Enough already of this Stanley Livingston role playing!
The mosquitoes are particularly heavy tonight, but I was not interested in an instant replay of my cage match with Mr. Cockroach. I opted for the DEET. My sales associate at LL Bean insisted that I get the full strength, non diluted. You do not want to flirt with malaria. Well, I took his advice.
I went to bed much later than the team. Applied the ointment liberally and lay down on my pad. Within five minutes my tongue swelled and my eyes shut completely. My heart rate went to 140.
Anaphylaxis ! (no, she’s not the Greek girl next door). I knew Suzanne had an epi pen as she has a bee allergy, but I decided to wait to see what course this would take. Since I had awakened everyone the night before with my profanity laced assault on the cockroach, I did not want to wake them again. Thankfully my symptoms cleared in about 10 minutes. What aggravated the situation was the fact that we have no running water, so I could not flush my eyes or skin.
When your lifelong outdoor pursuits have taken place on oceans or fairways, there has really no prior need for me to use DEET. Hence, this was to be my first, and certainly last exposure to that poison!
As mentioned, we are without water and electricity. You really can get by without power, but living without a source of water is tough. The packaged “Handi- Wipes” are very helpful, but simple things like brushing your teeth or flushing a toilet are sorely missed.
I didn’t relate the whole story about the teenage girl who died the day before, as I wanted to keep politics out of this entire relief effort. However, some of us are taking it harder than usual. It turns out that if the international medical hierarchy had allowed me to perform a simple procedure, one that I have done more than 2000 times in the States, she would be with us today. The procedure is a vena caval filter. It is a small filter made of titanium that we insert through a simple needle stick in the vein above the clot, so no further clots can break loose and travel to the heart and lungs. It’s a five minute procedure if that. We had filters in our possession and a portable ultrasound. The honchos were clearly not familiar with the simplicity of the procedure, and because it was not on their list of approved procedures to be done in a disaster relief zone, our pleas were turned down. It is not easy to live with a beaurocratic decision which led to such a horrific end.
I guess we should be proud of one accomplishment. Our team was asked to work with “Doctors Without Borders” the last few days. We were happy to, really didn’t think much of it. Last night, the Doctors Without Borders director in country told us that it was the first time in the organization’s history that an outside group had been asked to work alongside their doctors. They are an incredibly powerful, incredibly closed (and by reputation, arrogant) outfit. Again, it made us feel pretty proud that our team’s work was noticed and appreciated.
We saw a tough case on rounds today. This 42 year old woman, who was in one of our tents recovering from quake wounds, was found to have breast cancer on physical exam. It was fairly well advanced. She was occasionally confused, so they felt she had a chance of brain metastases. I asked about obtaining a biopsy, but the international team didn’t think it was worth it because she couldn’t be treated anyway (there is no radiation therapy or chemotherapy in Haiti). I asked about transfer to the States, but since it was a non-urgent situation it would not be possible. I asked if I could do a needle aspiration of the mass and take the specimen home for one of our guys to look at it. At least we would get a tissue diagnosis. No, it is against international laws to transport body parts. It is getting tough to lose these battles knowing that this young woman will likely not live a couple of months.
The mosquitoes are particularly heavy tonight, but I was not interested in an instant replay of my cage match with Mr. Cockroach. I opted for the DEET. My sales associate at LL Bean insisted that I get the full strength, non diluted. You do not want to flirt with malaria. Well, I took his advice.
I went to bed much later than the team. Applied the ointment liberally and lay down on my pad. Within five minutes my tongue swelled and my eyes shut completely. My heart rate went to 140.
Anaphylaxis ! (no, she’s not the Greek girl next door). I knew Suzanne had an epi pen as she has a bee allergy, but I decided to wait to see what course this would take. Since I had awakened everyone the night before with my profanity laced assault on the cockroach, I did not want to wake them again. Thankfully my symptoms cleared in about 10 minutes. What aggravated the situation was the fact that we have no running water, so I could not flush my eyes or skin.
When your lifelong outdoor pursuits have taken place on oceans or fairways, there has really no prior need for me to use DEET. Hence, this was to be my first, and certainly last exposure to that poison!
As mentioned, we are without water and electricity. You really can get by without power, but living without a source of water is tough. The packaged “Handi- Wipes” are very helpful, but simple things like brushing your teeth or flushing a toilet are sorely missed.
I didn’t relate the whole story about the teenage girl who died the day before, as I wanted to keep politics out of this entire relief effort. However, some of us are taking it harder than usual. It turns out that if the international medical hierarchy had allowed me to perform a simple procedure, one that I have done more than 2000 times in the States, she would be with us today. The procedure is a vena caval filter. It is a small filter made of titanium that we insert through a simple needle stick in the vein above the clot, so no further clots can break loose and travel to the heart and lungs. It’s a five minute procedure if that. We had filters in our possession and a portable ultrasound. The honchos were clearly not familiar with the simplicity of the procedure, and because it was not on their list of approved procedures to be done in a disaster relief zone, our pleas were turned down. It is not easy to live with a beaurocratic decision which led to such a horrific end.
I guess we should be proud of one accomplishment. Our team was asked to work with “Doctors Without Borders” the last few days. We were happy to, really didn’t think much of it. Last night, the Doctors Without Borders director in country told us that it was the first time in the organization’s history that an outside group had been asked to work alongside their doctors. They are an incredibly powerful, incredibly closed (and by reputation, arrogant) outfit. Again, it made us feel pretty proud that our team’s work was noticed and appreciated.
We saw a tough case on rounds today. This 42 year old woman, who was in one of our tents recovering from quake wounds, was found to have breast cancer on physical exam. It was fairly well advanced. She was occasionally confused, so they felt she had a chance of brain metastases. I asked about obtaining a biopsy, but the international team didn’t think it was worth it because she couldn’t be treated anyway (there is no radiation therapy or chemotherapy in Haiti). I asked about transfer to the States, but since it was a non-urgent situation it would not be possible. I asked if I could do a needle aspiration of the mass and take the specimen home for one of our guys to look at it. At least we would get a tissue diagnosis. No, it is against international laws to transport body parts. It is getting tough to lose these battles knowing that this young woman will likely not live a couple of months.
We have established a role for Suzanne Forte that utilizes her abundant talent as both an ER and ICU nurse. We have asked her to establish a recovery room. She is so flexible, which is of paramount importance in this entire mission.
Speaking of prostheses, this is going to be an enormous problem going forward. Word is that there are 40 thousand amputations in Haiti. In the U.S., amputees have the very best prosthetic fittings, yet there are always problems with correct fit, etc. There are constant revisions. If the prosthesis does not fit properly, abrasions and ulcers can result. This is in the U.S.! What will happen to these patients who may not even get a chance at prosthesis? I would imagine that the life expectancy of 49 years will trend downward in the years to come.
I have started to think about establishing some sort of an organization at home where prostheses from deceased souls, or nonfitting limbs which have been discarded, can be channeled to Haiti. Natasha is on board with it.
Speaking of pretty dresses, it is amazing how these people dress to come in for their follow up visits. You can tell that they are wearing their finest available clothing. One little girl had her first communion dress on today. Big smile when I told her how pretty she looked.
The ward tents are crowded, hot, and fetid. I asked the head nurse why so many family members were always hanging around. She explained that traditionally, even before the earthquake, when patients are admitted it is assumed that the family would provide hygiene and food for the patient. That is something that the hospital is not expected to do. This certainly enlightened us as to why our hospitals at home frequently deal with the situation where a recently immigrating patient has the entire family in the room throughout the day. This also leads to an interesting array of aromas, as the food is brought from home and frequently on one floor we see many different nations represented.
Natasha has probably been the busiest of all of us. She is a specialist in wound care, and has been doing a remarkable job with incredibly complicated wounds. As you might imagine, some of these people could not get any medical care for weeks, resulting in wounds that you hope not to dream about.
The ward tents are crowded, hot, and fetid. I asked the head nurse why so many family members were always hanging around. She explained that traditionally, even before the earthquake, when patients are admitted it is assumed that the family would provide hygiene and food for the patient. That is something that the hospital is not expected to do. This certainly enlightened us as to why our hospitals at home frequently deal with the situation where a recently immigrating patient has the entire family in the room throughout the day. This also leads to an interesting array of aromas, as the food is brought from home and frequently on one floor we see many different nations represented.
Natasha has probably been the busiest of all of us. She is a specialist in wound care, and has been doing a remarkable job with incredibly complicated wounds. As you might imagine, some of these people could not get any medical care for weeks, resulting in wounds that you hope not to dream about.
We had a scene this morning which made us all double over with unstoppable laughter. As we were pulling through the security gate into the medical compound, the tire of our van caught a baseball sized rock perfectly, propelling it like a missle. It caught an elderly man in the thigh. He angrily accused a group of young kids standing nearby. They didn’t have a clue what he was talking about. When some of his friends walked up a minute later, he pointed back at the kids and started yelling at them again. We couldn’t breathe we were laughing so hard. Gary says he saw him later on and he was still rubbing his leg.
I have found the wide variety of shirts, hats, etc. that the Haitian population wears to be quite amusing. I have seen an elderly woman with a U.S. Ski team shirt, an elderly man with a tee shirt reading “Will Golf for Food”, and a boy with a Florida State Golf Association Jr. Championship hat. Through an interpreter I asked where he got it. He bought if for a buck on the street. This was clearly a competitor’s hat, and its journey to this kid’s head must have been quite interesting.
A young woman with an open leg wound came back for follow-up yesterday with a Burberry scarf wrapped around her wound! On my examination it appeared to be the real deal. She might not have known, but even if she had, I believe it might have been her only option and she would have used it anyway.
A young woman with an open leg wound came back for follow-up yesterday with a Burberry scarf wrapped around her wound! On my examination it appeared to be the real deal. She might not have known, but even if she had, I believe it might have been her only option and she would have used it anyway.
My anesthesiogist today was an assistant professor at McMaster University in Toronto. More importantly, she grew up in Scotland and her father is the long time president of Royal Troon Golf Club.
We had a laugh provoking conversation yesterday as we were deciding the day’s assignments. Some were to go out into the field, while others would stay behind. One of the women asked why she could not go out into the field. You can only imagine the howls of laughter from the team when I unintentionally responded that we needed her to stay with us as she could perform well in any position.
Gotta work on my word choice.
Gotta work on my word choice.
Here is what I don’t get. This is a cute, twenty something RN from Paris who is working for a pittance in a poverty stricken nation paralyzed by a natural disaster. I asked her how long she wants to do this, and she said probably another 8 years as she finds it so rewarding. I can see if she were involved in direct patient care, but she is cleaning instruments in the back room! This is but one example of why I have a newfound and profound respect for the French people.
A BBC reporter told us this morning that the death count was now up to 230,000.
There is a nationwide prayer service scheduled for 4:53 this afternoon, to mark the exact minute of the quake. Apparently a powerful preacher has announced that if people don’t come, they will experience another ‘Event.” They are setting up a stage in the center of town. There is has been a steady stream of thousands, all in their Sunday best, filing into town.
There is a nationwide prayer service scheduled for 4:53 this afternoon, to mark the exact minute of the quake. Apparently a powerful preacher has announced that if people don’t come, they will experience another ‘Event.” They are setting up a stage in the center of town. There is has been a steady stream of thousands, all in their Sunday best, filing into town.
You can tell that Deann comes from a long line of military family. When assignments given or requests made, they are just done. No questions asked.
Saw a Voodoo ritual this morning. Peter told a plus sized middle aged woman that she needed to have surgery on her leg. The hands went up, she started chanting, and the eyes rolled in the back of her head. Victor, the Haitian surgeon told me later it was a VooDoo thing. All set with that.
Victor is right out of training, and was actually establishing a nice practice for himself before the quake. He has been told that he can no longer perform elective operations, even if there were no quake related cases. He says he has a long list of patients who had been awaiting surgery before the Event, but he would not be able to do them for a while. I initially thought that to be absurd, but when he enlightened me as to the reason, I understood. They did not want him to do an elective hernia, for instance, and send the patient to the pus filled, fly infested tents for recovery. Point well taken.
Victor has a real thirst for knowledge, and I have been lucky enough to show him a few things this week. I told him as I was leaving that I have been doing surgery for some time. Nevertheless, on three occasions this week I had to call colleagues back in Boston for advice on certain things. I gave him my number, and told him to call me if I could help in any way. If I didn’t know the answer, I could find someone who did.
Got to get ready for our evacuation. We are scheduled to be taken to the airport at 10 AM.
Victor is right out of training, and was actually establishing a nice practice for himself before the quake. He has been told that he can no longer perform elective operations, even if there were no quake related cases. He says he has a long list of patients who had been awaiting surgery before the Event, but he would not be able to do them for a while. I initially thought that to be absurd, but when he enlightened me as to the reason, I understood. They did not want him to do an elective hernia, for instance, and send the patient to the pus filled, fly infested tents for recovery. Point well taken.
Victor has a real thirst for knowledge, and I have been lucky enough to show him a few things this week. I told him as I was leaving that I have been doing surgery for some time. Nevertheless, on three occasions this week I had to call colleagues back in Boston for advice on certain things. I gave him my number, and told him to call me if I could help in any way. If I didn’t know the answer, I could find someone who did.
Got to get ready for our evacuation. We are scheduled to be taken to the airport at 10 AM.
No comments:
Post a Comment