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 third dispatch.
Day 3: Compassion.
Suzanne is cradling the baby in her arms with a blue sheet. The baby is wearing a pink outfit and she is breathing very slowly.
"Her heart rate is in the 40s," she tells me as she holds back more tears from coming. She continues to rock the baby back and forth, comforting her during her last moments. You hear the baby gasp for air. The little girl's parents had left for the day. Maybe they could not handle it. I put my hand on Suzanne's shoulder, two parents commiserating. Tears begin to build up.
I step outside for fresh air. It's the end of the day and it's the team's first death.
Suzanne has short black hair and wears hip glasses with colorful string that helps them from falling off. She is an experienced ICU nurse who is used to death and dying. The picture of the compassionate critical care nurse that I would want at my bedside.
Our day had started out on a more positive note. As soon as I stepped out of the car, I headed straight for the ICU. I walked hurriedly past people. When I entered, the room was full of patients and the little boy we saved yesterday was still alive! We smile at each other and then get right to work.
In the ED triage area, I find Dave. He is still smiling after a call shift. I tell him "I can't believe you have worked all night," we laugh. "How can we help?" I ask. He points to all of the patients. We jump right in.
A pickup truck pulls up -- by this time we have quickly learned that when a private car pulls up, it is the equivalent of an ambulance -- and something bad is about to come in. A middle-aged woman is carried in. Her body is flaccid and she is having difficulty breathing. This 40-year-old woman appears in extremis.
It is hard to get to her because of all of the family who helped her in. Through an interpreter, the family tells us that she has history of asthma. We are in the middle of a crowd and have no meds available. Normally, I would order an Albuterol nebulizer for her. There are no oxygen tanks in the ED, only in the ICU. I think.
"Can I have some epinephrine?"
Kristen reaches into her pocket. I remember that she has an allergy. She hands me her Epipen.
"Are you sure?" I ask. "What if you need it?"
She gives the patient the shot. I think to myself, what a selfless act. Kristen didn't think twice about volunteering her time and skills to helping those in need in Haiti. She is specializing in forensic nursing. The true picture of altruism.
I am called to the internal medicine wards. The doctor there heard that I have an ultrasound machine. I walk past a patient who is being bathed by his family. I meet Stevenson. He is an intern, like all the others, who is doing his public service month in St. Nicolas hospital. He is a stocky Haitian doctor wearing a white coat and speaks very softly. He usually starts his sentence with "I have a patient who."
This time he said, "I have a patient who is very sick."
I leaned forward intently. I trust his instinct and he has my full attention. She is about 35 years old and has a change in her mental status. She is delirious. He can't get any IV access on her. When I walk up to her bed, her abdomen is twice the normal size. She is thrashing in the bed. She looks like she has lost a lot of weight.
"I am thinking about starting medicines for TB," he adds. I nod in agreement.
The nurse has tried an IV everywhere. I ask him about the external jugular vein on her neck.
"Have you done an external jugular vein?" I ask.
With a shaky voice, he tells me that he has only done one. I remind him how to do the procedure and Sri and I help him. His hands are trembling but he is able to steady them. He looks, sees it, and cannulates the vein. Success.
Part of [Partners In Health's] mission is to train up the Haitian medical teams.
Sri is an internist from UCSF. He is the point person for PIH in St. Marc. He is calm and thoughtful. Inclusive by nature.
I walk across the hall into the operating rooms. There are two potential cases to add on for today. Chris and Mitch are working in the OR with the help of Roger, Andy, Cheryl, Debbie, and Ed. The OR team is amazing. A top-notch orthopedic surgeon and plastic surgeon from the [Brigham]. A stellar anesthesiologist. An efficient group of OR staff that make the place run as smoothly as possible under the austere conditions.
Walking back to the ED, I see a woman rushed back towards the maternity ward. Later that day I hear that the baby was crowning as they neared the courtyard. Back in the ED, I see more trauma cases. A man who walked in with a dressing on his head. He states that there was a "battle" 2 nights ago and he was injured with a machete. His wound, now sutured, runs across his occipital area. We reassure him and ask him to come back in a few days for removal of his sutures.
Next, a 12-year-old girl who was in school when the earthquake happened. The interpreter tells us that she was the sole survivor. We pause and look at her. She has multiple injuries. A crush injury to her right forearm has left her with a bruised radial nerve and a wrist drop. She has wounds in her legs. We dress all her wounds. A superficial fix to all of the deeper wounds, physically and mentally, that she must also be dealing with.
A woman is brought in by family. She is wrapped in a bloodied cloth. They say that she was hit head on by a taxi. Her face is full of blood from facial laceration. Her cheeks and lips are severely damaged.
Leaning up against the wall next to a gynecology stretcher is an older gentleman with a wooden walking stick. His hand is on his face. He is injured and has been limping since the quake. He has broken his tibia and fibula. Michael, Katie, and I tackle this one. Reduce, splint and follow up.
Michael is tall with a goatee. He is an ED nurse at BWH and we have worked together for five years. Katie is an ED nurse at MGH. She has a funny sense of humor. Both experienced and composed at all times, they are the glue that brings an ED team together in stressful situations. Johnnie, another resident, brings me to a case of woman who lost her near full-term baby. A stillborn delivery back in November.
Since then she has been feeling short of breath. She appears labored, taking quick rapid breaths, and sitting upright. Clinically she has fluid in her lungs. Ultrasound shows cardiomyopathy -- an enlarged heart -- that is also surrounded by an effusion. She is drowning and bolts right up. The interpreter tells us that she can't lie down. Katie places an IV, gives her Lasix, and we admit her to the ICU.
I am now walking through one of our post-op areas. It's full of the earthquake victims who had been operated on by the first team. Out of the corner of my eye, I see a couple singing. Very uplifting. I see our other team members working on their patients. Barbara and Karen with an elderly woman with a hip fracture. They have claimed victory as they help her walk.
Barbara and Karen are a team. Have been together since the airplane ride. Warm, caring, and always smiling, not only with their patients but with their team members. Empowering. I hear another woman crying. I am getting used to all of these sounds. This time it's coming from the maternity ward. A newborn baby cries. The crying stops.
In a very small room in the back corner of this building is the post-partum section. There are three women with their babies. I think to myself, there will be no sleep in this area. By the door is father proudly standing next to his newborn. "Wolf!" he proudly announces. He is lying still cuddled in a warm blanket, sleeping. An Michele, our Haitian interpreter. A jewel who has been the most affected by our experience. We could not have done anything without her. Thank you.
The reality is that normal life continues. Childbirth continues. Chronic problems continue. Trauma continues. Death continues. On our way home, we pass a street dog feasting on a box meal. It's the end of the day and most don't have a mode of transportation so they are forced to walk. There are street vendors selling food on the corner. During our ten minute ride we reflect.
Compassion. I am so honored to work with such a group of individuals and who are delivering compassionate care to our patients. Our interpreter, nurses, and doctors are awesome. I have seen all of them at the bedside caring, listening, giving, and sharing. I want to recognize these individuals today. Doing the greatest good for the greatest number. Something I learned while studying public health but really have had to apply here.
It's been two days of hard work. I sit down. I cry, uncontrollably, the kind of therapeutic cry that makes you feel so good after you are done. Our first death. Raw human compassion. We are all the same. Love, happiness, sadness, and death is universal no matter in what country or language.
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