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The day is winding down. I am in the OR with the team, but not very helpful.  There are three surgeons already scrubbed in on our 12th case of the day and I can’t even keep track of what number split thickness skin graft.  Night has fallen.  We’ve gotten the schedule squared away for the next day and we’ve done wound rounds.  We’re starting to get into a rhythm here.  Babak, Derek, and Jean Louie are scrubbed in. Jean Louie is surgical resident who is here and who, when he is not running the ward, tries and scrubs in to learn some general surgery and some orthopaedics.  We also have Jean Paul, a 3rd year orthopaedic resident – who I have called Jean Claude, Jean Louie, Jean Baptiste, and Jean Jean. He is very knowledgeable and an absolute asset to have another set of hands in the operating room.

Commending Dr. Maxi and the Partners in Health Students, Residents, and Volunteers

Speaking of running the hospital, I need to take a moment to commend Dr. Maxi as well as the volunteers from Partners in Health. Dr. Maxi is a Haitian OB/Gyn who essentially runs the medical complex in Cange, which seems like a bustling metropolis.  When I leave the OR and look to my left, I am always reminded that there is an entire city outside the walls of the hospital … we are separated from the world by wrought iron metal gates.  Dr. Maxi is an amazing resource … everywhere at all times, constantly walking, talking to every person, and on his blackberry communicating with the rest of the world.  In some ways, he reminds me of Dr. Bernie Johnson.

And, I have to take a moment to commend the residents and medical students from Partners-in-Health.  Unbelievable … simply unbelievable and that is an understatement.  The medical students and residents – Alysha, Koji, Thirry, Ranu, Leopold, Watkins – are the true stalwarts.  With due deference to the staff, physicians, and Haitian volunteers, these volunteers are the ones that truly make this hospital a special place – from knowing every single patient, arranging follow-up, working on supplies, transferring patients, and all essential day-to-day operations – with no concept of the 80-hour work week.  They are awake before we start rounding at 630 AM and are updating the list, talking island politics, working on global healthcare, and having a Prestige while we are trekking to bed.

A Blown Pupil, Hospital Politics, Local Politics.

A blown pupil. An 8-year-old boy.  Hospital politics.  In the middle of our day, Derek said our case was on hold for a “Hot” case in true HUP fashion – I thought he was kidding.  Turns out, Babak found a boy with a blown pupil, a GCS of 3, and closed head injury.  The boy had arrived the previous night and the house staff were going to give him Decadron.  As it turns it out, he had fallen off a horse several days before and gone to a local hospital who did nothing but wait several days to transfer him.  Our hospital here did not recognize the injury or maybe the did and chose to do nothing given his poor outcome.  Regardless, the situation was immediately changed when Babak got involved recognizing the need for a burr hole.  He consulted with Dr. Schuster at HUP.  An attempt was made at organizing a transfer to the USS Comfort however, that was declined because the boy’s prognosis was poor.  We were told of a neurosurgeon 30 minutes away at Albert Schweitzer hospital who might be able to take him.  The patient was brought to the OR.  A burr hole and intubation for surgery would necessitate the need for mechanical ventilation post-operatively – something our hospital does not have.  As we were preparing to do a burr hole using a tibial opening reamer, we were informed that the other hospital was not willing to accept the patient … why?  Because they were mad at our hospital in Cange and so the answer was “no”.  This sealed his fate.  Local politics.

We proceeded with our day.  We debated amongst ourselves if it was a good idea to delay the OR for this patient but ultimately we thought it best to at least give it a try. During one of our skin grafts, there was some commotion outside. I assumed the boy had passed, but we learned that the boy was still alive. His mother had said she had no money left to bury the boy.  She had sold everything to bury her husband and now she had to bury her son, but had nothing left.  I found out from Mike later that he offered to Maxi that our team would pay for the burial.  Maxi told us that, in most cases, there was no burial.  There had been so many deaths since the earthquake that the hospital morgue was arranging for this. 

The boy is still alive when we finish our last case.  The team is working on transportation so that he can die at home. 

One Last Case

On our way out, Alysha (a 4th year medical student from New York applying for a Med/Peds residency) asks Derek and I if we are willing to do one more consult … a septic calcaneus.  Derek and I look at each other and immediately think “osteomyelitis.”  We get to the Pediatric ward – Bed 6 – 12 yo male – swelling over his medial calcaneus.   The mother lifts up the shorts and there is a large lymph node … the size of a golf ball.  The “osteomyelitis” is a hard mass on the medial side the size of the tennis below.  Derek looks at me – I know what he is thinking – osteosarcoma – this boy is done for … the radiographs only confirm our fears.  So it is …

We get back the “Friendship House” and sit to have Cokes (in glass bottles) and Prestige.  Derek ventures into Cange proper to be introduced to the beer distributorship and the local bar.  The 8-year old boy’s mother has decided to let him pass here at the hospital.  As I sit and finish this writing, we get word that the boy has passed.

We have another set of twelve cases on the schedule for tomorrow.

 

This report was written by Samir Mehta, MD, during his participation in Haitian relief efforts through Penn Medicine in coordination with Partners in Health.

 

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