A day on the wards: 10:30am
Following morning rounds, I moved around the dimly lit ward trying to prioritize patient treatment plans based on available resources. THIS was suppose to be the critical care unit...sixty patients.
There were no monitors with colorful lines and numbers reporting heart rate, blood pressure, oxygenation, and respiration. No ventilators with sing song beeps and whistles to warn of preset highs and lows. No suction canisters to clear secretions from congested airways. Yet, it was clear that so many of the patients would have benefited from such instruments. In a corner there was an old electrocardiograph machine locked into an old movable metal frame. Multicolored wires were intertwined like an intimidating snake pit and it wasn't clear that the machine had been used in the recent past.
I returned to the beside of two of the sickest individuals.
In bed 4 of ward 1, a 39 year old woman with peripartum cardiomyopathy presented when her failing heart could not effectively move those little oxygen toters along their routes. Like Port-Au-Prince rush hour traffic, the congestion had a suffocating effect. Beads of sweat formed on her forehead as she sat up on the bed with both hands at her side to stabilize her frame. She repeatedly threw her shoulders back and heaved her chest upwards in an effortful attempt to get more air into her drowning lungs. After much bargaining we had managed to secure one of only four oxygen tanks in the hospital and was now providing her with some support in carefully measured doses for fear of depleting the tank. Her husband stood at the bedside with their two month old baby girl in his arms. He rocked the child back and forth hoping that the mother would soon be ready to resume nursing...they had no means of securing other nourishment. From her position the mother would steal glances of the baby and then return to her chore of trying to breathe. A nurse moistened her lips with water.
Treatment with intravenous medications equivalent to water pills? NOT AVAILABLE.
"Okay" I thought "I'll use whatever can get the fluid off her lungs...just keep it simple...just keep it simple."
In bed 1 of Ward 2, there was a barely responsive woman whose poorly functioning liver no longer adequately cleared toxins from the blood, thus allowing them to pickle her brain into a stupor. Treatment with lactulose or non-absorbable antibiotics?
"I need to reduce the toxins..."
In the middle of that thought the physician who previously ran the ward reappeared. He was now coordinating transfers between wards.
"Hey, how's it going?"
-Listen, we need some basic meds here, like water pills...
"Yeah, I know. Okay, I'll make a run to central supply. Can I tell you about a new patient?"
-Where am I going to put the patient?
"We can move some into the hallway"
"It's not a great option but we need beds"
-We also need more internists. What about starting to think about who's going to cover all these patients tonight? Is there a plan?
-So what am I suppose to do?
"You can't expect to save everybody"
-It's not a matter of expecting ro save everybody, it's about trying to do our best. Supposedly there are all these resources that were flown in and all these doctors floating around this place. Is this really our best?
"It is getting better. Besides, better that one dies to save two"
-So how many of these sixty should I choose to let die?
"I hear what you're saying. I'll work on the meds and coverage"
He shuffled away to the next ward and from the sound of metal grinding against cement, I could tell he had started to shift a bed into the hallway.
I went back to moving around the ward. Repeatedly I was stopped by a patient's relative who wanted to advocate for "serome", the name given to the bags of intravenous (IV) fluid. It did not matter whether the IV bag contained medications or simply water with a little bit of salt and sugar that provided no nutritional support. Perhaps seeing the fluid drip down from the IV bag and snake through the plastic tubing into the vein of a loved one was therapeutic for the family as well as for the patient. After all it was at times the only proof that the patient had not been completely forgotten in the cold dark bowels of a ward whose iron gates were locked at night.
I peered down at Mr Doe...John Doe to be exact. The name had become quite popular among the elderly who mysteriously appeared at the hospital. They were either not able to provide any coherent information about themselves or were completely non-communicative. He had a large pressure ulcer on his buttocks which was in the early stages of infection. He needed antibiotics, dressing changes, and nutritional support. He was in no condition to feed himself since he seemed to choke with even small sips of water. I had asked the nurse about a plastic tube that I could snake through his nose and down his throat and into his stomach to feed him.
"I don't think we have those tubes...I have not seen them in the week that I've been here. But even if we have one, we don't have any food to put through it"
As I looked down on the cachectic John Doe, I became aware of a commotion outside. A large crowd had gathered and there were loud exchanges even though I could not immediately make out what was being said.
I walked closer to a small window.
"WYCLEF!!!! WYCLEF!!!!" The crowd chanted.
Wearing a blue shirt with glittered lettering promoting his charity, the popular Haitian singer Wyclef Jean had arrived at General Hospital. Word had spread quickly and the crowd was now following his every move.
I turned back towards the lonely old man laying on the bed and stared at his bony frame.
There were no crowds around him. No family, no friends, no one at all.
Who was he? Had anyone cheered for HIM during his life?
"JOHN DOE!!!! JOHN DOE!!!!"
I would never know.