Guest blogs
David was a nursing student of mine last summer when I was still teaching in California. He recently finished his BSN and is getting ready to take the NCLEX, the licensing exam for RNs. He just came back from a medical mission to Haiti and he kindly agreed to share his blog postings with us. I love his writing style - very personal and you feel like you are there and as he describes it a 'stream of consciousness'. Note though, I didn't edit his postings so if you are offended by strong language you should skip this. His experiences in one week are much more than what most students get in their entire programs.
From David -
Let me preface this blog with a couple truths.
1. I only slept 3.5 hours last night
2. I woke up at 4:30am
3. Been traveling all day
4. I refuse to check or edit this blog for content save for, spelling errors
The Herzenbergs plan a disaster relief mission to Haiti in wake of the most recent earthquake… hilarity ensues. Keeping in tradition with past travels, our late night of packing is not to be out done by our early morning emergency. Our transportation to BWI airport seemed to have overlooked a minor detail of our reservation. It’s in situations like these that I see the true value in using military time. We somehow rise to the occasion and hit the road by our own volition at 5:30 am, or 0530hr to clear up any confusion. Miraculously we arrive at the airport with time to spare and manage to board the plane with thoughts of anticipation, excitement and nervousness.
And we’re up and off… and for the most part the first flight was uneventful, which happens to be a quality I quite enjoy while flying. Sleep, sweet, sweet much needed sleep. I however was somehow swindled into purchasing an $8 blanket… since when did airlines stop offering free blankets and pillows? Have I been grounded for that long?
We Land in San Juan around 1200hr local time. The reality of our mission is becoming more of… well… a reality. Although we are still in the terminal I can feel the sweet sensation of tropical heat though moistened breaths. I am slightly disheartened to see a Cinnabon in the terminal… Don’t get me started!! Anyhow, we board the tiny double propeller plane on the tarmac and I instantly feel like I’m sitting in a giant croc pot, stewing in my teammates juices. We have an issue with one of our bags that delays our departure. Apparently a few moderately large containers of hand sanitizer have managed to spill contents and the smell has alerted the crew. Unsure as to the source of the smell, the crew spends an additional 45 min “solving” the issue before we depart.
Finally we are up and off again… Just a quick oceanic voyage from San Juan to Port Au Prince. It is instantly clear we are traveling in the midst of the rainy season. I play a long game of charades with the low hanging cumulonimbus clouds. At times I feel like I’m floating over a giant air born petting zoo. It was not difficult to appreciate the Dominican landscape… rolling green pastures enclosed by even greener mountain ranges. My eyes pick out several unexpected yet familiar shapes. The landscape is dotted with a myriad of baseball diamonds, so many in fact; Sammy Sosa himself would be impressed. However, this wondrous backdrop does not continue forever. Like a slide in a power point presentation, our lush greenery is abruptly replaced by a landscape that is stripped and brown. My mind is jarred by the contrast and is searching for answers as to how such a dichotomy can exist. Static from the overhead speakers is followed by the captain’s voice, “Attention passengers, we have just crosses into Haiti’s airspace.” Closing in on the capital, tell tale signs of disaster make themselves known. Those bright blue dots, some spread out, some so close together, what are they, they seem so familiar. No, those drops of bright blue are not swimming pools, they are the lengths of blue tarp that are covering damaged homes and providing extra shelter from monsoon rains. Welcome to Haiti.
We land, we deplane, we make our way across the tarmac into the terminal. Unapologetically Haiti greets us in the only way she can. We are blasted by heat, assaulted by humidity, overcome by noise, and intimidated by a culture that remains a mystery to most of us. We rally, we steady our nerves, we collect our baggage. We feel good with the knowledge that all of our bags and our entire team has made it, at least, to the airport. Only one problem remains… does anyone know how we are going to get to the hospital? I’ll spare the details, but if you have ever traveled in a third world country, much less after a disaster, you understand how difficult it can be to get to your destination from the airport. After another hour in the sun, we wade our way through the airport loiterers and solicitors and fill three vans with our crew and bags. We are moving again.
I’ve had the honor of volunteering in the wake of several disasters; the atmosphere here in Haiti is no different. Filthy streets, undulating crowds of people, outstretched hands reaching into your vehicle looking for a donation, animals rooting out a meal, piles of trash clogging the streets, rivers of plastic damming up the gutters, the sweet stench of rotting organic matter, that dry feeling you get in your nose from swirling dust and diesel fumes, crippled buildings, roads, and infrastructure, numerous tent cities, and traffic, my god the traffic! Ladies and Gentlemen of Team Sinai, you have arrived; this is what you asked for.
There is more… but I’m just too tired to write. We have 6:30am preconference before we hit the floor. Just know that I’m safe, (perhaps not from the Mosquito’s) I’m at the hospital we are staying at, and it’s hot! Hotter then… well… Haiti…
Again, sorry for the bad grammar and poor usage of imagery, I just don’t care that much.
Stay tuned.
Sign off, log out, and close the laptop… That’s where we left off.
Again, I’m not going to edit this so deal.
I must say, I severely dislike the cot I’m sleeping on. If feels like I’m laying on the stretched skin of a tambourine. Similarities end when toss and turn on the cot. Rather than the charming jingle of a tambourine, my cot more mimics a creaking door in an Alfred Hitchcock movie. Anyhow… I digress. I attempt to erect my mosquito net and acquire my much-needed nighttime comforts. I am deeply saddened that I cannot construct my signature pillow nest ☹. Thus I lay in discomfort and attempt to will myself to sleep. I am actually almost successful, just as my subconscious begins to cross the threshold of my mind my animal brain is thrust into action. The scream of a patient’s mother sends bolts of adrenaline throughout my body. I’m up and running to her room before I realize I’m not dreaming. Lying, post ictal, the daughter stares blankly up at the ceiling while her respiratory level continues to drop. “Who has the key to the O2 tank?!” Yells our pediatrician. “Key!?” I think to myself. Now seriously, why the hell would you need a key for an O2 tank? On a side note this is the second time I’ve been in a situation where no one had the key for the O2 tank. That’s like putting a combination lock on a toilet.
After much cursing, crying, and possible voo doo? The girl is stabilized and I wander through the darkness back to bed. Struggling to fight my way through my mosquito net into my bed I find myself relating to sea turtles that are unfortunate enough to find themselves in fishing nets. I lie in bed still, and contemplate the unyielding heat. Even at 2:30am the heat is oppressive, the air sits heavy and thick around me. I feel like I could bite the air and spend a good deal of time chewing it. I fall in and out of sleep for the next few hours. Semi interesting fact about Haiti, the sun rises at 4:30 am… Weeeee! FML
Once again I wake up sweating and sticking to my cot from hell. I count at least three mosquito bites and contemplate the possibility of a lifetime living with malaria. 6:30 am morning conference… I stagger to the meeting, doing my best zombie impersonation… how appropriate for Haiti. Its not so hot today, my back doesn’t feel like it’s crying. (about 30 min passes)… Holy shit its so fucking hot! My black underwear and blue scrubs have saturated, the colors run and stain my ass purple… just kidding, but seriously, it felt like I just stood in the rain for about 10 min, and then shrank 4 feet and ran under a hand dryer. I quietly give in to the heat and accept the fact that all the baby powder in the world won’t keep my ass dry… I’ll just end up making paper mache.
There is no way I can sum up everything I experienced today. Suffice to say, I learned more today than I did over the past year in nursing school. I must have seen 40 patients myself on the floors. I lost count of how many dressing changes I performed. I struggled with language difficulties. I witnessed children and adults cry. I saw injuries that made me sad. I discharged patients that wanted to stay in the hospital because it was better than their own living conditions. I scrubbed in to two surgeries in which I suctioned, helped suture, and stapled wounds. I learned a lot more about what people look like on the inside. I saw bone being harvested from a hip. I ate rice and beans. I made new friends. I surprised myself. I missed people back home. And finally, I felt really good about what we accomplished today. It’s getting late and there is just too much detail to get into. If you’re really interested, ask me when I get home.
More to come…. Perhaps?
Drained… totally drained…
If you think the grammar in my last two blogs is poor then feel free to revise and repost yourself, the same rule applies to this one.
Again, with the 2:30 am crying. I have a feeling this is a nightly occurrence ☹. Hopefully I won’t strike out with the whole sleep thing again tonight. I’m draining my batteries faster than I can recharge them.
Today was Sabbath, supposedly the day God rested… I’m not a god. I awoke to the sound of church music and prayer. Saturday was supposed to be our slow day. Our usual 6:30 am preconference was replaced by 6:30 am rounds so we could get some rest… explain to me how that works exactly? Anyhow, rounds gave way to our frenetic pace, (I assume this the standard). I have my hands in a little of everything here, medsurg, OR, ER, social worker. After sweating my balls off in pre and post op, a couple quick dressing changes and finding adequate staffing for the ER, I found myself back in the OR. I seem to spending a lot of time in the OR, not specifically because I prefer it, but because I feel like I know the least about this area of nursing practice. There are so many protocols and procedures that must be followed in specific sequences. Even the act of putting on your gown requires a significant amount of planning and for thought.
I was the scrub nurse in one of the OR’s today. I was responsible for setting up the table, getting all the gear/tools/supplies, getting everyone’s gown and gloves, helping everyone get dressed, setting up the sterile field, knowing the names of all the instruments, killing insects (yes there are flies in our OR), producing the correct instruments when requested by the surgeon, and sweating my balls off. I was basically wearing a really ugly light blue sterile burkka. What with the mask, hair net, face mask, lead vest, gown, shoe booties and two pair of gloves I was following Shuria law to the T.
Our first case was a simple wound vac dressing change. Unfortunately we seemed to hit a snag with every step. What was supposed to have taken an hour ended up being more like two and a half or possible three hours. Our patient’s IV was infiltrated and was of course a hard stick. And to add the icing to the crap cake guess who our patient was. Yes, the little girl who has been keeping us up every night. A little history on our girl… Compound fracture of the fight femur during the earthquake. Ex-fix put on to keep the leg healing straight (think pins and braces), and a skin graft flap in an attempt to join a non-union, (think really big open would that is too wide to close on it’s own). Ok, so as you may or may not remember the Earthquake happened in mid January. Since then every team who has come through our hospital has attempted to treat our young lady. In that time her wound has been infected and debreeded on many occasions. In that time she has developed quite a tolerance to opiate and narcotic drugs. I’m beginning to understand why she cries every night, she’s in pain, not so much because of the injuries themselves, but because she’s in withdrawal. That shit is crazy.
Attempting to get an IV back into this girl proved to be a challenge. As you can imagine, the majority of her veins are all used up, I’m sure she has been stuck a million times by every team since the earthquake. We wanted to change her wound vac with conscious sedation and needed to have a line incase we needed to load fluids. In an attempt to calm her down, (she was already hysterical), we gave her 60 mics of Ketamine, and I can’t remember how much Fentanyl and Propophol. And during the entire procedure it was clear that she was still feeling it. She kept repeating, “I’m in pain, I’m in pain, over and over through out most of the procedure. Even at her most sedate she was still moaning and trying to wriggle off the table.
We had some trouble getting a good seal with the wound vac. Yes, I’m dropping mad medical term bombs on you. Imagine an open infected yet wound the size to two bananas side by side on a 60 lb girl’s thigh. Now imagine a bunch of pins sticking out each connected by an articulation yet fixed rod the width of a toilet paper dowel. All this is on a hysterical frightened little girl who has been traumatized, continues to live in trauma and is going through opiate withdrawal. Ok, you with me? Take out the old dressing, and vigorously clean out that wound. Pack it full of new sponge, cut it to fit of course, and seal it with really sticky flimsy sheets of tape. Make sure to wrap each of the six pins and prevent any air from entering or escaping the wound. Now cut a hole and reattach the vacuum pump. The suction should pull infected fluids out and promote tissue granulation and healing. Oh yea, and keep the procedure sterile.
Ok, so we do all that and we find out we don’t have a seal. Dimmit. I’m so sick of wearing this mask and not being able to scratch my nose! I can feel my fingers pruning up inside my gloves. We work on it for another 45 minutes. That’s it, we can’t get it to seal and she’s been sedated for a long time, we don’t want to keep her under any longer than we have to. I break my sterile field and race back into the hospital. As it so happens another volunteer who is not associated with team Sinai is a wound care specialist. It’s time to bring in the ringer. We get her in and within 30 min we have the wound dressed and resealed. Guerilla medicine is awesome. It feels so free to conduct our procedures based on need rather than protocol. We are working in reality; the ivory tower of NCLEX seems so alien and distant. I’m going to have to will myself back into NCLEX logic when I return to SF. But until then I will fully enjoy implementing need-based practice. There is so much more that went on today… I’m just too tired to relay it.
Final thought… I’m spoiled, really spoiled, so spoiled in fact that I have the audacity to complain about my sleeping situation in the face of all this disaster around me. Yea I may not be totally comfortable… but just down the hall are all my patients, just as hot, with broken limbs, only getting 1 meal a day, staring down an incredibly difficult future of rebuilding their bodies, lives and country. And I complain about heat and mosquitos… God get yourself in check David!
Doing it in the Dark…
Before I write anything of substance just know that my feet feel like hotdogs that were cooked in the microwave… all bloated and tight… about to pop and spill foot meats all over ☹ I’ve been standing up all day.
ANYHOW
As if the conditions in which we operate aren’t difficult enough, imagine trying to perform surgery without electricity and solely by headlamp. Yikes! Don’t every get sick or injured in a third world country. But I’m getting ahead of myself… lets start with how today began… or rather how last night ended. I’m trying to write a blog a day which is proving to be difficult. Not because there is a lack of content but rather because I’m fucking tired. The lack of quality sleep is catching up with me. Last night the same ole song was playing again. Same girl, same weeping. I’m a little ashamed to say just couldn’t face it again last night. I crept out of my cot and made my way into the dining lounge, which is much cooler btw. Finally starting to sleep for real I am again suddenly brain slapped back to reality. “Hey pretty boy!” “Is that you?!”, “I found you, Hahaha!”, “wake up its 3:30, Hahaha!
And then slam, they left the room. Seriously WTF, was that at all necessary?! I was so delirious and left helpless without the aid of my contacts or glasses. So I seriously have no idea who masterminded this deviously retarded plan. So thanks Mrs. Mystery dick for fucking up my sleep, yay, lets keep the shitty sleep streak going!
Meh… anyhow, had lots of surgery cases today. Here are some highlights.
1. We took off a guys Ex-fix and opened up his leg. Wow, necrosis… Dead muscle is gross, but dead bone is just sad. The total operation took 6 hours between removing the ex fix, removal of dead tissue, insertion of antibiotic beads (which I made myself), and application of an ilizerof cage fixator. This case requires extensive set up. Tons of tools, drills, pins, needles, a million little nuts and bolts of all sizes an variations… Orthopedic surgery is very similar to carpentry… or a really complex piece of Ikea furniture.
2. I did my very fist sterile set up all by myself today, Yay, all by my self; I’m such a big boy! (Just a side note, someone just Coded and died in the ER… like just now… Christ, second one today… at least that’s average) Ok yea, so my very first sterile set up, we put an Ex –fix on a ten year old girl with a fractured femur (very common injury). I had everything dialed in, and was totally sterile. I only forgot one thing…my lead… and yes we were using Floro (real time X rays). We must have taken at least 150 X rays during this case. I found myself ducking and diving behind team members every shot. I will consider hat my work out for the day. I’ve been doing push ups, sit ups and various other exercises every night, just as I said I would… but I don’t think it’s gonna happen tonight. It’s already so late.
3. Last case of the evening, hip reduction on a 44-year-old woman. Basically her hip was dislocated during the earthquake. We think she was trapped under rubble and her hip dislocated when she was dragged out from under rubble. The dislocation was severe, so severe the femoral head, (very top of the thigh bone which connects into the hip), tunneled through near by connective tissue and settled near the internal lady bits. The head surgeon asked me to insert my hand into the would and probe into the tunnel to feel calcified bone/scar tissue that had formed and prevented the hip from settling back into place. I almost got up to my wrist. I must say it was kind of exhilarating… I know how strange and perverted that sounds don’t worry, I’m not a serial killer. We lost power several times during this case and worked by headlamp… that too was exhilarating.
4. I finally left the hospital today and ventured into the outside world. A local anesthesiologist was kind enough to work with us all day. She worked till 9 (well after dark) and expressed her concern regarding driving home alone tonight. Apparently, our hospital is located in the second worst neighborhood in Haiti; only to be outdone by our neighboring town with is the worst and most violent. So I offered to ride her to her neighborhood and be followed by one of our vehicles, at which point I would ride back with our transporter. It’s pretty apocalyptic out there. Fires, rubble, police, burned out vehicles, and chaotic people everywhere. Life it tough… If you are reading this you will probably never struggle through life like these people are. (Obviously myself included).
Every day here is sobering. It’s really difficult to describe in words what I’m seeing and experiencing. How do you describe a hopeless moaning child, or driving through rampant population wide desperation in the dark, or hearing that a mother just stopped by the hospital because her baby is dead and is asking for verification so she can have her child buried for free, or the look of gratitude when you see a patient smile even though you know he doesn’t understand you and is scared out of his mind. I’m not a poet; I’m trying my best to bring you guys here with me, its not all mosquitoes, heat and insomnia. This shit is a real guys… it’s fucking real.
Fine, I’ll do the fucking push ups
’ve given up on editing
Sleep, glorious sleep! Finally, a full 5 hours. I feel moderately recharged. Today began with out power or water, kinda shitty considering you wake up sweaty and gross. The one comfort I’ve been able to keep constant is my oral hygiene. It took a while but I was finally able to brush my teeth today. There is nothing worse than smelling your own bad breathe inside a facemask for hours in the heat.
Today’s highlight
Went to the Red Cross to get blood for two patients whose labs made them ineligible candidates for surgery. The first, a little girl who needs a below the knee amputation and the second… well I’m not sure, I do know that he’s been waiting for three days now. We were so desperate to get him blood my aunt Merrill actually donated blood for him yesterday.
FUCK guys!… Just… fuck… had to stop writing and deal with several gut wrenching emergencies. I’ll get back to those in a few.
Anyhow, where was I? Im so frazzled right now. Ok, so she donated blood yesterday for this patient hoping they would type and cross it in a couple hours and we could get back and transfuse her quickly, (I should mention his hemoglobin was 50, that’s low) Of course this being an island third world post disaster country, nothing happens quickly. So they ask us to wait till today. Waiting for blood is never good. So we make the trip back to the Red Cross to get blood again today. And once more we are asked to wait an additional day. This, we cannot accept, our patients condition is growing more critical and an additional patient requires a transfusion as well. We attempt to explain our situation to the receptionist at the Red Cross without any success. Everyone else, (all Haitian) have similar stories if not worse.
Let me back up for a min. Obviously I left the hospital. We hired a Tam Tam, which is basically a covered pick up truck with an open tail gait that are used as communal taxis. Most are extremely colorful and painted boasting either Jesus references or music lyrics. The Red Cross itself was shockingly in disrepair. How may advertisements have you seen by the Red Cross asking for donations for Haiti? Seeing the actual Red Cross in Port Au Prince makes me wonder where all those donations actually go. This country went through its worst disaster in recorded history and the Red Cross which is multimillion dollar NGO only sponsors 1 blood donation site in all of Haiti, and its out dated and falling apart?! Ironically, as we are leaving, what seems to be a banana republic clothing model driving a brand new tricked out SUV with a Red Cross logo pulls up, beeps and waves at us… Fuck you dude.
Don’t remember if I described what driving in Port Au prince is like. I took some video and I’ll post it when I get a chance. Although it’s not as bad a Sri Lanka or Java, it’s pretty fucking bad; the combination of short burst acceleration and roads that are totally fucked makes for dangerous travel. I almost shit my pants when we were speeding down a one-way road into oncoming traffic, on the wrong side of the medium, during rush hour, for like 5 min straight!
So we get back, we are heroes, we transfuse the blood, we break and anticipate surgery. I sit and check my face book and begin thins blog. That was almost 5 hours ago. My team member runs up to find the rest of us. She’s bleeding, bad… We rush her to the or, scramble to prepare, and hope for the best. It was tense in the OR. She was definitely going to lose her left leg. The question was, is she stable enough to survive the procedure. Mind you she is an 8-year-old girl with a bad infection from a sloppy ortho operation. The Foot was already dead when we met her. We knew we would have to amputate. Sadly, because of the perfuse bleeding (near the femoral artery, (really big blood supply in the body)); we had to amputate much higher than expected to stave of any further bleeding.
Knowing you’re going to have to amputate a beautiful little girl’s leg conjures bizarre sensations. On one hand you feel terrible because you know you will take part in a life-altering event that will most likely affect someone’s life for the worse. (Forget being an amputee in the US, imagine it in Haiti) But on the other hand you are kind of excited to be part of this complex high-risk medical procedure. I still don’t know how I really feel about the whole thing. It was fascinating and gruesome at the same time, I found myself amazed yet horrified. Not so much because of the gore, but because she would have to live, (fingers crossed), with the outcome of this savage procedure. There were many tense moments; no one was totally confidant we could pull this off. Despite all the blood, bone and flayed flesh, the most disgusting part was after the leg was actually free. The sound the leg made as the head surgeon dropped it’s dead weight into a plastic bag really bothered me. The sickening thud accompanied by the sound of the femur piercing the plastic brought me back the the reality of what we had just done… We cut of this girls fucking leg… Oh my god… we really just cut off this girls fucking leg.
Confused, disgusted and upset, I found myself sitting alone on the front steps post op. I have seen a lot of fucked up things this trip but I haven’t cried. I even walked through a tent and saw at least 2-3 dead babies and several others very close to death and managed to remain stoic. But I just let loose tonight, I broke the seal.
I tried my eyes and gathered up the strength to go see her in post op and say a few encouraging words to her fully knowing there is no way she would understand. I did, and I felt a little better. (Not going to get into that). On my way out of post op 1, I crossed the hall to post op 2 to check on our other guy who received a transfusion as well. Although we could not communicate well, we knew each other. I always greeted him and we had somewhat of a connection. Kind of difficult to explain. I smiled at him, he did not return. I looked closely, something was not right. He looked paler than usual and was shaking slightly. Oh shit, transfusion reaction! Was the first thing that entered my mind. I got a quick set of vitals HR 129 (very fast) BP 130/90 (a little high, nothing serious) Respiratory Rate 25 (elevated), and Temp 104, (OH shit that’s really high). Fuck, really, now, of course! Fuck! I call our team over, the tremors become more violent, the temp climbs, his heat races, and his mentation changes. We slam some steroids, pain meds, Tylenol, and fluids. We are trying to cool him down. Ice, where the fuck did we get ice? I don’t know but now I have it in a basin. Carotid arteries, armpits, femoral arteries, neck, fore head, and abdomen. We pack his body in ice. We foley him, we run the Iv lines through ice baths, There is running, shouting, sweating, running, tripping and searching. All without any privacy what so ever. Every other bed and family member is watching exactly what’s going on. And his shaking gets worse, and his speech more garbled. I’m a bit too tired to get any more into what happened, I need to sleep. Ask me more sometime.
We are not made out of the same things the Haitians are made of; they are so much tougher and resilient in almost every way.
Out of any day here, I had the most difficulty getting up today. Everything inside me this morning wanted to stay in bed. I felt like I was in elementary school, considering playing sick, or at least hoping I could miss the bus and go to school a little late. I somehow managed to drag myself out of bed and face the day, luckily, my friend John magically produced a small packet of powdered star bucks coffee. MMMMM! OH joy! Small creature comfort! All I need is a cup… Got a cup, anyone have a spare mug? Dirty, Dirty, Dirty, EW… Moldy, Broken… Ok fine, I’ll drink out of a bowl.
So both of last nights patients managed to pull through. All things considered, they actually look pretty good. It was good to see them stable in bed this morning. I made a concerted effort to stop by their beds and visit them as much as possible. The little girl really stole my heart. Little Mia is so cute; it’s so hard to watch her go through all this pain. I go from holding her hand to giving her injections, to rubbing her head to inserting and removing tubes from her nose.
I really ran my ass off today. 13 hours of bouncing from OR to Post OP. Really strange to shift your mindset so quickly. Granted they are both areas of nursing, but your roles are SO different. I suppose that’s one of the reasons I chose nursing as a profession. In OR I have to be so sterile, so exact, in tune with what everyone else is doing and knowing where they are around me. All sterile fields must be maintained, sharp objects must be accounted for at all times and we must constantly anticipate each other’s movements and needs. But I also love post Op, I got to do some really gnarly dressing changes. Something that I was slightly intimidated by in nursing school. I now approach the most challenging dressing change with out any reservations whatsoever.
………..SCRATCH>>>>!!!!!!!
Ok well, that was unexpected. So as you could probably tell, I was just writing my nightly blog and I was called into the OR to fill in for another scrub nurse that was about to pass out. I had just showered and wanted to lay in my cot and tell you that although today was busy it was great, a real rewarding touching heart touching work day. However that will have to wait
So just got called down to finish up a case that went 2 hours longer than expected. To be fair, the other Nurse didn’t eat dinner and got up with all of us at 5:30. I at least was able to eat and relax for a bit. I was dragging some serious ass through this last case. Felt like my head was swimming and was racing to catch up the entire procedure. It’s strange stepping into someone else’s setup. It’s like walking into Home Depot and someone just start shouting out different tools they need immediately. Ronjer! Auwe! Pick ups! Mosquito Clamp! Bone Hook! Ugh… I can’t write any more… need rest; tomorrow is our ortho clinic and our biggest day of the week. I’m so drained and I haven’t shaved since I arrived. Beginning to look like I stumbled out of SF general. Gonna try to take some video tomorrow so you can see what its like here in the hospital. I’m not sure if I’m painting an accurate picture. Well hopefully this video will shed some light
Night
Oh and I have a mysterious rash on my chest and arms.. .Weeee
The Days feel like weeks and the weeks feel like days. I can’t believe this week is coming to an end so soon. Although I feel like I’ve been working my ass off, there is so much left to do.
It’s no stretch of the imagination that I didn’t get much sleep last night. Strangely I’m getting used to running on fumes. I am however totally over drinking instant coffee… what I wouldn’t give for a large ice coffee with a splenda. Soon enough… Anyhow, despite not having adequate caffeine I still managed to power my way though another marathon day. In fact it’s not even close to being over. Turns out I’m going to have to scrub for a late night case. I probably wont even begin to prep the case until 11: 30. Oh god, last one… well until tomorrow. I think we are going to squeeze in a couple before we head to the airport. I really hope we don’t have any complications tomorrow and we can just make our flights. Not that I’m eager to leave or anything. Haiti has captured a part of my heart. I’m sure this is not the last time we will meet and our paths are destined to cross once more in the future. There is just so much work to be done. There are so many obstacles to overcome. And there are so many desperate people here. People are getting word of our departure. I always feel awkward around this time. I’m almost embarrassed that I get to return to my American lifestyle. Like I said before, this is just an adventure for me, something that makes me feel good and gets attention and praise for others. But it’s weird, I’m not some angelic savior sent from the heavens to save the people. I guess I’m here for a couple reasons. First, someone needs to go, I have a really hard time watching people suffer. And second, it makes me feel good. A big part of why I do this is for myself. I makes me appreciate who I am and what I have. Although I really appreciate the fact that you have been reading my blogs, commenting and giving me such positive feed back, just know that I’m no hero. I’m not doing anything that is beyond any of your capabilities. Just like Michael Jackson said, “If you want to make the world a better place, just take a look at yourself and make a change”. Yea I know Uber cheesy, but very true.
Ok enough preaching. Lets talk about today. Nothing shocks me anymore, well almost nothing. Today was swelteringly hot, the kind of hot that makes you actually feel like your being slowly cooked. I had that gross wet pant leg stuck to your calves and thighs feeling all day. Ew… So again I bounced back an fourth between the OR and Post OP again today. If I wasn’t wet enough from my own perspiration, I walk into Post Op 1 and into an inch deep puddle of toilet water. Apparently a pipe burst in the bathroom and flooded. Ugh, great. Now my scrub bottoms are soaking up poo water and the water line is having a race to the back of my calves. Sigh… But like all toilet tragedies it isn’t the end of the world and eventually gets taken care of. The morning dressing changes continue. I become intensely focused on changing a complex dressing on an Ilizerof fixator. I kneel down on the tile floor silently, super silently. So quietly in fact that I touch down without any sound at all. That’s odd, I look down at the far end of of my thigh and am horrified that I just knelt on a turd, a wet, loose, lonely, brown turd. Good thing my knee decided to keep it company….
I’ve just been informed that the other scrub nurse decided she didn’t want to work this case anymore and left the OR. How the fuck does that work?!? I guess I have to scrub in and fill her place, I think they are doing a spinal fusion on a 23-year-old kid who was recently paralyzed in an MVA (motor vehicle accident). Ok, I’ll write more if I have the energy when I get back from both of theses cases. We’ll see though.
Can’t write any more, need to be awake in 4 hr. Very dramatic case, thought she might bleed to death… never been part of anything like that.
She made it
OK, well I wanted to post that last night but the Internet was down by the time I returned from the OR. I ended up catching the very end of the Spinal case. Although I didn’t end up scrubbing I saw them suture and close. The final case was to debride and do a dressing change for Mia, the little girl who had the amputation and captured our hearts. We didn’t even bring her to the OR until midnight, always a bad omen. I went to retrieve her from post OP one and found the room dark and everyone to be asleep. Rather than wake everyone up, I decided to carry little Mia into the OR. She is so brave, she barely protested at all. She knew what we were going to do and what kind of pain she would wake up with. She buried her head in my chest and held on to my neck with her tiny hands. That’s it; she crushed my heart right then and there. It’s a bizarre feeling; causing physical pain to children with the knowledge that it’s for the best. Although I knew I was taking part in an operation that was certainly going to save her life, I had to battle with the reality for how much cutting, scrubbing and trauma we were going to cause her.
I take care to step over sleeping family members asleep on the floor at the foot and sides of our patient’s beds. It’s truly amazing how devoted Haitians are to each other. They do so quietly, and with out any protest; thankful for the fact their loved one is receiving any medical attention at all. Seriously, think about that. They sleep on the dirty tile floor, most with out a blanket, some with the luxury of an unfolded cardboard box to lie on. Each patient has at least one family member who stays overnight with him or her. In the short week that I’ve been here I have never seen a patient alone. The difference between American and Haitian hospital culture is astounding. I walk down the hallway in the dark, guided only by minimal light and a sense of familiarity I have developed over this past week.
We got her on the table and gave her the anesthesia drugs. She cried a little and went to sleep before she made it to the point of being completely hysterical. We estimated the entire procedure would take around 30 min from start to finish. She goes out, we open her stump back up and are immediately blasted by the stench of infection and necrotic tissue. That smell is unforgettable, and indescribable. There is no known substance or combination there of that accurately mimics the scent of infected necrotic flesh. Although the wound didn’t look terrible, it certainly smelled that way. So we go in, scalpel, forceps, retractor, bovie (a tool that sears and burns flesh)…. Sponge…. Hold here…. Irrigation… suction, irrigation… suction, scalpel, forceps, bovie…. Scalpel… And oops… looks like we nicked an artery… bleed, bleed… ok pressure right here with those sponges…. Bleed, bleed. Wow this one is really going, do you think it’s the femoral artery? Squirt, Squirt, Spray, Ahhhh, holy shit, Sponge! Ok fuck, more sponges, get more sponges. At this point the sponges are soaking through just as fast was we can press them down. Bright red oxygen rich book flows out from around the sponges and floods the newly opened stump and runs onto the blue table dressing and down the sides of the table. These shoes are definitely not coming back to the United States with me. The possibility of Mia bleeding out right here in front of me is becoming a terrifying reality. My uncle John and I are furiously fighting to stop the bleeding long enough to have a clear view of the hemorrhaging artery so we can clamp and suture it closed.
She’s down about 300 ml of blood (1000ml= 1L). We cannot keep chasing her blood loss like this. John asks another surgeon to scrub in and help him search. Although I have learned A LOT this trip, I know when the limit of my skills has been reached. Looking at anatomy books and identifying color coded 3-D models is one thing, trying to pick through a mutilated, necrotic stump for an elusive artery as it is constantly being submerged in rising levels of blood is another. My role changes from stopping the bleeding to retracting the wound as wide open as possible. We need to find where the bleeding is coming from! It’s really squirting now, high enough where it sprays my goggles and gown. Shit! More sponges! We continue on like this for a few more minutes that seem to stretch on forever. Adrenaline thrums through my body and I am hyper aware of every passing second and ml of precious blood that is lost. Fuck, we can’t lose her, not after everything she and her family have been through.
Ok ok, one clamp on, finally the bleeding subsides. We quickly suture the artery and finally take a moment breath. We continue on with the debridement, although cautiously and remove bits of dead bone, muscle and tissue. I cannot accurately describe what this wound looks like, nor would I want you to be able to clearly picture it in your head. Just know it does not belong on this beautiful little girl. Life is cruel and indiscriminant. Being here in Haiti, I am reminded of how fragile humans really are, just membranes full of meat and bit of bone. We finish removing the odious tissue and pack the wound full of gauze. A couple loose sutures pulls the skin flaps around the gauze and recreates the stump. We tightly wrap stump with an ACE bandage and hope the compression prevents any additional bleeding. As it stands, little Mia is going to have to face a wound debridement and dressing change in the OR every day for a while, hopefully minus the severe blood loss. But for now she is stable and sleeping, and we bring her back to bed….Sigh… It’s 2:30 am; finally time to get some rest before my 5:30 am wake up call from the sun and the heat. One more day. Not even a full one. I don’t want to leave.
