Thursday, January 21, 2010 2300 Emergency surgery

Later in the evening, around 11 pm, I remember walking around the halls by the make shift supply room, when out of the corner, Bernice who is a part of our team told me that I needed to prepare for surgery for a young woman who was 20 or so weeks pregnant, who's unborn child died during the earthquake, after a cinder block fell on her. Bernice, who happened to be a nurse midwife was working the night shift and was watching this patient on the other side of the hall in another room with two other OB/GYN surgeons, who've been trying to "induce" her, so that she could give birth naturally to her already deceased fetus.

After so many hours of unsuccessful waiting, she apparently started losing a lot of blood. Her condition was worsening and they decided to perform an EMERGENCY CESAREAN SECTION!

Being the only anesthesia provider who was working that night, I had to scramble for help. Helen, turned out to be knowledgeable on gathering the necessary surgical instruments. Bernice volunteered to assist the 2 surgeons, and Luc was a trained O.R. nurse. Everything happens for a reason! Everyone who needed to be there, was there!

I ran to check the two operating room's anesthesia machines. One of them had an oxygen leak! Luckily, these old machines are the same ones that I trained on back in Ohio! I was able to trouble shoot the problem! But, it still had a leak! Can't use this one! So I ran next door to the other operating room and saw that the other anesthesia machine was completely disabled too! I needed to think of a way to perform general anesthesia on this patient, who was deteriorating quickly.

After seeing a huge oxygen tank on its side on the floor, it dawned on me that they probably weren't using the machine at all! I decided to manage her anesthesia with intravenous drugs only and with manually controlling her ventilations without a ventilator.

The next thing I recall was that the patient (Madeleine) who was still on her OB exam table, was wheeled into the room by both surgeons. They hurriedly prepared for surgery and waited for me to put her off to sleep and help control her breathing. The one thing that I will never forget.....is that despite the fact, that she knew her unborn child was already dead, she looked at me with her beautiful eyes, and gave me a nice big smile and said, "Merci" (thank you). I told her through the help of her interpreter to take a big deep breath, as I caressed her cheek, and put her off to sleep.

Once she was asleep, I told the surgeons to go ahead and "cut". Meanwhile, I was busy looking for medications that I needed during the operation. I asked Luc to ventilate the patient for me while I scrambled for some much needed medications to help sustain her during the operation. Another nurse helped me write down important blood pressures, etc.

Both surgeons worked expeditiously to get her unborn fetus out and help control her internal bleeding. They did the surgery in 20 minutes! She was becoming more stable! Thank goodness! Once the operation was done, her unborn fetus (a boy) was given to her husband who was waiting in her room. It was a sad night for all of us. Yet, I was very happy that Madeleine was able to pull through! Once she was awake and stable, we took her to the recovery room. I helped watch over her, along with the other 2 critically ill patients the rest of the evening.

Everyone tonight did a great job! We pulled through! Waited for the day crew to arrive and gave my report over to Brenda. The rest of my night shift crew went back to the house after getting a light breakfast (Chef Boyardee!). Saw the sun rise from the hospital balcony with Janet. What a beautiful site!

Once back in the house, Luc and I talked a bit about what had happened on our first night there. I was still too wound up on adrenaline to sleep. But I needed to get some rest for the next shift. I was assuming that I'd be back at the hospital again tonight...

Thursday, January 21, 2010 First night shift

Waited for the sun to go down. Had some mattresses outside the balcony. It was nice and windy. Got bit by one mosquito. Good thing I brought a lot of insect repellant wipes with me. The sunset was magnificent. What a view! A nice way to help relax before going to work that night. Once it was time, those of us decided to go to the main hospital to check out the "assignment list". Janet told us that assignments for everyone would be listed on this piece of paper. I was anxious to find out where I was going to be assigned for the night.

Once we got to where the list was posted, I didn't see my name anywhere. Did they forget about me? I thought to myself. There were a lot of people everywhere. Those preparing to work, and those getting ready to rest for the night. I was determined to do something tonight. I decided to go downstairs to the main floor where the operating rooms and patient recovery rooms were located.

First thing I remember doing, was helping someone move a hospital bed into one of the already crowded rooms. Once in this room, I was pulled aside by one of the other CRNAs named Brenda. She apparently was working the day shift with her team members and were providing nursing care all day. She saw that I had "Vince, CRNA" written on my shirt and pulled me aside and asked if I was working the night shift. After I said, "yes, I'm here to help", she told me that I needed to take care of a patient in the next room who was badly burned during the quake (he was apparently in his car in Port-au-Prince when the quake hit and was crushed inside his car which exploded. He was found 5 days later, badly burned over 90% of his body but still miraculously alive), and that he needed someone with critical care skills to look after him.

One of the physicians who was in charge of of the hospital that day spoke with me and gave me a quick history of his injuries, along with what needed to be done through the night. Another patient came in to the room from the operating room who was in critical condition. I now had 2 very ill patients to look after, with very little to no monitoring equipment available! All I had was access to a huge oxygen tank, a monitor that I shared between both patients, and a hardly working suction device (the only one in the whole place!).

Once I got a quick report from the physician, they asked me to go around with Brenda so that she can give me report on EVERYONE in the hospital (there were probably over 30 patients). Seemed that I was going to be in charge for the night. I asked the attending physician if he was going to be available for the night shift, to which he replied, "No. I'm going to rest and sleep. You'll do just fine."

At this point, I got very nervous. But then, I figured that if something urgent was to happen, I could just barge in one of the rooms upstairs to ask for help. No problem I kept telling myself.

Here I am with 2 very sick patients to look after, plus being in charge of all the other sick patients in the wards! I needed some help. Janet, who was an Angel throughout this whole week, managed to recruit 3 Dom. Rep Medical students for the night shift. She told me that I was to utilize them in whatever aspect of care I needed them to do.

I also asked Luc and Helen who are my team members to help and stay with me. They gladly agreed. Now I had 5 people to help for the night...

Once the dust settled, so to speak...when everyone from the day shift started leaving...I focused on what was at hand - taking care of these 2 critically ill patients. Meanwhile, the rest of our night shift crew got busy giving routine medications and medical treatments/care to everyone who needed it. It was chaotic to say the least. I felt like going into a battle zone with a blind fold. I'm sure everyone else felt the same way as I did...

I went around the hospital to help familiarize myself with it's layout. The night shift pharmacy crew was there...still organizing all the medications that were coming in non-stop from donors.

I found the surgical instrument cleaning room, where used instruments were soaking in alcohol or bleach. No fancy sterilizing machines here. This is OLD school now...

Thursday, January 21, 2010 The orphanage

Some of us decided to walk over to the orphanage - a two-story building that housed a make shift emergency triage area, as well as housing over 200 or so earthquake victims and their families. It was about a 4 minute walk from the main hospital. Along the way, 2 air conditioned trailers served as an ICU which had 4 critically ill patients. A small chapel off to the side also served as patient shelters. A huge tent around the back was full of patients, laying on cots with different types of injuries. There were so many children. Oddly, it was pretty quiet. Not a lot of crying children I noticed. Perhaps because they were all exhausted to even let a cry out...

Walking through the orphanage hallways, a dog was wandering aimlessly. He looked tired too. Even the hallways were filled with beds/cots with patients. A couple of ambulances and a school bus were dropping off patients who were once in the main hospital for one reason or another. This was the place where they would go for further medical care.

Feeling a little tired and somewhat overwhelmed of just seeing masses of injured people in one place, those of us who were going to be working the night shift decided to go back to our sleeping residence...little did I know that it was going to be a long and nerve wracking night for me...

Thursday, January 21, 2010 Inside GSH

Had a few hours till our shift started (1830). A few of us decided to go into GSH to get something to eat (were told that meals were being served every two hours for all the volunteer workers) as well as to get familiarized with the hospital's rooms, etc. First thing I saw was the make shift lobby. Lots of people in scrubs walking around. I felt "lost" and misplaced for some reason. I can only imagine what many of the injured were feeling...strange faces...the fear of the unknown.

Turned around the corner and saw a couple of rooms that were made into operating/procedure rooms. First thing I saw was written names of the groups who were working there. Written on a piece of tape read, "The Rainbow Group". The other room was called, "The Redneck Group" (pretty TACKY I thought to myself). Seemed that several medical teams from the U.S. laid "claim" to the rooms. Strange I thought. But I moved on and walked around the rest of the first floor.

Saw several rooms made into make shift "post operative" and "recovery" rooms. Each room had about 7 or 8 freshly operated on or sick patients with their family members laying on the floor with them. They were CRAMMED. Many were speaking in their native tongue. It was HOT and HUMID. I was already breaking a sweat. Lots of movement. Lots of people. If you were claustrophobic, this was not the place to be.

The smell of urine and soaked dressings stood out to me. But I got used to it quickly. The look of "helplessness" on the patient's faces overshadowed what I felt and smelled. I was there to help them now. I had no time to worry about my own needs.

Many volunteer workers from around the world and the U.S. were present. Puerto Rico's search and rescue team were in their trailers. They were going in and out of Port-au-Prince, rescuing earthquake victims and transporting them into GSH. The medical team from Spain were there already. They were easily identified by the vests they wore. The Japanese team had left already from what I was told. So did the Dominican Republic surgery team who were the first responders had left unexpectedly. Sadly, I will soon find out why they left later on during the week...

Lots of supplies were coming in by the truck loads. It took most of the space right on the first floor. An armed guard sat right by the entrance, perhaps to help prevent unauthorized personnel from taking them. Or maybe just to help maintain some sort of "order" amongst the people within the compound.

Went upstairs to the main lobby where several of the teams congregated for meals. A large freezer filled with bottled water! Lots of empty water bottles everywhere! Lots of trash! This is where the rooms were located. Where many of the workers slept as well. Many of the "administrative" personnel, who's job was to help organize this hospital were present. We had a meeting after our meal and were given a brief synopsis of what was going on and what was to come. I could already sense a "tag of war" between several of the group's administrators. COTN was not a part of it I noticed. We were not there to play "administrators" or "consultants". We were there to help and do whatever was needed. THIS MUST BE THE FRUSTRATION THAT VICKI WARNED US ABOUT...

Soon after, the truck that had our donated supplies arrived. 3-4 COTN members catalogued each and every donated supply on a log. Some of us who were going to be on the night shift that night decided to walk over to the "orphanage" which was a building on the other side of the hospital. It is where over 200 or so patients and families were sleeping and were being cared for. This is where the E.R. was located, where most of the injured from Haiti were being dropped off, whether by ambulance, school bus, or behind pick up trucks...

Thursday, January 21, 2010 Arrival at GSH

Arrived at the Good Samaritan Hospital in Jimani. The bus stopped in front of a residence surrounded by walls. It is where we were going to be spending the next several days in while we worked at the hospital across the way. Helping us unload our bags were a few children. They couldn't have been more then 7 or 8 years old.

We were shown a quick tour or the house, which was completely empty. Was told that it was a newly constructed home, but was abandoned for some reason or another. COTN managed to have this home serve as our resting place. Scott led us to our assigned area on the second floor. Some relief workers were already sleeping downstairs. All I saw was a lot of mattress scattered about. No specific bed assignments here. You grab flop down where you can to get some zzzzzz's.

Went outside the balcony and was able to see the Haitian border from where I stood. What a beautiful site! It made me forget for just a minute how much devastation was going on beyond that ridge. Port-au-Prince was just less than 50 or so miles from where I was standing.

There were 2 bathrooms in our area. A high tech shower! No running water. Flushing the toilet was done by pouring a jug of water collected from an outside artesian stream right in front of the gate of the house. It wasn't for drinking we were told. At least the bathrooms were private, I thought to myself. Good thing we brought a lot of body wipes. I have a feeling that I will be using them in lieu of getting a shower during the next several days.

Once we got our bags unloaded, we all gathered downstairs to meet our COTN medical team leader, Vicki. An emergency physician with a heart of gold, she was the first COTN member to arrive in Jimani. She was our main medical team leader and she was going to be the one to help lead our group. She gave us the best advice today: "Learn to focus and manage your own space". She told us that there will be a lot of frustrations that we may be feeling in the coming days ahead. After a group prayer, Scott handed everyone our COTN badges.

The group was then asked to write down work shift preferences. The night shift needed the most help, so I signed up for it without any second thoughts. All of our team members from Weeks, aside from Walter was going to be working the night shift. I had a feeling that the next few nights were going to be bumpy...