The Chicken

Eventually I will post an update of my first couple weeks in MSF, but until then, enjoy this short story I just wrote!

            Being a nurse has been one of the best decisions of my life and one I really cannot take credit for. My stepmother has been a nurse my whole life, mostly working in home health. One day when I was in middle school, she looked at me and said “You’d make a good nurse.” I was a painfully shy child, with big feelings. I had never been in a hospital nor observed her at work, but I took that statement and ran with it. My senior yearbook includes “be a nurse” as my future goal.

            A colleague (E) of mine told me a story of her first mission with Doctors Without Borders (MSF). She is a nurse midwife and was flown into a remote village to deliver babies for 12 months. She arrived at 2pm and by 5pm, someone stated “We need the midwife.” E looked around wondering where the other midwives were, and the person looked at her and said “I meant you!” Without any orientation, E was shuttled to an exam room where an unconscious pregnant woman with extreme edema was laying. E stated at first, she couldn’t even tell if the woman was pregnant, because of how edematous she was.

            The “room” was separated into two areas by mud walls- one side where they have deliveries and the other where women are examined. There was no electricity, the light was solar powered and had to be held by another person during the examination, so the provider could see what they were doing. After examining the pregnant, laboring woman, E saw the arm of the baby, hanging out of the vagina. E could see the contractions happen but without the pushing of the mother, there was no advancement in delivery. E was fairly sure the baby had already died. She sat with the woman all night, frustrated because there was nothing E could really do for the woman besides give her a little IV fluids and hold her hand. E was so afraid her uterus would rupture through the night.

They were able to transfer the woman the next morning. E was left wondering what she had gotten herself into and wondering if she was going to be able to make any difference during her time in the village.

            A week passed and E had gotten into the hang of life in the field, delivering babies and assessing pregnant women. One day, a pretty, skinny patient walked into clinic. E did not pay her much mind since E did not recognize her and kept up a conversation with a fellow midwife. The midwife asked, “Do you know this woman?” E responded in the negative. The woman came to the door of the room E was in and said “Don’t you recognize me? I was the woman whose life you saved last week! You had me transferred to another hospital!” E was taken aback because, no, she was unrecognizable! They hugged and E asked about the baby. The woman affirmed that the baby did not make it but said again, with a smile, that her life had been saved because of E. E offered family planning services and continued with the next patient.

            Another week passed and again, there was a woman loitering outside the clinic. The other midwife asked E, “Don’t you remember her? She is the woman whose life you saved!” Again, E had not recognized her. E went up to the woman and the woman again thanked her for her help with saving her life. She said, “I want to thank you for what you have done. Here is a chicken.” She thrust a chicken into E’s arms and then went off to her family planning appointment.

            E went to the head of mission, with the chicken in hand and explained what had happened. She asked, “What do I do with this chicken?” They responded, “Leave it with me, we will eat it tonight!” E said, “But I want to do something for her. I can’t accept her gift without giving her something in return.” The head of mission stated that soap and salt were precious commodities in that area and E could give her some. E returned to the patient with three bars of soap and two baggies full of salt. The woman was delighted. They hugged again and parted ways.

            E told me this was when she knew that MSF was where she was meant to be. It was clear she would be making a difference in these people’s lives. She has served in many other missions, doing many other roles.

            For me, it is a testament of the joys of being a nurse, caring for people during their most vulnerable, witnessing the sorrows and successes of the human experience. I have forever been grateful that my stepmother saw the spark in me, because from the beginning, nursing felt like a calling, where I felt most at home and with purpose.

            During my career, I have found that I did not have to go to other countries to witness severe suffering and healthcare injustices. Actually, I have my own chicken story. My first year of nursing, I worked at a very busy, well respected teaching hospital in the US. It was most known for its world-renowned surgeons. The irony is that it is in a city where there is a high crime rate with gang shootings and severely poor, uninsured people of color. There’s a huge disparity between the hospital and the people it shares its zip code. I worked on the trauma/transplant step down unit, frequently caring for people with gunshot and knife wounds, drunk driving victims and surgical patients receiving kidney, liver and pancreas transplants.

            Those first years of nursing were not only extremely rewarding, there was also a lot of sorrow. Many of the other nurses on the unit were also young and new, so there was an extra sense of comradery and bonding. Many of us were single, had moved far from our families and lived in giant apartment complexes with other single people. During that first year, we had three patients that shared the end of one of hallways, all terminally ill, for several months. The frustration was that the physicians were not blunt with the families of their prognosis, thus everyone was in a denial of the decline of all three of the patients. However, we as nurses could see everyday the suffering these patients were allowed to go through. Every two hours we would pair up and turn the patients to prevent bed sores. More often than not, the patients would grab my arm, while wincing in pain, and whispering for me to let them die. Then the patient’s family would shuffle in, holding their hands and talk about when the patient would be able to return home.

            I learned that first year that there were worst things than death in this life. The human suffering can be immense. One of these patients, a Columbian nurse nicknamed, Chicken. As he lost consciousness and his family continued to refuse to allow end of life comfort measures (and the surgeons refused to bring it up with them even after the nursing staff begged them to,) she would tsk tsk around his room murmuring, “my little chicken…” in her Spanish accent.

            Two of the patients at the end of the hall died within the same week and I was there while their breathing became more labored and again, their family continued their denial, holding their hands, speaking of the days they would return home. The patient I was closest too was a Mexican, undocumented man, who had come into the ER with a catastrophic gunshot wound. He would not have survived that injury at any other hospital, for that I am sure. The trauma surgeon performed a miracle surgery and saved his life. (The surgeon could not even believe he was successful). However, the patient developed an abdominal fistula that just would not heal and had to have an ostomy bag set up to suction to catch all the gastric fluids that would leak out of his abdomen. For over a year he was unable to eat solid foods without worsening the fistula, so was put on TPN (intravenous nutrition). Because he was unconscious when he was brought into the ER and he was a gunshot victim, he was given an alias, Golf Unknown. Even after we learned his name, we nurse still affectionately called him by his alias.

Beyond the fistula, he felt fine and would walk around the unit daily, helping to empty trash cans and linen bags. He wanted to be helpful and was so grateful for the care he was receiving. He spoke very broken English, while I spoke very broken Spanish. Somehow, we were able to communicate.

            About a year after he arrived and a fistula-repair surgery failed, discharged planning had meetings with the head of the hospital. At this point, all his care had been provided for free. They discussed sending him back to Mexico, but they knew that would be a death sentence for him since Mexico’s healthcare system (or what little of it there was) would not provide his TPN. For awhile he stayed in a hotel paid for by the hospital and visiting nursing would set up his TPN daily, but even that could not be a long-term solution. TPN cost thousands of dollars a day. One evening, management asked all the nurses to come to a mandatory meeting. It was there that discharge planning told us that the hospital had decided they could no longer supply his TPN. This was a death sentence to Golf Unknown, and we all knew it. They said they would send him to a local hospice, where he would spend the last of his days (since he would starve to death without the TPN). We were outraged, which they knew we would be. He had become a sort of mascot to our unit, welcoming us with each shift change, participating in all the staff parties. We even had a Cinco de Mayo party in his honor.

            He took the news stoically, as we knew he would. He thanked everyone for what they had done for him and then was transferred to the hospice care center. The nurses were devastated, and many tears were shed. The hospice care center happened to be less than a mile from my house and somehow, I had that week off from work. I went everyday and held his hand as each day he became weaker and weaker. I brought all his favorite drinks from the Mexican supermarket, since at this point it didn’t matter if it all just came out of the fistula. I brought in a cd player and we listened to Spanish music. I told him, “It feels like a party.” His last words to me, “My friend, with us, it is always a party.” I was the last person to hear him speak before he became unconscious.

            I had always planned on doing International Nursing, dreaming of it after a class trip to Guatemala during the senior year undergraduate studies. However, once I saw Gold Unknown’s death, I knew I did not have to leave my city to see healthcare inequalities and unjust care. I will always remember the real names of those three men at the end of the hall, including The Little Chicken.

            I have since received my Master’s and Doctorate degrees in Nursing and am now doing my first mission with MSF as Senior Clinical Mentor for nursing students and their instructors. I get to pass on the knowledge that was passed on to me as a student. I will never forget the difference that one can make by just holding the hand of a sick human being. I suppose E also learned that lesson when she felt hopeless and inept that first night on mission, with the gift of her chicken.