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Empty Beds

empty bed

Photo by Michael Ashburn

Today for the first time we found empty beds and open floor space while rounding. The inflow of earthquake trauma patients is slowing down. We are starting to see an influx of patients with a wide variety of advanced disease presenting for care.

One such patient is a young boy who appears to have advanced osteosarcoma. He has a very large lesion on his lower leg with a large solid node in his groin. We will do a biopsy tomorrow, but the outcome is poor in any country if he has the advanced disease we fear he has.

While empty beds are hopefully a good sign, thus is not always the case. This was the bed for the boy who fell off the horse. He died last night at 9 PM with his mother and our nurses nearby.

Education and Teamwork

Yes, Tom Floyd is a real man. Today we are doing a case that requires good muscle relaxation, which is not commonly used here. While they have ventilators on the anesthesia machine, it uses too much oxygen, which is supplied by tank and us in short supply. Therefore, when used, ventilation is by hand.

Tom Floyd demonstrating response

Tom Floyd demonstrates a normal response in neuromuscular monitoring. Photo by Michael Ashburn.

The local team does not use neuromuscular monitoring, a skill we are introducing to them. In this photo, Tom Floyd is demonstrating what a normal response is on himself. He then compared normal to the patient after vecuronium.

I am waiting to hear the yelp when they try this on themselves...

The local staff are exhausted. In spite of this, and even after working late last night, their team returned early thus morning to do a full day's worth of cases on a day off. The physicians joined us for rounds at 6:30, and are helping with anesthesia and scrubbed in learning from our physicians. This includes all the support staff, including folks to clean and sterilize equipment between cases. A very impressive group of dedicated health care providers.

 

This report was written by Michael Ashburn, MD, MPH, MBA, during his participation in Haitian relief efforts through Penn Medicine in coordination with Partners in Health.

 

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