Miracles in Chaos

Words from Linda

“It’s about 12:30 am here and I am having a hard time winding down. Gurpreet, Becky, Shan and I just returned from playing "Santa" to the kids in the hospital. We created little goodie bags with coloring books, crayons, pixie sticks and toys and then placed them by each sleeping child so that they could have a surprise when they woke up. We were very stealth about it and no one woke them up!

This morning we were up early to do rounds with the orthopedic surgeon. Afterwards we had planned to begin doing wound care on the patients but the triage tent was so busy that Gurpreet and I were asked to help down there. Dr. Turner and Emily had a long line of people waiting to be seen. I was told to take vitals and triage but after an hour and a half I was drenched in sweat and began to feel overwhelmed as I realized there was no end in sight. Not to mention I still had a lot of dressings to change! I decided to ditch the triage tent and do wound care with Brad. One wound patient takes an an hour + no matter how much we prepare, for the most part we have a good work flow. I am proficient enough in my creole that I don’t need my translator during the dressing changes. David and Melanie the PTs have become experts on wounds and wound vacs - they have been here the longest and provide continuity for the patients.

There is plenty to do helping the ED - lab draws, giving meds, starting IVs on dehydrated people, there is always someone who cant find a supply and they need a "gofer" There is a lack of organization here with the supplies. It is frustrating. Gurpreet was involved with some complex cases today as well as being stuck with entertaining 4 nursing students. Becky is just doing great things in the ED and is the go-to girl in that department.

We went out to eat tonight at a local restaurant. We had a few beers and shared our "war" stories of the day as we munched on fried plantains and piccoleas (sp?). It was nice to get away after a long crazy day. The young 24 year old mother with the skull fracture was a very sad case. She was transferred from Doctors without Borders, and after more than 6 hours spent trying to save this girl which included inserting our only central line in the hospital, intubating her, giving her IV meds and IV fluid etc., after a consult call was made to a neuro surgeon and the MD director advised letting her go. The whole situation is just extremely unfortunate and sad.
OK well I have to get at least a few hours of shut eye before tomorrow. “

Words from Becky

“Being here is hard, great, wonderful and awful. The inflexible and unadaptable need not apply. Doing things that are simple at home are very difficult here. Starting IV's kneeling on the hard floor in low light, with any variety of strange IV piggy tails or IV tubing, making our own saline flushes. Trying to find a small drinking cup to bring a patient some water so they can take a pill. Finding a good working thermometer and then run out of probe covers and resorting to doing axillary temps without probe covers, until that thermometer stops working and you have to search high and low for another one that works. Weighing the moms holding the babies and then the moms alone to get the weight of the baby. Wanting to explain something to a patient and scanning desperately for a translator. Wanting to give Septra/Bactrim to a patient but finding out that this antibiotic is currently not available here. Helping the patient connected to the large oxygen tank use the bathroom; the tubing is not long enough to reach the bathroom, they do not have a portable tank available, and they don't have a bedside commode or even curtains separating patient rooms. What do you do? Luckily the Haitian people are not very modest. They can't afford to be.

Dale and I had a sad case yesterday. A 12 year old boy came for a cardiology consult. He was very polite and wore dress shoes and grey trousers with a button up shirt. His oxygen saturation would drop below normal, and when I listened to his heart I heard a very pronounced murmur. Dale discovered the boy had a strong thrill (vibration) on his chest that was the source of the strange heart sound. He also pointed out his clubbed fingers. With the help of the translator it turned out the boy has a congenital heart defect. His mother said he needs surgery to try to repair it, but they cannot afford it. Dale is compiling a list of cases to refer to charitable organizations when we get back to California in hopes of finding someone who would do the surgery.

Apart from getting to feel good that I am helping people in need I am becoming a better nurse. I am getting comfortable doing things they taught me in nursing school but wasn't very confident in doing before; EKGs, nebulizer treatments, manual blood pressures. With so many really sick people, my triage skills are being put to the test.

Rich the pediatrician had a great case today. He saw a 3 month old baby that came to the hospital in with a cleft lip. Reg the ENT repaired it in surgery this afternoon. A success story to keep us going. (Miracle in Chaos)

Linda and Gurpreet are turning into little ED nurses, and Brad has been fantastically helpful in a number of tough situations. The Ukiah team is a very significant presence here (all of the teams). "Oh, you're from Ukiah, too!" We were the ED today. It is amazing to me what a huge impact our little hospital from our little town is making here and I'm very proud of us and thankful for the UVMC family for allowing it to happen, including those left behind to run the show short-staffed."

Pictures: Baby with the mom in the yellow shirt is one of the dehydrated babies, Becky with some new friends.,Ukiah team down time.