Haiti Update: What I've Learned
January 25, 2010
Top five rules for helping in a disaster.
1) Smile and Care: “It means more than any treatment you might render,” Garrett Chan told me this, and I believe it to be true. The more I do, the more questions I get asked, the more directions I get pulled into, the more important it seems to be there. The people that smile the most, those are the ones I will remember.
The most positive memory will be my very first patient (see picture below). He was 16 years old and had a swollen leg with obvious cellulitis. I met him on my first day in Haiti. His first through third toes were completely necrotic and dangling off his foot like autumn leaves. I was overwhelmed that day, but I couldn't walk away. By our triage system, he was someone else's responsibility. Everyday, I stopped, smiled, changed his dressing, and eventually got him to see Dr. Pier. His toes were removed. Now I see him everyday in the post-operative area. Someone said he would probably win an olympic race, with his attitude. I wouldn't be surprised.
2) Be flexible: Every day is a new day. On the first I was a mostly an intern, seeing a few patients, referring them to the surgeons, and sweating when I saw patients walk through the door. At different times, I performed the jobs of a tech, a nurse, a transporter, or a scribe. On the second day, I replaced Bob Norris to run an area, know all the patients, and triage the patients for the surgeons. On the third day, I spent much of my time taking Bob's job, the one he vacated. It was running the triage pre-operative area, doing more administrative work, and meeting with surgeons so they don’t step on each other’s toes. A few doctors came, wanted to help, but were mainly interested in specific tasks—ones they found fulfilling. A disaster veteran, Dr. Tascone, who made 25 trips to Africa as part of a reconstruction process, took the night watch.
3) This leads me to the third point. Keep the broader goal in mind: You came to help in any and every way, and with that, all other problems are solved.
4). Work until you drop: There was a plastic surgeon named Dr. Silver, who could barely walk by the end of the day. He was older but he maximized his effort, and I figured I could do the same
5) Take care of yourself: I think you can recover physically like Dr Silver, but it’s more difficult to be present emotionally day after day. That’s why I write, and that’s why I appreciate all the support I receive.
The end of each day delivers a blow and today was no different. Four days ago, a woman was shot. She was 32 years old and survived the earthquake. But during an aftershock, when everyone scrambled out of the house, a shot misfired, hit her in the back, in the right lung, and left her paraplegic. She went to another hospital. She probably had a pneumothorax, got a chest tube, and was sent here before being air lifted to to the USS Comfort medical ship. She looked okay, didn’t seem to be in distress, even had her chest tube pulled by someone. But she never made it on the ship.
We couldn’t predict that she would develop a pneumonia today as she did. To be certain, we checked her lung, heart, and abdomen with an ultrasound, gave her more antibiotics and fluid, and began the transfer to another facility. It was tough to find a small bottle so we moved the large oxygen bottle onto the truck, moved her onto the truck. And that’s when she began to really decompensate. She was frothing at the mouth, moaning, and breathing heavily. I jumped behind her to prop her up and elevate her chest. Bob sat beside her and lifted her chin, and we scrambled to get the old pick-up truck running. A we moved out of the compound, I thought she would slip out the back of the pickup but Bob told us, “Don't worry. I’ve got her head in my hands,” as he lifted her jaw for better ventilation. I just focused on bagging her as we drove through the crowded streets, and was glad to have a national expert in airways at my side. There was actually another patient sandwiched in the back of this open pickup truck, another septic young woman. Bob kept repeating and reassuring her, “Don't worry, I won't let you slip, I’ve got you.” He didn't let her slip, and we made it to the Disaster Medical Assistance Team tent. We both told the people there to get an airway together immediately, but they seemed a little too calm. There is a fine line between composure and delay. Luckily, the army escort helped us rush her to the treatment tent while we asked for an airway. A cardio-thoracic surgeon told us he would intubate. Bob was reluctant but we’re on someone else’s turf. But the other doctor forgot his stylet, couldn’t see anything, and put it in the esophagus. Bob snatched the tube and quickly put it in. Unfortunately, her heart had stopped. CPR wasn’t enough and she didn’t survive.
There were so many turns that could have changed events—from transfering her earlier, not disconnecting the oxygen, recognizing her earlier, vetting communication, and being more assertiveness with the various care teams. It was tough losing her. I couldnt find her family. They got lost in the chaos.
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.