Today is Dr. Gary’s Birthday!

This morning on the wards we took a small time out to celebrate Dr. Gary’s Birthday. A week ago when I had told the patients that Dr. Gary’s birthday was coming up, they were all so excited. We decided to make cards for him, and it was quite a sight. ALL of the patients were up and out of their beds. For several hours they bent over construction paper, crayons, stickers and markers writing and drawing beautiful things for him. For those who know how to write, there were beautiful messages speaking life upon him. Thanking him, saying he was sent from God, wishing him many more years. For the majority of our patients who have never had the opportunity to have an education they drew him beautiful pictures and attempted to write letters and numbers that they copied off their neighbors page. Today we handed him those cards all bound in a book. In addition to the book, the patients all decided to have the day workers write “joyeux anniversaire” on their bandages and head dressings so that as he did rounds to check on them they all could point at their bandages and smile boldly. We sang him Happy Birthday in English which was followed in French by our patients and dayworkers. They all clapped, cheered, came forward for hugs and hand shakes, thanking him and sharing blessings on him in their native languages. I just couldn’t get over the moment, standing there watching the 16 patients and all their caregivers coming forward to thank the man who has changed their lives, who has given them a second chance, who has given them the opportunity to be treated as a human, given the opportunity to be loved and accepted. Dr. Gary, one of the most amazing men I know, has helped hundreds maybe even thousands of people celebrate many more years of life throughout his 25 years onboard. He has added countless years to many, and for some he has been the person that gave them the opportunity to simply live to their next birthday by removing their tumors. So here’s to one more year and Dr. Gary’s day of birth! 

Breaking News--not really, but kind of......

So there’s this small-small piece of news that I have stewed over sharing for last few weeks. I don’t really know how to go about telling it in a way that does it justice, so I’m just going to put it out there......Are you ready? One, two, three------I am coming back to the ship for another outreach. Big deal right? After hours and hours of prayers, conversations with friends and family, and just listening to my heart, I have re-committed to another 10 glorious months aboard the Africa Mercy. This time sailing with the ship into the Republic of Congo. After almost nine months on this floating vessel, I have realized that this place is ingrained in me, has captured my heart, and I just simply am not ready to close this chapter of my life. I absolutely love our patients, the African way of life, and this melting pot of a place with crew from all over the world. I have made amazing friends, have poured into amazing patients, and have learned so much about this culture, and myself. Even single ounce that I have given has been returned to me ten-fold. Patients and friends have crossed all borders and have become family, people who I will never forget.  The idea of working in a Western hospital sounds amazingly unappealing, and I was honestly getting a belly ache simply thinking about it. As much as I miss people and the comforts of home, I know that God has put it heavily on my heart to stay. I’m not sure of the exact reasons I feel so strongly, but I just do. I feel certain that this is the correct place for me to be and to continue this season of my life......So I’m stepping out, jumping, leaping, lunging, skipping, falling, whichever mode of transport you choose, and trusting in His plan for my life. All of that said, logistically I’ll be home June 11th through July 23rd for a jam packed 6 weeks of catching up with friends and family, sharing my experiences, doing life alongside people I love, and soaking up every second before returning to the ship in a new role. I am honored to announce that I will be a Clinical Ward Educator this coming year. Fancy title, all to say that I will working on a team alongside two other amazing women to orient all of our new nurses coming through this place. We are responsible for equipping them with everything they need to be successful during their time here. I am so excited to share my passion for this place, to share my love for these people and this way of life. I am beyond jazzed to make the transition period one in which people feel supported, encouraged, and ready to do what they were called here to do from all sides of the globe.  Another aspect of my job will be focused on Community Health Education--I’ll share more about that later, but basically I will be working with a small team to develop a curriculum to educate local nurses in the Congo. Our program will consist of both classroom and ward time, and essentially we are striving to empower and educate local nurses to enable them to care for their own people. Exciting stuff right? So there it is---the big news of the day. I know that I can’t do this on my own and I am going to continue to count of the support, prayers, and words of encouragement from all of you amazing people at home. So thanks for keeping tabs on me, for loving me, for standing behind me day after day and most of all for caring about me enough to let me go fulfill my dream......

Two Teeth

They have been mentioned in Christmas songs as something a child longs for (“All I want for Christmas is my two front teeth”)  and we all have that dreaded picture in the first or second grade with a crater between your canines that people think is super cute when you are seven. However, somewhere between ages seven and twelve it becomes very awkward to be missing those pearly whites. Of course they are import for eating, and one of the first things people notice when they look at you. However, during my entire career as a nurse and quite possibly my entire life, two little teeth have never caused so much trouble. Tonight on the wards, two teeth- two small, jagged, pointed, bottom teeth that reached clear up the the underside of her nose were the source of three separate 15 minute conversations shared between three doctors, three nurses, four translators and six languages. “Mama” as we call pretty much any woman over the age of 30, was born with a cleft lip. Because of where she was geographically placed on this earth, her lip has remained split, for 51 years. She was admitted today for surgery tomorrow to bring her upper lip together and radically change her appearance. The first conversation was between her and her nurse just minutes after she came onto the wards as they went through what would take place in the next 24hours. “Mama” who has exactly 5 teeth came to the ship with a dream to leave with a full set of pearly white chompers to go with her new lip. Unfortunately that is just not a service we can provide. We are able to take out rotted teeth or crooked teeth, but we can’t replace them due to funding and supplies. The nurse explained all of this and Mama seemed satisfied, but not for long. The anesthesiologist came by later and she, full of joy and feisty spirit, asked him the same questions. To her dismay, he came and got me--who gave her the same answers. A few hours later Dr. Gary came by, and I asked him to set her mind straight so that she wouldn’t wake up disappointed by what we had enforced earlier in the evening. The conversation went something like this. Dr. Gary asked her would she like him to take out those two bottom teeth while she was asleep tomorrow. Yes, she exclaimed! Get rid of them! Wait, no, don’t unless you’ll replace them......will you replace them?.......are you sure you can’t?.......what if I want someone else to put new ones in?...That would be just fine, said Dr. Gary.  But, I’m just a farmer, how could I afford that, Momma asked? Then without hesitation she added, well-- I am the third wife of my husband, which means he loves me most, maybe he’ll pay for my teeth when he sees how beautiful I am!? A few second pause, she changed her mind again...No leave them, she said- just in case he wont pay for it, even though I’ve won his heart she added. Dr. Gary asked, is that your final decision? Yes--wait, no, okay--final answer, out they go!! By this point we were all laughing, watching her animatedly go back and forth. We received consent by her thumb print on the piece of paper, and quietly the humble Dr. Gary added, I think this was a longer consent process than what we have for patients who are about to have half their face removed!! But it was all worth the time and laughs, because today after 51 years, she had her lip made new-bringing together two pieces of flesh that have never touched in her life--and when I saw her tonight after her operation she was absolutely beautiful.....

The tube feeding situation of 2013

Well, we are in Africa, right? These past few weeks I have been reminded how amazing lucky we are to have what supplies we do. After smooth sailing for 6 months, we finally ran out of Ensure for our tube feedings. (Yes, here in West Africa we put that vanilla flavored drink you would give to the elderly or nutritionally deficient down feeding tubes) We had been making do for a few weeks with canned Pediasure (same idea, but designed for kids) and supplementing it with a few other things in order to give our adults the required protein and nutrients.---we moved to mixing up powdered ensure just 3 weeks ago and then just a short few days after that---bam, our blissful operation came to an end--We have now been successfully making our own tube feeding concoction! Yes you heard me, smoothie king would be put to shame by our mixing skills. Milk, peanut butter, sugar, liquid vitamins, a little fiber and a blender are all it takes to give our patients the required nutrients. Creative--yes... Functional---Not exactly. The peanut butter we use had to be bought locally in a large tub and is much more textured than something of the creamy variety you would purchase back in the states. This seemingly small task of feeding our patients often leaves us with the biggest frustrations of the day. As a nurse, we like efficiency, knowing we can hook up a bag and trust that it will deliver all of what we intended to our patients not run back 10 times to “mix it up” so that the peanut butter will flow through the tubing. The second problem with this method stems entirely from it’s composition-because the African diet is not typically strong in the dairy group we have had a few lactose intolerance problems----our answer to even this curve ball---make it with SOY! As we mix up liters of NG feedings a day, the common phrase is “if only my friends back in the ICU at home could see me now”. Never in the Western world would we mix our own feeding--it comes it’s own pretty little plastic bottle ready for attachment to a patient--easy as that. It’s things like homemade nutrition that cause “Africa Mercy Problems”......every single day here is an adventure---and I absolutely love it. See my friend Anna’s blog HERE  for a creative poem pointed at the tube feeding situation on board. 

Added note: Saturday we found out that the container of supplies from Texas sitting in customs may have ensure on it---best. news. of. my. week.  

My Starfish

You may have heard this story before--but I want to take the time to share it again with you all, and let you know what it has meant to me this week......

The Starfish Story

Original Story by: Loren Eisley 

One day a man was walking along the beach when he noticed

a boy picking something up and gently throwing it into the ocean. 

Approaching the boy, he asked, What are you doing?

The youth replied, Throwing starfish back into the ocean. 

The surf is up and the tide is going out.  If I dont throw them back, they’ll die.

Son, the man said, don’t you realize there are miles and miles of beach and hundreds of starfish? You can’t possibly make a difference!

After listening politely, the boy bent down, picked up another starfish,

and threw it back into the surf.  Then, smiling at the man, he said-I made a difference for that one.

On Wednesday, My starfish, “T” returned. He has returned for a second surgery to move around the excess skin left behind by his massive tumor. If you don’t remember him, check out his story HERE (or just read the majority of my blogs in November/December) We all knew this day was coming, I even put it on my calendar to mark the momentous occasion. Sadly, only 5 of us nurses on the ward were here to witness his miraculous recovery. The nurses have almost completely changed over, and the man that made such an impact on my life and many other lives we now have to explain to those who are caring for him. The man we saw struggle, whose hand we held in the tough moments and the joyful moments, the man who came to us literally skin and bones, who we fed and gave air, the man who faced death, and won--The man who is a legend here, is meeting an almost completely new staff. On the day he arrived, I was working a stretch of night shifts. I was told at dinner, that he had in fact arrived, so I rushed down to the wards to greet him. As I bolted into the ward, he happened to look over and gave me such a heart warming smile. I rushed over, hugged him, and was told through a translator, “ Hannah--He has searched the ship high and low for you today! He wants to know, where have you been?” The answer to which was, In my bed sleeping so that I can watch over you tonight!”  He felt this was okay, and we just stood for a few minutes in each others presence. Being the man he is, he loves to ask about the nurses who were here before, “The Emily’s? Andrea? Ann? Beth? Becky?” he smiles when I tell him they are well, that they are back in the US, working and enjoying life. Normally caregivers are only allowed on board for patients under the age of 18, or in special circumstances where language or other things pose a problem. T of course, is a VERY special circumstance. So I knew that “Momma T” must be around somewhere. In true Mercy Ships fashion, I ducked down to look under the bed, and there she was, sleeping soundly. I left the ward, and told him I’d be back at 10 pm. Early into my shift Momma T woke up, saw my feet, and instantly called out.  I ran over and dove under the bed without even a second thought. Hugging her, being showered with kisses, and again having those heart strings pulled knowing that she is my family. That both T and she are a part of me that I will carry around forever. That I have made an impact with them and them with me. It wasn’t until after I climbed out from under the bed and was moving to the other side of the ward to check on patients that it struck me how odd that would have been to anyone who didn’t work in this place. That in the west caregivers don’t sleep below the beds, and you definitely don’t hug and kiss them, or call them anything remotely close to “Momma”. I left work Thursday morning on a high-- my beloved T was back, and he was having surgery that day after a quick X-ray to show them exactly what would need to happen. When I came back into work Thursday he was sitting in his bed, face untouched by surgery. I gave him a puzzled look, and through motions he told me they wanted another picture. I confirmed with the charge nurse, and he was in fact going for a CT scan the next day at the local hospital. That things just didn’t look “quite right” on the X-ray. My heart instantly broke into a million pieces, I sat down on a chair to receive report from an evening shift nurse, and despite my best attempt not to, tears began streaming down my face. I don’t think she really knew what to do with me, but she just listened, gave me a hug, and told me it was okay to cry. T went for his scan on Friday, and I still don’t know the specifics of what the scan showed because I was off for the weekend, but what I do know is enough; the tumor is back. That it is growing alarmingly fast, and that It may be close to vital structures. All of our pathologies told us that it was benign, but with this growth rate, we are afraid that it might be something else. This knowledge still sits on my chest like a load of bricks. How can it be? How can this be happening? Why is this happening?---we thought that we beat this, that we gave him a new lease at life, that he was given his second chance. To be honest, I don’t know. It’s still raw and painful, and I’m just not really sure what to think. I do know that everything that touches our lives passes through God’s hand--but to be honest I have NO CLUE what God is doing with this--the purpose and the plan of this tumor returning. All I can do is pray. Pray for God to give T peace, to guide our hands and give us wisdom, and to ask for strength. To give me faith and strength to trust Him when I can’t see HIS plan--that he is still good even when my heart feels so heavy and unsure, full of doubt. T is going in for surgery today. He is booked for 4 hours, and the plan is to explore and see what we can do. I went to visit him this morning- As I gave him a hug and Momma kisses I honestly just wanted to sit down on his bed and cry. But I didn’t, because I have to hold it together. I need to be strong and I need to be faithful. So, If you don’t mind, please ask for strength and wisdom for us today. That we can figure out what to do for this man, and even that God just takes care of this. I know that at some point our Western medicine fails, and this is where I am--on my knees with my arms outstretched, holding it up to God. 

The difference a cleft lip makes......

Looking at these two lovely babies what immediately jumps out at you? Do you notice the baby on the left or do you instantly gaze at the one on the right? Perhaps the first thing your eye picks up on is that one baby is very malnourished and one appears healthy. Do you notice the stark contrast in size, can you count his little ribs, see his loose skin? From simply looking at this photo can you tell that they are the same age? Can you tell that they are in fact TWINS? Simply looking at this photo can you see how the momma has had to struggle to keep one baby alive while the other is plump, healthy and happy? The reality is this beautiful twin brother and sister have had very different paths. The little girl has gained weight from day one, where the little boy has had to fight for survival. Because he was born with a cleft lip he cannot create the suction that is necessary to breast feed. Babies with this deformity have to have milk hand expressed into their mouth, or be fed using a spoon---either option is not easy. No matter how much the mother wants to give her baby nutrition it is simply not possible. Even with the most determined mother many of these babies die of malnutrition, dehydration, or pneumonia from aspirating milk so frequently.  This lively pair were seen at our screening day, and were instantly enrolled in our infant feeding program with our amazing dietician Jess. She works hard with these families. Teaching them proper techniques for feeding, providing them with supplements, and tracking their progress closely over the months getting them to a goal weight leading up to their operations. 

Gaining Weight!!! This is a photo of the twins mid-way through their participation in the infant feeding program.

Looking at this same pair they don’t look quite so different--not nearly as shocking. I want you to understand that those beautiful chunky rolls are the representation of insanely hard work and their momma honestly deserves an award. The babies were such a joy to have on the ward, and through this simple surgery “A”’s life will be forever changed. He will continue to gain weight, to live a life without the stigma of having a split lip, and will be given the same opportunities as his twin sister. 

Ready for surgery! Pretty amazing stuff, right?

The Twins with Mom and big sister

Jess with the twins--- notice the beautiful new lip on "A"

Noma season

We have begun what Dr. Gary lovingly calls “Noma Season”. This is the time in the outreach when we begin our multi stage surgeries to repair what has ravaged so many here in West Africa. In the following paragraphs it is my hearts desire to explain the horrors of this disease, and the people in which it has struck that have captured my heart. Think of it as a case study---I’ll give the background information and a few case examples...we’re never too old to learn, right?

Noma (Cancrum Oris) is a devastating gangrenous infection that mutilates the tissue and membranes of the face. The word Noma derives from the Greek "voun", meaning to devour, emphasizing the rapid progression of the disease. In Ghana it is called the “melting disease”, appropriately named as it literally melts off the tissue, bones, and muscle of the face. It is an opportunistic infection which typically strikes young, severely malnourished children between the ages of 2 and 5. In almost every case shortly before onset they have had an illness such as measles, malaria, scarlet fever, tuberculosis, or are HIV positive. The disease begins as an abscess typically on a mucus membrane such as the gums or inside the nose. This is an opportunistic bacteria, which means that it lives in every single person’s mouth on this earth, it is just given the upper hand due to a weak immune system and malnutrition. In a few days time, the abscess opens up and the infection rapidly spreads to the surrounding skin, and tissues, even eating straight through muscle and bones. Of these victims, 90% will die from the acute infection (sepsis), dehydration, and malnutrition. There are anywhere between 100,000-200,000 cases of this each year with only 10,000-20,000 of them surviving. Thats right, faced with this illness you have only a 10% chance of making it, of fighting it. What strikes home the hardest and something I want you to understand is that Noma is a preventable disease. It is a disease allowed to exist by the cornerstones of poverty: lack of clean water, basic sanitation, vaccinations, proper nutrition, and basic healthcare. Something I want us all to realize is that this horrific disease could be prevented by simple vaccinations, and during the acute phase a simple coarse of antibiotics. That’s right, something that you or I go to the doctor and have in our hands within hours, Penicillin, could stop this ravishing disease in its tracks if given in the first 2-3days. Something that may cause you to stop and think, maybe even put it in further perspective; the last time the world outside of Sub-Saharan Africa saw Noma was during WWII in the concentration camps---Those are the types of horrific conditions that foster this disease.

For the 10% who survive the acute phase, those lucky ones who are able to maintain hydration, receive proper nutrition, or are able to get a course of antibiotics their entire life is changed in one week. In just a few days they are left with a severely disfigured face. A sentence they must carry around with them for the rest of their lives. Every time someone looks at them, the first thing they will notice is the hole in the side of their face, their missing nose, lips, gums, and teeth. They are subject to ridicule, outcast, and abandonment. Some, due to scar tissue, will have jaws that lock down, ankylosed, forced to eat mashed food through what they do have left fighting for survival. For some they will never have anyone treat them as a human again, that belief that they are cursed, or from the devil will start to take hold in their life. How could you be rejected every moment of every day of your life and not begin to believe it for yourself? Some come to us broken, and for them, this place is a solace. A shelter in which they can just be themselves. They come, and see others like them. Others who understand their hurt, who know what they have been through without having to say a word. Where people look them in the eye and tell them they are important, special, and most of all loved. Others come to us with alive spirits, somehow miraculously having been able to persevere and maintain a somewhat joyful life. Can you imagine a life like this? When I try, I am ashamed of my vain ways. I am the product of a culture that teaches us to pay great attention to our appearance. To be concerned when we go out with a “bad hair day” or a pimple on our face--how would I cope? How would I live my life with half of my face mutilated, each day being rejected by all those around me? These beautiful human beings are cast out, alone, hurt, longing for the love of someone, anyone, who will recognize the human heart in them. Despite our best efforts we can never make them look completely normal, but what we can do is try to make them as normal as possible so that they are accepted. Our goal is to make them look human again, to convince the human eye to look past their deficit and see their spirit. They won’t make Miss Africa or the cover of Time Magazine, but they will be able to go to the market, to walk along the roads in their village, and maybe have a friend.

These surgeries take time, it’s a waiting game, a marathon of sorts. Each complex surgery is separated by 21 days--three weeks is the length of time it takes for our miraculous bodies to recreate a blood supply and latch on the the tissue we have moved before we can sever it from it’s original source of oxygen and nutrients. Sometimes even I am confused when I wrap my mind around what we are doing, restructuring and recreating the face with parts of the scalp, neck, thigh, ribs, and chest. It truly is a jigsaw puzzle pulling pieces from all over, and our expert is Dr. Gary Parker. With over 25years of work with these patients, he has it down to a science that few others understand. The way he can think outside of the box, come up with a plan and execute it is astonishing. The way he explains it to patients is using the metaphor of a journey. Before he begins their surgeries he talks at length with them about the journey in which he will take them. That what he is about to do will seem worse before it is better, and there may be days they are unsure, but that they have to trust us. That they won’t understand the complexity of what we are going to do..but that each day we will put one foot in front of the other and take those steps together.... How hard must that be when you have never been able to trust anyone in your life and here stands this group of people on a big white ship that are asking you to live with them for months in their western world and put your faith and hope in a group of strangers. But they do, because it is the only hope some of them have ever been given. Hope to look normal, hope for a better life, and hope to experience love. 

So there it is, basic information about the disease that has wrecked my heart. I am overjoyed to tell you about the group of Noma survivors who we get to pleasure of doing daily life with for this time: 

Bed 3- “F”--The man who loves to color and just wants a wife....

F is one of the most joyful, wonderful people I have ever met. He lives far upcountry and makes his way in life by farming. He has this zeal for life that warms my heart and truly makes each day with him so amazing! He is an extrovert, and has made friends with almost every patient that has come through the ward doors. From day one he has talked about how he is going to “get his face fixed, and then find a wife to love”. He is an expert with crayons and water colors, and has loved teaching his ways to anyone who gives him the time. Several nurses have been working with him, and my heart overflows when I get to tell you that at 51 years old F learned the letters of the alphabet and how to write them. This is huge, for a man who said to a nurse one night, “I may have never known the door steps of a school, but I can color”. For weeks F has been practicing diligently, and two weeks ago wrote his name for the first time on a legal document to consent for his 2nd surgery. The concentration in his face and determination was beautiful--so there it sits in his chart, his beautifully written name resting next to his last consent form where he simply gave his permission by his thumb print in ink. 

Bed 8-”A”The quiet farmer who has a constant smile and quiet observing eyes. “A” came to us with his head down, unable to look others in the eye. His life spent farming, has not been the same as “F”s--not nearly as kind to him. The second night he was here one of the night nurses startled him trying to take a set of vitals. “A” threw his arms up in defense, ready to take on his challenger. It scared them both, but the sad reality is this---he has lived a life in which he had to be ready at any moment to defend himself. His month of living in D ward has began to change him. He’s happy, loves to play games, and interact with the patients and nurses. He has had a rough go thus far, even with us, the skin we have tried to move to repair his lip has not taken well. We are heading back to surgery today, and even then, may have to start back over. I pray each day for this guy, that he will heal well this next time around, and that we can transform his physical appearance (even though I know we have already started on his heart)...

Bed 1 “M”--The woman without a nose and the most loving cousin anyone could ever ask for. M is now 14days out from the first surgery that will completely change her life. She lost her entire mid-face when she was 2. Now 31 years old, she has lived in outcast her entire life. She will be with us until the end of the field service, and needs a least 2 more surgeries to complete what we have started, but it’s a journey. She has an amazing friend by her side the entire way, and we all have fallen in love with her as well. Right now she has lots of dressings, a feeding tube and a tracheostomy to maintain a constant airway.  With the trach, she can’t use words to communicate, but taking care of her each day she speaks to us with her actions. Even yesterday, as I sat with her outside, she was concerned for ME, and my pale white skin in the sun. She has had more surgeries in one go then most have had in a lifetime, and she is still caring for others, putting their needs ahead of her own.

Bed 13 “D”--the kid who was abandoned. Imagine being six years old and having been through more things than most will ever have to in their entire lives. By the time he was six, he had been ill, and noma had ravaged his face. His father, believing he was cursed and was better off dead tried to drown him. When this didn’t work, he was thrown out into the street--where a woman thankfully took him in. He was brought to the upcountry screening trip, and on the way down to the ship for surgery almost perished. He came to us with pneumonia, severely dehydrated, the open hole in his face bleeding, and so very scared of everything. He spent a week with us in which we gave him the care he needed, and sent him to our HOPE center to finish recovering before we could do his surgery. It is here that this little man transformed. He is no longer the scared, cowering little boy I met back in January. He is rambunctious, full of life, hilarious, playful, and so very loving. He has been changed, transformed, made new by this ship in the weeks he lived onboard.......even last night as I visited him at the HOPE center where he waits for his second surgery, I was forced to realize how much I love this little boy, how much he challenges me, and makes me realize how his life would look had another human being not given him a chance to fight for survival. 

Bed 15 “I” The man who is a hermit. Forced to live alone in a shack he withdrew from society, from normalcy, from life--landing somewhere in his mind in a childlike state. Angry, hurt, and lashing out when things were out of his control. The one and only thing in this place that brought him pure joy was coloring--and boy did we color. Pages and pages littering and lining the walls surrounding his bed. After nearly 2 months he was healed and left us right before Christmas time, and has since decided to leave our HOPE center due to behavior issues. I know that we couldn’t change everything for him, we couldn’t take away all the years of hurt that made him the way he was.....but for the time we had him, we were able to love him, to give him a new nose, and to show him what it was to be cared for. 

I know this was a very long post, but I hope you stuck with me. That you realize that I am unable to give justice to life here no matter how many words I use, or how many times I retype my thoughts. These people, this place, have changed my life. I am in awe of the amazing things I get to see every day. That no matter how much I give, how much I sacrifice, It will never be enough to repay what is being given to me.