Life and death at sea

I am walking alone along a boardwalk by the sea after disembarking 417 passengers in Italy. I am trying to process the events of the last three days and feel numb.

I am walking alone along a boardwalk by the sea after disembarking 417 passengers in Italy. I am trying to process the events of the last three days and feel numb. I am holding onto the handrail on a flat, straight path because somehow the rhythm and texture are making me feel grounded and I realize that even though there are cars whizzing by to my left and the sea crashing on the shore to my right, compared to the noises of the boat over the last few days, it sounds close to silence to me. 

I look up, the sun is setting and I instinctively take a picture. I don’t even realize how beautiful the scene is until I see it pop up on the screen and I can only think: 

How can the world be both so beautiful and so ugly at the same time? 

Our little boat has been my world for the last few days and it feels unreal that there are beautiful sunsets and people strolling a boardwalk all the while that we have been completely absorbed by life and death on board the Dignity I. 

I’ve been off the ship less than an hour but there are already memories competing for space and needing to be processed in my mind. It was a rough series of rescues and one boat carrying just over 100 people had a minimum of 7 fatalities that day. 

My mind flashes back to a picture of a throng of women boarding our boat, screaming in agony and collapsing on our deck. I was searching to figure out what is wrong until I smelled “the smell” and I heard “I’m burning. My skin is burning”. The stench of fuel permeates the area and their clothes and I know from previous rescues that the corrosive combination of salt and gasoil is causing the first layer of their epidermis to peel off with their clothing. I barely have time to leave instructions for the staff to shower anyone smelling of fuel immediately when my field coordinator radios to let me know that two woman who had been submerged under water are being brought aboard. They are not conscious. I race to them and they are brought to the hospital where Kamma, our other nurse, and I start to work on them. Their oxygen levels are dangerously low and they are critically ill from aspirating water and fuel- one of them appears to be about 5 months pregnant.

I start to wonder where our doctor is when he walks into the hospital cradling a young boy and reeking of fuel. Pierre says he smelled so strongly of gasoil that he brought him immediately from the dingy into the shower and I peel off the sheet he is wrapped in to see most of torso covered in a fuel burn. The little boy tells me he is 4 through chattering teeth. He is shaking uncontrollably. We prioritize and split up tasks and as I wrap the shaking child in an emergency blanket and try to find a vein to start an intravenous infusion, I see terror in his eyes. I hold him as tightly as I dare and maintain eye contact. I tell him he is ok and that he had just fallen in some funny water that hurts his skin so we had to wash it off, but it may sting for a bit. I tell him he is safe and that we will give him a stuffed bear and as much chocolate as he can eat when he is feeling better. I ask him if he understands me and he nods and slowly stops trembling. He is stable, but given his age, the location, and size of his wounds mean that he may not stay this way for long. 

We continue to work on our patients while the rest of the crew showers and settles the 100 plus other traumatized passengers from that boat and loads still more onto our ship. The possibility of a medical evacuation is at least 4 hours away for our 3 critical patients and we are worried- only two will survive till then. 

There is the memory of a wail I do not think I will ever forget. Iris: “My two children are dead. Where did they go, they are not here. My babies are dead and I am all alone. I have no one. My two children are dead.”

Iris is a woman who boarded our boat in a panic along with everyone else, except Iris’ panic was different- she wasn’t injured or worried about her own safety. She couldn’t find her children.

I explain that it’s not unusual for families to get split up in a rescue and we would try to locate them. After we manage the medical evacuations it is confirmed that the children are not onboard neither our boat nor the military boat in the area. There are witnesses who saw two children fall off the back of the boat when Iris leaned over to help pull another woman’s child out of the water. We have to break this news to Iris and I see her eyes dart around the room as we start to talk to her- she knows what we are about to tell her and I can see the fear and disbelief in her eyes.

I think of a dear friend of mine who lost her beautiful baby boy and remember her telling me that she thought she knew grief after finding out her child only had months to live, but that she didn’t know she was a “collapser” until she had to say goodbye one final time, lost the strength she had to hold herself standing and fell to the floor. I see this in Iris as she finds herself unable to keep upright any longer and collapses off her chair and I wish that my friend was here instead of me to comfort her- someone who understands first-hand the universally abject horror of losing a child. Iris has just lost two, precious and beloved children, 4 and 5 years old. She spends the next 36 hours in a daze, alternating between sobbing, moaning, and staring off into space.

She agrees at one point to a mild sedative to help her cope and falls asleep on Pierre’s shoulder as he hugs her- I have only just given the sedative so it is far too soon for it to work, but I can see that a shoulder to sob on is what she really needed. I can hear him singing to her softly and look around; Every woman who is sharing the space of the ladies´ waiting room is crying quietly with us and I am grateful that at the very least, Iris is surrounded by love. 

Finally, there is the memory of a white body bag being carried off our boat while we are disembarking in Italy. I can make out the bulge in the belly of the young, pregnant woman who lies within it and I remember her face and voice clearly. The young woman who fell off her dingy and could not swim. She fought like hell to survive and we fought like hell to save her in our tiny hospital but we couldn’t. There is a crowd of people watching as she is placed in the waiting vehicle and even though I know that we did everything that we could (and I have complete faith in my very experienced medical team), I can’t help but feel like my own failure as a nurse to save her is being witnessed by a 500 person audience. 

The most important audience, however for the loss of this young woman’s life is not the press or the crowd watching her body be placed in a hearse, and certainly not mine or the medical team, but her sister. Unbeknownst to us, the two women brought into our hospital unconscious were sisters - both precariously ill and in respiratory distress. After two resuscitation attempts Joy died and the patient next to her who was also critically ill, but showing signs of recovery asked me:

“What happened to Joy? She is my sister. What happened to my sister?” 

My heart drops even further and for the first time in my career I consider lying to a patient or at the very least stretching the truth. I have a sister. The idea of getting the news that she has died would send me into hysterics and this woman is already struggling to breathe. Knowing that I cannot even put off the bad news until she is more stable (our hospital is too small to hide the body bag we are bringing in), I have to tell her then and there that we tried very hard, but her sister has passed away. Upon receiving the news she sobs agonizingly. We needed every hand available that day and the journalist who we pulled in to help support her body in an upright (ie. breathing) position whispers intently, but soothingly into her ear and rubs her forehead. The only positive thing about her current state of hypoxia is that I don’t think she fully grasps the news yet and she begins to slowly improve. 

Now, two days later as we pull into port, the press filming the disembarkation of Joy’s body shows me that the world (or at least part of the world) is seeing it. I have to remind myself that it is the failure of immigration policy and basic human justice that has caused this woman’s death and not my failure as a nurse.

Finally, I remember my last few moments with Iris. She needs two people to help her disembark as she is too weak to carry her own weight so we are struggling down the gangway together. She is wailing softly and I hear someone in the crowd scoff that the woman is being “theatrical”. He has no idea what this woman has been through and even though I know she hasn’t heard him I tell her it’s ok to cry and it’s ok to scream. I secretly hope that she cries and screams loud enough that everyone in the world can hear her. I want everyone to know the injustice of what she is dealing with. I want those who have the power to change migration policy and those who think that migrants- even economic migrants- are something less than human and less deserving of the basic rights and standards of living that we living in developed countries so often take for granted, to hear her. I want them to experience for themselves the wail of a woman whose children have slipped off the back of a boat to their deaths as their mother tried desperately to provide them passage to a better life.

It is deplorable that passage to a better life for the thousands who attempt it each year, is also one of the deadliest migrants´ routes in the world. Rest in peace to the 4,200 plus victims of this route.