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.