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