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 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 l
ooking 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.
ooking 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 tim
e, 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.
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 tim
e, 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.
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 an
d 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
d 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.
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.
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