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Haiti Update: Anatomy of a Day

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Editor's Note: Healthline blogger and Stanford University emergency medicine instructor Dr. Anil Menon is in Haiti to help with the global effort to provide medical care in the wake of the January 12 earthquake. Because communication outlets are limited, he has been sending updates to his mother via text message. She has been transcribing those messages for us so we can pass them along to you. Please know, these updates are being relayed directly from Dr. Menon, and some of the information is graphic and might be emotionally difficult for some people to read. We will be posting new updates as we receive them in the days ahead. 

January 22, 2010

Each day brings a new challenge and a completely different job description—so much so that at times it becomes a blur. If I find a free moment, I scribble down what I'm doing, hoping this would help me make sense of everything around me, and would improve my thought process.

For the past few days, we wake up at 0600 and drink only coffee for breakfast. Chris Sloan, an astronaut candidate and an emergency medicine doctor from the University of California, San Diego, brought a portable hypoxia monitor. Out of curiosity, I tested my heart rate and found it had gone from a resting heart rate of 50 to a rate of 85. Everyone else’s was about the same, with all of us hovering in the 90s. That must be due to a lack of water intake. One of the tips I learned is don't eat protein if you're in a survival situation, when you have less than a pint of water per day. It requires water in order for the protein to be utilized. This was just a curious medical thought because none of us had any time to eat. Most people managed a powerbar, at most. But again, this isn't surprising for people who work in the emergency department.

Around 0700 everyone crams into the bus and makes the 3-minute trip to the hospital.We start at the supply room and pack a box of injectable antibiotics, like ceftriaxone and ceftaz, and then grab a few of the more exotics ones if they are visible. Our top concern is to learn who made it through the night, where they might be lying today, and what new challenges this day will bring.

Guyta was helping me translate. I looked for him before heading to the pre-operation area. He spoke English well and told me his help at the hospital was “the price he was paying for surviving”. None of his family members was hurt and he felt guilty about his luck. He confessed, “I always felt I had one miracle to happen in my life—and it happened.”

As we talked and collected our supplies, another aftershock hit and everyone bolted for the door. No ankles were broken but it was clear no one was willing to return inside. One patient later asked me if they would be in danger of the earthquake if they were transferred to the USS Comfort medical ship.

It was good to know today more help was on the way—more supplies, and better coordination with our experience. The pain medications no longer had to be rationed, the IV fluid for people more dehydrated than us would be available, some food rations for patients, and specialty surgical care that never existed were coming.

One of the first people I looked for was a beautiful 5-year-old girl with bi-lateral femur fractures and a hematocrit of 15. She would receive our first blood transfusion (a special effort from the Haitian Red Cross) and would be on the top of my list to get to the USS Comfort (a floating hospital). The army was able to save her life as well as transport her via air evacuation to the Comfort. There they could handle neurosurgery, ICUs, CT scans, and fix many of the complicated orthopedic fractures which had to remain broken in our beds due to lack of IM rods, fluoroscopy, and other hardware.

The next person I looked for was an older woman named Official, who lost her right arm and leg in the earthquake. She was just brought in. Her son struggled to get her to our medical area. Dr. Pier, the lead surgeon, took her to the operating room immediatly for wound cleaning, debridement, and amputation. From the Haitian's viewpoint, the appearance that anyone who came to the hospital, left with an amputated limb, stopped many from coming. Though Official looked good the day she came in, given those injuries, she did not look good that morning. She couldn't talk and she struggled to breath. Early on, her 13-year-old son asked if she was alive. I thought, of course she is alive. I looked over and she wasn't breathing and didn't have any reflexes. My lowest point came when I had to tell her son she was not alive. I held him as he cried and asked if he had anyone to help. He didn't because they were all crushed by their fallen ceiling. It was hard to leave him, even when an older woman came to take my place. It felt insufficient to give him food because that wasn't enough. Even worse, the boy left sometime in the afternoon before we could be certain he had any support. I will never forget his face.

I'm reminded of the boy pulled from the rubble recently that was featured on CNN and the Los Angeles Times. Gaby helped this child and he returned to visit her. He looked so dry initially when he was pulled from the rubble. It does feel good to see people turn around, especially those with so much left to see and live.

To read all of Dr. Menon's updates, click here.

To read Dr. Paul Auerbach's blog from Haiti, click here.

For more of Healthline's Haiti coverage, click here.
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About the Author

The Stanford Emergency Room is the center of emergency care at Stanford University.

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