The last two days were a different pace and tempo, likely because I am gearing up to go home. We spend most of the morning seeing the last team off and cleaning the bedrooms to prepare for the new team. I am disconnected from this team; they are all old friends and I make small talk and try to be helpful but there is not much to do. They are still running around trying to figure out what to do, where to start, and finding their rhythm for the week. It’s amazing to watch them and remember that only a few days ago I was glued to the wall watching the chaos and trying to figure out if I would ever be useful or helpful. I know what they feel. It’s exciting and overwhelming at the same time. Things are different down here.

With all my free time I am able to spend some time with our interpreters for the week, who I am sorry to say have not had as much of a spotlight in my posts thus far. They were absolutely critical to our successes here and I don’t know what we would’ve done without them. They are twenty-somethings just like me.  who were fortunate enough to learn English from a missionary or from time spent with family or friends in the US. They, to the best of their ability and beyond my expectations, translate our questions about pain and instructions on medications. They teach us words in creole that we forget daily and they laugh and remind us countless times. We have become friends.

As I speak with them I learn some of their stories. Spellcheck won’t allow me to type most of their names, but they are all amazing. They flirt with each other, share stories of their children, ask us things about life in America, and they tell their stories. A girl tells me she is saving for medical school so she can help her people. “They do not understand how to be clean and stop infection,” she says soberly, “they will listen to me because I am one of them.” Another boy is the interpreter for the operating rooms and I make him change into scrubs so he doesn’t wear street-clothes in the OR. I pat him on the back and tell him he looks like a doctor. He laughs, but on our way out the door I catch him looking at his reflection in can the mirror. He pauses and for a second I think he imagines what he could be. I tease him that day and poke my head into the OR and ask if he has everything under control. He asks the surgeon if everything is OK and the surgeon salutes him. He grins and gives me the thumbs up. He feels important.

A twenty-two year-old Haitian man about my height is my favorite. He is always smiling and he tries to make everyone laugh. He is also the only one who will translate the stupid things I say when I tease the Haitian nurses, as most of the translators have stuck to translating the medical stuff we say. He and his girlfriend had a son together, an infant, that he lost in the earthquake. He sleeps on the ground in his village underneath a tree. I give him all the t-shirts i brought with me and a pair of North Carolina basketball shorts, he stares at the ground and stammers and tries to ask me for something and I ask him if I can help him more. All he wants is a tent, something to keep the rain out. I give him some cash and ask if it is enough and he says he can buy two tents with this. I hug him and I say I will see him again.

My heart breaks for him and for all the people of Haiti, as their current fight for survival consists of finding shelter, and tents are the only thing they can afford and the only thing that is practical. There are thousands of tents in the city, crammed together in claustrophobic clusters of filth, noise, smoke, and despair. The UN and military presence here helps provide some security and prevent complete anarchy, but no army can stop the stealing and raping and kidnapping that happens in those tent cities. No army can stop the rain, as the season for tropical storms looms in the not-so-distant future and those tent cities will literally be washed away in ankle deep water. Hundreds and probably thousands more will die from disease as the rain turns the filth into a cesspool. They will die slowly, they will suffer, and national attention will be diverted to somewhere else and nobody will watch CNN and cry. Some of the artists in the city have been carving wooden bells that I learn signify the cry of the poor. It makes no sound and is barely noticed unless one sees it with their own eyes. It is a fitting symbol.

I dont think I have painted a grim enough picture of Haiti, and honestly most of my pictures I upload to my computer and delete, because they will never come close to describing what it really looks like. I  have seen hundreds of amputees, many of them children. I saw a toddler with both of his arms amputated just below the elbow try to hold a lollipop between his stumps and cry out of frustration, and drop it, try to pick it up, and sit down and cry more. A pediatrician I met in the tent hospital downtown told me she has to take Ambien to sleep at night and she has only been here 3 days. She told me one morning she woke up to find something to drink and tripped over a bundle of sheets outside of the neonatal tent. She unwrapped the sheets to find a dead newborn. She said he must’ve died days ago, maybe someone left it there for them to treat but never told anyone.

A pediatric nurse from Boston shows me a pile of rubble where yesterday they uncovered three hundred bodies. He is cynical and sarcastic but good natured. “I guess that’s where that smell was coming from… but I haven’t showered yet so who knows.” The pile of rubble was a nursing school. Every where you turn in the city there are spray-painted walls and pieces of cardboard that say ‘Help,’ a child is asking for your shoes, a person limps by with grossly disfigured limbs, and you smell the filth and burning trash.

But I’ve seen good and inspiring people, Haitian and American. I have seen children laughing and playing and enjoying life with casts on both legs. These people have joy and hope and a strength that has carried them through unthinkable conditions for generations and while this may be the worst yet, they are spirited.

I am excited to go home, I miss it. But I will miss this place and hope to see my friends again. In some way, this has changed me, and while I do not fully know how and to what extent, I will soon. And I hope to come back or go somewhere else to be changed again.

Machete. The man’s brother was going to chop off his head and the patient raised his arm to defend himself. This was one slice.

We trudge through the dirt road up to the school about a quarter of a mile. A man from America is here with a big tractor to smooth out the road after the rains have made it a squishy mess. Gravel and baseball-sized stones are scattered over the mud to give it some semblance of solidity, but it only takes a few days for the thick mud to engulf the stones and suck them down so far you cant reach them.

The mud is always there, and a few hours of overnight rain can make a road practically impassable. All you can do is throw what you can on the mud to try to delay the inevitable. This is the way of life in Haiti. The mud is as inevitable as hunger and death and disease and the war waged against them often feels as futile as tossing rocks on a muddy road. Forty five patients have had some sort of procedure thus far but it’s a drop in a bucket in the grand scheme of things, a few rocks on the road.

I know I can’t think this way. We were talking earlier and we’ve decided to see it like forty-five people won the lottery. Some people’s lives have changed and they’ve been given a leg up, able to function normally again and go on surviving, and hopefully go on living.

As we shop around and barter for little knick knacks and move along to the dirt road past the school we walk through a gate in a cement wall and see a village. It is an odd assortment of straw huts and adobe homes, a scattering in no particular order of shelters with varying levels of luxury. Some are actually very pretty, and I imagine that once this place used to be perhaps 3 or 4 nice homes, and poverty drove people to cluster together and nestle themselves in between the nicer homes hoping for a sense of protection and togetherness.

Our group is about 25 people, and before we even enter the village there are two or three children for each American hand, tugging and pulling in opposite directions. “You! You! What your name? You are friend?” they say, and they demonstrate with fingers pointing to their chests what their names are and point to you and demand you repeat their names. They laugh and clap their hands as we try to pronounce their names with embarassingly horrible faux french accents. Their names are not quite french and not quite as african as we make them sound but they are wildly entertained by this game as they wait a few seconds and ask us again what their names are and we forget them or try to say something we made up hoping to come close.

I am trying to take good pictures of this village, because I am absolutely fascinated at the living conditions. I think that the men of the village have somehow (quite ingeniously) stolen electricity from the powerlines and a TV that doesnt seem all put together is working and a soccer game is on. Through one doorway and a thin hanging sheet I see a few men watching the game and a baby goat runs out bleating, and the men stare at me blankly as I look into their home or saloon or whatever it is.

We tiptoe around trash piles, cow manure, and piles of smelly things I can’t identify. A tumbleweed of barbed wire outside a hut is covered with damp laundry washed in the river, drying in the cool air. Our walk through the village is a challenging task as our juvenile tour guides are poking at our clothes and asking for our shoes, tugging and pulling. They dont quite beg, and their blunt and direct requests are funny. “You! You! Give me your shoes?” they shout, and you cant help but laugh. The phrasing sounds like they are holding us at gunpoint but they smile as they say it, in a playful sentence bordering on sing-song.

Some of the girls are wearing t-shirts with no pants and few have dresses, and they dance and jump and run. It seems at first like they are clamoring for attention, to see who can be the cutest and who can get the most american cameras pointed at them, but the ‘wild rumpus’ is infectious and the children are having fun, they are laughing and jumping and chasing each other and playing.

They see my tattoos peeking out of my scrub top and they touch and rub my arms in amazement, pointing at them and showing each other, quiz me on their names, ask me if I am their friend, quiz me on their names again. It is almost overwhelming and a little claustrophobic as we wind through alleys and through tight corners and my poor sense of direction is quickly confused. I have my camera and the children are so cute I try to take their pictures but they have this habit of throwing up gang signs so I try to encourage them to smile and give thumbs up and benign things like that. I show them the pictures of themselves and they clap and run in circles and sometimes stare blankly, and some of the younger ones don’t understand that what they are seeing is their own face.

I learn the word for friend is ami. The older ones have a clearer goal of asking me for money but the younger ones are cute and are having fun seeing this strange tattooed and slightly brown person, and it becomes a game to see who can show me the neatest thing to take a picture of. They grab chickens by the neck and baby goats by the legs and bring them to me yelling “Photo, photo, You!” I feel sorry for the poor beasts and dont take any pictures. I have twenty dollars left, and it burns a hole in my scrubs. I want to give it to someone so badly but I know then everyone will chase me and beg and I’m liable to end up naked. I finally get some breathing room and give it discretely and quietly to a boy wearing a Spider-Man shirt, and I put my finger to my lips and tell him to not tell anyone. I point to his shirt and make reference to Spider-Man and he looks at me confused. Of course, I think, this shirt is something to keep him warm and dry. They dont pick clothes based on liking the pictures on them. I ask him to buy food and candy for himself and friends. He points to me and says “You ami, eat here.” He wants me to come with him and eat it with him. I say I can’t.

But I could, I suppose, but I dont want to be separated from the group or walk back by myself at night. I’m scared a voodoo warlock will stab me with chicken bones and feed me to a goat or something crazy like that. It sounds stupid but that literally crossed my mind. My Jamaican friend growing up told me his dad saw a witch doctor tell a pig to eat a man he didnt like. He might have lied but I just saw a huge pig that could probably finish me off.

I also, when I’m honest with myself, don’t want to eat with him. I dont want to get sick, and I want a shower, and I’m tired.

That’s the thing that wakes me up from my TV commercial moment as I feel like someone in a movie, holding little black children’s hands and gracing the village with my American presence. I can give these kids my shoes, I can give them money, I can give them clothes, I could even run to my room absolutely stark naked and give them everything on my person and just dig through my suitcase and be fully clothed in seconds. I am torn by this, not sure what to do or feel. I can see how people come home from experiences like this and have a hard time not slapping people back home whenever they complain. In fact, I can foresee having a hard time restraining myself after hearing people complain about the US government. At least we weren’t robbed blind by a corrupt catholic priest in charge of the country, at least there is some semblance of infrastructure, at least both parties are generally still obliged and accountable to some extent to promote the well being of the citizens. I have a hard time recalling a president of the US ever being exiled to Africa for the damage done to the country during his term; but I digress.

I spent most of the evening laying awake thinking about what I felt. I had the urge to come home and live the life of a monk, sell everything I had and sort of inflict poverty on myself in protest to the consumerist and materialist lifestyle I felt so guilty of leading. I felt an equal urge to return to America and have a glass of scotch and eat a nice dinner and enjoy it in a way I never had before, thankful I can worry about food I don’t like and not worry about whether or not I will starve to death. And then I had the urge to just go home and carry on as normal, tucking this experience away and carry on with business as usual. Red flags and sirens went off as something in me felt first that this was wrong but more thought has led me to a place that is quite similar to ‘carrying on as normal’.

I think that the people of the world, figuratively speaking of course, are all in line, facing a certain I-don’t-know-what. The front of the line is quite successful, wealthy, and they are the ‘haves,’ whereas the people in the back of the line are the ‘have-nots’ and are as you might imagine the polar opposite of those fortunate enough to be in front. I imagine myself sort of in the middle of the line, far enough from the front to spend quite a bit of time trying to move forward and far enough from the rear to not really ever think about it. Who, in their right mind, in line at the theater or the grocery store, ever thinks of the people far behind them? It is the ones in the front who are almost done, who got waited on much nicer and quicker than I will certainly ever be, who have purchased a lot more than I will be able to, who are wearing very sharp clothes. I spent most of my life worrying about them, and almost none of it even contemplating what it must be like for those so far back in line they don’t know what the line is even for, let alone what is at its’ end. This is what I believe is the problem, and if we can use my weak analogy a bit more imagine how asinine it would be to ask someone if they could hold your place in line, and you went to visit the very last spot. You were so moved by the condition of said person that you surrendered your place in line altogether and joined him. It would be a bit like feeling sorry for an amputee and cutting of your own leg just for the hell of it, because you felt sorry and brashly wanted to resolve your feelings with some outward display.*

Well, I am sure much debate could be had breaking down this analogy and much arguing would ensure, for after all that is what most analogies do. But stick with me and imagine that we were all standing in line and now we’ve got tickets in our hand, like the ones at the deli, and they signify not just our place in line but have a sort of value in them like a paper currency. Some mischievous soul who is not part of the line comes up and sets off a bomb somewhere in the line and everyone is scattered about. There is no front, middle, or rear, the ones in the front are mingled with middles and rears and combinations of each and there is much chaos and confusion. For a second, everyone forgets about the line and we are just people, some with nothing, some with everything, and some with a moderate amount of stuff.

Imagine the power of everyone forgetting about looking ahead, the power of everyone stepping out of line so nobody was limited to seeing who was in front but seeing people first and position and rank second. There is nothing wrong with the ticket in their hand, or that they have a lot or a little, so long as they open their eyes, look around, and help. If everyone surrendered their tickets then their really wouldn’t be much use in that and nobody would be able to help anyone. But for a second we would stop pressing forward and would begin to react outward, laterally, and help.

So what do I do when I go home? Sell my stuff? Maybe, but I think what I need to do is incorporate an ever-present awareness of poverty and disease and filthy living conditions into my everyday life. I need to remember that there are fronts and middles and rears everywhere and that I am where I for whatever reason, and should not take it for granted but also not waste a lifetime in a line pushing forward trying to gain the position of the people ahead of me. I should, rather, exploit to the best of my ability my position in line (or the value of my deli ticket) to widen the radius of my impact as greatly as I can. I do not need to inflict poverty on myself, nor do I need to dive into the rat race to get rich quick. I need to be self-aware, others-aware, humanity-aware, and broaden my vision beyond just marching forward in line but breaking up the line and doing some mingling.

This is what I’ve learned from this trip, and what I hope I do not forget. I will still have that glass of scotch and I will still smile when I lay in a comfortable bed, but I will remember that somewhere, someone is sleeping on the ground and drinking dirty water.

I try to wake up early to see if I can weasel my way into something interesting and the Wisconsin people start early. I walk by a procedure room window and peer in to see one of our cooks is coaching a woman who apparently has been in labor for about 12 hours. He and a nurse have been up all night coaching and cheering her on, and I wait with them because she seems close.

Jaime and Mike are part of the Wisconsin team that came down. They are non-medical, and have fed us well this week, with whatever they can scrounge from the kitchen. They bring down trays full of gatorade and powerbars to the ORs and help with whatever they can, from dishes to fetching supplies. Jamie encourages the woman to push, with his Fargo-esque accent and we tease him that he is now an official midwife. He grins sheepishly and everyone is happy for him, and there is an unsaid understanding that he is sharing in something special. He is helping someone, and making a memory of a lifetime. There is new life amidst the chaos and disaster, like a flower struggling through a crack in the concrete.

The baby (according to one of the OB/Gyn docs) is posterior and this is the patient’s first vaginal delivery so it’s taking forever. The mother-to-be begs for it to end, and we continue to cheer her on. We want to see this baby. The Haitians (patient included) are begging for a c-section or an episiotomy and we try to hide the sharp objects before an overzealous friend has any bright ideas. I remember the stories from a few days ago and hope nobody has a piece of rock or salt hidden in their pocket.

After a few hours of pushing, sweating, and excellent coaching, and an episiotomy, the head finally pops out. The shoulders follow, and out pops a baby boy, and cries. Jaime tears up. He is proud.

We congratulate the patient, trying our best with hand signals and broken Creole to tell her she is strong and the mother of a baby boy. The baby must be cleaned and dressed before it is given to the mother, and while people do this we ask the mother what she will name it. Apparently it is customary to name the child after someone present and helpful during birth.

She names him Jaime. Jaime is still teary-eyed, and proud.

As the day goes on I find things to help with, change some dressings, and fetch meds and supplies. One of  the doctors is a urologist and asks me if I want to be his CRNA. I laugh and say yes, confusing this for sarcasm.

He was serious. They were running to ORs until now but figured we could get more done this way. I am excited.

A real CRNA does the spinal block in a procedure room that looks like an exam room at a doctor’s office but not as clean. I sit at the head of the bed as she gives me a crash course in conscious sedation and hands me my arsenal of Versed, Ephedrine, and a manual blood pressure cuff. The bovie fires up and push some versed.

I freaked out a bit, because I wanted monitors and was worried about knocking my patient out so hard we’d have to intubate him. We dont have any ventilators.
Things went well, but it was challenging. The patient’s scrotum was incised and the hernia was excised and i peek at my patient’s face to see if he is still sleeping.
He is wide-freaking awake, looking around quiet as a churchmouse. I wonder if he can feel his testicles being tossed around like marbles and I push some Versed and he starts to snore.

It’s music to my ears. I check manual blood pressures every few minutes to make sure I dont make him crash, and I use a little portable O2 sensor to check his pulse and saturation. I get nervous every once and awhile because his sat drops and I have to tilt his head just so to open his airway. I love it. It’s a ton of fun. I get to do a few surgeries this way and was just ecstatic.

Altogether a great day. We are heading out to the school down the road where local artists in the villages have made some crafts to sell. We are planning to walk through the village to see the people and come back to eat the tilapia from the mission’s fish farm.

• 15 Hysterectomies (2 vaginal)
• 1 Mini Lap tubal ligation
• 3 Breast mass removals
• 1 circumcision
• 1 Distal tip penisectomy
• 1 Hand trauma reconstruction (sort of)
• 1 Bilateral below the knee amputation
• 9 Hydrocele/Hernia
• 1 Post partum tubal ligation
• 10 lump/bump/lipoma removals
• 2 Vaginal deliveries

45 total procedures in 3 days as of 3/6/10 1500

The OR

People

Good day today. Grace, a doctor here who has been in Haiti for a few months and a good friend of the PA who is sick found a private jet that will medevac her to Miami, FL. I went along for the ride and pushed meds while we jumbled along the mile of muddy road to the main street. I was sitting in the back seat behind shotgun,  where the PA was sitting. She had an IV in her right arm and would twist it back for me to push Zofran and Phenergan while she clutched a paper wastebasket in her lap and tried not to vomit. The driver is a bat from hell, weaving through traffic and running red lights and cutting people off. Everytime we narrowly escape death he looks at me and gives me the thumbs up and giggles. If you’d like to experience our trip, go watch the harry potter movie when he gets in that crazy bus that squishes. That is what it reminded me of.

We get to a small airport where some Lear jets and prop planes were parked and Grace hopped out of the car and used her fluency in Creole to figure out what was going on. I pushed more meds.

About 45 minutes later Grace comes out to the car and she practically carries the PA to the tarmac, where a Texan (from Africa from a missionary pilot group) man waves in a Lear jet to take her to Miami. There is a nurse and a paramedic on board and I give them report and they look at me blankly when I tell them how much morphine I’ve given her. I shrug.

We wave and see her off and our Haitian driver hauls it back to the clinic but decides to stop for red lights this time. I call him ‘ambulance,’ and try to pronounce it french-like, and he pumps his fist in the air ecstatic about his new nick name. I learn he is a cable repair man.

Most of the day was spent running around between ORs, the Wisconsin people are nice and let me snoop around and help out where I can. I help stock the anesthesia carts and grab random odds and ends and help transport patients back and forth. They did 17 surgeries today, most of which were hysterectomies. These women have the most gigantic uterii I’ve ever seen. I dont understand how they walk around with those things, but they are eager to have them out whenever a surgical team is around.

The front gate has become a triage of sorts, and hopefully tomorrow I can help out there.

I am also getting sick and hoping it’s not whatever that PA had since Grace and I had the most contact with her. Sore throat, itchy eyes, cough, and overall drippiness. We’ll see what happens. I am very tired.

Lizard in the OR

Biggest uterus I have ever seen. And it was growing more