The early hours of the afternoon marked a steady stream of apprehensive patients arriving in the waiting area of the operating room (#22 on map) where David Feldman, Ken Mroczek, Mary Ann Hopkins, and Diana Voiculescu continued to immobilize bones, deep clean wounds, and explore abdomens.
A man on a stretcher examined his x-ray with great fascination while waiting his turn. To anyone who approached he would offer a well rehearsed argument against any surgery on his leg for fear that it would be amputated:
"Moin pa we anyen la. Moin bon" (I don't see anything here. I'm good)
In fact, the x-ray showed a clear tibial fracture.
In the pediatric tent (lower right corner on map), Patricia Poitevien had just identified a child who was slowly drifting towards respiratory distress. Without the benefit of mechanical ventillators an intubated child would need someone to stay by the bed and manually squeeze precious air into the lungs with the aid of an ambu bag.
Where were the ambu bags anyway?
The best option for the critically ill was to arrange for a transfer to the US medical ship, The Comfort. Some nearby children cried from hunger while still others laid quietly on their backs staring up at the bland ceiling of the tent.
No dancing bears, smiling clowns, or goofy duck characters would entertain them.
Nestled in between the pediatric areas, were two other tents that had been designated as Maternity Wards (lower right corner on map). It was there that Prisca Bernard-Joseph held hands, administered pain medication, and gave encouragement to pregnant women who at times seemed preoccupied with the uncertainty into which they would deliver their children.
Why hurry up and push? This was not a place for children to set their sights.
Back on the dimly lit and poorly ventilated critical care unit (#6 on the map) tensions were mounting between the patients and the legions of flies that seemed to have summoned reinforcements.
Groups of them swarmed around day-old soaked bandages and tried to land on exposed skin.
At times the number of insects that successfully remained in close proximity of a patient became an early warning system to the deteriorating condition of that individual.
With only two nurses for all the patients on the unit it was impossible to attend to everyone's needs in a timely fashion. The situation was made worse by the fact that the two english speaking nurses had only one interpreter to share. Yet these patients and families who had already endured so much hardship, were steadfast in the dignified and patient manner in which they dealt with the situation.
Many patients suffered quietly until the very last moment when the unbearable pain would drive them to the edge of consciousness. At that point a very faint plea might emanate as I passed by:
"Dokte, fe ou bagay pou moin" (Doctor, do something for me).
One of the quietest patients was a 17 year old boy who days before had presented with massively swollen legs from crush injuries. He now wore precisely made foot-long surgical incisions down both sides of each leg. While these unsightly fasciotomies saved his lower limbs in the short term by releasing built up pressure, they now threatened to take his legs by being portals to possible infections...as his daily fevers (despite antibiotics) would suggest. He never watched when his bandages were being changed, choosing instead to bury his face in his right arm. He remained in that position well after cleaning solution had been applied to the raw wounds, poorly healing tissue had been scrubed or cut out, and new bandages had been applied. Only the rapid rise and fall of his chest hinted that the pain medication he had received prior to the wound care might not have been sufficient.
He did not ask but graciously accepted the morphine that I brought him.
"Merci" (Thank you)
I tried to get him to talk.
-So what do you think of Wyclef?
-Yeah? Sounds like you have another favorite.
"I don't have a problem with him. He's okay."
-What about you? Are you a musician?
"Not really. I just play sports."
All of a sudden I regretted the direction of the conversation.
He shifted to pull himself up in the bed and grimaced as he did so.
"Before this...I wanted to be a professional soccer player...that's what I WANTED"
He emphasized on the past tense.
My stomach sank.
Two transporters arrived to take him to the dialysis unit run by Medecins Sans Frontieres.
He was on his second session for rhabdomyolysis.
I touched his arm and offered
-Kenbe fem (hold firm)
He nodded and simply buried his face in his right arm again as he was carried away.