Wednesday, January 20, 2010: "Midnight to 0600"

Wednesday, January 20, 2010: “Midnight to 0600”
Our midnight arrival and work at Jimani was chaotic and immediate. The Puerto Rican team went to work immediately cleaning and doing their best to sterilize the surgical and procedure rooms. Blood and feces and medical waste blanketed the tile floor. Toilets were overflowing in to the foyer. The hospital was averaging 60-80 operations a day, mostly amputations; a pace that would continue for the balance of January. Indeed, from January 13th through January 20th, 537 operations took place at Good Samaritan. Mostly amputations…
For those who survived the earthquake, the injuries were garish and gruesome. Only the twisted minds of Hollywood could conjure such a scene. And the ensuing infections were even more catastrophic. By the end of this day, I could identify sepsis by sight when the “daytime docs” thought patients were just over-reacting.
The patients arrived at the hospital by the grace of God alone—by helicopter; Tap-Tap and motorcycle; by make-shift ambulances of every conceivable design; and, some it seems dragged themselves inch by unbearable inch along the still trembling ground.
Initially, the staffing was chaotic and top-heavy in favor of surgical teams, especially in the first day or two of the arrival of the Puerto Rican team. This meant that operations took place with no consideration of post-op care. Patients were cut and sent out into the unknown. Immeasurable credit is due to those nurses who were on the ground at Good Samaritan in those early days, especially. Their stamina was heroic. And, I love them for it.
When I arrived at Jimani, there was no oxygen, which meant that anesthesia machines could not be used. Patients were given ketamine, among other drugs, and medicine for pain. And, then the cutting and sawing began. Already suffering from tremendous blood loss, they lost more blood on the table; and there was no way to tranfuse.
Post-op conditions were horrendous. Few of the nurses were oriented to Recovery and Med-Surg care. Even fewer were accustomed to nursing “by the seat of your scrubs,” as Sharon Thomas calls it. And, no one could have been prepared for this—me especially. This wasn’t your average Communion visit to “the Reg.” This wasn’t a television medical drama. And, it sure as Hell wasn’t a weekday afternoon hanging out at the 2nd-North nurses’ station waiting for my Mom to finish her shift.
Within an hour of my arrival at Jimani, the last dose of morphine had been administered, even though a sea of patients required it. Imagine the scene: no oxygen, no blood, little to no IV fluids, and no morphine—and, hundreds of post-op patients with one or more amputations and massive infections, recovering everywhere…and anywhere.
I started translating and ministering to patients immediately. It was a scene I never could have imagined.
Within an hour and a half of arriving, I was helping Sharon Thomas fill out the tag on a body bag.
All we knew of Venette was that her entire family had died in the earthquake. She was alone in this world, and incredibly ill. Her left leg had been amputated. She had lost untold amounts of blood when she was injured and again during surgery. The amputation took place two days after she arrived at Jimani, and a week after the earthquake. For two days after she was triaged, she had laid in the hallway waiting for help. There were just too many patients. She was now septic, and dying.
I stood on the right side of Venette’s bed and held her hands as she frantically reached out for life, clawing at my gloves. I worried she would tear through them and tried to keep her fingernails away from the thin latex. She could no longer speak, but knew she was slipping away. Her eyes communicated everything she wanted to say. Her IV would not stay in and its fluids emptied all over the bed. She bled from the site and Dr. Mana tried in vain to reinsert the line. Cindy Siegel did her best to help Venette fight a critical temperature, but it was in vain: her fever broke and she quickly began losing her body temperature.
I spoke to Venette in kreyol. At first, I tried to reassure her, and then to console her. It was a sad, pathetic scene. She never would have died this way in the States. Dr. Mana seemed frantic and refused to accept that Venette would die. I looked across the bed at this ER doc who was accustomed to having so many life-saving tools at her disposal and told her it was okay: she had done everything she could do. Tears filled her eyes.
Venette remained conscious almost to the very end. Sharon Thomas confirmed a systole. The body took one last unfortunate gasp despite the absence of a heartbeat. And Venette, whose life’s story was never known to us but whose death we will not forget, was gone. I tried to close her eyes, said a silent prayer and made the Sign of the Cross on her forehead. It was 1:30a.m. I had been there 90 minutes.
The other patients, who were horrified by the scene and saddened by yet another intolerable loss of life, began to weep. A husband—whose young wife’s fate was in question—ran out of the room. Kimball consoled him across the hall in a room which would be full of patients by day’s light.
I can’t remember who helped me place her in the body bag, once one had been located; maybe the tall nurse called “pH.” It didn’t seem sad or surreal, just necessary. Since I was on the side with zipper, I closed the bag.
Sharon Thomas filled out the tag on the body bag. I suggested she write “Inconnue” on the tag, which is French for “unknown.” As I write this, it dawns on me that we didn’t know her name until that point. From the corner of the room, the shocked husband who had returned to the side of his dying wife spoke up: “Venette. Her name is Venette.” In the course of a week, Haitian families had been dramatically realigned, and new friendships formed. Venette had found support in these strangers. Millions of Haitians would do the same at tent cities and hospitals and refugee camps, throughout the country.
Sharon wrote “Venette” above “inconnue”, the time of death and the date, careful to follow the French order of writing the day first, month second.
Dr. Mana was in the hallway, overcome by all that had happened. I embraced her and told her again that she had given Venette the dignity she deserved, and had done all she could have medically given the circumstances. We spoke for a few minutes. She thanked me and moved on to the next patient.
It was some time before enough hands were free to remove Venette from the room; several hours in fact. Four or five of us carried the body bag from the room, through the halls and out to the side of the building where the simple, lightweight coffins were stacked. We placed her in the coffin. Her right leg had settled outside the coffin. I looked up and the others had walked away. I placed her leg inside the coffin, tucked the body bag in around her and placed the lid on. I made sure some of the body bag was showing so that others would recognize this coffin was different from the others.
I was told later that morning that Venette would be “cremated” in the day’s burning of trash and medical waste, which included the dozens of amputated limbs; because the Dominicans weren’t offering burial services. I don’t know if this was true of the Dominicans. Diplomatic crisis aside, they never seemed unkind. I suppose this anonymous cremation was necessary and maybe preferable to what was taking place in the mass graves along Route 1 in Titanyen.
The rest of those early morning hours were a blur. The Puerto Rican team was pounding out surgeries, and we were left to deal with the chaos. Doctors and nurses needed information from patients. Patients had questions for doctors. I told parents their children would lose limbs. I told a wife her husband was dying on the operating table a few feet away on the other side of the door. Critically patients were everywhere, and required care. That was all that mattered.
Kimball and I went back to the bus at six o’clock or so to sleep for a bit. Within a half hour, the bus shook with the return of the PR team. It was the smell that woke me: Haitian bleach, body fluids and death—the smells that would define this trip to Haiti.