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
Monday, January 24, 2011
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!
Subscribe to:
Posts (Atom)