Code Blue

Beth was part of a code yesterday and told me this story. It was flag day, and the streets were crowded with celebration, parades and dancing. A women age 40 something felt really sick, her family took her to the closest clinic. The clinic recognized she was critical and called an ambulance to transfer her to the Miami Field Hospital, traffic was at a standstill and she was deteriorating so they brought her here. The woman arrived and was placed on a cot which is about 1 foot off the ground. She was initially responsive but no blood pressure. Beth says she ran for the EKG machine which was down the hall in a closet that was locked, it is a very old machine, she puts on the sticky tabs for the electrodes and Shan followed her hands putting tape over the electrodes because the patient was diaphoretic (sweating)(who wasn't?). She had flash pulmonary edema and rapid atrial fibrillation heart rate in the 200s. The anesthesiologist comes to help and got a central line, they started dopamine, and they shocked her. Luckily, the day before Beth and Tami had found the defibrillator plugged it in and straightened out the cords (Tami says it looked like macrame). They charged it up found the pads which were somewhere else and had it set up. All the people in the ER and family members were watching (privacy violation in the US). First thing the anesthesiologist says is can you raise this gurney (not quite). So people were on their knees on the cement floor running the code. They decided to intubate as her O2 sat was dropping to 8,(normal is greater than 90), they had no suction, they only had 45 minutes worth of versed to paralyze her. They used all of the drugs and all of the resources the hospital had on one person. Laura says,"Our concern is how many people will come in the next 24 hours and need those resources. They used up all of the oxygen and versed. It was worth it because she was salvageable." She was shipped to the Miami Field Hospital. A state of the art tent hospital. The code went well because Beth, Mikell and Tami had done codes together before, and Mark is a great ER doctor. The ambulance transfer was a comedy, a very tight space, they put the patient on a stretcher and then put it on Mikell's foot.

In Haiti we do rapid diagnosis with very little tests, if the problem is not curable, or out patient treatment is not sustainable we back off. In retrospect, Laura looked at the EKG and felt this woman was going to live and the treatment was worth it.

For the past year in our hospitalist program at Ukiah Valley Medical Center (my day job) we have been focusing on improving end of life care. We have a holistic approach and do everything we can to provide physical, emotional, and spiritual care. In our hospital the sheets are clean, the rooms are private, the morphine is available. Here at the Hopital we have few sheets, no privacy and rarely morphine, but we do have spiritual care. Yesterday Laura had an elderly man die and I called in a RN volunteer who lives in the US and is Haitian. She came into the room and lead a long prayer in Creole, then I lead her to this beautiful sweet elderly woman who has been here for several days. The patient came in with chest pain and is suffering from an acute heart attack. Everyday her chest pain gets worse and she knows she is dying. She kisses our hands and thanks us for caring for her. We prayed together in Creole, holding each other in a knot, she was so moved she seemed almost ecstatic.

Today was the club foot clinic. Children from all over Haiti come here for recasting to straighten out their feet. I was walking down the hall and the families and children were sitting in a row waiting. They gave me permission to take their pictures. Scott says it is a pleasure to be giving care that is "elective" and not a response to the earthquake, moving forward away from the disaster, making a big difference in the lives of many children.

The Leap team (plastic surgery) is here during the week. They go home at night to the Leap house. Near them they found an orphanage with about 100 children. They noticed some health problems and asked us to go examine the kids. Laura, Michelle the pediatrician and I went out there and examined about 20 children. We gave them medicine for scabies, impetigo, and fungal infections. Michelle recommended, lab test and follow up visits on a few of the children. The place was incredible, the noise level was deafening, the kids were running around crazy. The house was big and had been a mansion in a past life. This orphanage as opposed to the other one we visited does not turn any child away and has both girls and boys. We left clothes, toys and medicine, but much more is needed. There were several American couples there arranging to adopt children that had been orphaned before the quake. There are many parents here in Haiti who want to have their children adopted because they cannot provide food or schooling for them. They want the children to have a chance to live to their potential I have had several talks with Gregory one of our translators who placed his 3 daughters in an orphanage, one died about a month ago and he wants Patti our nurse to adopt the other 2. The Haitian government allows adoption if the parents are alive and sign the papers, at this point they do not allow adoption if the parents are dead.

Pictures of Laura the Condom Lady at work, the orphanage house, Laura with the baby girl at the orphanage she called "her girl" and would not let go of, code blue in our ER, Miami Field Hospital, club foot clinic, Flag Day parade/traffic jam.