Posts Tagged Haiti
During this free Webinar at 1 pm CT Thursday, you can ask questions about responding to a major disaster with thousands of critically injured victims, the skills necessary for an emergency physician to be effective in such a situation, and lessons learned from the experience.
Dr. Auerbach is Professor of Surgery in the Division of Emergency Medicine at Stanford University, and former Chief of Emergency Medicine at Stanford University and Vanderbilt University.
A Day. A gasp. Day number three of gasps.
I found myself no longer counting the respiratory rate. It was rapid.
The pulse oximeter remained 72% on a 100% nonrebreather. No worse but certainly no better.
His wide-open eyes conveyed fear while also demonstrating the strength of the human spirit to survive. No translation was necessary to decipher any spoken Creole words.
There were no ventilators available in the entire city of Port-au-Prince and I had the misfortune of watching an otherwise healthy 18 year-old boy slowly deteriorate before my eyes. Coincidentally and due to poor luck, he had somehow managed to develop trilobar pneumonia around the time of the devastating earthquake in Haiti.
Four emergency medicine residents and myself arrived at a busy hospital overwhelmed with victims of the recent earthquake. Our trip was funded through a local professional football player’s foundation. I admit I had never heard of him prior to this trip. Now I will never forget his name or his efforts even though I have yet to meet him.
Although we had no reservation, we were greeted at the hospital door by a remarkable nursing supervisor clearly open to any help offered.
“Where are you all from?” she asked with a slight twang in her weary, exhausted voice.
“We are emergency physicians from Detroit,” I answered.
“That’s great. Would you be able to staff the Intensive Care Unit tonight?”
And that’s how the greatest humanitarian crisis in the Western Hemisphere entered into my life.
The teenage boy started off in a general medical area with difficulty breathing. His mattress on the floor was a luxury compared to many patients using blankets only on the hard concrete floors. His care was a coordinated effort by many health care professionals that crossed continents. “Team Sweden” provided excellent care given the austere conditions. The pneumonia, however, was rapidly progressing along with its counterpart, a large pleural effusion. I found myself supervising a thoracentesis performed on this mattress while the father lovingly wrapped his arm around his son. Over 700cc of fluid was removed, improving his work of breathing though the pulse oximeter remained poor. He was transferred to the ICU.
The ICU was a simple room of critically-ill patients and those who had undergone multiple, major orthopedic procedures. Overall, it was not unlike the remainder of the hospital though it did have a physician designated to that area only. The absence of any monitors beeping, nurses talking or ventilator machines breathing made his gasping only that much more unavoidable to hear. And then there were those eyes.
This patient wasn’t a challenging case. Any emergency physician would know that he needed to be placed onto a ventilator with aggressive pulmonary care. He was already receiving multiple antibiotics and some TLC but needed so much more that would be readily available in the United States. We had arranged transfer to a hospital in the United States but funding for the private jet fell through at the same time that the US government halted humanitarian visas. He was stuck at our hospital, as all other facilities were full with no additional resources to spare. I faced the problem of patient boarding on a worldwide scale. Patients needed to be transferred off the Navy ships to allow hospitals in the city to offload their patients and make room for more injured or ill people.
During the final night of our stay, the hospital was down to only one oxygen tank that was designated for this patient. There were no other tanks for the entire facility with the next shipment due in over 12 hours. It was at this point, the thought of this boy suffocating, that I hit bottom. Tears flowed briskly. His father could see that our transfer wasn’t going as planned. “Ma vie,” he said softly. My life.
We had met several Army personnel during our stay who were aware of our predicament. In fact, the entire hospital staff, volunteers, and other patients and their families were aware. It was about 5 hours into our 8-hour supply of oxygen that an Army team returned saying they had a ventilator. The sense of relief when the medical team entered the ICU cannot be conveyed in words. They only had a cot, however, and the ventilator was at their disaster base and not accompanying the team. We had no choice.
Loaded into a chair along with a bed sheet, the patient was placed in the back of a HumVee and driven away into the night. Dogs barking replaced the sounds of the gasping to which we had grown accustomed.
Back home in the United States, efforts continued to transfer the patient to a more definitive place of care, specifically the USNS Comfort. The next day, I received a phone call from a medical commander stating that the patient could not be located but a spot was available for him on the ship. The US government as well as our charity organization had been searching for him all day. I repeated the location and provided them with the father’s phone number to no avail. This had quickly turned into our version of “Saving Private Ryan.” More than 16 hours passed and he was nowhere to be found.
Finally, a charity staff member reached his family who was aware that “the United States government was looking for them.” Likely the context was lost in translation somewhere. We were able to gather specific information as to the location of the patient within the disaster unit. To date, he is graciously and skillfully being cared for by medical personnel aboard the Comfort.
The gasping has stopped.
A radio talk-show host asked me today if we needed some “downtime” upon returning home.
“We’re emergency physicians. We are trained to keep going. We have patients here in Detroit who need us just as much as the Haitian people. Fortunately, we have the necessary resources here to get the job done.”
Pimsleur is giving away free basic Creole lessons, if you’re considering going to Haiti. Strong work.
A couple of people recently asked me: “You’re an emergency physician, why haven’t you gone to Haiti?” I considered a snappy comeback, but in light of the heart-rending and dispiriting pictures and videos that have cropped up almost everywhere since the quake; snappy comebacks would have to be considered inappropriate, at best. So why haven’t I gone to Haiti? It is a question that begs for a considered and honest answer, even if frankly I didn’t give the question that much thought before I had already decided not to even seriously consider the option. Yet somehow, this question kept me awake for a couple of hours the nighrt before last, searching first for excuses, then for legitimate considerations, and finally for the truth, in the hope that at least I would learn something about myself in the process.
I had plenty of good excuses:
I retired from clinical practice more than a year ago, and was definitely getting a bit rusty already. Of course, being retired, I wouldn’t have to worry about my partners having to cover my shifts, and I wouldn’t have to worry about the loss of income.
I hadn’t yet had all the shots required for the trip to Haiti. Here is the CDC’s guidance for relief workers traveling to Haiti for earthquake disaster response:
http://wwwnc.cdc.gov/travel/content/news-announcements/relief-workers-haiti.aspx However, I was up to date on most of the immunizations needed, and could certainly get the typhoid shot required, and take the anti-malarial meds (reluctantly).
I am 60 years old, and not the best physical specimen for my age; and I am not sure I could still put in long hours and be as productive as I once was. However, in a disaster like this, it is hard to imagine that even a retired 60 year old physician wouldn’t come in handy.
I don’t speak French. I am not that familiar with tropical diseases. I’ve had two back surgeries. All seemingly reasonable excuses, but this is a huge disaster, and they need doctors – you hear that on just about every broadcast related to Haiti. Plus, this is one of those disasters that Haitians will be dealing with for years, if not decades. I had time to get ready.
There were also lots of reasonable considerations that must be addressed before deciding to go to Haiti as a relief worker, as a physician disaster responder. I had never been trained to be a disaster response physician. Surely, you should have some training before you go traipsing into the middle of a disaster that has claimed more than 200,000 lives, and destroyed just about everything for miles around. Frankly, I had the chance to get such training, but never thought of myself as the kind of doc that would respond to a disaster in a foreign country; I thought of myself as the kind of doc that would suck it up and work my ass off to cover for the docs that did respond. Of course, I live in the Bay Area, not far from the San Andreas fault, so I might well have to respond to a disaster on my own home turf AND cover for the docs that might be victims themselves.
With regard to going to Haiti, I also had to consider that I might be more of a hindrance than a help; someone who would take up important resources being rescued from my own ineptitude or susceptibility to the slings and arrows of traveling under duress. In addition, I am an emergency physician who is used to having ultrasound machines and CT scanners and hemograms and sterile fields in my practice. I have absolutely no experience with wilderness medicine or battlefield practice, and might be at a total loss trying to diagnose and reduce fractures sans x-rays and conscious sedation. A paramedic, or even an EMT, might be more useful than I could be in Haiti. Still, I do know how to use hair to tie scalp lacerations together, and could probably be half-way decent at sorting injuries, since practicing emergency medicine at times has seemed a lot like field triage, or wilderness medicine.
Finally, I had to admit that the excuses, and the considerations, were not the real reasons that I didn’t go to Haiti. One of the reasons I retired from practicing emergency medicine was that the stresses of the practice were beginning to take a toll that I could no longer ignore. I imagine many of you have been watching, with admiration, Dr. Sanjay Gupta and Anderson Cooper and other correspondents reporting from Haiti, and the physician responders they have interviewed and captured on video doing their thing in impossible circumstances. Something I noticed over the course of the last few days is the subtle but unmistakable effect on the speech and facial expressions of these guys that has come from watching the bodies pile up, and being tossed into mass graves; something hesitant that washes over the feelings of self-worth that come from saving lives, something too tight in the smiles in response to the expressions of gratitude from those who have lost so much. The CDC warns of the post-traumatic stress that is likely to plague relief workers exposed to such a massive tragedy, and I had to admit to myself that I may not be up to that. I’m not sure many of us are, even though we are emergency physicians, and deal with tragedy and loss and blood and gore every working shift.
So yesterday I cut some good-sized checks, one to the Clinton-Bush-Haiti Fund, the other to Doctors Without Borders. I will probably cut a couple more in a few weeks – when some time has passed and the money starts drying up – as this is one disaster that is likely to drag on for quite awhile. It really doesn’t matter if this is my way of assuaging guilt for not going to Haiti, or just a way of making the most effective kind of contribution that I reasonably could.