PASSION.
I couldn't sleep the first night. I was amazed that I was actually in Haiti, amazed that I was able to sneak out of residency for a week to actually contribute my skills in Haiti. I couldn't sleep because of the buzz about the place. How was it that I had ended up in Milot, working with some of my colleagues from Massachusetts. The buzz of new people arriving daily to help, of people I'd just met the day before who were now leaving. I'd walked into the pediatric ward, shocked to see a room crammed with not only 45 pediatric patients, but parents, siblings, aunts, uncles, and in some cases, complete strangers taking care of children. I'd picked up Jamesly, who had a "spinal fracture" and noticed that he was breathing way too fast for his age, looked at his spine xray, and seen that his lung fields showed a classis picture of PCP pneumonia. He had AIDS. The back fracture was Potts Disease (TB in the spine). This kid was in trouble. I was working with two pediatric ED attending from my hospital back in MA, but here I was, the expert about this child's condition, and treatment. Jacki was flown in from the USS Comfort missing a large portion of his skull, which was removed because of infection. The USS Comfort had sent him here with 6 weeks of an IV antibiotic. Fat chance of keeping an IV in this kid for 6 weeks. Maybe in a hospital set up to place more permanent IVs, but we didn't have that luxury. Looking over his notes, there was a better choice, which he going get as a once daily injection into the thigh (for when he lost his IV). I made the change to his chart (and later confirmed with 2 infectious diseases docs, who agreed). Our pedi team had gone back to the tent after our 8pm staff meeting, making sure that evening meds were given, re-examining the few kids with active medical issues (meaning those who had more than just orthopedic issue).
After the night round, we all hung out talking about what was going on. There were almost 400 earthquake victims here. The place was abuzz. We were all here, most having taken unpaid leave from our jobs, some paying their own way here, all with the same purpose. To provide what we could to those who were affected by this horrible earthquake. I couldn't wait for morning, for a chance to get back into the tent, to get a better understanding of what needed to be done for all the kids who had casts on, all the kids who had external fixation of their fractures, all the kids who had bandages covering their wounds and their skin grafts.
The days quickly because 16 hour days. There were minor victories (no more bandage changes, seeing the physical therapists getting amputee kids up on crutches), and set backs (not being able to treat phantom limb pain, not having mental health counselors to deal with those most severely traumatized by the earthquake).
When word came that I was going to be pulled out of pediatrics and be sent to Tent 4 my colleagues from MA went to the director to protest. "He can't be pulled from peds, that's where he is needed, he knows what's going on with all those kids." But I saw Tent 4 as a challenge. 35 female patients. And a test to flexibility. That's the gift of being dually trained in internal medicine and peds, I can treat both. So when the schedule came out in the morning, I went to Tent 4, starting anew with women who had shattered pelvises, shattered femurs, nasty wounds, hypertension, diabetes, and one with extreme heart failure. (Tent 4 had been run by a doc from MA who had been in the first med-peds class where I do my residency. 23 years ago, she took a year off from residency to work in Kenya for a year. She and I are the only ones to ever take a year off from residency-we bonded quickly). The temperature in the tent approached close to 100 degrees on the worst days. But the work was so invigorating...
The 16 hour days continued. I'd pop into the pedi tent to check up on the few kids I couldn't let go of (was Jamesly getting any better?), and then head to Tent 4. After the evening staff meeting, one of the nurses and I were back in Tent 4 for an hour, giving meds, checking temperatures on the patients who were teetering on sepsis.
Getting back to the staff compound after rounds, it would be time for social rounds. After a few days, it felt like I'd been there for weeks.
I laid in bed the last night, petrified that I would sleep through my alarm and miss my ride to the bus station (to take the bus back to the Dominican Republic). I was beyond exhausted. But unable to sleep. What would happen if I showed up a week late to residency and stayed another week. How could I go back. How could I leave the most meaningful work I've done since I left Johannesburg???
It was painfully clear. This is the work I want to do with my life. I fight an overwhelming urge to call my future employer and tell them that I made a mistake, that I don't need an income, that I don't want to work in a fancy hospital with MRI available at all hours, and let them know that I'll be working in Haiti, or back in Sub-Saharan Africa. Sorry for the hassle. My bad. [Though, of course, the job is a done deal, and it's a necessary step for professional reasons as well].
I like the chaos. Chopper landing with new patients, our tent is basically full, but we're getting 2 more patients. No problem, we'll scoot the cots even closer together and make room for 2 more patients. What, we're going to get three patients?? Fine, we'll scoot the cots right next to one another.
I like the challenge. I went on a drug search for my patient in extreme heart failure. What drugs are available? The smallest lisinopril tablet is 10 mg? Fine, well cut them in half and start at 5mg. There's no spironolactone, anywhere? Fine, what other diuretics do we have (this is post lasix diuresis for NYHA Stage IV). Somebody thinks they saw carvedilol tablets a few days ago in a plastic bag in tent 1? Great, I'll go find a stash for my patient.
Watching a random group of doctors, surgeons, nurses, therapists, logisticians, translators, carpenters come together and work non-stop in less than ideal conditions, working for free, all to help out a group of people who have been marginalized for a long, long time, in a attempts to save lives and alleviate suffering after a horrible disaster, and meeting a group of patients who define resilience and have so bravely taken on the challenge to get better, and to go on with life was one of the most profound experience of my life, and I'm utterly humbled to have been able to play a small part.
Is it Dengue or Malaria?
It started the night I got back. The fevers were sky high. The chills so bad I couldn't keep from shaking. The sweats to bad I had to change clothes. The fatigue so bad I had to sleep in my Jeep before driving to clinic. Coming back from Haiti, sick, was not part of the plan. I'd been pretty careful. Had taken my malaria prophylaxis. Had gotten my typhoid vaccine (though a bit late). Had used plenty of DEET for the few mosquitoes that were around. But something was kicking my ass. Bad. The treatment for Malaria didn't help. The dengue labs would take a week. A bunch of my labs were outta whack. My doctor (one of my clinic attendings) was consulting an ID doctor, I'd seen an ID doctor the day she'd been out of the office, and that ID doctor was consulting the Chief of Medicine. Always a joy to be the mystery patient... my PCP, plus 3 specialist in infectious diseases... It took a week, and the verdict was Mono. Thankfully dengue was negative! Somewhat ridiculous to get mono at this age. And having mono during residency is less than ideal, nothing like adding fatigue to the picture, as if the job wasn't tiring enough. How I got mono remains a mystery, and of course the rumor is that there was some secret romance in Haiti... If only my life were that exciting. In a weird way, it was good being sick. It can be easy to minimize the symptoms that patients complain about, so it was a good reminder that it really sucks to be sick.
100 Days
I have 100 days of residency left. ONE HUNDRED. It's so close I can taste it. The next phase is coming... and it's exciting. Back to Haiti for 2 weeks. 4 weeks to study for medicine boards (some pedi studying) and to figure out what will get moved to Denver. Medicine boards and then 2 days later back to Jo'burg for 2 weeks. Then back to MA and leaving the following day to drive to Denver. And in all honesty, as much as a part of me doesn't want to be in Denver (my adolescent side), part of me is really excited (my adult side); excited to be close to nieces and nephews, back to the Rockies, a place where I can walk to things (and maybe even bike to work here and there), and part of me is really excited for the job that I'll have-I'm going to learn tons and become a better doctor, and have flexibility to keep working abroad (most likely Haiti) a few times a year. It'll help me get to the next place in my career.
BPB
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