Dr. Christian Arbelaez, an emergency physician at Brigham and Women's Hospital, has gone to Haiti with a team that will work with Partners In Health in St. Marc to help victims of last month's earthquake. Here is his second dispatch.
"Christian, can you come see this kid?"
Katie and Mike call me over. Hiding behind a group of family members huddled over him, I find a naked 7-month old boy who is limp, eyes glaring into space, and breathing rapidly. It's my first patient of the day and I know that this kid is dying - my heart races. Images flash in my mind of my mom and dad telling stories of "when I almost died as a baby in Colombia." I take a deep breath and think to myself, I can't let this kid die.
Our day had started out with a tour of the facilities. There were masses of people in lines, some walking with paper slips to the pharmacy, women breastfeeding their newborns, and an elderly woman lying alone on the ground too weak to get up. The hospital is a collection of one-level buildings with open windows. The triage area, several wards – emergency, maternity, internal medicine, pediatric, and surgical. There are two operating rooms with a recovery area.
In the wards, the patient’s beds are labeled with a numbered piece of tape. The patients lay on old mattresses and are surrounded by family and personal belongings. No privacy or confidentiality. The pharmacy is located in a central location near the entrance. This is important because, as we quickly came to learn, if a patient needed medicines, a script was given to their family member so they could go and get their medication. The x-ray room is not close and requires a group of red cross volunteers to transport patients there. Once the films are processed, they are brought back to us still dripping for us to read – I now appreciate the radiology term “wet read.”
Quickly, I came to understand how instrumental the family is to patients care. They are the ultimate patient advocates. They wave the nurses down for pain medications, they get the meds, they feed, they bathe, and they stay with their loved ones all night.
Passing by the morgue, we noticed the number of flies and the putrid stench of decaying bodies – we are told of two children who probably had malaria, diabetics with acidosis, and countless others who had suffered.
I was brought back to the triage area and this is where I met Dave. He looked about 18 years old and was fresh out of medical school. Wow, I thought to myself, this is the young man who is triaging all of these patients? He had a bright smile and shook my hand with a hardiness that said, 'Boy, am I glad to see you here.' As he led me through the triage room pointing at different patients that he wanted to discuss, I was impressed by the chaos.
The patients were really hard to keep track of. They would show up and just find a stretcher, a chair, a wheelchair, or even a spot on the ground. The volume and acuity was high. I saw cases today that I had only read about in books – typhoid fever, leptospirosis, and pulmonary tuberculosis to name a few.
A van pulls up, there are about 10 people lifting a semiconscious male who had been struck by a car. They place him on a gurney. He has obvious head trauma and a broken tibia on the left leg. In the hall, a young man lying in the floor vomits and is carried away to another room. A woman screams from the maternity ward. A 16 year-old cachectic boy sits quietly with his mother. Someone hands me his radiograph and it shows pulmonary tuberculosis. I walk over to the OR and talk to Mitch about my multi-trauma patient. There are no phones or ability to communicate with others. We discuss his plan and I head back.
The operating teams have been non-stop. Their board is full of cases but they accommodate my few unexpected patients. When I return, I find an 8-year- old little boy sitting with his father. He fell on his right hand. He appears stoic as I examine him. He has an obvious deformity and the x-ray shows that he broke both of his forearm bones. He will need reduction. I touch base with Kristen who is now keeping our patient list. She tells me about a woman who complains of pain on the left leg after falling out of a mountain (I chuckled inside, I have never heard that chief complaint before).
It’s the end of a grueling 12-hour day, I feel as if I have worked two shifts at the BWH emergency department. I am drained physically and emotionally. I drank plenty of water and melted power bars for lunch and dinner. It’s amazing how tasty they can be when you are starving.
I think about the endless "merci" from patients and families. Their trust when they hand over their loved ones care to me in such a grateful manner. All of this within a strained and fractured healthcare system with limited resources.
This trust is exactly what the family of my first patient had done. The little boy who we had rescued as a team from death earlier this morning. He had made it through the day and was now in the ICU. I rounded on him before leaving for the day. With a group of about seven family members now huddled around me and Suzanne, we explained with the help of Michele, our Creole interpreter, how critical his condition continued despite all of the medications. Time would tell. I was honest, I didn’t know if he would make it through the night.
It’s the end of day 2. As exhausted as I am now, I find it hard to fall asleep thinking about him, but I know that he is in good hands with a loving family who will be at his bedside all night if he dies. I pray that I will see him in the morning.
About white coat notes
|White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at firstname.lastname@example.org. Follow her on Twitter: @cconaboy.|
Gideon Gil, Health and Science Editor
Elizabeth Comeau, Senior Health Producer