"Can I use your phone?" said my first patient who was pulled from a building after the earthquake in Haiti.
We landed in Port au Prince under the cover of night. Prior to the disaster, commercial flights arrived during the day and the passengers were welcomed by joyous music played by local Haitian artists. This time the airport was full of military cargo planes, and the tarmac was lined with the fortunate survivors who had the passport and the finances to escape the mayhem. We got out of the plane, ducked underneath the fuselage of the jet, collected our supplies, loaded a patient in acute renal failure being medivac to the US on to our plane, and hopped on to a truck that was parked next to an Argentinian cargo plane that had recently brought in aid workers and supplies.
We drove a short distance to the UN base by the airport where we saw the day team of doctors and nurses laying in sleeping bags on the street. They were so exhausted that the droves of UN trucks passing by did not disturb their sleep. We arrived to the “makeshift hospital” that used to be a storage tent for the UN. After the earthquake, it transformed into two dim warehouses full of injured bodies on cots. We received a one minute orientation, and the day team doctor in charge told me that the new arrivals would take the night shift. Unfortunately, I was the only new doctor that had arrived that day.
A nurse called me to the "ambulance bay", because another round of patients recently pulled from a building had arrived. That was when I met her. My first patient was found in a collapsed grocery store. She was trapped underneath aisles of food and store cabinetry with just enough space so that she was not crushed by the falling debris. She also had the good fortune of being buried amidst jars of peanut butter and jelly and bottles of water. I took out my satellite phone and dialed a U.S. number for her. She exploded into tears of joy as she spoke with her loved ones. As I witnessed this intimate moment, tears also began to well up in my eyes.
Lying next to her cot was the man who was also trapped in the same grocery store with her. They supported each other and prayed together during their horrible ordeal. They looked at each other and held hands in silence.
I left my phone with this man so that he too could share his news with his family. Immediately, a nurse pulled me aside to see a post op below the knee amputation patient who was becoming septic. I asked him what the patient’s vitals were. He looked at me with a puzzled look and asked me “do we have blood pressure cuffs here?” We found the single blood pressure cuff that was available for the entire hospital, and started our patient on intravenous fluids and whatever broad spectrum antibiotic that was available to us at the time.
The next patient in the ambulance bay was a man who was also just pulled out. He was severely dehydrated and had an open humerus and an open tibial/fibula fracture with a compartment syndrome. The trauma surgeon who had been there several days examined the patient and asked me to take over. I was puzzled. No splinting, irrigation, or fasciotomy? He then pointed to the over one-hundred patients in the two tents that needed similar treatments. We lacked supplies, resources, and volunteers needed to treat all the patients with the gold standard of care. I promptly started my new patient on antibiotics, intravenous fluids and pain medication. The patient went to the "OR", which was a picnic table surrounded by cubicle walls inside one of the tents, and got amputated the next day.
The one detail that I remember the most about this patient was how stoic he was as we examined his body. He must have suffered unbearable pain throughout his ordeal. He laid there in agony, but also with incredible inner peace and strength expressing gratitude for the care that he was finally receiving. I had always felt from my previous experiences of running medical clinics in Haiti that Haitians were good people and had high pain tolerance, but many of the patients that I treated were exceptionally dignified.
The rest of the night was spent triaging mangled bodies transferred from different makeshift hospitals and clinics, and rounding on existing patients to provide pain management and proper dosing of antibiotics. The new nurses were under a substantial amount of stress because every three nurses were responsible for a tent with more than seventy-five patients. Nobody knew where any of the supplies were, if there were any.
New patients stopped coming in at 2 am. I told the exhausted trauma surgeon to go to sleep. He reluctantly fell asleep inside the tent, under a tripod that had been set up for daily broadcast by CNN. He woke up less than 4 hours later to start rounding on his patients and started amputations at 7am.
There were a few patients who I discharged during that night. However, the nurses promptly pointed out to me that these patients with minor injuries had nowhere to be discharged – no home, no food, no money, and in many cases, no family. How do you discharge somebody with these obstacles? I later found two of the discharged patients working alongside nurses translating and transporting patients.
Some physicians feel that the time from 4am until the day shift takes over seems like an eternity. This time span felt like an eternity to me for the first time. I performed a variety of duties: inserting a foley on a man with spinal cord injury; rocking a badly injured orphan infant to sleep; checking repeatedly on the foley that was temporarily inserted as a chest tube on a man with a tension pneumothorax; assisting the nurses with their duties; and being pulled from one end of the tent to another with endless inpatient problems.
As the warm glow of the sun hit the tents and the rumble of the UN trucks passing by signaled the end of the night, we tried to finish rounding on all the patients. Slowly the volunteers who were lying on the streets and inside the tent roused from their slumber. I asked the trauma surgeon to whom I should turn over. He said that there were enough of the day team volunteers awake and that I should just go to sleep. So I did.
That was the first night. I marvel at the heroic, selfless and dedicated volunteers, and the strong, grateful patients that I witnessed on this trip.
