Thanks

Thank you to all the read this. I started this blog almost entirely as a way of exploring and expressing the pains of what I feared I might experience. Catharsis.
I thought that maybe a couple of people beyond my parents would read this.
But your responses, both public and private, kept my spirits up during difficult times. They made me aware that my words could open eyes to the reality of what is happening in Haiti, beyond CNN News or 60 Minutes.
I'm glad I could share my experience with you. And thank you for hearing me.

Home

I made it home. I've never been so excited to plant my ass on my couch (after I am done planting it on my toilet). Over the past few days, a common discussion amongst the volunteers would planning the first meal and how early in the day would it be OK to start drinking.

Me, Jean, Jean's dad, and Jean's psychologist

Goodbye

Such an incredible mix of emotions to get out of here. So excited to get home, be clean, eat a meal that doesn't consist of a bar, sit on my couch, watch the Lakers.

But to leave behind my patients and all I have and could do for them. There is an unending need for help here. I know that we have so much need in the US, but here it is so pervasive. They feel like victims to me. What did they do to be born in the poorest country in the western hemisphere? Or to suffer the worst natural disaster of our lifetimes?

I, or any of you, would be so fucking bitter, and ready to blame anyone I could find. But they are grateful. They smile and say "bonjour" every morning. They say "merci" after our conversations. They are even gracious when family members die. I've never treated patients like them.

God bless them. Because it sure feels like he's been ignoring them for a long time.

There was a brother and sister who followed us around the cathedral ruins, climbing all over the rubble, putting a show on for us.

The cathedral

The destroyed cathedral was the most awe-inspiring part of the tour. Previously a massive stone structure, it was completely destroyed with just a few pillars, 1 cross with a chandelier still attached (in this photo), and pew remaining.

I got sick to my stomach when I walked in, thinking of the people who had come to pray to their God, only to die.

The presidential palace

This tent city is in the city center, surrounding a famous statue.

Sometimes the tents spill out into the street, obstructing traffic.

Tent cities

This picture definitely doesn't do it justice. Just as Port-au-Prince is basically one huge shantytown, there are these tent cities all over the city.

They are filthy, disgusting, modern day ghettos. Few of them have running water or toilets. There's a hallway about 3 feet wide between tents that are stacked side-to-side. Sometimes there will be a ditch in the hallway where people "relieve themseleves." There is drug-dealing and violence dominating these cities.

What lies beneath

Looking at these piles, and walking over them, I couldn't stop thinking about all the dead bodies underneath.

Stairway to Heaven

The destruction

There's no way I can describe in words or show in picture the unbelievable extent of the damage from the quake. There's still piles of rubble all over the place. In fact, there are very few places where they've even started to clean up. Word has it that most of the donated money has "disappeared," and even food and goods have been confiscatwd by the government and sold to the people.

Flat bed truck

Normally I wear seatbelts when I'm traveling in the back of a flat bed truck, on uneven roads that are full of potholes, with the worst drivers in the world, but then I thought, "When am I gonna make it back to Haiti?"

Bad Idea Jeans

PS, that's me with Adam Vella, Sinai Peds ER attending extraordinaire.

Coconut jews

Tap-taps

That's another tap-tap in the background.

In the foreground is a dude who walks around with a big-ass machete and a shopping cart full of coconuts. For a couple of bucks, he slices the top off the coconut, and, after you drink the delicious juice, he perfectly machetes the thing so that you can eat the insides. So god damn good.

Tap-taps

These are the cab-equivalents that the Haitians ride around in. They're all brightly colored and designed. They jump on and jump off whenever they want, and just chip in a little bit of money. And there's usually about 50 people in them. And on top of them. In fact, there was a major tap-tap accident this week and the hospital got about 25 patients with fractures, head bleeds, amputations, etc.

The newbies

This weeks group of volunteers just got here. They are clean, dressed in clean clothes, rested.

I look around, and we are filthy, and stinky, and exhausted.

They look scared. I know I was. I think they should be. I had no idea what I was getting myself into. Neither do they.

Oy.

Haitian fun fact #198

Haitians have their own time:
--Things happen late (like my flight out of here tonight, which is delayed).
--Things happen slow (like patient care).
--Some things don't happen at all (like patient care).

The streets 3

These women and children appear to be going somewhere, don't they?

They aren't.

The streets 2

This looks like a street fair. No, its just a street.

Thes streets are SO noisy. Lots of loud car horns (they still have that old school, early '90s, multi-songed car alarm). People screaming and yelling, trying to sell crap.

But I didn't really feel unsafe the entire time. Even when we were harassed, it didn't seem threatening.

The streets

Haitians obviously don't mind the heat or the trash or the smell. The streets are flooded with people. Lots of vendors, selling the most worthless shit that no one wants to buy. Lots of kids harassing us for water or food (they don't ask for money). Lots of women carrying bags of who-know-what on their heads. And lots of people just walking around, with apparently nothing to do and nowhere to go.

Shanties

This is what the whole place looks like.

Tour through Haiti

I was incredibly lucky to get a tour through Port-au-Prince yesterday. I'm gonna post a lot of pics from the day over the course of today.

As I mentioned before, its not a beautiful city. It smells like shit and putrescence (I learned that word yesterday). There is rubble everywhere, but to be honest, its not always evident what is from the earthquake and what is from utter poverty. Gutters are filled with green "water" that overflows into the streets.

But one of the things that really struck me was the extent of the poverty. There aren't shantytowns, like Wyclef tells us. The entire city is a big-ass shantytown.

Blood drive

Possibly the most important and scarce resource in Haiti is blood.

No patient is allowed to receive more than 2 units of blood; for the very sick and the victims of trauma, this isn't close to enough. We've had numerous patients this week whose death would likely have been prevented if they couldve gotten a transfusion.

So it was a wonderful idea to have the Red Cross come to the camp for the volunteers to donate blood. But damn, that's a big f'ing needle they use.

Communication

Why is it that whenever I'm in a foreign country, I instinctively speak Spanish?

Hydrocephalus

There is a hydrocephalus clinic here at the hospital today. 50 people from newborn to young adults, packed into a 125 degree room.

We very, very, very rarely have healthy kids with hydrocephalus in the states, because there is access to health care. For many of them, this is the first time they are seeing a doctor.

Water

Except for the back-up "emergency supply" of about 100 bottles for 120 volunteers, we ran out of water this morning. Good thing I'm coming home today.

My bunk

My home for the last 8 days.

Packing up this morning, I found an enormous colony on ant-looking critters under my sleeping bag on my cot. I wonder how long I had roommates that I didn't know about.

The ill-prepared

My job at Mount Sinai involves dying people. Everyday, I work with people who are dying. Almost always, we know what they are dying from, when they will die, and how they will die. Some days, they die.

In Haiti, we work with dying people. But often, because we have no resources, we have no idea why they are dying. And often, because us Westerners are seeing diseases we've only read about in books, we don't know when or how they will die.

Today, a 2 year old child, who was so malnourished that he looked like a 12 month old, and so emaciated that we couldn't draw blood for testing or place an IV for hydration, died. And we didn't know why. And we couldn't predict it. And after it all went down, we were only left with questions.

Who is responsible for this? Why don't we know what's going to hurt them? When is this going to get better? How can we, the supposed "experts," not know how to help them? What can any of us do to change this?

The flood, part 2

The flood

Its rained here every night (its the rainy season). When it rains, it fucking pours. Since our tent was built rather hastily in kind of a basin, it floods whenever it rains. Tonight it rained even harder than usual.
This is one picture of our tent. I like it for a couple of reason.
First, the simple fact that we live in a lake is amusing.
Second, that they are building a river that runs through the tent, so that the lake drains out, is funny.
But third, and most hilarious, on the left you can see the 147 year old orthopedic surgeon that I mentioned earlier. He sat there for an hour without any clue what was going on as the wokers built a canal around him. Imagine what he's like in the OR.

The hills

The airport, and our camp, is in a valley between to low mountain ranges. The ones in this picture are scattered with houses, shacks, and tents.
The view of this at night is particularly spectacular. Unfortunately it doesn't come through on my camera, but you'll have to take my word. Although there are thousands of people living up there, only a few have electricity. So, at night, when the skies are super dark (much like Times Square), there are a handful of floating lights. Beautiful.

The battle

Tuberculosis and malaria are battling for control of my body.

Not sure who is winning, but I'm pretty sure I'm losing.

Jean, the translator

There are lots of translators here to help out. I already told you about Stevenson who wanted me to buy him a computer and told me how to wire him money. The guy I've been using the most, a really nice guy, is Jean.

Jean and I have had a lot of time to hang out. We talked about his wife and their expecting child. He was concerned about his blood pressure, so I've done daily full physical exams on him and discussed his health.

Our conversation today...

Jean: "Do you believe in Jesus."
Me: "I believe there was a guy named Jesus."
Jean: "Its important that you believe in him and that he's coming for us and you repent."
Me: "I think me being down here doing this is pretty god repentance for bad doings."
Jean: "Well, if you don't repent and accept Jesus, you will burn forever in a fiery Hell and I will not give you a cup of water to drink." (Ironic since we ran out of cups for water for him.)
Me: "Well, if you don't give me a cup of water to drink, I won't check your blood pressure."

MASH

I never watched MASH. I mean, Jeff used to turn it on in between cooking shows and The Golden Girls (I wasn't really allowed to use the remote control), but I think I used that time to focus on growing my mullet.

Anyway, I feel like this camp -- what we see, the personalities, the dark comedy, the hills that look like Calabasas, and even the military choppers landing and bringing in traumas -- is a lot like the show.

I'm excited to get back to New York, watch it, and figure out which character I am.

Hydration

We ran out of cups. And its 115 degrees outside. That means we can't give our patients water. Sweet.

Eric

For those of you who aren't in medicine, ill let you in on a secret: there's an (un)spoken rivalry between surgeons and internists/pediatricians. We approach problems from different perspectives and don't always see eye to eye. And internists/pediatricians have an additional frustration because we are often left to clean up the mess that surgeons leave.

But here, surgeons (and neonatologists) are the ones truly saving lives. And I have been more than happy to clean up after them.

Eric Halvorson is probably the most important and impressive volunteer at the hospital. He is a plastic surgeon from Chapel Hill (which is not the reason he's awesome, but it sure as hell doesn't hurt).

He operates between 12-15 hours everyday--and he's not doing breast augmentations or nose jobs. He, with help from the other couple of surgeons here, takes on any case that comes in, from traumas to bowel resections to fasciotomies to scheduled cases. In between surgeries, you can find him around doing consults on post-op patients and wound care problems. And he does it all with a smile on his face.

But it isn't his technical abilities as a surgeon that make him a great doctor: he was in on the 7pm interdisciplinary meeting that I wrote about, advocating for a patient that he barely knew and had never operated on. And then, afterward, went back to surgeries.

And when he was done a few hours later, he came back out, smiling, and had a couple of beers with everyone else.

The toilets

Holding back taking a picture of what is going on inside the port-a-pottyies is very difficult for me.

I expect the sincerest of thanks from every one of you.

Again

I've debated whether I should post this or not. If I could, and make sure my mom didn't read it, itd be a lot easier. But I didn't start this blog to give half-truths.

Or tent was broken into again tonight by some non-volunteers. Luckily, the person who was being robbed woke up in time to chase them away.

Where were the security guards? How did they get into our camp? And 2 nights in a row? WTF?

I have no idea. But, needless to say, there are a lot of "strong" emotions amongst us....not that we needed anything else on our minds.

I don't think I've seen a shooting star in years. That's sad.

Haitian fact #134

Haitians drive with their hazard lights on....all the time.

Sounds of Port-au-Prince

I'm standing on the balcony of the hotel, overloking the city of Port-au-Prince. Its isn't the most beautiful city you've ever seen; in fact, it might be the least beautiful.
But it isn't what I'm seeing right now that strikes me, but its what I'm hearing. Loud, festive, reggae music accompanied by hand claps and cheers dominates the valley below me.
I don't know if they are celebrating or not, but, in spite of where they live and what they've lived through, the music that they are living to is still celebratory.

The Oloffson

I was lucky enough to be invited to dinner tonight at the high-dollar Hotel Oloffson in the hills overlooking the sea and downtown Port-au-Prince.

Its a beautiful, historic, turn-of-the-century, almost Victorian structure; white, white, white on the outside; pink towers; with brown wood throughout.

It feels exactly how you might expect a Carribean, colonial mansion.

Haitian fun fact #68

Haitians LOVE Jean-Claude Van Damme

My favorite shower. Ever.

I showed you pictures the other day of what our showers look like. The one on the far left is by far my favorite, and likely my favorite shower I've ever been in.

Why?
1. Because I can see the Haitian mountains all around me as I clean myself.
2. I can wave to my friends as I'm cleaning my twig and berries.

Its amazing. Its like streaking, but without the embarassment of having to expose my junk.

Oral rehydration powder

In order to prevent all of us from dehydration, Medishare (the organization that created/maintains/funds this hospital) provides us with oral rehydration powder. It has electrolytes (mainly sodium, chloride, potassium) and some sugar in it. It tastes pretty nasty (salty and a little sweet), but it doesn't bother me too much.

I was just filling up my water bottle and poured a packet of the powder in, and was noticed by another one of the volunteers.

"That stuff is nasty. Have you tried it?" she said.

"Yeah. Not too bad," I replied.

"Well, if you were a woman, you'd be a swallower."

The triple crown

I've had Montezcuma's Revenge. I've had the Kenyan Ka-Ka (also known as the Tanzanian Turds).

Now I've got the Port-au-Prince poops.

And I was worried about not shitting for an entire week....

Death

Even when we act like it doesn't bother us, like we've seen it so many times that it doesn't matter anymore, death will never be easy and simple to process for health care workers.

But there are times when its even harder.
When its our patient.
When we're there when they code.
When we have to be the ones to tell the family.

My patient just coded and died. But what was even more difficult to swallow, was that she shouldve had a better shot. If she had had the proper access to the proper care, she wouldn't have been here, today, now dead. Why should she be the victim just because she was born in the wrong part of the world, or even the wrong part of the island? Why should she have to live without antibiotics because there aren't enough of them, when people a couple hundred miles away are spending thousands and thousands of dollars every year on cosmetic surgery?

What made it even harder for me, selfishly, was that when it was time to tell and comfort the family, I couldn't tell them in their language. And I didn't know how to comfort them and say "I'm sorry" in their culture.

Now what do I do?

Clinical diagnosis of diffuse scleroderma and interstitial lung disease in a 54 year old woman.

She has no acess to any medications that could help her. What do I do with her?

The morgue

This is the morgue.

I showed you before a picture of my friend Jean, the 17 year old with TB, whose tent is 15 feet from where we sit and eat and socialize.

Well, the morgue is about 30 feet from where we sit and eat and socialize, and 15 feet from Jean.

Everyday, whenever our patients die, they bring the bodies to this tent, where they sit, in the 115 degree heat, in an un-air-conditioned tent.

And they sit there. Until the "hearse" come once a day. And Jean has to sleep 15 feet from it.

The victims

If I was robbed, and I think if many of you were, I would be fucking pissed (I am anyway) and I might have a hard time giving all of myself back to the people who I suspected robbed me.

But a true tribute to the hearts of those who were robbed. They are smiling and right back to work. "Its just my camera and my cell phone and my food." Its all replaceable. That's inspiring.

P.S. If all those things are replaceable, and losing them is not upsetting, what are the things in our lives that are irreplaceable and about which we should be upset?

Whose help is needed

I was talking with Margee Louisias, a friend and MedPeds colleague of mine from Mount Sinai, about is helping here in Haiti.

Its not just doctors who are making the difference down here. In fact, often times I feel like little more than a coordinator here. But the people who contribute so much are the physical therapists, pharmacists, occupational therapists, wound care nurses, and so many more.

Anybody even remotely involved in health care has a huge role down here.

In fact, without people who can create the infrastructure required to run a hospital (from construction workers to people who are willing to organize the supplies tent), this place would not exist and our help would be useless.

Coffee

The good news? They give us hot coffee every morning.

The bad news? The spout has had hair on it the last 2 mornings.

Theft

After the entry I made last night before I went to bed (which didn't mention how a few of us pitched in and bought hot dogs for all the kids and some others at the hospital), I woke up to hear that 2 (at least) American volunteers in the tent had their bags stolen in the middle of the night while everyone was sleeping. Their cots are 3 feet from mine.

it baffles me. These people are giving their time, money, and emotions to the cause of helping Haitians. And this is their reward. They didn't come here expecting to be thanked, but they didn't expect to be robbed. This is bullshit. This is disheartening.

Jean

Its impossible to try to make huge strides in any day when we are faced with what we face, especially in only a week. But we try.

The first couple of day were difficult. So many obstacles and adjustments to a chaotic system that we don't understand and a language and culture we don't speak.

Yesterday was just painful. Sad. It was like we finally had the chance to lift our heads out of the bullshit barely long enough to see the horrific things going on around us.

Today, today felt different. I've never been busier. I woke up earlier, didn't take the time to shower (sorry everyone) or get coffee, and worked later. But, for the first time, I worked with purpose.

I had a teleconference today with a team of very generous neurologists from Baltimore regarding the girl who I briefly mentioned yesterday. She's been here for over 6 weeks, suffering from an undiagnosed illness from which she will no doubt die, unless an intervention occurs. And we made progress.

I was walking the short walk from the volunteers tent to the hospital tent, and started to pass a young man who was walking with a limp. The physical therapist with him grabbed me and said, "look at him walk! Its the first time he's worn his prosthetic leg, and he's walking!" I looked up at the 25-or-so year-old-man, and he was beaming. I swear to god, I've never seen someone as proud.

My 89-year-old "topless dancer," on her way out of the hospital, had her daughter steer her way over to me to tell me she wasn't coming back because we did such a good job healing her wounds (which I had nothing to do with, it was all people like Judy).

And my buddy Jean, the 17-year-old with TB. Well, Jean is the proud owner of my Asics running shoes and my USC medical school T-shirt. And he's pumped to show it off because he feels so much better after we drained 500 mL of pus from his chest. Now, I'm not naïve to think that we've saved Jean's life, but I know for a fact that he's a lot more comfortable today than he was yesterday.

But, knowing how volatile and emotional things are here, tomorrow's prolly gonna really fucking suck, and I'll be cursing the asshole that wrote this.

Lesson for tonight

If you're in a foreign country, and you get bit by something that you can't identify, and your hand starts to swell and turn red and itch, don't put calamine lotion on it. Instead, rub some IV benadryl on it. It works amazingly.

However, if you don't hear from me in the morning its prolly because I'm dead from anaphylactic shock.

Let's see what happens.

Another sunset

Beers, burgers, and Lee!!

The UN sent a truck to us tonight with a barbeque that is grilling burgers and dogs. But, way more important, there is ice cold Haitian beer in that motherfucker!! What a morale booster.

In the pic is Lee Morris, and friend and colleague of mine at Sinai (isn't it amazing how clean and attractive and happy she is in spite of what we've seen?). She's a pediatric ID fellow, but here she's ding anything and everything, including consults on disgusting things that grow out of old, stinky men.

The 89 year old lady

She put her shirt on just before leaving.

Haitian facts #41 and 42

#41. Despite the crappy food they eat, there aren't many overweight Haitians.

#42. The women do not like wearing shirts. I haven't seen this much nip since my bachelor party.

Deet

This shit does not work!!

Judy

There are some exceptionally amazing people that work here.

One woman is named Judy Coster. She is a wound care nurse from Baltimore who is not just incredible at her job; she is passionate, intuitive, and a tremendous advocate for the Haitians. She's been here for over 6 weeks, taking an unpaid leave from her job, but is leaving Friday. She says she plans to come back this summer for 2 months, and I completely believe her.

She told me a story this morning about going into the city. When she first got here, the smell of rotting corpses overwhelmed the city. They were there, beneath the rubble, but unable to be reached for removal.

What's amazing is that over the many weeks since the earthquake, time and dry heat have decomposed the hundreds of undiscovered bodies to such a point that they don't even smell anymore.

You want to send something that Haitians love and can't get enough of?

QTips. No idea why, but they walk around using them in their ears the way DLodge used to use toothpicks.

Another picture you can't see....

The most priceless of all. The images I talked about yesterday were all real fucking sad, I know.

But the best one is the 89 year old woman with 1 leg who refuses to wear a shirt, laying there with the saggiest boobs I've ever seen in my life. I mean, they are below her waist. For some reason, she likes Dr. Dave, and when I just walked past, she's lying on her elbow, holding her head up with her hand, naked boobs all over the place, and, with raised eyebrows, she points at me and winks.

The NG tube

Follow up:

Y'all can stop looking for the NG tube. I found one. Does it matter that it was used?

Supplies

Can someone please find me the NG tube?

On call

If I had a nickle for every time I got woken up in the middle of the night with "doctor, doctor, we need you to come admit a patient with cerebral malaria"....

ROUS

There are rats around the camp. Not surprising. There are rats all over the upper west side, why wouldn't they be in Haiti. But these rats are fucking big.
Anyway, I just went to go brush my teeth and wash my face--not because I think I can get myself clean or smell-free, but just because it makes me feel like I'm not a total piece of shit. Another one of the volunteers told me how she just saw a big rat. I laughed at her and walked away into the dark to wash myself.
There I am, minding my own cleanliness, and Splinter's big, fat, angry uncle ran across my feet. So I yelled. It was a very manly yell. I know that because I can't scream. Its against my testosterone.
I finished cleaning and came back in the tent, where I was immediately asked who the woman outside was that was screaming and woke up the volunteers.

Interdisciplinary meeting

The CMO, the plastic surgeon, the wound care nurse, the neurosurgeon, a psychologist, and myself met this evening to discuss one of my patients. I'm not gonna get into the details of her illness (enough already today), but let's just say she's very chronically ill.

We were all mentally and physically exhausted. And there are so many patients at our hospital, not to mention all over Haiti, who could benefit from the extremely limited opportunities to go to the US for further care.

But we still all met and talked for over an hour after work about what more could we do for her. From outside of the walls of this hospital, what could we get her that would make her life longer or better.

We didn't come to a solution. But its really so remarkable how willing and eager everyone is to do everything they can to help these people. Coming down here isn't enough. Working all day everyday (and sometimes through the night) without breaks isn't enough.

Awesome.

Wheelchair

The pictures I can't take

I wish I could take pictures of all the things I've seen without being disrespectful of my patients and their rights. But I can't.

You can't see the 7 year old girl who just came in because her entire left arm has dry gangrene (black, shriveled, and ready to snap off) from falling out of a tree 6 weeks ago.

You can't see the lime-sized, ulcerated, bleeding skin cancer coming out of a mans groin that he "happened to mention" before leaving clinic.

You can't see the line of 8-10 children who have lost a leg (or two) and sit at the entrance to the tent and open the door when the volunteers walk in or out.

You can't see the 13 month old boy whose parents brought him in for a "rash" that had been going on for over a week, only to see that he has necrotizing fasciitis (flesh-eating bacterial skin infection) of his entire thigh, and may end up losing his leg and maybe his life.

I can't show you these. But you know what, I'm sure there have been plenty of other people who've been to Haiti or other places like this, and took pictures like these, and posted them on their blogs, without any respect for their patients.

Sunset

Volunteers tent

Conversation with Haitian

One of the interpreters is a very outgoing guy, 22 years old, and apparently a huge Jason Bay fan (or he stole a jersey from another fan). We got to talking last night. A pretty amazing conversation.
His mom died when he was 8, his dad died when he was 13, and he's been an orphan since. He's managed to be lucky and adaptive enough to make his way through school.

When the earthquake struck this year, he lost his home, and now lives with a friend 60 km away from the hospital, which he takes 2 cabs to everyday. He plans to take his entrance exams to become a doctor later this year.

He was very inspiring and charismatic and we talked for a while about his family, growing up an orphan, the earthquake, and more.

Then he asked me if I'd buy him a computer. And he asked to give me his phone number, and told me that one only needs to know another persons phone number to wire money from say, New York, to say, Haiti.

Hmmmmm.

What the fuck is this?

Unfortunately, I wasn't one of the lucky ones that still had the "animal's" original hair on it.

The "beard"

I know its not a beard. Its more like a pre-pubescent teen wolf. Or like a real man who got in a fight with a bottle of nair or ringworm.

But when I get back, and this thing becomes a moustache....look out Ralph Macchio!!

Updates to follow.

They tell us the prevalence of HIV in Haiti is 3-4%, and minimally higher in our hospital. None of us believe this.

I was pulled to work on our Emergency Room today because of the overflow of patients and lack of doctors. My first patient is a 60y mother, lives alone, who was complaining of increased abdominal girth that has occurred over the last 8 days - 9 months, depending on which interpreter I used.

Examining her, I found huge lymph nodes all over her body, a dress that appeared 4 sizes too big, thrush (a white funus infection on the tongue), a large spleen and liver, and shingles on her back.

We actually have the blood test available, but it wasn't necessary to diagnose her with HIV, actually AIDS, very advanced.

I have a psychologist with whom I work, but we don't know the culture: their shame, their secrets, their trust. She (the psychologist) and I explained (through a very poor interpreter) to the patient that she has a virus, what it means to her now and in the long run, and how taking medications could make her live a lot longer (if she's willing and able to take them).

She chose to keep this a secret from her sister and son who were there with her. We referred her to the only HIV clinic in Port-au-Prince. I would be surprised if she goes. I would be very surprised if she sees the fall, let alone 2011.

Like a rock...

I just admitted a 34 y guy who hasn't crapped since BEFORE THE EARTHQUAKE!!
I promise I will never complain again.

Werthers original

There's a completely wrapped Werther's Original candy on the floor of the tent--and I have no idea where or who it cam from. I love Werther's Originals.

Can I eat it?

Its been a very long time since I was able to sleep without some form of "aid." Not here.

I'm so fucking tired by the end of the day. I fall asleep at 930. Come to think of it, I eat dinner around 4, have my tea around 830, and am asleep at 930. Apparently I've aged 60 years while in Haiti.

Anyway, I digress. I have fallen asleep without any problem. However, I wake up a lot during the night. There are people making noise; that's not it. There are occasional flashlights scanning the tent; that's not it. It rains sometimes; that's not it either.

I realized in the middle of the night last night why I wake up so much: I smell so bad. And its not just regular BO. There's a touch of fresh paint odor to it. I have no idea what that means.

My TB buddy

Bad evening for my 17 y friend. I talked with a local doctor today (actually a Haitian who trained in the US) who runs a tuberculosis sanitorium (yes, believe it or not, those still exist, just like leeches for blood-letting and Roy Williams' ability to coach). He agreed to take him as long as he's fairly healthy (which he had been).

This evening he became very short of breath, his oxygen level came down a little, and he had worse pain where his infection had been. But now, you can see a boggy fluid collection protruding from his chest wall. He has a complication of tuberculosis called empyema necessitatis; basically, the infection has spread out of his lung and through to the chest wall.

In the US, the treatment is not that difficult: 1) surgical removal of the fluid and 2) treatment of his TB. Obviously not the case here.

1) As I mentioned before, we don't have any XRays or CT scans to evaluate the infection. We don't have an operating room that could handle a major surgery. And our chief of surgery is a plastic surgeon. And, given that he has diffuse TB in his lungs, and spread throught his right side, and he's built like Karen Carpenter, its gonna be tough for him to fight through any major surgery even IF it could happen.

2) I found out today that the nurses have been refusing to bring him his meds or his meals. So I've taken on all responsibilities as his doctor, his nurse, his dietician, and, really, the only guy that talks to him during the day.

Most of our internal medicine team

Civil unrest

Aparently there have been some protests (riots?) in downtown Port-au-Prince, regarding the Haitian president.

If you were concerned, I just wanted to let everyone know that the airport is far from downtown and we have not be affected at all by the protests.

If you didn't know anything about this, put down the "US Weekly" or "People" magazines, and turn on CNN.

And if you did know about the protests and weren't concerned, screw yourself.

The teams

Its absolutely remarkable (but really not all that surprising) how much willing teamwork goes on here.

Given how busy and disorganized we are, it can be real difficult to get everyone together and on the same page; however, every morning my team (which consists of me, a nurse, a psychologist, a physical therapist, an occupational therapist, and a wound nurse) round on all our patients (about 12).

Its a very fun and cooperative attitude--as opposed to all my other teams and my pain-in-the-ass interns in residency.

The other services that we consult here are surgical subspecialties: 1 plastic surgeon; 1 neurosurgeon; 1 almost brain-dead, 147 year old orthopedic surgeon, and an OB/GYN doctor.

Additionally, there is 1 pediatric ER doctor and 1 adult intensive care doctor. One of the internists here is a cardiologist and one is a pulmonologist.

Occasionally, and often without notice, a urologist, an ophthalmologist, and maybe someone else will show up to help.

Between all of us, we fill in all the holes--including making any and all medical decisions that we wouldve gotten consults on in the hospital. There's no ID or oncology or GI consult. There's definitely no palliative care here.

But, have no fear, should we have a question about blood sugar management, or vitamin D deficiency, or even thyroid storm or myxedema coma....I'm here to help.

Today's lunch is....

Hot ham & cheese!!

Actually, it isn't, thank god. Its some form of meat, likely either tuna or chicken, but definitely fishy smelling/tasting. Its on a hoagie, and apparently I was a good boy, because I got a sliver of an onion on mine. Yay!

I was able to sneak one to my TB buddy, who is loving it--in fact, I just turned around, got a whiff of his mycobacterium, and received a hearty smile and thumbs up. Very nice.

HOW IS IT POSSIBLY HOTTER TODAY THAN YESTERDAY?!?!?!?

TB tent

This is my 17y M with disseminated TB (tuberculosis that's spread throughout the body). He's in the "isolation tent," which is 15 feet away and upwind from where everyone sits, eats, and socializes.
You can't tell from the picture, but he's probably 90 lbs and looks like he's 13 years old. He's super sweet and gently holds my hand while I examine him. His dad lives with him in the tent, he takes his meds without complaints or concerns or questions, and all he really cares about is getting shoes and being able to keep their tent so that their family has a place to live.

CMO

I knew I was gonna be the internal medicine MD on call tonight. But I was recently given a special gift: I get to be the Chief Medical Officer for the hospital tonight. WTF?
I'm now in charge of all medical services (surgical, medical, and otherwise) and transfers (to and from) for the largest and most specialized hospital in Haiti.
Thank God this is only for the next 10 hours. Its also, unfortunately, a sign of the disorganization and lack of leadership here.

Army dudes

There's an American army base here at the aiport in Port-au-Prince. Every night a few of them come over to the hospital just so that they can hold or feed some of the kids.

Clarification

In reference to the gentleman who was getting a "massage" from his girlfriend: the woman was actually his wife. So, its all good.

NERD!!!

Linner

We get fed most days 2 times. A sandwich at around 11 (today was ham and mayo....apparently there aren't many Haitian Jews). We also get a hot lunch (not the one you might find on urbandictionary.com) at around 330--this one is a very carb-heavy meal. Today's meal (below) is cold, hard noodles with bits of some sort of meat in it, and a cold, hard, phallus (not creme-filled, thank god).

Peds

Left to right: picu, nicu, pharmacy; with peds ward in foreground

Adult ward

Really? Hemoglobin of 2? Come on...

Pretty sure I just walked in on my patients girlfriend giving him a handy.

Intro meeting

Some take home points from this morning's meeting:
-we have no Xrays (oviously no CTs, MRIs, nuclear medicine)
-we have CBCs, urinalysis, and chem7's (though there are less than 50 total for the hospital for the week)
-there is a morgue 20 feet from where we eat and "socialize"; it is not refridgerated
-we only transfuse blood for Hgb <4 and symptomatic
-1/3 of everyone that arrived yesterday has not received their luggage....and they don't know where it is or when it'll get here
-yesterday it was 115 degrees at 11am, and prolly 80 % humidity

My new girlfriend

Sorry I can't help myself.

How I wash myself

There are 4 of them for the 120ish people. Didn't have a hard time getting one, though; I think most people are already resigned to the fact that we all smell like shit. And, maybe, there's some sort of mosquito repellant in the shit-stink. Its a real quick wet-down, lather up, wash off. Which is totally fine, except for this intense, manly, testosterone-driven beard I've got going on (more to follow).

Piss

Waking up in the middle of the night when its raining, having to take a leak....not awesome.

Check that. Not soothing when the tent is flooding.

Pitter patter

Its real warm, and starting to rain. The sound of the drops on the tent roof is real soothing.

First code unsuccessful. 3 month old with cerebral malaria. Chest compressions in dad's arms, while mom dancing and shouting in creole, translated to "please god, bring the coffin for me, not for my baby."

My god there's SO MUCH to do here. We have a pretty clear call schedule laid out, but I don't think there's any way ill be able to just stop working. How can I when there's an unending amount of work to be done?

Holy shit

Its obviously gonna be real hard to document this all. But, let me start with flying in. The first thing we saw was a hillside filled with tents, a makeshift town of refugees from the earthquake.
As were landing, and once were on the ground, its honestly hard to tell the difference between ruins from the earthquake and just utter poverty.

There's a palpable sense of nervous excitement among the workers. Everyones really eager to work, but no one sure exactly how to do this.

There's basically 3 tents. One houses the volunteers. The idea is to find a cot 1) on high ground (yeah, not level ground) so that your cot hopefully doesn't flood when the rains come; and 2) close to the fan, which does little to no good.
The second tent has the ER's, the adult ICU, and some surgery stuff.
The last tent houses the general peds and adult patients, the pediatric ICU, and the neonatal ICU. There are patients on mechanical ventilators, and patients actively dying. Lots of open wounds, lots of malnutrition.

Oh, shit.

Apparently the chairman of Medishare just announced that he's gonna cancel the MedPeds portion of the trip to Haiti. Margee and I are gonna turn around and come home. They're gonna replace us with 2 "physician scientists."

The Sinai crew