DAY FIVE - Friday, Feb. 5, 2010: The Endless Night

A bumpy, hot, loud 2-hour ride later, we returned to the compound. I showered, tried to email home to let them know I arrived, and crawled into my cot. Two hours later, up, back on the bus to go to the hospital for another overnight shift in the ICU. I went straight to the ICU to take sign-out from the day time doc. My heart fell as he told me we were taking a transfer, who was intubated. The hospital had two ventilators, neither of which was working as of yet. The hospital had used one the week before to help save a patient with paralysis from tetanus. They tried to tweak the vent into working while the patient was on the vent; the patient died.

Tonight, though, an outside clinic had seen this man, who was having fever and respiratory problems plus was combative and not responding appropriately. He was very ill, and they had heard we had a vent. They intubated him in the field, hand ventilating him, and carried him (literally) to us. The physician signing out to me accepted the transfer to give us a chance to see if our vent worked. “Don’t worry too much; we don’t really expect him to be alive in the morning. We just need to see if we have the vent working yet.”

When the patient arrived, it was like something out of a movie. A crowd came in with him, including someone with a cameraman. Chaos. I pretended I knew what I was doing, tried to be in charge and run the code. I attempted to ask all the right questions, tried to chorale unnecessary people out of the ICU. And in the midst of this, tried to explain to his wife what was happening, again in my limited French. The trick was, I had no idea what was the matter. All we knew was that he had a fever and headache early in the week. He could have had everything from bacterial meningitis to a stroke.

The other patients and families in the ICU didn’t seem to register that I was having a personal crisis trying to keep this man alive and kept on coming over to me. They would dutifully request pain meds for the family member and ask questions about them. Not more than an hour after my ventilator guy arrived, another patient was brought in who was having crushing chest pain and other symptoms that seemed very much like he was having a heart attack. Two ill patients, neither of whom I could get labs for or even a chest xray or EKG. We could only process labs in the morning. We had an EKG machine, but no cord to plug it into the wall. I have never felt so helpless in my life.

In the midst of this, around 2 am, one of our post-op patients began complaining her chest hurt. She had come in the day before for help with her right arm, which had clearly been broken since the earthquake. While they had her in the OR preparing to fix her arm, the surgeon noticed her left ankle was at an odd angle. An xray revealed a compound fracture of her leg, which they repaired the next day. So, there she was hours after her second surgery, with chest pain. My mind whirled with possibilities, dutifully creating my differential diagnosis as I began to assess her.

After what seemed like forever, I managed to figure out she was telling me her heart ached. Literally. Sometime since the injuries, since the earthquake, she had suffered a miscarriage. "Lost her womb." It was the closest to crying I’d come so far. I told her I didn’t have the words, in French or English, to help her feel better. And that was all I could do. The language barrier, and two seriously ill patients, prevented me from doing more than periodically patting her on the head as a hovered over the patients in the ICU.

In the US, I would have spent 30 minutes on admission asking every detail about the patient’s past medical and social history. Here, I could barely figure out the major problem they had. I had always found names difficult to understand in French, and the Creole accents made it nearly impossible for me to figure out. Here, I barely knew anything about the folks I was in charge of caring for.

And so I spent the night. Trying to keep my ventilator guy alive and sedated, panicking a little every time my chest pain guy flinched. I so would have liked to have done an EKG, get some blood, an xray, anything. All I could do was give him aspirin and morphine, lots of morphine. So helpless.

Betty found a cot so we took turns for an hour or two laying down for 30-45 minutes at a time. I curled up on a chair beside my patient with the ventilator, periodically giving him morphine and diprivan to keep him sedated. Everytime he groaned or flinched, I’d try to say something comforting to his wife. Mostly, I just kept apologizing to everyone for how terrible my French was.

In the morning, we found a large jar of applesauce so we gave everyone, including family members, a urine specimen cup filled with water and another filled with applesauce. Otherwise, no one would have had breakfast. In Haiti, patients only eat if family brings them food. Part of the team coming after ours had folks who were designated the “feeding team.” They would start feeding us, then would progress to feeding the hospital. For that night though, our ICU patients had little food. We had given them Pop Tarts the day before since Kelloggs had donated many boxes of them for the aid workers. Applesauce for breakfast was all we had, but they were incredibly grateful for that small thing.

In the morning, relief came. The intubated patient stabilized, ended up being extubated and stable just with additional oxygen. That meant he could potentially be transferred to the USMS Comfort or to Miami. Just somewhere with the capacity to find out what was wrong with him. Apparently, something we did for him helped. Whether that was the antibiotics, the medicine to remove fluid from his lungs, time, prayer, who knew.

We finally got labwork at least on my chest pain guy, and he didn’t appear to be in the middle of a heart attack. He felt better, so we sent him home with some aspirin and blood pressure medicine, as well as a prayer. I went to check on the folks working triage and found one of the girls I had treated earlier in the week was here-waiting for me. She wanted me to change her dressing. I told her I was working in a different part of the hospital today but that one of the others would care for her. She told me she wasn’t afraid as long I changed her bandage. So, I sat down on the concrete and dressed her wound. She still teared up in pain while I changed her bandage, but she never said “hey” and she didn’t flinch.

That moment, those 5 minutes, are among my favorite memories of my time in Haiti. For that young lady to have one dressing change where she wasn’t afraid, that alone would have made the effort and exhaustion worth the trip. Helping that one little girl made it worth it for Audrey to be missing me.

Shortly after that, one of the US Virgin Islands team members asked for help from across the courtyard from our team. She was in the middle of a dressing change and needed someone to finish taking care of her patient since she was an hour late to leave to catch her flight home. I went over to find a 14-year-old named Louis Randolph, who had had most of the muscle from the front of his arm and forearm sheared off in the earthquake. He had received skin grafts from his thighs and was supposed to be doing daily dressing changes, but his family couldn’t get him there for a few days.

As I tried to unwrap his dressings from his thighs, he cried and asked me to stop. His wounds bled. It quickly became clear I was causing him excruciating pain. Never before had I so directly inflicted suffering, and I had no alternative. We didn’t have meds I could give him, we couldn’t sedate him because he wasn’t ill enough, although in the US he would definitely have been medicated somehow.

A psychologist named Winston saw what was going on and ended up staying with me and Louis for the nearly two hours it took me to treat him. I ended up injecting nearly 50 ml of lidocaine into his thighs to numb him enough for me to remove the bandages on his legs. Applying the new dressings was much easier. I finally took off the bandage on his arm and saw 110 (I counted them as I dug them out later) embedded staples on a swollen arm that he couldn’t bend or use in any way. We ended up admitting him to the hospital so he could keep his arm elevated. Hopefully, improving the swelling would make him more comfortable. He just can’t keep his arm elevated when he’s living on the streets with a little sheet for a roof.

When we were done, some of the other patients sitting around waiting for their turn applauded. I gave him 3 dum dum suckers, one for each body part I treated, and two bottles of water – one for each hour I spent with him. I have never inflicted so much pain on another human. Throughout it all, he kept apologizing for crying, for needing time. Then he’d thank me for helping him. Those two hours were the closest I think I’ll ever come on earth to being the hands and feet of Christ.

I was so relieved to see the bus make its way to the hospital. It took us 3 hours to get home. Everyone was a little punch drunk, and there was much singing and goofiness. Once we arrived at the compound, I guzzled down several glasses of water. I was thirsty much of the time I was in Haiti. Our bottled water was rationed to make sure it would last until the next team came with replenished supplies, but we could drink water from the well at the compound since they had their own, clean system. So that night, after 2 days with a few bottles of water, I drank my fill.

A quick shower, and into bed for a wonderful, fabulous 7 hours of sleep.