Usually I blog around 5:30 when all the cases are done and we have wrapped things up for the night. It's currently 7:45pm, and we still aren't done. They don't need me in the OR because the case we currently have is so sick she needs two surgeons... But, let's start at the very beginning. A very good place to start.
We started the day with our 6:30am walk again today, but this time we went to the river instead of the mountain. The walk was a fabulous dichotomy of beautiful and ugly. The streets are filled with delightful people staring at us and waving. The walk had to take a slight detour when we had to negotiate around a man sitting in the path butchering a cow with a machete. Lots of people were standing around, talking, waiting for their piece. I have pictures for those who are brave enough to look.
The path to the river was through banana trees and planted fields with gorgeous mountain scenery all around. The path itself was bordered the entire length in a 3 foot pile of trash. Some burning, some not. Goats and pigs grazing on it. Women at the riverside were doing laundry and cleaning themselves... we did not touch the water, of course, given that this could also be called 'cholera central.'
We got back, had some breakfast, and started with what was supposed to be a quick, 'wrap it up' kind of day. One hysterectomy, one hydrocele (that I actually performed), two hernias, a breast fibroadenoma, and a few lumps and bumps seen in clinic. We heard just before lunch that there was an appendicitis in clinic, so he would be an add-on.
After lunch, the drama began. The appy was a 70 year-old man. He signed his consent in the OR and then had his spinal anesthesia. This is when we learned the people who came with him weren't his family (as previously believed), and they were insisting we don't operate. You see, here there is no food service. This is no significant nursing. So you have to have someone who stays with you and brings you food and water, someone who will take you home. And the people screaming outside the OR said they wouldn't and that we were just going to kill him on our table.
Well, then it turns out they are his neighbors. They don't want to get in trouble if something bad were to happen, so that is why they were refusing care. Since they weren't family,AND none could be found, AND the man was going to die without surgery, we went forward (his own consent not being worth much).
This is when Leslie comes into the OR and announces that over in clinic, a woman who had had an abortion yesterday came into clinic bleeding. They attempted a D&C (uterus clean out) in clinic, but instead ended up with small intestine coming out of her vagina. And we only have one OR that can do these serious cases.
So, we dive into the appendicitis case at 2:30pm hoping it goes quickly, knowing the woman could go south very quickly. Steve and I got into his belly, and it initially looked like a ruptured appy that has been there for a while. Lots of scarring, lots of nasty looking tissue... but then we found ourselves inside the cecum, i.e. into open bowel. After looking around some more, it turns out he has metastatic colon cancer that had ruptured. We end up having to widen his incision and do a right colon removal (i.e not quick at all). By the time we have his colon out, his bowel put back together, remove another met that is about to perforate, and sew him back up, it's 6pm.
Needless to say, laying in a hospital in Haiti with intestines hanging out of your vagina for 4 hours isn't really good for a person. Steve and Leslie got into her belly to find a hole in the top of the uterus from the botched abortion/D&C, and 5 feet of dead small intestine (half in, half out). They have just about wrapped up the bowel repair as I type this. Then they will begin her hysterectomy. She has 5 kids. Her husband is out of the country right now.
So, we finish with a bang. And tomorrow we hand off these super sick patients to the incoming team from North Memorial with a piece of paper handed off at the airport in Cap Haitian. We still have the seizure lady, who still doesn't recognize family members but does recognize our interpreter. There is the guy who has his suprapubic catheter and will just wait for the urologist to come fix his prostate. And lord only know what could happen in the next twelve hours before we leave.
But, what I do know is that this is my last post from down here. I will wrap this up, check the OR, and start packing. Thanks to all of you for your well wishes and good thoughts. Steve summed this whole week up with 4 statements: 1) I love it, 2) I hate it, 3) I want to come back, 4) I never want to come back.
Au revoir.
Friday, January 28, 2011
Thursday, January 27, 2011
I spoke too soon again....
Ah, just when you think it is safe to blog, something goes all crazy on you.
Last night, after blogging and heading to dinner, we were sitting around chatting when a person started yelling into the dining building. Translation? "One of the hysterectomy patients is seizing." Well, that's not good. So the table emptied as we all ran back to the hospital.
By the time we get there, the seizing has stopped, but she is laying there largely unconscious. We put one of our portable oxygenation monitors on her - 65%. You really want to see above 94%. So, you say, put her on O2. Well, we don't really have any, per se. The only O2 tank is in the operating room. And the bed she is on doesn't fit through the door. We do have an oxygen concentrator, but that only got her up to mid 80's. Usually after a seizure, you are out of it for a bit, but then you come back around. That was not happening.
So, we got a cart, carried her by her sheet out the door (of a room that has 4 people and all their families in it), and take her back to the OR for O2. Thankfully, that got her up to 100%. Meanwhile you have 4 MDs and 2 anesthetists trying to figure out why she seized. Does she have an unknown seizure disorder? No. Does she drink and lot and is withdrawing? No. Could she have low sodium, low calcium, or low magnesium? Your guess is as good as mine, seeing as how we don't have any way to test for that. So we replaced all of them. She had had surgery under spinal marcaine, a bit of versed and she got the wound injected with Marcaine as well. None of these were at doses that should cause anything close to seizures. She then seized 2 more times without coming out of it in between, officially putting her in status epilepticus. Thankfully we had IV Versed, then found some valium to break the seizure. But she still was completely out of it.
In the US, we would intubate her. Here? There are no ventilators, so if you get tubed, someone sits there all night and bags her. That someone would be me. Thankfully she kept breathing on her own. We would also give IV seizure meds. None here. So we placed a tube in her stomach, confirmed it's placement only by listening, and poured phenobarbitol liquid down it. When she still wasn't coming around, we wondered if she had had a head bleed (and just our bad luck to be her surgeons that day). But, her lumbar puncture showed no blood, and when she did move, she moved equally on both sides... another theory blown.
By 9pm, we started setting up for shifts to watch her throughout the night. Since the surgeons and the anesthetists should be awake (preferably), Yvonne and I said we would do it. I went to bed until 1am, and was going to take the 1am-6am shift. At 12:30am, Yvonne came to our room and told me she had come around, had good oxygenation on room air, was recognizing family and was back in her room. Today, she has been groggy all day, but able to answer questions.
So good doctor, you say, why did she seize? I have no flippin' idea. Will she do it again tonight. Well, tune in tomorrow to find out.
Today was hyterectomies, hernias, hydroceles and lipomas. The funniest story was the guy I was examining in clinic for scrotal swelling. I was trying to determine if this swelling would go back into the abdomen (hernia) or stay in the scrotum (hydrocele). I started to gently squeeze the area to see. He moved my hands, and I was afraid I had hurt him. But instead, he knew exactly what I was doing and showed me his party trick. He pushed the whole thing between his legs, squeezed them together with great force, and with a strange sucking sound, the swelling disappeared, and he opened his legs with a great smile to show a normal scrotum. As Leslie says, this is Haiti.
Last day tomorrow. Mostly little surgeries because we don't want to leave major recovery in our wake. There are many abandoned children here, 9 of which have major medical problems (CP, MR, developmental delay), and 4 of which are delightful and healthy. Givenson turns 8 tonight, so we are wrapping up some clothes, toys and shoes for his birthday. Luvins (4), Reece (5?) and Shebani (3) take turns sitting on our laps and getting hugs. They are a joy to have around as I miss my own little ones. Soon I will be giving them hugs too.
Last night, after blogging and heading to dinner, we were sitting around chatting when a person started yelling into the dining building. Translation? "One of the hysterectomy patients is seizing." Well, that's not good. So the table emptied as we all ran back to the hospital.
By the time we get there, the seizing has stopped, but she is laying there largely unconscious. We put one of our portable oxygenation monitors on her - 65%. You really want to see above 94%. So, you say, put her on O2. Well, we don't really have any, per se. The only O2 tank is in the operating room. And the bed she is on doesn't fit through the door. We do have an oxygen concentrator, but that only got her up to mid 80's. Usually after a seizure, you are out of it for a bit, but then you come back around. That was not happening.
So, we got a cart, carried her by her sheet out the door (of a room that has 4 people and all their families in it), and take her back to the OR for O2. Thankfully, that got her up to 100%. Meanwhile you have 4 MDs and 2 anesthetists trying to figure out why she seized. Does she have an unknown seizure disorder? No. Does she drink and lot and is withdrawing? No. Could she have low sodium, low calcium, or low magnesium? Your guess is as good as mine, seeing as how we don't have any way to test for that. So we replaced all of them. She had had surgery under spinal marcaine, a bit of versed and she got the wound injected with Marcaine as well. None of these were at doses that should cause anything close to seizures. She then seized 2 more times without coming out of it in between, officially putting her in status epilepticus. Thankfully we had IV Versed, then found some valium to break the seizure. But she still was completely out of it.
In the US, we would intubate her. Here? There are no ventilators, so if you get tubed, someone sits there all night and bags her. That someone would be me. Thankfully she kept breathing on her own. We would also give IV seizure meds. None here. So we placed a tube in her stomach, confirmed it's placement only by listening, and poured phenobarbitol liquid down it. When she still wasn't coming around, we wondered if she had had a head bleed (and just our bad luck to be her surgeons that day). But, her lumbar puncture showed no blood, and when she did move, she moved equally on both sides... another theory blown.
By 9pm, we started setting up for shifts to watch her throughout the night. Since the surgeons and the anesthetists should be awake (preferably), Yvonne and I said we would do it. I went to bed until 1am, and was going to take the 1am-6am shift. At 12:30am, Yvonne came to our room and told me she had come around, had good oxygenation on room air, was recognizing family and was back in her room. Today, she has been groggy all day, but able to answer questions.
So good doctor, you say, why did she seize? I have no flippin' idea. Will she do it again tonight. Well, tune in tomorrow to find out.
Today was hyterectomies, hernias, hydroceles and lipomas. The funniest story was the guy I was examining in clinic for scrotal swelling. I was trying to determine if this swelling would go back into the abdomen (hernia) or stay in the scrotum (hydrocele). I started to gently squeeze the area to see. He moved my hands, and I was afraid I had hurt him. But instead, he knew exactly what I was doing and showed me his party trick. He pushed the whole thing between his legs, squeezed them together with great force, and with a strange sucking sound, the swelling disappeared, and he opened his legs with a great smile to show a normal scrotum. As Leslie says, this is Haiti.
Last day tomorrow. Mostly little surgeries because we don't want to leave major recovery in our wake. There are many abandoned children here, 9 of which have major medical problems (CP, MR, developmental delay), and 4 of which are delightful and healthy. Givenson turns 8 tonight, so we are wrapping up some clothes, toys and shoes for his birthday. Luvins (4), Reece (5?) and Shebani (3) take turns sitting on our laps and getting hugs. They are a joy to have around as I miss my own little ones. Soon I will be giving them hugs too.
Wednesday, January 26, 2011
Long day in the OR
Well, the good new today is that no one died. I will say that in jest at home, but here? It is actually a good way to measure the day.
We started the day off with a 6am sunrise hike up the nearest "mountain." I have definitely learned I need to do more climbing before my anniversary trip to the Alps this summer! After walking through a garbage heap, a neighborhood, then straight up (not a switch back to be found), we got to watch the sun rise while listening to many woman chant their songs to god. It was a really beautiful way to start the day.
Once we got to the hospital, Yvonne and I checked on all the post-op patients while the surgeons started taking in the new patients. One man with a hernia repair from yesterday was having terrible urinary retention. Using the ultrasound we brought with us, we were able to see that his bladder was up to his belly button. Our 3 tries at a urinary catheter were unsuccessful due to a whopping prostate. He ended up in the OR for a catheter that passes through the abdominal wall (with none of the usual tools we usually need), but that clotted off and was back for a re-do by lunchtime. Yvonne and Steve were finally able to find a stray guide-wire, sterilize it, pass that into the bladder through a needle, dilate the hole and then pass a catheter that finally had good flow. We lost a lot of time on other cases, but finally, this man can rest. (and come back next week to have his prostate worked on...)
We had 3 hysterectomies, and a few hernias. The scheduled c-section was here earlier than really needed, so she was sent home for another week. I saw a pair of 3 month-old twins that mom was concerned about them having tight foreskins. No biggy. I talked her through the treatment at home. The incredible thing about these twins were that they born at home, the first at midnight, the next at 10pm. 22 hours in between. Good. God.
I got to be a plastic surgeon as well, removing a fatty tumor from a young woman's face. That was rewarding. The case of the day that took the cake was the hydrocele. It was an older man, with one year history of swelling in the right scrotum. The fluid bag we drained measured 1700cc. That is just a swig shy of a two liter bottle of coke. Can you imagine carrying that around in half of your scrotum every day? He will be a very happy camper once he can feel the lower half of his body again.
In a perfect picture of how things get done in Haiti, we couldn't start our last case of the day because the scrub nurse had decided to get in line to be seen by the dentist who is with us (the OB, Leslie's, husband). We had to send someone to go get her back. Another staff member was yelling at the head of the hospital because she felt she should be paid double because another person didn't come to work. As Leslie says as she shrugs her shoulders "This is Haiti."
I am certainly feeling the tug of home. The only thing I'm not starting to miss is the weather! I want to hug those adorable little boys of mine and the big one too. But, that will have to wait. We already have a full schedule for tomorrow including some cases that were bumped from today.
Thanks for all the good thoughts and notes! I have read every one of them. Don't be shy!
becca
We started the day off with a 6am sunrise hike up the nearest "mountain." I have definitely learned I need to do more climbing before my anniversary trip to the Alps this summer! After walking through a garbage heap, a neighborhood, then straight up (not a switch back to be found), we got to watch the sun rise while listening to many woman chant their songs to god. It was a really beautiful way to start the day.
Once we got to the hospital, Yvonne and I checked on all the post-op patients while the surgeons started taking in the new patients. One man with a hernia repair from yesterday was having terrible urinary retention. Using the ultrasound we brought with us, we were able to see that his bladder was up to his belly button. Our 3 tries at a urinary catheter were unsuccessful due to a whopping prostate. He ended up in the OR for a catheter that passes through the abdominal wall (with none of the usual tools we usually need), but that clotted off and was back for a re-do by lunchtime. Yvonne and Steve were finally able to find a stray guide-wire, sterilize it, pass that into the bladder through a needle, dilate the hole and then pass a catheter that finally had good flow. We lost a lot of time on other cases, but finally, this man can rest. (and come back next week to have his prostate worked on...)
We had 3 hysterectomies, and a few hernias. The scheduled c-section was here earlier than really needed, so she was sent home for another week. I saw a pair of 3 month-old twins that mom was concerned about them having tight foreskins. No biggy. I talked her through the treatment at home. The incredible thing about these twins were that they born at home, the first at midnight, the next at 10pm. 22 hours in between. Good. God.
I got to be a plastic surgeon as well, removing a fatty tumor from a young woman's face. That was rewarding. The case of the day that took the cake was the hydrocele. It was an older man, with one year history of swelling in the right scrotum. The fluid bag we drained measured 1700cc. That is just a swig shy of a two liter bottle of coke. Can you imagine carrying that around in half of your scrotum every day? He will be a very happy camper once he can feel the lower half of his body again.
In a perfect picture of how things get done in Haiti, we couldn't start our last case of the day because the scrub nurse had decided to get in line to be seen by the dentist who is with us (the OB, Leslie's, husband). We had to send someone to go get her back. Another staff member was yelling at the head of the hospital because she felt she should be paid double because another person didn't come to work. As Leslie says as she shrugs her shoulders "This is Haiti."
I am certainly feeling the tug of home. The only thing I'm not starting to miss is the weather! I want to hug those adorable little boys of mine and the big one too. But, that will have to wait. We already have a full schedule for tomorrow including some cases that were bumped from today.
Thanks for all the good thoughts and notes! I have read every one of them. Don't be shy!
becca
Tuesday, January 25, 2011
Day 4
Well, here I am again. Bonsoir from Haiti. We are still well and happy and getting a bit more tired and bit more sore in the legs and backs. Cement floor tend to wear on you after a number of hours/days. Today had many aspects that already felt like business as usual. 3 hysterectomies, 3 hernias, 2 hydrocele repairs. Same view in the morning - a line of people waiting to see if they will get in to see the "blancs."
The baby from yesterday died during the night. He was so sick, and I knew dying was very possible, but that doesn't mean you don't hope for the best. I hoped we had swooped in and righted his ship, but to no avail. His mother is already dead from cholera, dad lives in the Dominican Republic. The lady here with him was dad's aunt. She leaves with his body, on her own to deal with the burial.
One thing that is throwing me off quite a bit is the advanced state people have progressed to before they get here. Of course I knew that was going to be the case, but by definition that means these are cases unlike anything I have ever seen in the states. The man with one testicle three times it's normal size and firm? Cancer? Don't know. Come back and see the urologist next week (and walk for a few hours again?). The man with the mass protruding from his cheek that was reaching the size of a grapefruit? Cancer? Benign? How do I know? No one in the states would let a mass GET this big. Go to Cap Haitian because you will need a facial surgeon. The woman with the mass in her right breast the size of a kiwi? We'll find out tomorrow when we do her likely mastectomy.
in the morning, one of the Haitian residents came running to our clinic asking if there was anything we had to offer the old woman with the "grade 3 tumor in her head." They had already given her mannitol (emergent treatment for severe brain swelling). I have NOTHING to offer, nor did anyone with us. Let's say I did jump in and try to be superman... the end result is no better. We later went to clinic to see if there was anything to help with, and there was the body, head wrapped with a blood soaked bandage, waiting for family to come pick it up.
Yvonne had a clinic case yesterday of a 5-day-old home born baby who arrived with a meningocele (a fluid sac at the base of the back filled with spinal fluid and sometimes cord) leaking spinal fluid onto the exam table. Meningitis in inevitable. We told them to hold him, love him and go home. They were going to try to make it to the Dominican, but there is very little hope.
On the flip side, I got to feel right at home with the retained nail in the leg for the past year. Numb it, make your incision, pull it out and bandage it up. THAT I know how to deal with. And the patient and the daughter were so thankful you would think I had performed a miracle! They sang and raised their hands to the heavens. At least for that moment, for those women, I had made a real difference.
My overall reaction to all of this is very dichotomous. At times, I feel like we are doing so much. At other times? Soooooo little. I can't help more than half of the people I am telling you about. And when you see how many people are here and how sick some of them are, you just feel like you are addressing one grain of sand on a whole beach. It is disheartening at times. But, we do what we can, right? It' s better than if no one was here. But it is also very humbling. I'm no hero. I'm not feeling like I'm changing the world. But, I guess changing the world isn't the goal.
We all continue to be well. Kisses to all.
The baby from yesterday died during the night. He was so sick, and I knew dying was very possible, but that doesn't mean you don't hope for the best. I hoped we had swooped in and righted his ship, but to no avail. His mother is already dead from cholera, dad lives in the Dominican Republic. The lady here with him was dad's aunt. She leaves with his body, on her own to deal with the burial.
One thing that is throwing me off quite a bit is the advanced state people have progressed to before they get here. Of course I knew that was going to be the case, but by definition that means these are cases unlike anything I have ever seen in the states. The man with one testicle three times it's normal size and firm? Cancer? Don't know. Come back and see the urologist next week (and walk for a few hours again?). The man with the mass protruding from his cheek that was reaching the size of a grapefruit? Cancer? Benign? How do I know? No one in the states would let a mass GET this big. Go to Cap Haitian because you will need a facial surgeon. The woman with the mass in her right breast the size of a kiwi? We'll find out tomorrow when we do her likely mastectomy.
in the morning, one of the Haitian residents came running to our clinic asking if there was anything we had to offer the old woman with the "grade 3 tumor in her head." They had already given her mannitol (emergent treatment for severe brain swelling). I have NOTHING to offer, nor did anyone with us. Let's say I did jump in and try to be superman... the end result is no better. We later went to clinic to see if there was anything to help with, and there was the body, head wrapped with a blood soaked bandage, waiting for family to come pick it up.
Yvonne had a clinic case yesterday of a 5-day-old home born baby who arrived with a meningocele (a fluid sac at the base of the back filled with spinal fluid and sometimes cord) leaking spinal fluid onto the exam table. Meningitis in inevitable. We told them to hold him, love him and go home. They were going to try to make it to the Dominican, but there is very little hope.
On the flip side, I got to feel right at home with the retained nail in the leg for the past year. Numb it, make your incision, pull it out and bandage it up. THAT I know how to deal with. And the patient and the daughter were so thankful you would think I had performed a miracle! They sang and raised their hands to the heavens. At least for that moment, for those women, I had made a real difference.
My overall reaction to all of this is very dichotomous. At times, I feel like we are doing so much. At other times? Soooooo little. I can't help more than half of the people I am telling you about. And when you see how many people are here and how sick some of them are, you just feel like you are addressing one grain of sand on a whole beach. It is disheartening at times. But, we do what we can, right? It' s better than if no one was here. But it is also very humbling. I'm no hero. I'm not feeling like I'm changing the world. But, I guess changing the world isn't the goal.
We all continue to be well. Kisses to all.
Monday, January 24, 2011
I spoke too soon...
This post ain't short. Grab a beverage and stay a while...
Well, it initially seemed like my post yesterday was a pretty good summary. The only real action that wasn't captured was the scraping of a courtyard's walls to prepare for a new coat of paint and then dinner. We were all nestling down for a book or cribbage last night. But then we got the early introduction to the OR.
The Canadian MD, Brian, came rushing into our building around 8pm to announce we had just received 3 gunshot wound patients. And no, he wasn't just pulling our chains. We all changed clothes and ran to the hospital. Security was trying to keep 20-30 family and friends out of the "triage" area (read: room with 4 tables in it). None of them hostile, all just concerned. One man was shot in the belly, the other through the arm and a third on the jawline. The two surgeons and Yvonne (the other ER MD) tended to the belly guy, and I was covering the others. The arm was a through and through, minimal bleeding. He got a bandage (strip of old sheeting) and 10 ibuprofen. Thanks for stopping by.
The man with the shot to the jaw was standing in the middle of the room, looking the complete picture of health. He had what looked like a grazing wound to the left jaw line. But he kept telling me his back hurt. He guided my hand to just inside his left scapula. And that is where I could feel the bullet under the skin. This was later confirmed by his otherwise normal chest xray. The bullet had passed into the skin of the jaw line, through the neck, through the trapezius muscle and down the soft tissues of the back. No broken bones, no popped lung, no significant swelling in the neck (ie he missed his carotid and jugular). I stitched him up and he also left with 10 ibuprofen. Completely insane.
While I was doing this, they were finding the 3rd man to have a hole in his stomach and uncontrolled pooling of blood in the abdomen. They patched and looked for the bleeder. Family gave blood (there is no blood bank). But just as the first unit was ready, they found the source of all the trouble. He had a large hole in the inferior vena cava (for those of you not medically inclined, that would be the main vein that returns all blood from the bottom of the body back to the heart). It was a fatal injury. They could finally see the hole because the man was largely out of blood to bleed.
So, we all piled into bed last night at 11pm feeling like we had already worked a full day.
After sleeping MUCH better than the first night, we rose to a hospital lined up with patients for our team. They had all been told to return today to be seen by the surgeons. We went into clinic, which could best be described as a basement utility room with an examination table from 1963. For expediency, I am going to list the people I saw today. Realize, this is not for the faint of heart:
1) Older woman sent for removal of her uterus due to fibroids. Unfortunately, what she actually has is metastatic uterine cancer. Surgery would hasten her death. She was sent home with 10 ibuprofen (are you seeing a theme?).
2) Younger woman, sent for removal of her fibroids. She was examined in the same gown and on the same sheet as #1, as were all the following patients. She was worried about not having periods again because all the blood would build up inside her. She was reassured, and she was the first case of the day. (She is resting comfortably now. I was 1st assist on the case. In case you are wondering what we use to scrub before becoming "sterile" for surgery? Palmolive dish soap).
3) An older man with an enlarged prostate with urinary catheter already in place. He likely has prostate cancer. He was started in antibiotics and told to come back next week when the urologist will be here.
4) Same story as #2
5) An older man with what appeared to be an incarcerated right groin hernia. In the OR Dr. Mestitz actually found a hydrocele and other fun I don't entirely understand. But he's doing ok.
6) An 8 year old boy with a hernia. We told mom to wait until he was older, and she was fine with that.
7) A man with pain with swallowing for 5 years. We didn't have anything surgical to offer.
8) A husband and wife with matching hernias. They are both recovering as I type this.
9) A couple more prostate patients. Same story as #3.
Before lunch, Brian asked Yvonne and I to come look at a kid on the cholera ward. He has been in the hospital for 5 days. The cholera has passed, but he is looking sicker today. We get there and he looks profoundly dehydrated with breathing very poorly. We learn that yesterday he had seemed "congested" and the nurse (and some MD? There are resident haitian doctors here) had given this 10 pound 9- month-old 20mg of IV lasix and then taken out his IV. That is an extremely potent diuretic in an adult. It also can cause very low potassium levels. We started a new IV in the boy's neck and started fluids again. Before our eyes he looked better. I have no way to check his potassium... We give the cholera oral rehydration liquid and hope.
After lunch, I went to the general walk-in clinic to help out. Again, here's a list:
1)****Warning**** This is the worst. First guy I see? He is ~24 years old, scorching fever and says he has pain in his stomach and genitals for 2 WEEKS. He undresses and has a gangrenous penis with fully infected scrotum. He very likely is going to die. I don't have a surgeon who can do what he needs. He gets 2 injections of antibiotics (drawn up and injected by yours truly with one needle) and a shot of pain medicine (same needle), and is carried away by his family to get in a car and head to Cap Haitian where the might be able to save him.
2) high blood pressure check
3) wound check for machete to the toe
4) recheck of a broken finger with k-wires in place (there was an orthopedic doctor here 3 weeks ago).
5) A swollen leg from a bandage tied to tight this morning after his motorcycle accident.
6) An old man with chronic wounds on his ankle. Bandage and hope. Chances they will get more infected and kill him? Pretty good.
7) others I can't remember.
Needless to say, I am tired and a little blown away. I feel we can offer so much, but at the same time so little. I need to give up the computer, but I will try to keep it shorter tomorrow. We are all doing well, and looking forward to dinner! Our thoughts are will all you back home!
becca
Well, it initially seemed like my post yesterday was a pretty good summary. The only real action that wasn't captured was the scraping of a courtyard's walls to prepare for a new coat of paint and then dinner. We were all nestling down for a book or cribbage last night. But then we got the early introduction to the OR.
The Canadian MD, Brian, came rushing into our building around 8pm to announce we had just received 3 gunshot wound patients. And no, he wasn't just pulling our chains. We all changed clothes and ran to the hospital. Security was trying to keep 20-30 family and friends out of the "triage" area (read: room with 4 tables in it). None of them hostile, all just concerned. One man was shot in the belly, the other through the arm and a third on the jawline. The two surgeons and Yvonne (the other ER MD) tended to the belly guy, and I was covering the others. The arm was a through and through, minimal bleeding. He got a bandage (strip of old sheeting) and 10 ibuprofen. Thanks for stopping by.
The man with the shot to the jaw was standing in the middle of the room, looking the complete picture of health. He had what looked like a grazing wound to the left jaw line. But he kept telling me his back hurt. He guided my hand to just inside his left scapula. And that is where I could feel the bullet under the skin. This was later confirmed by his otherwise normal chest xray. The bullet had passed into the skin of the jaw line, through the neck, through the trapezius muscle and down the soft tissues of the back. No broken bones, no popped lung, no significant swelling in the neck (ie he missed his carotid and jugular). I stitched him up and he also left with 10 ibuprofen. Completely insane.
While I was doing this, they were finding the 3rd man to have a hole in his stomach and uncontrolled pooling of blood in the abdomen. They patched and looked for the bleeder. Family gave blood (there is no blood bank). But just as the first unit was ready, they found the source of all the trouble. He had a large hole in the inferior vena cava (for those of you not medically inclined, that would be the main vein that returns all blood from the bottom of the body back to the heart). It was a fatal injury. They could finally see the hole because the man was largely out of blood to bleed.
So, we all piled into bed last night at 11pm feeling like we had already worked a full day.
After sleeping MUCH better than the first night, we rose to a hospital lined up with patients for our team. They had all been told to return today to be seen by the surgeons. We went into clinic, which could best be described as a basement utility room with an examination table from 1963. For expediency, I am going to list the people I saw today. Realize, this is not for the faint of heart:
1) Older woman sent for removal of her uterus due to fibroids. Unfortunately, what she actually has is metastatic uterine cancer. Surgery would hasten her death. She was sent home with 10 ibuprofen (are you seeing a theme?).
2) Younger woman, sent for removal of her fibroids. She was examined in the same gown and on the same sheet as #1, as were all the following patients. She was worried about not having periods again because all the blood would build up inside her. She was reassured, and she was the first case of the day. (She is resting comfortably now. I was 1st assist on the case. In case you are wondering what we use to scrub before becoming "sterile" for surgery? Palmolive dish soap).
3) An older man with an enlarged prostate with urinary catheter already in place. He likely has prostate cancer. He was started in antibiotics and told to come back next week when the urologist will be here.
4) Same story as #2
5) An older man with what appeared to be an incarcerated right groin hernia. In the OR Dr. Mestitz actually found a hydrocele and other fun I don't entirely understand. But he's doing ok.
6) An 8 year old boy with a hernia. We told mom to wait until he was older, and she was fine with that.
7) A man with pain with swallowing for 5 years. We didn't have anything surgical to offer.
8) A husband and wife with matching hernias. They are both recovering as I type this.
9) A couple more prostate patients. Same story as #3.
Before lunch, Brian asked Yvonne and I to come look at a kid on the cholera ward. He has been in the hospital for 5 days. The cholera has passed, but he is looking sicker today. We get there and he looks profoundly dehydrated with breathing very poorly. We learn that yesterday he had seemed "congested" and the nurse (and some MD? There are resident haitian doctors here) had given this 10 pound 9- month-old 20mg of IV lasix and then taken out his IV. That is an extremely potent diuretic in an adult. It also can cause very low potassium levels. We started a new IV in the boy's neck and started fluids again. Before our eyes he looked better. I have no way to check his potassium... We give the cholera oral rehydration liquid and hope.
After lunch, I went to the general walk-in clinic to help out. Again, here's a list:
1)****Warning**** This is the worst. First guy I see? He is ~24 years old, scorching fever and says he has pain in his stomach and genitals for 2 WEEKS. He undresses and has a gangrenous penis with fully infected scrotum. He very likely is going to die. I don't have a surgeon who can do what he needs. He gets 2 injections of antibiotics (drawn up and injected by yours truly with one needle) and a shot of pain medicine (same needle), and is carried away by his family to get in a car and head to Cap Haitian where the might be able to save him.
2) high blood pressure check
3) wound check for machete to the toe
4) recheck of a broken finger with k-wires in place (there was an orthopedic doctor here 3 weeks ago).
5) A swollen leg from a bandage tied to tight this morning after his motorcycle accident.
6) An old man with chronic wounds on his ankle. Bandage and hope. Chances they will get more infected and kill him? Pretty good.
7) others I can't remember.
Needless to say, I am tired and a little blown away. I feel we can offer so much, but at the same time so little. I need to give up the computer, but I will try to keep it shorter tomorrow. We are all doing well, and looking forward to dinner! Our thoughts are will all you back home!
becca
Sunday, January 23, 2011
Day 2
Well, it's only 2pm, but I don't know when I'll be on the computer again.
Sleep last night was, well, noisy. I had pictured the hospital being in the middle of nowhere, but we are smack in Limbe, which is a bustling town. Our house (cement floor, stucco walls, screens but no windows, tin roof) is close enough to the one road paved road that there were sounds of horns (usually honked for little reason I can find) throughout the night. I have also learned that roosters do not wait until dawn to crow. It's more like 4am, and they continue until about 7am.
We all had breakfast in the dining building. A few Haitian ladies are employed by the organization to feed all the hospital staff and volunteers. I may actually gain weight in Haiti, which seems twisted. After breakfast we headed back into Limbe to walk around. The people are very nice. First, it's staring and pointing. Then some giggling. If we say "bonjour" and wave, they return it and smile.
Church was the event of the morning for Limbe. In our loop around "town" there were 4 churches (One adventist, one Catholic, one Baptist, one unknown). The witch doctor's office is right next to the hospital, so we have that covered as well. You would not believe the absolute finery that is worn to church. Think of the fanciest dresses you see for little girls at Target. Frilly, shiny shoes, boys in suit pants and ties, men in full suits. The women! Beautiful clothes, hats, HEELS (on the dirt, rock and mud puddle roads). Many many people dressed in brilliantly white clothes, perfectly pressed.
Contrast that to the underlying scene. There is no plumbing. No sewage system. People urinate in the trees, or by the side of the road. There is no electricity, but you can find cell phone stations at the market to buy minutes as you can afford them. Cell phones are not rare. Grains are seen laying out on sheets on the paths to dry out... but you can have the little problem of the dog urinating in the middle of it like we saw this morning. Trenches can be found with rancid water and the trash is pretty much everywhere. There is no garbage system. Refuse goes pretty much wherever.
We are highly pampered in the compound with running cold water, toilets and trashcans (can't really tell you where any of it goes...). I have a bed, a pillow, and a ceiling fan! I am in shorts and sweating while outside, so that seems luxurious by any Minnesota standard!
Tomorrow we will start the surgical week. I am here with an OB/Gyn, a general surgeon, 2 nurse anesthetists and another ER doctor. The schedule is full all week for surgical cases. We will check them out in the morning, then the surgeons will start and I will take care of them as they recover as well as get the next patients ready to go. At least that's what I think I'll be doing. Tomorrow's message will tell you the reality.
To my family - thanks for the messages left. I will see if I can get into my email as well. I hope I haven't left you in the lurch too much! Thanks for letting me be away to do this. I miss you all very much.
Sleep last night was, well, noisy. I had pictured the hospital being in the middle of nowhere, but we are smack in Limbe, which is a bustling town. Our house (cement floor, stucco walls, screens but no windows, tin roof) is close enough to the one road paved road that there were sounds of horns (usually honked for little reason I can find) throughout the night. I have also learned that roosters do not wait until dawn to crow. It's more like 4am, and they continue until about 7am.
We all had breakfast in the dining building. A few Haitian ladies are employed by the organization to feed all the hospital staff and volunteers. I may actually gain weight in Haiti, which seems twisted. After breakfast we headed back into Limbe to walk around. The people are very nice. First, it's staring and pointing. Then some giggling. If we say "bonjour" and wave, they return it and smile.
Church was the event of the morning for Limbe. In our loop around "town" there were 4 churches (One adventist, one Catholic, one Baptist, one unknown). The witch doctor's office is right next to the hospital, so we have that covered as well. You would not believe the absolute finery that is worn to church. Think of the fanciest dresses you see for little girls at Target. Frilly, shiny shoes, boys in suit pants and ties, men in full suits. The women! Beautiful clothes, hats, HEELS (on the dirt, rock and mud puddle roads). Many many people dressed in brilliantly white clothes, perfectly pressed.
Contrast that to the underlying scene. There is no plumbing. No sewage system. People urinate in the trees, or by the side of the road. There is no electricity, but you can find cell phone stations at the market to buy minutes as you can afford them. Cell phones are not rare. Grains are seen laying out on sheets on the paths to dry out... but you can have the little problem of the dog urinating in the middle of it like we saw this morning. Trenches can be found with rancid water and the trash is pretty much everywhere. There is no garbage system. Refuse goes pretty much wherever.
We are highly pampered in the compound with running cold water, toilets and trashcans (can't really tell you where any of it goes...). I have a bed, a pillow, and a ceiling fan! I am in shorts and sweating while outside, so that seems luxurious by any Minnesota standard!
Tomorrow we will start the surgical week. I am here with an OB/Gyn, a general surgeon, 2 nurse anesthetists and another ER doctor. The schedule is full all week for surgical cases. We will check them out in the morning, then the surgeons will start and I will take care of them as they recover as well as get the next patients ready to go. At least that's what I think I'll be doing. Tomorrow's message will tell you the reality.
To my family - thanks for the messages left. I will see if I can get into my email as well. I hope I haven't left you in the lurch too much! Thanks for letting me be away to do this. I miss you all very much.
Saturday, January 22, 2011
Home sweet Haiti
We are safe and sound on the ground in Limbe! The plane trip from Miami to Cap Haitian was smooth as can be. They hadn't loaded any luggage on the plane (that's right, ANY), so we waited at the airport for the next plane 45 minutes later. Thankfully everything was on it (it was the only other flight for the day), and we all piled into the van.
The road trip was very bumpy and quite a quick snapshot of the poverty that is around us. The earthquake didn't really affect this area - we are pretty far north and the epicenter was at Port au Prince on the southern half. But, the amount of crumbled buildings just from decay is still profound. We got to the hospital compound an hour later, unpacked, had some lunch (very yummy), took a tour of the hospital and then went for a walk through the market.
It was an extremely crowded circle of booths and vending stations selling, beans, tomatoes, underwear, soda, shrimp, dried fish, chicken feet, greens, soap, pharmacy mystery pills, water, oil, shirts, skirts and other necessities. We heard a lot of "blanc" as we walked through. Though we certainly stick out like a sore thumb, the market is very near the hospital compound, so the locals seem to know who we are and why we are here.
We will start work on Monday, though the cholera unit is running 24/7. The numbers are down right now (only 7 patients) and there is a full time MD from Canada covering that. For now, we are acclimating.
Love to you all! I am very well. For me, the only real worry was getting here. So, that is done! I will try to keep things up to date!
becca
The road trip was very bumpy and quite a quick snapshot of the poverty that is around us. The earthquake didn't really affect this area - we are pretty far north and the epicenter was at Port au Prince on the southern half. But, the amount of crumbled buildings just from decay is still profound. We got to the hospital compound an hour later, unpacked, had some lunch (very yummy), took a tour of the hospital and then went for a walk through the market.
It was an extremely crowded circle of booths and vending stations selling, beans, tomatoes, underwear, soda, shrimp, dried fish, chicken feet, greens, soap, pharmacy mystery pills, water, oil, shirts, skirts and other necessities. We heard a lot of "blanc" as we walked through. Though we certainly stick out like a sore thumb, the market is very near the hospital compound, so the locals seem to know who we are and why we are here.
We will start work on Monday, though the cholera unit is running 24/7. The numbers are down right now (only 7 patients) and there is a full time MD from Canada covering that. For now, we are acclimating.
Love to you all! I am very well. For me, the only real worry was getting here. So, that is done! I will try to keep things up to date!
becca
Friday, January 21, 2011
Leaving on a prop plane...
T minus 7 hours. Sitting in the Miami hotel trying to convince myself I'm sleepy even though it's only 8pm at home. We leave for the airport at 4:30am (ie 3:30 at home).
Just had dinner with the crew and am so excited to get started. It is so clear that anything we can do to help is so much more than they have. We are the first surgical crew to be at the hospital in 6 months! There will be a line of patients waiting for us Monday morning. We will do 8-10 cases a day. My roll will be triage and post-anesthesia care, though the MD who is leading us said the best approach is No Expectations. We will do whatever needs to be done. She said to expect at least one death, and the orphanage is so heartbreaking (all disabled kids, CP, incontinence, MR) that we may not be able to stomach it.
Tomorrow will be getting settled and taking it all in. I'll post when I can. It may be more for me than anyone else...
Just had dinner with the crew and am so excited to get started. It is so clear that anything we can do to help is so much more than they have. We are the first surgical crew to be at the hospital in 6 months! There will be a line of patients waiting for us Monday morning. We will do 8-10 cases a day. My roll will be triage and post-anesthesia care, though the MD who is leading us said the best approach is No Expectations. We will do whatever needs to be done. She said to expect at least one death, and the orphanage is so heartbreaking (all disabled kids, CP, incontinence, MR) that we may not be able to stomach it.
Tomorrow will be getting settled and taking it all in. I'll post when I can. It may be more for me than anyone else...
Thursday, January 20, 2011
And on a serious note...
This blog is about to take a serious turn to a different theme. The antics of the crazy A boys will be on temporary hiatus as this becomes the journal for my medical mission trip to Haiti. I leave tomorrow for Cap Haitian, then a quick car ride over to Limbe.
If you want to check out where I will be, link to HBSLimbe.org.
Feel free to leave me comments. The internet may be my only form of communication to the states. For good or bad, I am sure I will have lots to write about!
If you want to check out where I will be, link to HBSLimbe.org.
Feel free to leave me comments. The internet may be my only form of communication to the states. For good or bad, I am sure I will have lots to write about!
Thursday, January 13, 2011
Boy update
It's time for one of those snapshots in time where I can look back and see what my boys were all about back in the beginning of 2011.
Max (8yr old) - You continue to be a very heart-felt and empathetic person. You LOVE hugs from your littlest brother and get a little hurt if he doesn't want your affection in a moment of 2yr old defiance. You are still having a bear of a time with your spelling homework and I try to fight the natural pattern I fall into of getting crabby at you when you appear to give up on it. You are the team leader of the shenanigans that go on around here, and it is difficult when you brothers want to take their own turn and making up the rules of a game. But, with some encouragement, you are OK with it. When it comes right down to it, you are a very adaptable little man. I love you so much.
Spencer (5 and a half) - You are my incredibly loving and emotional little imp. The daily tribulations that used to turn you into a puddle of frustration (like putting on your socks if they were for some reason being difficult) aren't nearly as bothersome to you as they used to be. If I say no to something, you have grown up to the point that you can say "Ok mom" and TRULY be ok. Your devilish little smile can crack my heart open wide. Color by number is a current passion, though anything can wait if Phineus and Ferb is on TV. Your favorite snack is a pickle, or a bowl of cherry tomatoes. Apple slices will do in a pinch. Your favorite place in the world is still hanging from my body. I love you so much.
Calvin - (5 and a half) Whatever you do in this life, it will be with great determination and focus. You can be such a little goofball, but if you have something in mind, you will continue towards your goal come hell or high water. Unfortunately, the flip side of this is a strong leaning towards stubbornness, which I have to say you came by honestly from me. You DO NOT like being rushed or being told what to do... which is a bit of a tough road as a 5yr old. You love to read with us and are very interested in starting to read yourself. You love watching Max doing his homework, wishing you had some too. I love you so much.
Leo (2yrs old) - Oh, my little baby man. You think you are hilarious. You also think you are at least 5 years old if not older. Whatever your brothers are doing, you are right along side, not at all aware that you are limited by age and size. You love to dance, try to make us laugh, and snuggle up with us. You have really turned on the "mommy mommy mommy" lately. That includes who you want to change your diaper, so Dad doesn't get a complete bum deal. You have to have your stinky blanket shoved in your mouth to sleep, and you are showing similar focus to Calvin, especially if it involves your shoelaces. I love you so much.
Max (8yr old) - You continue to be a very heart-felt and empathetic person. You LOVE hugs from your littlest brother and get a little hurt if he doesn't want your affection in a moment of 2yr old defiance. You are still having a bear of a time with your spelling homework and I try to fight the natural pattern I fall into of getting crabby at you when you appear to give up on it. You are the team leader of the shenanigans that go on around here, and it is difficult when you brothers want to take their own turn and making up the rules of a game. But, with some encouragement, you are OK with it. When it comes right down to it, you are a very adaptable little man. I love you so much.
Spencer (5 and a half) - You are my incredibly loving and emotional little imp. The daily tribulations that used to turn you into a puddle of frustration (like putting on your socks if they were for some reason being difficult) aren't nearly as bothersome to you as they used to be. If I say no to something, you have grown up to the point that you can say "Ok mom" and TRULY be ok. Your devilish little smile can crack my heart open wide. Color by number is a current passion, though anything can wait if Phineus and Ferb is on TV. Your favorite snack is a pickle, or a bowl of cherry tomatoes. Apple slices will do in a pinch. Your favorite place in the world is still hanging from my body. I love you so much.
Calvin - (5 and a half) Whatever you do in this life, it will be with great determination and focus. You can be such a little goofball, but if you have something in mind, you will continue towards your goal come hell or high water. Unfortunately, the flip side of this is a strong leaning towards stubbornness, which I have to say you came by honestly from me. You DO NOT like being rushed or being told what to do... which is a bit of a tough road as a 5yr old. You love to read with us and are very interested in starting to read yourself. You love watching Max doing his homework, wishing you had some too. I love you so much.
Leo (2yrs old) - Oh, my little baby man. You think you are hilarious. You also think you are at least 5 years old if not older. Whatever your brothers are doing, you are right along side, not at all aware that you are limited by age and size. You love to dance, try to make us laugh, and snuggle up with us. You have really turned on the "mommy mommy mommy" lately. That includes who you want to change your diaper, so Dad doesn't get a complete bum deal. You have to have your stinky blanket shoved in your mouth to sleep, and you are showing similar focus to Calvin, especially if it involves your shoelaces. I love you so much.
Saturday, January 1, 2011
Well, that was a whole lot of fun
The madness that is the Ansari love of skiing officially has two new initiates. After a fun (and work packed) X-mas season, we packed up the bags, tossed the baby boy off to my parents, and headed to Truckee, CA to our dear friends' parents home. Matt, Megan and their two awesome kids Casey and Claire hosted a fantastic week of powder filled madness, the first of many for Cal and Spence.
All 5 kids took 3 days of lessons (except for the one pukey day for Claire... boo) while the adults gave themselves daily reminders that we just aren't 20 anymore. It snowed an amazing 20 inches during the second night, and we headed out like kids to a candy store. After our first run, the legs were screamin', the bodies were covered in the snow from multiple major diggers, and the sweat was pouring under our pile. It got easier as the day went on, and we finished the day feeling great. Northstar is a really nice mountain.
The nights were filled with hot tubbin, Highlights-and-Lowlights, giggles and games. When it came time to ski with the kids, they amazed us with their new skills. It's fascinating how the personality of the kid comes through. Cal skis exactly how they taught him, with meticulous attention to his snowplow form and beautiful little S turns. He is in control at all times, proud of his precision. Spence is like a little maniac, skiing with his skis in parallel at all times, slowing down with one turn that either finishes with a full 360 spin or a wipeout. Either way, he smiles and starts bombing it again.
Cal, Claire, Spence, Max and Casey (boys sporting post-hot tub mohawks)
Final Hot Cocoa
We did finish with a flourish when we awoke to a snow storm and news that I-80 to the airport was requiring chains on all vehicles that didn't have 4-wheel drive (i.e. our rental car). Omar and Matt were casing gas stations at 6:30am, found a pair, came home, found out they were the wrong size, returned with all of us in tow, bought the second pair (and no, they don't take returns on the ones they sold you 15 minutes ago) and put them on. All of this before 7:15am. Yippee! That's the way to wrap things up! We made our flight home, and now all are in bed.
Thanks Matt and Megan (and family!). We had a total blast. Next year, 4-wheel drive!
All 5 kids took 3 days of lessons (except for the one pukey day for Claire... boo) while the adults gave themselves daily reminders that we just aren't 20 anymore. It snowed an amazing 20 inches during the second night, and we headed out like kids to a candy store. After our first run, the legs were screamin', the bodies were covered in the snow from multiple major diggers, and the sweat was pouring under our pile. It got easier as the day went on, and we finished the day feeling great. Northstar is a really nice mountain.
The nights were filled with hot tubbin, Highlights-and-Lowlights, giggles and games. When it came time to ski with the kids, they amazed us with their new skills. It's fascinating how the personality of the kid comes through. Cal skis exactly how they taught him, with meticulous attention to his snowplow form and beautiful little S turns. He is in control at all times, proud of his precision. Spence is like a little maniac, skiing with his skis in parallel at all times, slowing down with one turn that either finishes with a full 360 spin or a wipeout. Either way, he smiles and starts bombing it again.
Cal, Claire, Spence, Max and Casey (boys sporting post-hot tub mohawks)
Final Hot CocoaWe did finish with a flourish when we awoke to a snow storm and news that I-80 to the airport was requiring chains on all vehicles that didn't have 4-wheel drive (i.e. our rental car). Omar and Matt were casing gas stations at 6:30am, found a pair, came home, found out they were the wrong size, returned with all of us in tow, bought the second pair (and no, they don't take returns on the ones they sold you 15 minutes ago) and put them on. All of this before 7:15am. Yippee! That's the way to wrap things up! We made our flight home, and now all are in bed.
Thanks Matt and Megan (and family!). We had a total blast. Next year, 4-wheel drive!
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