final days in haiti

Things were so hectic the last few days in Haiti that I am now only getting a chance to write now as I sit at home. I had such mixed feelings about leaving. As our bus was pulling out Saturday evening from the camp, I was looking forward to returning to civilization (and oh- to be able to SIT on a toilet seat again!). But I looked out at all the tents and felt sad that I'll probably never again see the patients I grew to love, and never know where they'll end up.
First, as a follow up, Carlyle, my translator was able locate a sister of the 14 yr old girl who I mentioned in the previous blog. So she was making her way to the camp from Port-au-Prince the last I heard. So I was thankful for that.
There are so many images I have in my head and I don't know how to describe them. Time and time again, I would watch patients family members helping their loved one to the port a potty, which was a fair distance from the tents (for obvious reasons). I remember seeing one of our patients who has a below the knee amputation on one leg and an external fixator on the other, being helped by her young daughter. The whole process of getting her there in the wheelchair over the gravel, helping her out of the wheelchair and into, then out of the port a potty took the better part of 45 minutes. I can't even imagine having injuries like that and not having a readily accessible bathroom. I also remember the worried look family members would have as their loved one was carried on a stretcher into surgery. And the young man who went to surgery for a debridement of his leg wound and when he woke up, the first thing he asked was if they had amputated his leg - thankfully they didn't, and it looked as though if it was going to heal. I will never forget Rose, the young, 3 months pregnant mother of a 2 yr old, who had a large skin graft on her foot on the first day I arrived. There was some thought that she may lose her foot if the graft didn't take. We watched closely, and she was so compliant with everything we told her to do - which included keeping the donor site on her thigh and also the foot graft clean, which is an almost impossible task in the camp. By my last day, it was apparent that the skin graft was going to be successful. With physical therapy, she should have full function of her foot.
The things I experienced and witnessed on this trip eclipses anything I've seen in my previous 20+ years in hospital nursing. The post operative patients - many of them amputations or fasciotomies - would possibly receive 2 intramuscular shots of Morphine 2mg the evening after surgery (for those non-medical folks reading this, that's a very small dose), and then a Percocet every 12 hours the next day. My stethoscope never made it out of my suitcase, and the only vital sign I checked the entire time was a temperature on one of my patients who felt very warm to me (and turned out to have a fever of 104 degrees). The only charting was to write on silk tape with a sharpie the date of the last dressing and what type of dressing was used, ie wet to dry, xeroform, packing strip - or whatever and then affix it on top of the dressing. We (usually me and the MD that was assigned to row #5, and if I was really lucky, a second nurse) started rounding at about 7am to try and beat the mid-day heat. By the the time we usually finished seeing all the patients and doing the wound care, it was somewhere between 11am and 2pm - depending on how the patients were doing, and if I had to remove sutures or staples, which always added time and was traumatic for the patients. We gave vitamins to everyone every day, and medicated pain with Tylenol or Ibuprofen - or Percocet if they were a new post op. I have never worked so hard in my life, under such harsh conditions. I have also never felt so needed and useful as a nurse. The feelings of exhaustion, hunger and my aching feet at the end of the day paled in comparison to how rewarding it was to care for these patients who are so gracious and appreciative. I live in admiration of their spirit to overcome their circumstances, and their cheerful outlook, despite being dealt such a blow.
Many of the MD's were forced to be more "hands on" than most of them were used to due to the shortage of nurses. The worst part of that is that the Operation Smile team that replaced us had even less nurses than we did - it caused a pang of guilt to hit me as we were leaving to know how hard they're going to have to work. There was a bit of a glut of doctors - many had been assigned to non-patient care duties like logistics and even stocking supplies.
The people on the Operation Smile team were awesome. There is no way to describe how much I enjoyed getting to know each of them and working with such dedicated and caring professionals. I will never forget Jeanne, Genie, Dianne, Ann, Brenda, Craig, Natasha, Joelynn, Stan, David, Tim, Lisa, Donna, Susan, Violette, Tracy, Stuart and Terry (plus Mark and Tory - our team coordinators who did a great job). I truly hope to work with them again, if the fates allow.
It's nice to be home and not feel hot and dusty for the first time in almost 2 weeks. But I'll miss my patients and the feeling that I was somehow making just a small difference in some of their lives. I'll never forget how proud one of my patients was at being told that she had done a great job doing the pin care I had taught her the previous day on her bilateral femur fixators, that she asked me to take a photo of her both her legs.
The day before we left, an unfortunate boy with a scrotal abcess arrived at triage. The doctors called several places to try and get treatment for him, but no one would take non-earthquake related problems. So our plastic surgeon ended up taking him to surgery and doing an incision/drainage . So this was definitely territory he wasn't used to, but the surgery was a success, and the boy was up and walking the next day and felt much better.
A few of our team members including me went into Port-au-Prince (about 30 miles East of Fond Parisien, which is about an hour drive on Haitian roads) on Friday, the 12th - exactly one month after the earthquake. Our plastic surgeon speaks French and was able to communicate well enough to be our translator. The devastation there is indescribable. And what's worse is that we saw almost no one with heavy machinery clearing away rubble. The one exception was at the Hotel Montana where many foreigners perished. I can only hope that Haiti will get the help it needs from the international community and that the millions (or is it billions now?) of dollars raised will actually go towards helping rebuild that country, and realize it's potential.
On Saturday morning as I was on my last round of dressing changes and was telling my patients that it would be my last day, one of my patients, Marcelin, reached out and kissed me on the cheek and I didn't need a translation to know that she said "I love you Katty." I'm so glad I went and I hope to return sometime in the future.