Day 9: Coming Home & Tom's Reflections

Coming Home

We roll out of our army cots on the converted patient ward for the last time. Tom, as usual, is up first. We have a ride to the airport at 6am so by 5:30 we're all busy doing some last minute packing, showering, and de-bulking our packs, mostly by giving stuff away to our Haitian friends. I benefitted from a lot of stuff left behind from previous folks (well mostly food, really), so I try and unload what I can. Tom as usual outdoes the rest of us ... he gives his bedding to Jeanty, and he gives his pillow to the lady with the forearm osteomyelitis from last night. She loves it, even with 9 days of accumulated sweat from Tom's noggin. We say bye to my replacement Rick, who now occupies the cot previously occupied by Julie from Loma Linda, then Kristen from Loma Linda. If I'm not mistaken, he'll the only doc here this week. Fortunately he's got two things to help him out: (1) more experience under his belt than I (he's been to Afghanistan among other places) and (2) Jess the nurse from Macon, who's supercompetent and should keep him on track. I tell him I hope we haven't left the place too much of a disaster. My biggest worry is still the lady with the above knee amputation wound ... last night when I signed out to him, I told him she needed another washout and VAC change on her leg today. She was looking better last night and her son personally thanked me and Tom and said he was happy that we'd been taking care of her - this really meant a lot to us to hear him say that and smile. In a week she went from puffy faced, edematous, hyperglycemic, febrile, and super painful ("sick as sh*t" in medical parlance), to sitting up in bed, smiling, talking, afebrile, and, well, may be a little less painful. The battle is far from over with her, and I'm anxious to hear how she does in the future.

We say our final goodbyes to friends here, both Haitan and expat. Besides Jeanty, Franz from xray has come, and of course Nathan and Amy who are in overall charge here see us off. It's been a great 9 days and we're all truly thankful for getting the opportunity to stay at Adventist and work with such an awesome core team (Nathan, Amy, Brooke, Jess, and Kenny) and the various groups like us that have come in and out. People like Kristen and Cheri who stayed up multiple nights with the 31 week old preemie, doing their best in an NICU that has no ventilator. People like Khalid, Matt, and Jackie who took charge and anesthetized and monitored the lady with the open amputation wound when we had to take her urgently to the OR on a day when there was no anesthesia staff available. When we get to the airport to wait for the Miami flight, Thea from Boston Medical Center tells us about the poor chap that the ER folks saw on Thursday with the abdominal mass. I remember them curbsiding me in clinic that day and seeing this rock-hard mass coming out of his abdomen like the thing from the Alien movies. Thea took him downtown to get a CT scan, chipped in to pay the $250 for the CT and the $40 for the oral contrast, and are going to seek consultation from colleagues in the US. (There was an MRI scanner too but that was damaged in the quake.) The sad thing is that even though this guy may have hit the lottery with the folks who've pitched in to take care of him, it's possible it may already be too late. You wonder what he was thinking for the two months it took him to get this big. In the US the answer is often denial, It's nothing. It'll go away. Meanwhile, there's a big fist-sized lump staring up at you and you say "Oh hello, you abnormal lump of flesh sticking out of my abdomen, are you still there? You haven't gone away yet?" Here, however, the usual answer is because that's how long it took them to see someone for it.

After the Port-au-Prince to Miami flight the big highlight is getting a good greasy burger in Tom and Liz's bellies, which is something they've been looking forward to all week long. Finally, late on a Sunday night, we're all finally back home. Liz to roommates, Tom to clean sheets (he always was the one with the most foresight and planning), and me to Corky who's raring to go for a walk. I just wanted to end by saying the Haitian friends we've met were absolutely incredible, and were the highlight of the past nine days for all of us. And also by saying that there is still a huge problem down there. Sure, the quake may have been 6 months ago, but there are a lot of patients still waiting to get taken care of - in fact, the majority of the people we saw. More importantly, though, the underlying reasons for why they're still being untreated - poverty, disparity of wealth, lack of infrastructure, lack of good "local-grown" orthopaedic care - are the same before and after the quake. As Nathan told us, the basic problems are the same now as they were before ... hopefully the earthquake can focus attention on Haiti and get these problems solved. Hopefully after a few years there will be a real orthopaedic training program so that they can have a sustainable solution to taking care of people with broken bones. We'd love to be a part of that. For the last nine days, we did what we could, hopefully helped a few people out, hopefully grew in the process ourselves, and definitely made some really, really, good friends. Jeanty with his bag of toys and a mile-wide smile as he distributes them to the kids, Junior with his boundless energy just days after his father dies of AIDS in our hospital, the infectious enthusiasm and laughter of Tony, Albert, Emmanuel, and Franz. Several of them want to become doctors and surgeons, which I suppose is natural in a place where there's a lot of maimed people and very few people to take care of them. The young Haitians we met give me hope that this can be a better place.

As we've waited for various flights today and eaten our greasy burgers (and 1 veggie sandwich), we've talked a lot about what this trip has meant to us, if things will ever change, and what - and whom - we'll remember the most. We'll leave you with some of Tom's reflections on our trip.

Reflections

My mind is a flurry of surreal thoughts and gritty emotion. I've just returned from a third world country, where six months after a catastrophic earthquake, things appear to be not much different than they were before...except for the rubble which could fill the Louisiana Superdome 5-6 times, the death, the injuries, the lack of housing, the lack of food...the basic necessities to live. It's hard to swallow. Trash literally lines the streets, children sleeping on dirt floors, people carrying disease, the poorest of poor...this is Haiti. My memories dart back and forth, children bathing in street water (basically sewage and rain water), tents held together with pieces of clothing and twine, and a little boy who lost his father...yet never loses his smile. Haitians who have lost their homes, their place of work, their possessions, their limbs, their mothers, their fathers, brothers and sisters, their world literally came crashing down in 35 seconds...but they never lost their dignity, and their belief in God. This I know; you can see it in their faces. This is Haiti. The simpliest thing as a hug, or holding a patient's hand, offering them food (many go without), a basic smile, making eye contact, using your body language and facial expressions can speak volumes...even if you can't speak Creole. The very basic things we unknowingly takes for granted, means everything to these people. They don't crack, stoic people during a time of disaster...patient people who appreciate what we do. There is no magic cure, no perfect idea, it won't happen over night, or in six months...it hasn't gone away. This is Haiti. People speak of trying to reconstruct the city...these people are simply trying to survive...to make it to tomorrow. Some of the patients we saw died, and some may still. You can't hide from the reality, when it stares you in the face every day. You can't pretend like it doesn't hurt, because it does. You want to take away the pain, the anguish, and treat every single person you meet...but you can't...resources are limited...time is of the essensce...you want to work and operate around the clock...but you can't...you do what you can. This is Haiti.

I saw the beautiful country it is, and the beautiful people within...the beaches, the countryside, the gorgeous homes and the wealth. I saw heartache, extreme poverty and pain...but I also saw hope. We give hope. I meet some of the most amazing people over the past nine days, and I came to realize something...each person who came to volunteer did just that...volunteer. You see, true compassion stems from the unconditional love you have for other human beings, other living things. You either have it, or you don't. These people did. Without hesitation, we give our time, our energy, our own compassion, to help another human being.

Looking back, I don't need to feel proud, or receive any kind of recognition. I sure in the heck didn't do this for the glory. I guess sometimes everyone needs an outstretched hand to help them up...these guys just need a lot of them, and we had six hands to lend. We wanted to help...we want to go back. It's a long road for the people of Haiti...and nobody knows how it will be built, but we can give our time, our smile, our hands. We can't fix everything, but we do what we can. We tried to do it in Haiti.

Looking ahead, I now wholeheartedly how thankful I am for this gracious life I've been given. You never truly know until you've seen the other side of life...the extreme other side of life. It's kind of like someone who tells you about a great movie, book, or place to eat. Sure you can try and imagine, but the fact of the matter is, you don't really know unless you go there... We'll continue to check on the patients we saw via email, and make future plans to return. We didn't blog because we wanted to keep in touch while we were away...we did it because we felt it necessary for people to know how things actually are in Haiti...six months later. Yeah, things are still pretty horrible, the humanitarian effort there is making a difference. From the 400 some organizations that were there immediately following the quake, about 70 are left. It's a continuous effort my friends...one Pat, Liz and I will remain supportive of.

I'll think of our trip as a stepping stone to being a better person, a better human. The world needs good people. We can't be perfect...but we do what we can...

...just like we did in Haiti.

Day 8: This is Haiti?

Saturday. Not much happens here on Saturdays, being an Adventist hospital, so we've decided to take one day off on this trip and enjoy it. They won't let us do surgery today anyway. Might as well enjoy the day and venture outside the hospital for an extended period for the first time since arriving in Haiti. As we get ready I learn another one of life's certinties besdes death and taxes: Tom's laughter. We haven't even started our day and he's already cracking himself up about something! On the way out the door we're greeted by the four patients and their families who thought they were having surgery today. On the front steps of the hospital we have to explain to them that there's no anesthesia today and that once again we'll take their numbers down and call them when the hospital opens again for business on Monday. This again totally sucks for them but again there's absolutely nothing we can do. I take down their phone numbers and add them to the list that we've compiled for the next guy, which now numbers 17 people, a week's worth of surgery before he even hits the door! The ride is late (by about 3 hours, kind of like the anesthesiologists here) so we spend the time saying goodbye to the UFGH group (the ER docs, pediatricians, nurses, and therapists from the east coast), playing with the kids, and giving away stuff. I'd brought a bunch of pens and notebooks and give most of it all away in about 10 minutes. We also have time to check out our translator Jeanty's tent, right next to the Canadian tent. He has a pretty nice setup, even with power, as the hospital's been nice enough to provide a long extension cord. I suppose if you're going to lose your house in a quake, setting up a tent on a hospital front lawn with power ain't too bad.

We join Kenny, who's starting med school at UCSF this fall, and Jess, the nurse from Hotlanta, and drive over to the Project Hope compound to pick up the rest of the crew for the beach. It's quite a way from Carrefour, where Adventist Hospital is (southwest of Port-au-Prince) to the Project Hope house (southeast). On the way we see the US Embassy and a large UN compound. We also get a chance to see all the rubble still laying around. Now they say only about 25% of the buildings were completely destroyed, but that's still a ton of buildings, and a lot of the other ones show visible signs of damage. Plus, of the rubble that was there, 98% is still there 6 months later. We reach Project Hope. This is where Kristin the peds resident from Loma Linda, Cheri the nurse from Wisconsin, and Ruth a therapist with Project Hope are temporarily staying. The tradeoff for being so far from Adventist is that this place is really nice. I almost wish I hadn't seen it because I was perfectly fine with my army cot on an open hospital ward! There we also meet up with Natalie, who's of Haitian origin but lives in Ft. Lauderdale. The place is a private residence (even with a pool and tennis court) rented by Project Hope after the quake. There are medical supplies stacked everywhere, even on the tennis court and soon to be in the pool (people as late as last week were emptying out the pool - by hand). At the very bottom I can see where they missed a spot and some happy tadpoles are swimming in the drain. Among the supplies we see an entire 3 pallets of fluoxetine, generic for Prozac. Tom comments that as non-emergent as it may seem, these people have plenty to be depressed about. Either that or it could be prematur- .... ah, never mind. We then drive all together to Wahoo Bay. On the way over there we pass by a large tent camp north of Port-au-Prince, and a lot of scenic countryside and a few small town markets. Natalie, Kristin, Cheri, and I share the pickup's bed and from the look on their faces I'm really glad I'm facing rear and can't see where we're going. Apparently there's a lot of risky passing and swerving going on. After a bumpty hour and a half ride we get to Wahoo Bay which for a $10 entrance fee somehow makes you forget all the poverty outside. This seems kind of wrong, but I figure we're helping the locals out. Once inside, we kind of realize in a guilty way that we don't feel like we're in Haiti. Guilty because we've automatically thought of only the earthquake, injuries, poverty and forgotten, or rather never got to experience, that this is actually a really beautiful country. The beach is awesome, the water is warm, and the beer is cold. Somehow, $2 a bottle changes over the course of the afternoon to $5 a bottle but I'm too tired and content to care. Tom, Liz, and I look at each other and shake our heads at the huge disparities in wealth. The statement "This is Haiti" accompanied by a what-can-you-do kind of shrug we've used all week long, has become "This is Haiti?" for today.

Unfortunately at 5 we need to start heading back because navigating around potholes, pedestrians, and livestock on a 2-lane highway is difficult enough during the day let alone at night, and it gets dark early here. The trip back is highlighted by a massive flat (Potholes every 30 feet for 50 miles? Driving around piles of trash with broken glass bottles? Wow, who coulda seen that coming?) ... whereupon our driver decides that rather than the nice area of empty curb up ahead, the best place to stop is partially blocking an intersection, and no, there's no reason to pull over to the side, just leave the car partially in the road so that when you change your left rear tire you can put yourself and your very vulnerable rear end right in the road, cause that'll probably help other drivers see you better. After narrowly missing the opportunity - er I mean tragedy - of taking care of a pelvic trauma patient at the roadside we finish the ride back home listening to gangsta Creole hip-hop laced with a generous sprinkling of profanity. Let's just say the profanity they use here, though there's plenty of good Creole profanity the OR guys taught us yesterday, is borrowed straight from American hip-hop and you can guess what the words are.
We make it back to Adventist in one piece and meet Rick Wilkerson, my replacement, and sign out the patients to him. This involves going through the list and tell him what surgery everyone's had done and what needs to be done with them. The most important part is the list of 17 people who are still waiting for surgery ... eight of whom are still languishing in the preop room downstairs (one decided to go home and come back Monday - suprising not that she left, bu that she was the only one who did leave. Kind of makes you realize how desperate these peole are for care), and four of whom showed up on a Saturday and were told to leave. It hurts every time I think about that but you just do the best job you can and forget about what you can't - except I can't forget.

We're off early in the morning tomorrow to catch a ride back into Port-au-Prince (Carrefour is kind of a separate-ish development southwest of the capital) for our noon flight. We say our good-byes to the hospital translators, especially Jeanty, to whom Tom has given a bunch of stuff and I gave a pair of running shoes, and Junior, who got a pen and notebook.
The last offcial act tonight, our last night here, is a VAC (vacuum assited closure) dressing change I have to do on the ward for the woman from Tuesday who had an infected left radius (forearm bone) debrided. Jess from Hotlanta is Johnny on the spot with some Vicodin and Toradol for her (sorry, no morphine in this hospital) but her screams still draw a crowd of curious passersby into her room. Fortunately her wound looks great and we stop the VAC and she's OK and still able to smile at me afterwards. I say my goodbyes, tell her and her family that this is her new doctor, wish her luck, nod to the crowd, and leave. The crowd watching you is something I don't particularly like doing, and neither is having to pull a piece of vacuum sponge out of someone's forearm bone without adequate anesthesia because the hospital won't let us use an OR on Saturday, but I'm a visitor here and I just want to do the best job I can and not rock the boat too much. This is Haiti.

Day 7: A Day of Mantras

This morning, fortunately, we all wake up on our own around 6:30 without dudes outide clanging away on metal. After morning meeting on the hospital front steps, we head down to the Canadian tent to check out a woman's external fixators (she has arthrogryposis - yeah, a mouthful, but basically in her case two clubfeet and a lot of contracted joints), prescribe some antibiotics, and arrange for Brooke the mover and shaker to get her admitted back into the hospital. The sad thing is that there just aren't enough beds to take care of everyone, so there's been a huge push to get people transferred out to Tent City. But even though this is a comparably clean tent settlement compared to others, there's still piles of trash laying around, and a lot of people sleeping in close proximity to each other, many with open wounds, infections, external fixators, or all three, so it's no wonder you get some pin tract infections. But what can you do? There are simply too many people to take care of and you do what you can to try and save b edsfor the sickest people. And our patient does end up getting readmitted back inside.

Afterwards, while I go make rounds and head to clinic (sorry that part's kinda boring so I'll spare you the details, just kinda nonstop work), Tom and Liz make a beeline for the OR and organize stuff. Today's a lot cooler (or shall we say, less muggy and miserble) so Tom actually manages to wear the SAME pair of scrubs all day, which is a first! Tom sifts through literally a hundred boxes of suture, consolidating things that are in a bunch of different places. He also does some QC and does his best to play god cop, showing Liz and the instrument room staff how to process things. Little details, like how to wrap stuff for the autoclave so stuff doesn't get contaminated. Though with flies and mosquitoes buzzing around the OR, a strip of flypaper hanging right above the operating table, and an air conditioning unit blowing air right onto the "sterile" field, I'm not sure how much that really matters. But this is the way they've done things here. Yeah you can maintain your own standards in surgery and do things you have control over, but you can only do so much. That has been a recurring theme this trip, and today we all realize that it's really become a mantralke chant. And you can only do so much. Which is kind of like the same thing but sounds good.

Afterwards, Liz gets busy organizing stuff in OR 2, and unearths a bunch of Ioban, an iodine-impregnated sticky bandage we use a lot here. This stuff is like gold here, and helps to seal off "dirty" body parts like toes, armpits, and the groin (which Tom for some reason calls the "crotchal" region, though I'm not sure that's a real word) when you drape patients out for surgery. So Liz get's a finder's fee of a big sweaty hug and the promise of a bottle of Prestige later tonight at Israel Park down the street.

As is often the case in hospitals back home, we're all basically waiting for anesthesia to show up (heh heh guys, come on, we're just kidding). But seriously, I see everyone in ortho clinic and Tom and Liz get the storerooms organized before anesthesia even shows up at noon. By the time they get ready to go we're making incision at almost 1pm. Our goal today is - OK, now make that was - to get as many surgeries as possible done. Jess from Hotlanta has compiled a list of 18 patients who need surgery. With anesthesia showing up around noon, and thus an average of 2 surgeries a day this week, you don't need to be a rocket scientist to figure out that there are going to be a lot of pissed off people. Another mantra: two surgeries is better than one, and one is better than none. We're not going to get through the five surgeries we were hoping to do today, let alone play catchup on the people who needed surgery the past three days whom we couldn't get to. And don't even mention taking care of the four people who werew scheduled for tomorrow when the OR's closed. But you do what you can. At we all have a good laugh at the end of the first case when we're ready for a C-arm (intraoperative X-ray) shot, and we call out to Tony in the hallway for an xray, and he bolts right in frantically and zaps a shot of nothing before he realizes the C-arm machine is still sitting in the corner!

In between cases we have a bunch of things to do like see some late stragglers for ortho clinic, and check in again on some postop patients, so we literally run upstairsfor 5 minutes while they're getting the second patient to sleep so we can wolf down lunch. Today it's very appealing homogenous thick unknown liquid - mmm, brown. I take the poultry industry approach and fold the styrofoam into a funnel and pour the souplike substance down my gullet so we can run down faster. Tom takes the cattle industry aproach and eschews the brown liquid for some Jack Link's beef jerky. Though it's still unknown and weird looking it is very "Haitian money," or good. It's a play on words ... goude is the unit of Haitian currency, which sounds like "good" said with Haitian accent. A little thing that Emmanuel our clinic translator ikes to joke about. After lunch we try and squeeze in two patients who need hip fractures repaired and quickly find out that it would take an act of Congress to perform even emergency surgery here late on a Friday, and impossible to do so on Saturday. Since we're leaving Sunday morning, it looks like they're going to have to wait for Dr. Wilkerson when his weeklong shift starts Sunday. People here unfortunately have to wait a long time for emergencies that normally get done a lot sooner back home. Like the kid Wednesday with the open wrist fracture and elbow fracture sitting in the waiting room hallway - if we hadn't been here this week, he probably wouldn't have been taken care of for a week or more. Or the first hip fracture we did Tuesday whose fracture was a month ago. You can only do so much.

As the week has progressed, people have been trickling in day by day into the preoperative ward, where people come and stay (and usually for a loooong time) while they wait for their surgery day. So by today there are ten people and their families waiting in preop who've had surgery scheduled and cancelled various days this week. We get two patients' surgery done today before anesthesia takes off, and one of them was the guy upstairs whose shoulder was dislocated, so there's really only one patient in the room of 10 we can take care of today. That leaves nine unhappy people whose surgery can't get done this week. Nine people to whom duty demands a personal apology and explanation and what I hope is not an empty promise that the next guy will take care of them. Walking through a small crowded room with ten patients, each of whom has a couple family members (or friends or neighbors if all their family died in the quake), saying 9 genuine apologies and one very muted congratulations you're the lucky winner. We choose the one not based on age (there are a lot of teenagers and twentysometing year olds we have to turn away), how badly it affects their life (there's a 15 year old girl with a left forearm compartment syndrome from the quake who has a left claw hand and wrist drop, and everyone here has something that needs surgery), but rather pure practicality: The shortest one, the guy who needs a radial head excision so he can bend his elbow again. One short enough that we can get done before anesthesia leaves. Short enough that maybe we can even help more people afterwards. They always say you need compassion to do this job, but they don't say you also need a little bit of a cold heart. Cause how can you tell one person they're the lucky winner, then turn to the nine patints and thei families right next to the first guy, look them in the eye, when they've been waiting in the hospital for four days, and actually since the quake really, and tell them to either wait for an indefinite time, or go home and come back? Gosh this totally sucks to think what they've been through and what you're now putting them through. Again, you do what you can, but that doesn't make you feel any better.

This evening after anesthesia takes off I see another lil' kid in the Canadian tent whose leg's been hurting, check his xray, and reassure him and his mom that he's ok. Afterwards, while Liz is tutoring Michard in English again, Kenny, Jess from Hotlanta, Tom, and I walk through the preoperative ward, postoperative ward, and the regular ortho ward upstairs and hand out leftover brown soups from lunch, and a whole boatload of Tom's extra cliff bars and granola bars. For some of the families who come to take care of the patients (families are responsible for feeding you, bathing you, and helping you go to the bathroom when you're in the hospital), it might be the only food they get for a day. The postops and the ward people get th cliff bars, and we save the soups as a special treat for the preoperative people downstairs who've decided to wait and try their luck waiting for surgery instead of going back home. It's a small consolation, and it doesn't even come close to making up for the inconvenience of traveling a long way to the hospital, having your surgery cancelled four days in a row, and then on the last day being told that you're simply going to have to wait for the next surgeon to come by. But Haitians are super patient people and I get the feeling that because these folks have been through so much they're pretty used to waiting. I suppose the frustration of waiting with no clear end in sight isn't so bad compared with the pain of a really painful injury you've been dealing with for the past 6 months. Again, it still totally sucks that they have to go through this. We chant our mantra. You do what you can.

We're sitting here tonight, the three of us together, Liz, Tom, and I, in between playing with Junior and talking with our translator Jeanty, just reflecting on things as I type this right now. Tom is struck by the contrasts between rich and poor, and by the walk we took Wednesday night through the neighborhoods around here. There is a Haitian guy who drives around downtown in a Porsche. And we can look outside the hospital (it's open air, without walls) up on the hillside where big fancy houses look down their noses at the shantytowns and tent camps below. Here in the hospital meanwhile the nurses are making $10 a day and the ortho clinic smells like cat pee. $10 a day for working your butt off, 1 nurse for 14 patients, with no aides to help. At least the families are expected to feed the patients and clean up their poop so it could be even worse for the nurses. There's one patient downstairs who doesn't have family who lay in her poop for 6 hours. Liz is struck by the incredible stories that she's heard as she's gotten to know the Haitian patients and volunteers this week. Three of the volunteers are here because they lost their houses in the quake and are living in Tent City on the hospital grounds now. One of them is Michard, whom Liz has been tutoring in English. Most days he doesn't eat until the evenings. Not because he doesn't want to get fat, or because he's too busy to eat (though he is busy), but because he can't afford to.

We try and help out what we can - giving away a lot of our stuff, like sandals, shoes, pillows, sheets, a mattress pad, t-shirts. So at the end of the day we go through the mantras of the week. You can only do so much. Haitian money! Anesthesia always shows up at noon. You can only do 2 cases a day. But two's better than one, and one is better than none. This is Haiti. And you do what you can.

Day 6: Lessons Learned

We woke up this morning to the din of someone outside beating on something metal with something else that was metal. Whatever it was it was probably heavy enough to make a really really loud sound but small enough to be whacked over and over fairly fast. Which, after wolfing down half a large mushroom pizza last night and falling into a food coma, is how my insides pretty much feel today.

We have an ambitious surgery schedule for the next three days (Thursday through Saturday). Perhaps overly ambitious, with five cases for today, six for Friday, and four for Saturday. We quickly find out from Brooke who pretty much is everyone's boss here that this being a Seventh Day Adventist Hospital, operating on Saturday is pretty much a no-no. We should have realized that beforehand, but what's that saying about "easier to do first and ask for forgiveness later ..."?

So after seeing some postop patients (the kid is doing just great!) we start off with clinic where there are a few patients, one of whom needs surgery, but unfortunately we're not even getting through the cases we scheduled from Monday's clinic, what with not having our own anesthesiologist, so all we can do is take his number and address down and tell him Jess from Hotlanta will call him sometime soon once the next team arrives. We've long ago decided that we have to be realistic and just accept that we can only do what we can do.

We're waiting for the Haitian anesthesiologists to arrive so we can start the 5 cases scheduled for today. They roll in around 11 and we start our first case, another hip hemiarthroplasty, around noon. I can't really blame them because their Adventiste salary is around $15 a day so they do need to have a private practice on the side and hustle and work at different places to make ends meet. Until then Tom, Liz, and I continue to familiarize ourselves with what there is available to work with. The storerooms are fairly well stocked, much better than we had expected, but there are also shortages or absences of some pretty basic things, so we - OK, who am I kidding, Tom - keeps a running list to send to the next doc. We find a freezer and stick our heads into it and it feels soooo good. We go up and change a VAC dressing on the patient while we're waiting, for a patient with a bad infected tibial nonunion with a big gap between the bone ends and an Ilizarov ring fixator on. Haitians have a pretty high pain tolerance and he doesn't even flinch as we shove (I mean gently place) a big black sponge into his wound down to the bone. We go back down and the hemiarthroplasty goes OK, but already the anesthesiologists are asking if we can run two rooms simultaneously to get our cases done faster. Even back home when you get offered this, it's a total windfall and you say uh, yeah of course, does the pope wear a big hat? Here, it's like winning the lottery. Unfortunately,as awesome as Tom and Liz are, we can't run two rooms cause we just don't have enough people. Note to self: next time I happen to be swinging through Haiti bring a second orthopaedist AND of course your own anesthetist. I hope all of our anesthesia friends back home are feeling super guilty, hahaha. We've had some pretty awesome people offer to help us out in the OR. Kenny Pettersen, who's here in country for months and starts med school at UCSF this fall, helped us out on Tuesday, and Cheri, who's hails from Milwaukee (where Liz is from) graciously helps us out today.

The second patient has had a bad left ankle fracture-dislocation untreated since the January 12th quake but had reasonable motion when I saw her in clinic and I didn't want to fuse her ankle, which is a common thing to do. Moreover, when we get in there, the cartilage is actually pretty good and it'd be a shame to fuse it.We struggle for awhile trying to get it back, but it just won't go ... We'd have to osteotomize (rebreak) her 3 healed fractures in that ankle and replate it, with a longer surgery and higher risk of infection here in Haiti, so we make the difficult choice of doing what's right for the situation and fusing the ankle, even though ideally what I'd want for myself would be to press on. A hard choice, and I mutter to myself "what a shame" as I scrape away perfectly good cartilage, but it's another lesson in just doing what you can. Sometimes what's ideal and what's right aren't the same thing. By the end of this my back is feeling like Tom just beat it with a two by four because the lead aprons we're wearing under our gowns (to protect against the radiation from the xray machines we use in surgery) weigh a TON. My stomach feels worse, and I'm tired and pissed off at myself, and I'm sure Tom and Liz don't feel much better. And then the absurdity of it all hits me ... what am I complaining about, I've just finished operating on some poor lady who's been walking on a dislocated ankle since January 12th.

I scrub out and talk to her family (interestingly enough, using Spanish as a common lingo - how surreal). Unfortunately there are a bunch of people whose surgeries we never got to. It's amazing how patient these people are ... they understand, it kills me to think about everything they've been through and now they're kind of waiting in limbo for their surgery. Jess and I figure out which ones we're realistically going to be able to do before we leave. Bummer... well, you just do what you can do. At 7pm we finally get to eat for the first time today. We're sooo tired and have absolutely no energy, but somehow it feels good in a weird way, and it helps to play with Junior, an adorable 8 year old tyke whose got one speed only: full speed ahead. He dances for us and sneaks up behinds us and tries to tickle us to death. You'd never know his dad just died yesterday here at Adventiste from AIDS. And at the end of a long, hard day for all of us, when Tom and I are slouched out feeling like a sack of potatoes ... Liz remembers she has another tutoring session with Michard and somehow has enough energy, dedication, and kindness to make good on her promise to help him pass his English test, and goes downstairs dutifully to tutor him one more time.