bandage, every pill, ointment, dollar, prayer, everything helps because the need is so great. These people have nothing.

We leave at 7am tomorrow. I am changed a little, in ways I didn't expect. In ways I won't begin to realize for months to come. "Was it worth it?" my husband asked me last night. Yes. Would I do it again? Absolutely. With fewer expectations, and more forgiveness for myself. Will I come back? Maybe. Maybe yes, maybe no. Certainly not for a while, I'm going to need some time to recover.

The right opportunity always presents itself.

Day 4- Tuesday

Today's challenge is in organization- finding a way to get things to the people who need them involves identifying their needs in the first place. What this place could use more than anything is a big, fat needs assessment.
I finally found a rhythm of sorts doing wound care rounds, but I left it too soon, to my regret, again hoping I would be needed more elsewhere. I was wrong, and spent the rest of the short day doing nothing but following people around, trying and failing at being useful. I am dissatisfied with everything- with myself, with the situation, with my inability to function autonomously here and commit to something. I guess I really just do better with structure, but I think it would be hard for anyone to come into a short-term, chaotic situation without a well-defined role. This is not teaching me what I thought it would. It is unfulfilling. I am ineffective. I am a little overwhelmed today, and probably dehydrated but at least I am not sick!
The novelty has worn off, the adrenaline rush is gone, reality is glaring in my face. Heh, it's the 4th day, playa bends set in at burningman about this time... This isn't easy, glamour or glory. Nursing is rarely glorified work, but what did I expect? To those people coming in behind me: have a plan. Have a role you are stepping into, otherwise you'll be totally lost. Know where you're going and what you're doing. Expect all of your plans to change. You are not the expert. There was a routine to things before you got here, and it will continue after you leave, so don't try and shake things up too much. There are lots of problems here- don't become another one. Remember that EVERYTHING you do helps. Every smile, every kind word, everything.
Made some new friends on the ward during wound care rounds. The man in the corner likes his name written on the bandage on his knee. The young woman across the way is one of 3 survivors from her nursing class of 85. The other two survivors are downstairs. She is missing a 6"x3"x4" hunk of flesh from her right butt. Her wound gets packed with wet gauze twice a day - in the US, we would administer heavy doses of morphine for such a large wound. Here she gets a couple of tylenol. She spends most of her day lying on her belly. She likes us to use some alcohol to remove the tape from her 5 or so other bandages so the tape doesn't hurt as much. I kept rounding with an advanced EMT from the US who will be there another 3 weeks. She shared with me some of her frustrations about the constant chaos and well-intentioned volunteers. Some people make promises to help, to send money, to bring kids to the States and then disappear. The Haitians wait for that. They look toward the door every hour to see if their new friend has come back with the food, soccer ball, or other thing that was promised. The Haitians remember. "Relationships are about saying goodbye" she told me. I'll remember that.

We discovered today that the supplies being donated to Les Cayes General - the "county hospital" type facility we started out at - are being sold back to the patients. We had to wait 20 minutes for a man's family member to go to the pharmacy and buy the valium we wanted to administer to him before trying to reset his dislocated shoulder. We were unsuccessful, and scheduled him for surgery. He thanked us when we left. For what, I'm not sure. Now our Ortho surgeon has a fever. We're going home Thursday. I am done.

Day 2-Sunday part 2

I spent Sunday doing what I could as an OR nurse. Without an anesthesia machine, endotracheal tubes, pulse oximetry, cardiac monitoring, oxygen, suction, or even a proper BP cuff, there wasn't much for me to do but take inaccurate manual BPs and a radial pulse. The anesthetist did what he could with spinal anesthesia and ketamine. The Supernatural Anesthetist. He did well, much of the time. Our Ortho surgeon fixed femurs, tibias and a humerus or two. I started an IV in the ER in a man with a large, bloody bandage around his head. I left later after I realized he was in agonal respirations and no-one was going to do anything. I kept looking at him and thinking "he's really sick." "He's REALLY sick. He needs help." "Can't one of our docs see what's under that bandage and do something?"
Oh yeah. There isn't anything to do. If he's bleeding that badly from that much of his head... There's no ICP monitoring, no pressors. If they cut a window in his skull to relieve the pressure, the flies will take up residence there, too. The feeling of helplessness is still with me.
Failure to prevent the inevitable. No attempt at clearly futile heroics. Powerlessness. Humility. Faith. Grounding.
I'll get over it, but I know his stridor will echo in my ears for a little while.