The end of peanut butter as we know it

Tuesday, 20 September 2011

                I think I would be shortchanging you if I neglected to tell you about the ant story from last night. During our last case, I felt these creepy crawly things all over my face. I thought to myself, Oh well, that kind of stuff just happens down here, I suppose, deal with it. I asked Bonhomme (who was our circulating Haitian nurse) to take care of it for me, and I just kept working. Problem solved, no more ant crawling around on my cheek. Until it happened again … and again … and again. These little suckers were crawling all over my head having a freakin’ picnic! My entire head and face were itching like crazy and Bonhomme had her hands full swatting my head with her hands killing ants.  I look back and think Holy cow, I was jumping around swatting my arms about like I’m crazy in the coconut, no wonder people were giving me funny looks. At the end of the case I took my headlamp off, opened up the battery case, and lo and behold, it was full of ants! Looks like the little buggers were making a little ant colony for themselves there. I kinda cringe when I think of putting that thing on my head. More than that I was relieved that it wasn’t all in my head – just on it.

                So we’re up and at it again at 6:30 this morning. We eat a yummy breakfast of energy bars while we check email, followed by morning huddle in the chapel. Nathan’s message today is about the two fish and five loaves of bread story that most of us are probably familiar with. The idea being that whether in abundance or in small subtler amounts, we’re provided for. I start thinking, I wish I was provided with an umbrella so the sweat off Tom’s forehead doesn’t drip all over me. But I also start thinking about healthcare. If you live in the States you’re like the guys with thousands of leftover fish and bread at the end of the day – more plastic surgeons, same-day appointment MRI scanners, and Lasik sweatshops than you can shake a stick at. If you live in Haiti you simply get volunteers like us, just enough flour and oil to make it to another day if you’re lucky. Five volunteers from Loma Linda, including Marq the “lifer” from Adventiste, and Heather, Sarah, and Vanessa  from Loma Linda are off to fly to Cap Haitien to run am outreach clinic there for a few days. Story is there’s 300 patients out there waiting to see them. I think, holy noodles, good luck with that! There’s also a full slate of surgery cases for us today. After rounds, surgery starts off with two bilateral clubfoot cast changes, and a knee manipulation under anesthesia. The knee manipulation kid previously had a 7cm limb length discrepancy and is being lengthened with an external fixator and the principle of distraction osteogenesis. This is basically where you break someone’s bone and stretch it out gradually with time, like a millimeter a day divided into four quarter-millimeter intervals, and new bone grows in the gap, Unfortunately this kid has lengthened about as far as he’s gonna get, at about 4cm (so he’s still 3cm short) as his knee is getting pretty stiff, hence the knee manipulation. Now the key with this is to push hard enough to move the stuck knee but not so hard you break his leg. That would obviously not make someone’s day, so after CJ and I nearly give ourselves hernias pushing on this lil’ tyke’s knee, caution wins out over making the knee move better and he’s unfortunately still stuck. A definite whomp, whomp moment.

                After a few more cases, the last case of the day is a 68-year-old woman with a broken hip. Believe it or not she actually comes in as a scheduled elective case for this, and has been at home for the past few days waiting for surgery.  Amy notes that this is the sweetest little old lady you’ve ever met and didn’t complain about one thing or say peep during the whole case. We lay her lateral decubitus, or on her right side, to perform a left hip hemiarthroplasty, or partial hip replacement. Once inside the hip it becomes apparent it looks like more than a few days old, more like a few weeks. After a lot of struggling we eventually get things done and things turn out just fine. As we’re getting the nice old lady off the table and back onto her gurney, Tom and I are undoing her “seat belt” which is strapping her securely on her side. Back home this is a real seat belt made of leather with metal buckles. Here it’s a roll of this semisticky stuff called Coban which is a 3M product (go Minnesota).  Now they’ve been known to reuse everything under the sun here (ventilator tubing, bloody laparotomy sponges, screws that come out of other patients) out of sheer necessity, so I ask Tom, “Do they reuse this stuff?” meaning the Coban which I’m about to unwrap. Tom pulls out his scissors and – Snip! – “Not this one!” Hahahaha!!

Besides thinking that everything’s funny, we’re all too pooped at 9:30 pm to do much else besides sit in a zombielike trance, eating food and sitting in puddles of our own catatonic drool. The danger with having jobs where you work ridiculously hard (this actually refers to memories I have of residency, not volunteering here at Adventiste – it’s too much fun here to be considered work) is that you feel entitled to eat whatever the heck you want to eat when you get home because you justify it and say, “Hey, I worked 118 hours last week, I deserve a whole bag of tortilla chips and a whole jar of salsa.” We all exemplify this rule as we spend the next hour sitting, mechanically shoveling food into our mouths.  I speciously justify my gluttony with the convenient argument above and eschew peanut butter (not having pb for the third night in a row, no way!) for some Annie’s mac ‘n cheese and half a box of Puffins … of course not to mention a few handfuls of Beth’s honey roasted almond mix. Sitting here kind of reminds me of the 60-hour stretch of continuously being awake I had early in my career. (You may wonder “Wait a minute, don’t they have that 80-hour work week and a 30-hour workday rule? – Nope, only for residency!)  After a while, you’re too punchy to really fall asleep. Everything becomes funnier. The vibe is similar here at Adventiste. We’re not nearly that overworked here, but we’re all truly working our tails off. We’re having fun  - meaning the work itself is fun, not that we’re goofing off. The camaraderie is great. We’re making cool friends from Haiti and other parts of the US. We socialize and laugh with our patients and try to make them feel comfortable. It’s fun down here because every single one of us down here – not just our group of 4, but the “lifers” Lynne and Marq and Brian and Nathan and Amy and CJ … and Heather and Sarah from Loma Linda … and our awesome Haitian friends like Jean Joel and Jeanty and Albert  and Aleksei  - are all here at Adventiste for the same reason, to help a brother out. Just cause we can.

Then to our surprise we run into Marq, Sarah, Heather, and Vanessa walking back into the hospital – they were supposed to be in Cap Haitien till Friday. You know the cliché about thinking your day being crappy until you hear about someone else’s misfortune? Turns out these five never made it to Cap Haitien. Rather, their plane actually made it, but after circling above the thunder and lightning for a while in a pattern, their Salsa Air pilot flew them back to Port-au-Prince. The pilot flying the Tortuga Air flight 5 minutes ahead of them wasn’t so cautious. He apparently tried to land his plane at Cap Haitien in the thunderstorm. Our friends were in a holding pattern in the air right above the other plane when this happened. The plane below them crashed and all three people aboard were killed.