Tom's reflections on the past 9 days

Monday, 8 November 2010

(These are Tom's final thoughts looking back on our return trip to Haiti - a snapshot in time as to how we feel right now ... the thoughts going through our minds as we return home from 9 days of travel, hurricane, sleepless nights, serving the Haitian people, and sharing time with our good Haitian friends. -Pat)

I caught myself this morning being bummed out we missed our flight by less than a couple of minutes...literally. I had to take a moment; I thought about how grateful I should be for having the luxury of riding in an airplane, to a country where I can be free...a place where I have air conditioning (and heat)...a home that has carpeting, drinkable water, and a refridgerator to keep food cold. In a land of flat screen tvs, name brand clothing, and food that makes us obese, life's necessities are lost in the glitz, the glamor, and the $5 footlong. We left behind an amazing culture, a land where people simply don't have the basic necessities to live...and some of those people die because of that. We have health insurance that may make us pay $10 or more for a visit to the doctor...so many of the people of Haiti don't have the $1 for an ER visit. It saddens me...it completely breaks my heart to be perfectly honest. I arrived home this morning, and had a great cup of coffee at good old MSP airport, and a turkey sandwich. Those two items would be a pretty hot commodity back in Haiti. I chugged down two cans of pop as Pat and I got caught up on the blog...I'm willing to bet those children at the orphanage have never even had pop in their lives. As we all stood amongst those 44 children the other day, I shed a tear that nobody saw (becaue I was sweating profusely). How these children make the absolute most out of nothing; in America we have everything, yet complain we have nothing. Five children played with one empty bottle of sprite in the middle of a sewage-ridden street...in America we'll fight tooth and nail to make sure our children have the latest and greatest video game. How ironic is that...
We amputated the leg of a gentleman who was so excited to have it removed, he was "bumpin' knucks and blowin' it up" post-op. A little girl smiled as the pin sites on her external fixator were cleaned. Pat and I witnessed a miracle in Andre, who back in July was paralyzed in a halo...and now walks around and does yoga. (Andre  has JRA, or juvenile rheumatoid arthritis, and was a partial quadriplegic due to cervical spine subluxation when we were last here back in July. In the previous 3 months he's made a complete recovery - Pat.) I'd also like to say he has no home. Andre has no parents, but has an uncle, so no orphanage will take him. It isn't a safe environment for him to be with his uncle, so he lives at the hospital. He loves to color, loves to read, and doesn't like to let go when you hug him. Andre's story is all too common in Haiti...it makes my soul cry. We don't share these stories with you because we're trying to make you feel bad. There's  nothing wrong with having some blessings. We share these stories, because it's important to let people know what really goes on in a country that's not our own. That having material goods and living in the comfort that we are accustomed to is a pipe dream that we should not take for granted and that most of the world would be dying to achieve. We saw people bathing in ditch water and kids playing soccer with an empty Sprite bottle. We saw homeless people taking a bath in the sink in orthopaedic clinic late at night. Earthquake aside, Haiti had a lot of problems begin with, but it's slowly making changes. You can only see these changes if you've been there...we want everyone to understand it's an ongoing effort, unknowing if the end is in sight...but you do what you can, and you leave it all out on the field.
We had a spectacular team this time around, and each and every person got worked to the bone, literally (our bones were aching). As we said before, it's not about how many cases we did, or about how much we could donate...it's about each minute of our time we gave to each patient, each Haitian hospital worker...each innocent child. I can't speak for everyone, but if an experience such as the one we just had doesn't make you pause, and thank the good Lord for the life each of us has, you might want to get your heart examined...because it might be missing. Every person has a breaking point, and we each hit ours on the same day...but we overcame, we conquered those 9 days we were there...we did what we hope was some really good stuff, at least for the few people we were able to touch. There is so much need, so many people we weren't able to touch, but at least we were able to touch a few. Each person in that hospital should get an award, because our supporting cast was unbelievable...bring-the-house-down awesome! In a situation like we were in, we always wanted to do more, give more money, donate more supplies, hand out more food, including our own, clothe one more child...but we're human...and you do what you can...and you leave it all out on the field. We did that every single day.
Looking back at this trip, I realized more it's the relationships you develop, it's the 5 minutes here, and the 15 minutes there you spend with the patients, with the children, with the workers who sleep on the countertops at the hospital. It's the smile you smile, the hand you shake, the hug you give, sometimes that's all the medicine someone needs. There is still much work to be done, and we left an awful lot of it for the incoming team, and they'll do the same for the one after that, and the one after that...
We'll go back again. We'll continue to fight for every inch, strive for every yard, and help as many Haitians as our bodies give us strength for. The six of us did just that...we did what we could...we left it all out on the field...and we'll go back for another season.

Our last Day: A day of Sadness and a Day of Joy

 Saturday, 6 Novemer 2010

So the morning began with a 7:30am church service.  All of a sudden, Nathan is called out immediately, and Paige follows suit.  We wouldn't find out until after church, that a new born baby had just arrived unresponsive from one of the tent cities.  An anesthetist from one of the tent cities an hour and fifteen minutes away went to check on this little soul, who was born at 36 weeks. The baby had no pulse,  and was not breathing.  Upon arrival, CPR was performed, and Paige intubated the child, as the local anesthetist was unsuccessful.  Unfortunately, the baby did not survive.  This death added to the weeks' toll...it is without question gut-wrenching, that I say there were four deaths at the hospital during our stay.  Sometimes, even when you do what you can, and you leave it all out on the field, you end up with heartache.  This is again one of those times.  On a more positive note, we've been following the poor lady with the pelvic and acetabular fracture (and did we mention she also has a left femur fracture that needs to be fixed) closely and day by day her hemoglobin is slowly inching upwards, she's making more urine (those beans are working again!), and her blood pressure is holding steady. She actually might pull through. Once Paige breaks the news about the poor newobrn to all of us, we look that much more forward to visiting all of the children at the orphanage that Frantz's parents run.  The six of us, as well as Sarah Carignan from Boston, and guided by Frantz, Claudy, and Roosevelt, the Adventiste translators who've become our friends, gather our backpacks and a few other donated goods we have, and head out into the sweltering heat.  Along the way, heaps of trash, piles of rubble, and homeless Haitians line the streets.  This is nothing new.  Ten months after the quake, little has changed.  We noticed more of the streets are getting

cleaned; we actually saw more than one garbage truck, and some people were sweeping the sidewalks.  Although a lot of aid groups are pulling out (for example, MSF Holland and the German Red Cross) because the disaster phase of the earthquake is over, other advancements have been made, like Wycleaf Jean's group clearing rubble, and money to the government for cleanup. So despite things still looking pretty desolate to the casual observer, there are some unglamorous but important changes being made. We are all looking forward to visiting the orphanage that Frantz's mother runs here in Carrefour. Upon arriving at the orphanage it hit me; the sight of 45 children, huddled together under a tarp.  In an area smlller than most apartments, these children eat, sleep, play, and live with remnants of sheet metal and tarps held up by tree branches.  Their carpet is dirt and rubble.  A faint, hauntingly familiar odor hovers in the air, in the background of your awareness, making you wonder where you've smelt that before, and then you realize it's stale urine. They had one toy that everyone shared...one toy.  It's difficult to write this, as my memory is instantly haunted.  They have so little; we already saw children with some of Cole (my 4-year-old son)'s flip-flops and clothes on... the same one's I'd brought when I came down with Pat back in July. You can see these flip-flops in the photo... Amidst all of this...they never stopped smiling.  We all spent time singing and playing games with them...looking into their sweet innocent eyes, and wishing we could take all of them back with us...but we know we can't (eve though Tom's bag could probably hide a few inside it - sorry, couldn't help adding that in - Pat.).  These kids range in age from 2 to 16. Among them is Jean Junior, or just Junior, whom everyone at Adventiste knows well and has been a constant source of joy to all at the hospital, with his charm, energy, and infectious smile. He's right there near the front, in red, his smile a mile wide as he dances and sings to all the songs that the kids sing at the orphanage. You'd never know his father had just passed away on a Wednesday morning in July, the last time we were here. (He passed away due to an AIDS-related opportunistic infection.) Among the games we play is Detective. It goes somehin like this ... one kid, the detective, leaves the room. The kids pick a leader who beats out a rhythm using his or her arms and/or legs ... as he or she changes the rhythm, everyone else follows suit. This can be hand clapping, fist pumping, or my favorite, the chest pounding. The detective comes back in and has to guess who the leader is. The whole time, the rhythm is punctuated by collective chants of "Changez movement!" to the beat ("Change movement!"). It's catchy, fun, and makes you forget you're surrounded by the smell of urine and the filth of the street. The kids, especially Junior, seem to love anything that involves them getting to jump around and sing, and frankly so do we. Beth, Sarah, Paige and Tom do a great job of whooping it up as leaders of Changez movement. Tom in particular brings down the house. Something about the sight of large bald bandana-covedred dome and his big blue eyes really captivate the kids. Looking at the roomful of adorable face makes you want to bring them all home with you ... Unfortunately, as big as Tom's bag is, I'm not sure how many of them we could sneak home in it! As it is, the odds are not good. Junior is the only one I know of of the whole lot of them who's been adopted. As it came time to leave, we became rejuvenated with some awesome Haitian hip-hop music. Frantz is kind of a mover and shaker and stops the tap-tap every so often to jump off at this kiosk or that to get another CD for Beth so that by the end of the trip she's amassed quite the collection of Haitian hip-hop, pop, and

boy-band stuff. This is what we needed, despite these conditions, we found joy in the day, just like these amazing people we're here to help.  You see, if you didn't know what had happened last January, and had never seen the filth, the tents,the unemployed, the homeless...you'd be awestruck at the outlook these people have.  A strong faith, and a big smile gets these Haitians through each day...take a minute, and it's easy to see. As Beth and Sarah groove with Francesca (Frantz's niece) in the back of the tap-tap, we head back to the hospital to gather our gear.  We need to decompess some, have a little bit of relaxation, reflect on what we've done, sweat a little more, and have a cold one...for Andrea this would mean an ice cold Mountain Dew.  We leave Pat at the hospital to do the hand off to the incoming orthopedic team, Andrea to complete the census, and the rest of us load the gear (why is my bag the heaviest?) and bring it to the hotel. ..

As Tom and the rest of the crew bring all of our stuff to the Auberge du Quebec (we've decided to take a break there for our last night before heading home tomorrow morning), Andrea and I go over the census with the new team from Dallas. Unfortunately, despite the week's worth of work (including three consecutive 20+ hour days), we've still left them with 7 patients in-house who still need surgery and at least that many who are out there in Carrefour with instructions to return to clinic to meet the new team on Monday who also need surgery. Fortunately, this group includes three orthopods, their own jet, and a lot of equipment. The funny thing is, no matter how hard you work, and how much you bring (and all six of us truly felt that we gave it our all and left it all out there on the field), there's always going to be that feeling of regret, that you could have done more, seen more patients, operated longer at night, stayed longer ... I suppose it's a natural feeling when you're in a country of 9 million million people, surrounded by so much need. One of the HCMC residents had asked me after our last trip, did I get the feeling that it was just spitting into a bucket and didn't I get the feeling that there's no way you could do enough? Well of course you can't do enough for everyone. Out of a country of 9 million people, did it really matter that we saw x many patients in clinic and did x many surgeries? The more appropos question to ask would be, for the people we did operate on, how much did it matter to them? And did helping them out make your trip, the preparations, your time, and the lack of sleep worthwhile? I think if you look at it that way, the answer is clearly yes. For the 44 kids at the orphanage who didn't get adopted, the weekly groups of doctors visiting them may not have made much of a difference. Junior is one kid whom if you asked him, I bet 100% he'd say yes as well.

 

 

The Breaking Point

Day 6: Friday, November 5, 2010

The day started with us waking up and realizing that the hospital was still standing. Last night we moved our cots from the open ward (open because the walls are actually open) to the hallway inside - our temporary hurricane shelter. Fortunately there wasn't too much damage so we're all pretty thankful for that. We are still officially supposed to be on standby for potential victims but it looks safe enough to try and do a few cases as time allows. Morning rounds are highlighted by the two awesomest kids ever, a little boy and girl both of whom have external fixators on. The few kids on he ward are very social and are often going up and down the hallways in their HAH wheelchairs, visiting each other in their rooms. Fortunately the lady with the pelvic fracture is hanging in there. She's now starting to mobilize all the fluid we've been pumping in to her to keep her pressure up, and is peeing like the proverbial racehorse. Her hemoglobin is back up to 7.5 (still low) after 4 units of blood. So things are not completely out of the woods yet, and we don't feel comfortable yet rodding her femur fracture (best to wait until she's more stable).The guy downstairs smearing poop on the walls is doing it less. Sarah is happy for once that she hasn't gotten any new bugbites, which is a particularly good thing for her since she has a scratched out bugite on her right arm the size of Rhode Island. The rest of the team is in a pretty good mood as well. Tom and I have a thing going where both of us see how much facial hair we can grow in the 9 days of the trip and compare growth at the end. Tom's is coming in nice and thick, wereas mine is coming in in patches like a badly reseeded lawn. However, we've all been working so

 hard the past few days on such little sleep that fatigue sets in quickly for all of us, particularly after tough cases like trying to do a hip fracture without C-arm (the machine hasn't been working the whole time we've been here, though the next team has apparently planned on bringing the parts to fix it). During the third case of the day today, I'm so tired I start nodding off, and the team suggests that we finally wrap things up and tell the remaining patients that we've done all we can do.Tom comes up to me after the case, flapping his hands in the air with elbows bent like an ostrich trying to fly, and says emphatically, "Pat, let's be done." after all, one of the mantras that we've been guding ourselves by over the past week, besides "Do what you can" is "Don't leave the country without Tom." The team is at a breaking point, and it's about time for all of us to get some much-earned rest. We should be happy with what we did and leave it at that.  Sure we could try and squeeze in more surg

eries but what would happen if out of fatigue we hurt someone. Fortunately it hasn't come to that yet but we all know w're at the breaking point. If we by some chance had the capacity to do 100 surgeries a day, we'd still be unhappy about not being able to help the million other people we couldn't get to. We should be happy with being able to help out those whom we did, and remember that it's not about the number of surgeries but rather more about the individual people we were able to help. It not about us ... it's about them!

Pop Quiz!

Day 5: November 4, 2010

Now that all of you have had a chance to read about us for a few days, we thought we'd give you a chance to test your knowledge about the group. Try and match the quotes to the people on the team!

Quotes for the day:

a. I can't imagine a better place to be during a hurricane than in a hospital.

b. Two beers and a brat ... thats what my fat ass is gunna be having in 60 hours!

c. Where the !@# are my Skittles?

d. You're not the boss of me!

e. What exactly does "Oriental flavor" mean? (referrring to Maruchan instant Oriental flavor ramen)

f. I'd give my left kidney for a Mountain Dew right now.

g. We're gunna try and do 10 cases today. Can I borrow your towel?

Can you match the above quotes with the following volunteers???

1. Tom Slater

2. Paige Saunders

3. Jessica Bice

4. Andrea Paulson

5. Beth Bard

6. Pat Yoon

7. Frank Spruce - guest contestant!

Answers (Don't cheat!): a-4, b-1, c-2, d-7, e-3, f-4, g-6.

Well, let me (Tom now) first say we knew our work would be cut out for us today.  With many cases still backlogged, the hurricane coming upon us, beef jerky running low, and some of us only getting a couple of hours sleep (due to demanding blog followers), we are all hesitant about leaving the front steps of the hospital after each morning meeting.

While everyone else does morning rounds, J. Bice and myself hit the O.R., to get the days cases picked and such.  One thing we learned very quickly, was that you ned to restock your own trays with implants, make sure they all have the proper jigs, etc., or the chances of you missing pertinent instrumentation is escalated.  I of course had no issue, and gladly helped to a little "mini teaching exercise" to the instrument room staff.  Madam Jordan (kind of like the Queen Elizabeth of the operating room), is very appreciative, and comments on how she loves my eyes...so I bat my eyelashes a couple of times, and ask if I can have the Stryker battery power ASAP.

I remember the walkie talkies Nathan was charging for us, so I get them from Amy (Nathan's way better half), and give one to Pat, and tell him not to lose it.  For those of you HCMC peeps, you can attest to Pat's uncanny ability to "misplace" electrical devices.  Soon, Pat and I are exchanging a few "10-4's", and I inform him we'll be ready for the first case shortly.  Yeah...our first case of the day... 

...Beth and Andrea tag teamed clinic on Tuesday while Tom, Jess, and I were in the OR and saw a guy with elephantiasis (yes, I know it sounds better to call it elephantitis) and an enlarged, infected, deformed leg. He actually came in wanting an amputation. Tom nearly herniates a disc holding the leg up while Jess and Frank (he's a volunteer from Napa, California and is an honorary member of our group) prepare the leg for surgery. This proves to be rather difficult, in no small part due to the sheer size of his leg, and we do encounter significant bleeding. I'm wondering to myself holy !@#, all this poor guy wanted to do was live a normal life, and here he is possibly losing his life. Fortunately it's nothing a little gelfoam, silk ties, and surgicel can't fix, Tom and Beth are a huge help in getting me through one really rough day in the OR and keep reminding me of all the fun cool things this guy is now going to be able to do with his life with his new leg. After his amputation we all need to just sit back and take a deep breath ... although today is far from over yet, this will prove to be the third day in a row of 7am till 3am days which is 20 hours a day if my math is right. We have to be realistic. Although we'd all love to help out as many people down here as we can, and return home with the satisfied feeling that we did absolutely as much as we could, we're going to help nobody out if we're so exhausted we can't function. After a much deserved rest we hit the OR again to take care of a poor woman who broke her right femur in a motorcycle accident 4 months ago and was never able to get it fixed. The last group couldn't get to her so she showed up this week ready for surgery.  Detaching two ends of your femur that have been overlapped 4 inches for the past 4 months is super hard and I think this last 5 hour case turns out to be a sort of watershed moment. Until this time, Tom's been able to give 100% ... but now you add physical pain to the mix, on top of the sleep deprivation, beef jerky rationing, and the lack of any establishment nearby that serves beer and brats, and you have someone at the breaking point. Nathan Lindsey, our "boss" here, tells us this morning that there's a chance we may need to take care of any hurricane victims Friday, so all surgeries for that day are on hold for now. In the shape we're in, none of us is really complaining about it.

While our spent Minnesota team continues in the operating room and some clinic today, two wonderful friends of ours from the east coast, Sarah and Chia-Ti are helping prepare the hospital for Hurricane Tomas (and no, this is't me after eating a can of chili either).  Those two kick it into high gear, and get all the volunteer's gear and cots into the hallway by the administrative offices, and the volunteer lounge (it's air conditioned)...Sarah's nursing her crazy huge bug bites, while I take a much needed break off my feet (and my aching knee).  Chia-Ti is sipping on some green concoction, which she says has an entire days' worth of veggies, while Beth has just finished bringing the last of the gear dow the steps from the volunteer sleeping area.  They are predicting torrential flash flooding, and dangerous mudslides. Especially disconcerting in this regard are the nearby mountains to the south!

The second, and last case of the day ends at 2am, and we all are about to collapse onto the oh-so-comfy army cots...however, Andrea has an exam to study for, and well...Pat and I need to keep this blog updated.  I think it's important to keep in mind that we're here not for ourselves; it's not about us ... it's about the Haitian people and trying to help them out. It's about opportunity and good fortune to be able to be in a position to help and to serve. The primary objective of humanitarian aid is to save lives, alleviate suffering, and maintain human dignity...think about it a little bit...photos will come tomorrow...it's 4am, and hurricane duty starts now...

Don't Be Afraid of the Dark!

Day 4: Wednesday, November 3, 2010

Today started off with all the preparations for the tropical storm Tomas that is going to hit Haiti in the next 24 hours. It's been downgraded from a hurricane to a tropical storm, from 90mph to 75mph winds, but that doesn't deter an army of volunteers all around the hospital from putting important supplies up on pallets and boarding up windows with plywood and 2x4s. And, in case you were wondering, no, tropical storm Tomas and its 75mph winds does not refer to Tom's gas after the chili he ate last night! 

After yesterday's marathon performance, we'd all love to take it easy today. However, there's a list of ten people that need surgery today and just not enough time to do it. Again, we repeat the mantra from this past July - You do what you can. Starbuck's instant Via coffee pretty much saves our morning as we'd be walking zombies without it. After supercharging ourselves on caffeine we hit the OR. During the third case, ORIF of a Galeazzi injury (English: fixing a forearm bone) in a poor guy who got pommeled by a rock, the power for the entire hospital goes out for about 30-40 minutes. Luckily, Tom, Beth, and I are all already wearing camping headlamps and we just continue to work like this sort of thing happens all the time where power goes out in the middle of surgery! Jessica grabs Tom's phone and supplements our light with the Flashlight app. Tony, one of our translators, entertains us by teaching us to swear in Creole. Next time you happen to be passing through Haiti on the way to the grocery, try out "Ou dwe fou!" or "Coco mama" or "Deplasse la!"

In the meantime, there's some good news and some bad news. The pelvic fracture woman from last night is still hanging in there after four units. We order a fifth unit today. She still eventually needs her femur fixed but not until she's stable, which she isn't by any means right now. We feel her belly and check her pressure periodically. She is now finally starting to make some urine which is a good sign. Her belly is getting swollen from her pelvic hematoma but not hard or particularly tender, which is a good thing, since the Haitian general surgeon here whom we've called for help won't see her. The bad news is that the nonverbal guy with the femur fracture who's been languishing in the hallway (no beds available) since Monday is terrorizing passersby by flinging his feces against the wall and tossing his dirty adult diapers onto the floor as they walk by. Everyone is asking us to get his surgery done ASAP so they can discharge him back to the referring hospital.

Today is also the day where we discover Tom's true soul mate ... BETH! Because she is the one person on this planet who sweats anywhere near as much as Tom does, and eats about as much beef jerky as he does, which is saying a lot. After the operating in the dark episode (during which, of course the AC went out), she shows us her scrubs which are absolutely drenched. Paige, meanwhile, is terrorizing the poor Haitian kids in the hospital in her own way, with the alien embryo hatching from the back of her head. After reassuring them that it's only a false alarm (the egg hasn't hatched yet), the relieved Haitian kids come back out from the closets and under the beds where they've been hiding.

I also find out I left my phone in the OR twice today, whereupon Tom had to retrieve it, thus showing that even traveling down to Haiti some things never change. So we add to our list of mantras for the trip ... "Don't leave the country without Tom." Beth, as the baby of the group, still apparently needs her afternoon nap; we find her curled up in a fetal position sitting on the c-arm machine in the OR - which, by the way, is defunct, making surgery a lot more ... uh, interesting. Speaking of which, we do our last surgery of the day, which we've just finished about 2 hours ago, about 1 am, without c-arm, which is nothing new since we haven't had it since we got here, but this one is particularly difficult as you have to guess how far into someone's hip joint you've gotta drill this pin. Kinda like playing craps. You want to keep drilling so your screw can make the fracture more stable, but then oops, you roll 6's and penetrate the bladder. Fortunately after a lot of really tense operating and tight sphincter tones the patient turns out just fine.

After another long day and night of operating, Jessica proves to us that no matter how many pairs of shoe covers you put on, you're still going to get your $50 French pedicure ruined with all the dirt, dust, and hospital germs you come into contact with constantly. Jessica still has yet to hop on the bandwagon  started by Tom's bandanas ... we now see that both Andrea and Beth have drunk the Kool-aid and are sporting them too. Pat never will since his noggin is simply too big. Any head that has its own atmosphere and orbiting satellites will probably not fit into your standard sized do-rag.

Well that's it for tonight! Thanks for following our second adventure down here in Haiti with Team Tom and Pat 2.0! Stay tuned for another exciting episode tomorrow. Take care, stay safe, and be thankful for what you got!

One Whirlwind of a Day

Day 3: November 2, 2010

We're finally getting to sit down and take a break now at 3am after a whirlwind of a day that started at 7. After morning meeting, making rounds, and orthopaedic clinic, we take care of a 16-year-old boy with a femur fracture. This is an injury that as recently as World War I was triaged into the "too far gone to help out" category when seen in a mass casualty type situation. Nowadays, the standard of care for this type of injury in an adult is an intramedullary rod (titanium or stainless steel) essentially shish-kebabing the pieces together - or at least if you're lucky enough to have been born in a country where they have them available. If you're born in much of the developing world however, you're oftentimes like the hapless French WWI soldier on the battlefield ... essentially SOL. Fortunately, we now have these nails called SIGN nails (Surgical Implant Generation Network) developed by Dr. Lew Zirkle which lets people just about anywhere, even without intraoperative xrays, put them in. He's an orthopaedic surgeon in Richland, WA who uses his personal savings and company donations to set this all up - the nails are free for the international surgeons who use them in places like Vietnam, Afghanistan, Nigeria, and yes Haiti. We have them here at HAH, our temporary home. I'd scrubbed on a few cases when I was volunteering in Uganda but it had been a year, so we email Dr. Zirkle this morning right before the case and within minutes, poof, he's kind enough to email us the technique guide in PDF format. We put Andrea's laptop up on a Mayo stand in the OR and Tom and I refer to it as we do the young gentleman's surgery. Sounds trite but that's truly technology put to good use. Kinda reminds me of the oldster who came into the ER last night who had dislocated his jaw from yawning too widely, and pop! there goes his jaw out of whack. (Don't you hate when that happens?) Now I normally don't do this kind of thing back home, but Jessica (the long-term nurse from Hotlanta) grabs me anyway to go see him because, well, who else is there? I call Lance Svoboda, an OMFS colleague back home at Hennepin County Medical Center, and within minutes he's texting back directions step-by-step on what to do. The last instruction about having to watch your fingers because when you relocate the jaw you might get bitten is a bit disconcerting until I realize this gentleman has no teeth. Thank God for small miracles, eh?

So after we get done with fixing the kid's femur, the poop really hits the fan. I think it's the bad karma I stirred up when I accidentally dropped the "q" word earlier today, as in "We're keeping today's surgery schedule quiet on purpose so we can leave room for emergencies that come in." I mean, come on, isn't that just inviting a bunch of bad stuff to happen? The first couple to hit the ER doors simultaneously are a 25-year-old woman with left acetabular (hip socket) and femur fractures who was riding a motorcycle, and an "old" woman (no one knows how old she is) with an open ("compound") left tibia-fibula fracture whom she hit. They were ambulanced down here from Petit-Goave, about a 4 hour drive away. It takes about an hour for Tom to have the SIGN nail set reprocessed so that gives us time to squeeze in a quick washout of a patient with a nasty foot infection whom Beth admitted from clinic yesterday. He's probably going to lose at least a toe but we figure he deserves at least one try of washing things out and seeing how things go. In the meantime,  people come pouring into into the ER ... a guy with a left hip fracture after falling at work, another with a both bones forearm fracture after being hit by a rock,  another guy riding a motorcycle with another open tibia-fibula fracture, a guy who got shot in the clavicle ... All of them are medically stable for now, except for the woman with the pelvic fracture. We've been up with her all night (it's almost 4 am now as we write this) and she may not make it. Her hemoglobin's 7 (that's low) and we have a pretty good idea most of that blood she's lost is sitting in her pelvis and her left thigh. We don't have a CT scanner here but it's not in her lungs or belly. Unfortunately it's not the kind of pelvic fracture that you can stabilize with an external fixator or a bedsheet tied around her pelvis ... it's the kind that you really can't do anything about, that in the States you'd send off to angiography to see if the radiology whiz kids can embolize (block off) any bleeding arteries, and that if you did squeeze it together with a sheet or external fixator you'd probably do a real good job of pushing her hip joint into her bladder - generally not a good thing. It's frustrating but there's absolutely nothing we can do for her here except stay on top of her fluids and give blood. We give her 4 units of blood. Blood is super hard to come by here in Haiti and even getting 1 unit is an ordeal. There are several other guys laying around in the hospital waiting for surgery because their families have been driving all over tarnation trying to find blood. One of them, a guy upstairs on the ward, just got his blood, 2 units, which we promptly divert to the lady who's dying downstairs with the pelvic fracture. At some point the question arises (I won't say who brought it up but it wasn't me) as to what point you stop diverting blood to a woman who is likely to not make it through the next day, when you could use it to fix up a bunch more people who have been laying around waiting for surgery, delaying things, potentially increasing their risk of dying because their risk of getting a blood clot is going up, and potentially making their surgeries more difficult and dangerous because of the delay ... the ethical issue is there but I think you have prioritize the 25-year-old woman for whom you can increase by even a small amount the chance she might make it.

In the meantime we do have to fix the "old" lady, who's the pedestrian the dying woman just hit on her motorcycle. Whereas on the surgery dry erase board in front of the OR, as well as the scheduling book, everyone else's age is listed ("16yo male, right femur fracture"), everywhere this lady is listed, she's just listed as old. Kind of mean, isn't it? We get done with her SIGN nail for her tibia fracture about midnight and at that point I'd love to keep working all night and fix up at least the motorcycle guy with the open tibia fracture, but we face a revolt by the rest of the team who needs some serious rest. They are used to pacing themselves and having a reasonable schedule even if I and the two med students, Beth and Andrea, are not (I did stay up 60 hours in a row once). We're forced to concede that it is totally reasonable to delay what would normally be urgent, middle-of-the-night kinda surgery back at home so that we can recharge ourselves and do a better job in the morning. After all, Paige is crucial to our game plan of doing a lot of surgery here and we feel bad about stretching her thin. Beth and Andrea spend a few hours updating our patient list and organizing the schedule for tomorrow, even after the crazy day that all of us have just put in - Elinor and Jess, Frank, our team of Andrea, Beth, Jessica, Paige, Tom, and I. We could use an easy day tomorrow, but as we're looking at the surgery list for tomorrow, filled up with the cancelled cases that got pushed back from today due to the emergencies, plus the emergencies that came in tonight that we never got too, we see that we have ten cases on. Well, we knew this could happen, that crappy things could strike this many good people, and this is what we signed up for when we came down here to Haiti. Going to try and grab a few hours of sleep before the poop hits the fan again tomorrow.

Hitting the Ground Running

Day 2: November 1, 2010

Any day that starts off hot and humid where Tom's sweating by 6 am before exerting himself can't be all good. After all, the ashes and odor from burning trash that fill the air have got his lungs so messed up he had to sleep sitting up in a foldup patio chair. However, then again any day that starts off with some instant Starbuck's coffee, a cold shower, and a morning meeting led by Nathan that makes everything seem like it's going to be OK can't be all bad either! Today indeed was a day filled with a lot of hard work, some frustration, but punctuated by enough fun stuff that itkept all 6 of us going strong.

Even before we were done with making our morning rounds to see all the orthopaedic patients in thehospital, we had the hallway outside ortho clinic nearly full with the

day's appointments. Nathan tells us that people here have it ingrained in their psyche that the sooner they show up - many are here at 6am - the sooner they'll be seen. Never mind that we won't be done with morning rounds and then our morning meeting until around 8:30a

m. Apparently at one point they did experiment with giving people a set time to show up. It really didn't work since even the patients with noon appointments would show up at 6am. The rest of the morning and early afternoon is kind of a blur. Changing dressings, pulling pins, checking xrays, putting on casts, and just keeping your nose down and trying not to look out into the hallway too much to see how many bajillion people were still waiting. Fortunately, our whole team of 6 is working its tail off, and we are helped by Frank, an OR nurse from Napa who's with us for the whole time we're here. One tough dilemma is seeing the lady who was in a motorcycle crash 2 days ago and dislocated the medial (inner) end of her collarbone right where it meets the sternum (breastbone). A lot less common of an injury than dislocating the other end - something that almost all hockey players get. I've seen a few of these before, at HCMC, but we always had vascular surgery available in a nearby room in case we got into trouble (those big pulsating blue and red things behind the sternum tend to make us orthopods kind of nervous). It kind of takes a lot of apologizing to convince her there's nothing we can do - or rather, nothing we should do under the circumstances. She and her daughter are hopping mad but it's something I'd rather put up with than risk someone bleeding to death in surgery. Every single member of the team pulls his or her own weight getting through the day's patients. (In Tom's case, that's quite a bit of weight!) Andrea, Beth,

and Jessica at some point come up with the great idea of splitting up into different rooms and prove invaluable, while Tom and Paige get things ready to go in the OR for the afternoon's surgeries. There's the 19 year old woman with the infected Achilles tendon wound, a kid upstairs whose tibia smelled a little south of cheese, and a guy downstairs whose shoulder was washed out by Rick, the previous orthopod last week, and who's due for another washout today. Thanks to having Paige with us, we have the "luxury" of seeing all the clinic patients and getting to operate till reasonably late (7pm) without having to worry about our anesthesia providers taking off for home.

After wolfing down some rice and beans for lunch we don't have much of an appetite for dinner with it being so hot. Jess, Paige, and Andrea busy themselves with organizing the dressing cart and I go see the two new patients with femur fractures who got admitted earl

ier today as transfer

s from another hospital. MSF (that's the French way of abbreviating Doctors without Borders, though the running joke is it stands for Many Single Females) Holland closed dow

n recently so we're getting a lot of orthopaedic transfers. One's 16 and already is in some traction; the other has an unknown age, doesn't speak, and has no records or family mem

bers with him. He's lying down on his broken femur side with a plate of half-eaten spaghetti in front of him, partially spilled onto his hospital scrubs. Both these poor guys are lying on beds in the hallway for lack of room. The nonverbal guy's

break is a subtrochanteric fracture, just below the hip, which is a tough nut to crack even back home at HCMC with a working C-a

rm xray machine, an army of residents, and modern orthopaedic devices. Here, it's going to be really, really tough. But at some point this week it's gotta be done - who else is gunna do it? We have a little adventure for the next hour trying to jury rig skeletal traction (putting a pin in his left tibia attached via some rope to weights hanging off of the end of the bed to help keep his femur aligned). Except in this case the "weight" is a cinder block Andrea finds in a hallway, the rope is one of the cords holding up some mosquito netting upstairs in our sleeping are

a, and the traction bow that normally holds the rope to the pin is a couplea pieces Tom borrows from the external fixator set. I take Andrea and Beth through this process and they do a great job. Heck, sure it's her first time putting one of these in, but just think how easy it'll seem for her when she puts them in as a resident with all the right equipment available. ("Boy, I remember when I put one of these in for the first time as a medical student in Haiti ...")

At the end of the day I look back and am really proud of all the members of our team, as well as the other volunteers we've met here at HAH. I'm also thankful for the deceitful indulgence of getting to do something that peopl

e think you're really sacrificing a lot to do, and yet which is actually rewarding, and even fun at times. And, as always, it helps to step back and look at the big picture. Despite the frustration at how limited we are, how helpless we feel at times with the patients we can't help, the temper that flare when things aren't going the way we want

them, it helps to remember why we're here and whom we're here to help. From the volunteers to the patients to the OR nursing staff to the security guards, we see that answer every time we stop and look around at the smiling faces of the Haitians around us.

A New Group!

Day 1: October 31, 2010

Ten months ago the people of Haiti experienced a magnitude 7.0 earthquake, leaving 230,000 people dead and over a

million displaced. Lots of people have helped out on the ground in Haiti, many of them for years before the quake, and something like 1 in 6 Americans donate

d some amount of money. Against this

backdrop, going back to Haiti for a second trip pales in comparison, but here we are

doing our small part. Thanks for following along ... these are some of our thoughts upon coming back do

wn to Hospital Adventiste d'Haiti again to do some

more orthopaedic volunteer work. If you experience any lame attempt

s at humor, please keep in mind that it's simply to lighten up a narrative written about as boring as can be, about a situation that might otherw

ise seem depressing and hopeless and can be... but with enough

time and help, doesn't have to be. After our last trip in July, the th

ree of us have had a really strong desire to help out some more. We've taken the lessons we learned the last time to heart and made some steps to see how we could help more people the second time around. Although Liz unfortunately couldn't join us this time; we recruited some more people, and so here's the team for our second go-around:

Beth Bard - third-year medical student extraordinaire at the University of Minnesota. She's really gotten into the international orthopaedic swing of things and is looking forward to spending the next year of medical school vol

unteering

abroad to Uganda and

India! Both she and Andrea hail from Alexandria, Minnesota and were one year apart in high school ... and hadn't even been aware of each other's existence until this tri

p!

Andrea Paulson - fourth-year medical student at the University of Minnesota. She's a medic

al mission veteran having been to Mexico, Tanazania, and Nepal already! She's got her husband Jake and son Bauer holding down the fort at home, hopefully not eating radioactive orange mac and cheese every me

al.

Paige Saunders - part-time rastafarian, part-time certified registered nurse anesthetist at Hennepin Co

unty Medical Center in Minneapolis, MN. She's the one holding this whole house of cards together. Now we are no longer at the me

rcy of the Haitian anesthesiologists' schedule! She misses her kids Isaac (13) and Sidney (6), but unlike Andrea, is

100% certain the ARE eating radio

active orange mac and cheese every meal.

Jessica Bice - this is one cool lady. Harley rider extraordinaire, dog owner/lover, and has a brother named Vince who dishes up the grub at the Whisk

ey, which if you haven't be

en there, is a fun place to ride your Harley to and watch cool shows. In her spare time,

she holds down a day job at Hennepin County Medical Center as an operating room nurse, dealing with immature squirts like Paige, Tom, and Pat.

Tom Slater - former surgical tech extraordinaire, now trauma implant coordinator at Hennepin County Medical Center. For those of you who speak English and not hospitalese, he sits in his office and drinks coffee for about 11.9 hours a day, and does actual ordering of orthopaedic and neurosurgical devices for about 0.1 hours a day. He likes to think of it as just

being super-efficient. He's excited about his son Cole (4) starting mini-mites next year!

Pat Yoon - orthopaedic surgeon at Hennepin County Medical Center specializing in fixing broken stuff in the lower extremities. Unlike his buddy Tom, he actually does 11.9 hou

rs of actual work a day and spends the other 0.1 hours in Tom's office drinking coffee. He has no kids to watch playing hockey or worrying if they're eating radioactive mac and cheese, but does have a lab mutt named Corky (4) and three cute nephews named Matteo (5), Oliver (3), and Owen (1).

Our travel day started off with cleaning up after the Help Haiti Part Deux par

ty. We had a great turnout with about a hundred people, and this helped out a lot in defraying the costs of going to Haiti. Essentially our only costs

were the plane flights, so those of you who pitched in can sleep easy tonight, and rest assured that it all went to a good cause – getting us down there. Jessica Bice’s mom Carol drive us to the airport where we meet up with Paige and Andrea. After a quick layover in Chicago we arrive in Miami where we retrieve our luggage to re-check it into the Haiti flight. Somehow, American Airlines loses the biggest bag of all, this 75 lb. behemoth of a hockey bag which has a lot of important stuff in it … spinal trays, scrub brushes, shoe covers, surgeon caps, laparatomy packs, Paige’s glide scope, and mos

t important of all, Tom’s entire supply of beef jerky (we are going to a Seventh Day Adventist Hospital, af

ter all, where they don't serve meat). We speculate how in the world they could lose such a huge bag – it’s not like it’s easy to miss or anything. I’m thinking the baggage handlers

are just looking at this thing going “aw, hell no, we’re not lifting that” and just leaving it on the tarmac in Minneapolis or Chicago … by this time, it’s past midnight and our connecting flight to Port-au-Prince is at 6:40 am. The 6 of us curl up next to a couple of seats near a SmartCarte vending machine near the ticket counter at Miami airport to grab a few hours of sleep. I unplug the SmartCarte machine so we can use its extension

cord to recharge our phones. I have a ha

zy memory of a

poor guy trying unsuccessfully to retrieve a cart from the machine. After a few hours of tossing and turning we got on the Haiti flight and arrive in Port-au-Prince and are instantly welcomed by the death grip of the heat and humidity. Tom’s prepared with a do-rag which is almost instantaneously soaked. We retrieve our bags in the open hangar that passes for an immigration hall / customs room and meet up with our driver from Hospital Adventist d’Haiti, Richard. Somehow the drive only takes about 20 minutes this time when our memories of the last time took about an hour. Things look about the same on the drive in. Lots of rubble, lots of trash, and lots of people despite it all just going about their daily lives.

Once at Adventiste we get to meet up with Jessica Scott from Georgia, affectionately known as Hotlanta, who's been down here ever since June, as well as Sarah Carignan, an ER administrator at Mass General in Boston, and Chia-Ti Chiu, a massage therapist and yoga instructor from Brookly

n. We all worked together the last time we were here in July, and arranged to all work here again this week as part of Team Yoon (or Tea

m Carignan depending on whom you ask!). Literally the minute we put our packs down people start rolling into the ER. I run down there to start seeing patients, Andrea and Beth organize stuff in the supply room, and Tom sweats. No, seriously he works his tush off organizing stuff in the operating room, delivering the supplies we brought down with us (we brought 12 big hockey bags with us, 2 per person). One of the patients we see in the ER was referred here from another hospital when her heel got cut by a motorcycle. She shows up with a gaping wound and Achilles tendon and bright blue prolene suture flapping

in the breeze. We set her up for an I&D tomorrow in the OR to wash things out.

We get a warm welcome from Nathan and Amy Lindsey, the long-term volunteers who run this place. Furthermore, this being Halloween, Sarah and Chia-ti welcome us with decorations of pumpkins and bats, complete with nice grills, bling, and glitter! Although it’s late at night, we’re tired and sweaty, and we've been traveling and working for the past 36 hours straight, it feels good to be back!